4-30-09

Yesterday evening I had some unexpected pain relief. In the afternoon, after my morning dose of pain medications had worn off, my pain level was down so I didn't take any Dilaudid, Percocet, or Ultram. Even without those in my system, my pain level was 4-5 and I was able to walk without a cane for the first time on a week or so. I was very happy and thought maybe the end of this outbreak was at hand. By 7:00 pm my pain level was increasing and and by 9:00 pm I had taken all these pain medications again out of necessity, and had a pain level of 7-8. I am trying to understand what led to the decrease in pain, possibly that I had cooled my foot in cold water for 4-5 hours through the day while I sat at my desk at work. That is the only change I can think of from what has become my daily routine.

I see Dr. Abraham this morning to try and get a referral for Dr. Belgrade. I also received the name of another pain specialist, Dr. Scott Schultz, a radiologist who works in Robbinsdale, MN. I got this name from Jill Landecker, a pharmacist at Cub Foods where I get my prescriptions filled. Being at the pharmacy every week, I have gotten to know my pharmacists at Cub Foods pretty well over the years. After my appointment this morning, I will call and try and set an appointment with this doctor as well.

My hope is that things go well with Dr. Abraham this morning and he can be my primary physician. I have been without a primary care physician for a couple years now, since Dr. Bosmans left my local clinic.

notes from 4-29-09

Since my last post, my pain level has continued to increase. Last Wednesday 4-22, after having pain spikes every minute or so at a pain level 9 with a base level 7-8, I went to the ER at North Memorial Hospital. I was given 2 mg of Dilaudid IM injection, which got the pain level down to a 7 with spikes at 8. Then I was given 10 mg Morphine IM injection, which eliminated the spikes. I left with level 6-7 pain.

On 4-23 I was prescribed Dilaudid, 4 mg every 3-4 hours. Without this and other meds, may pain level is 7-8 with spikes at 9. I also am slowly increasing my dosage of Neurontin (Gabapentin) up to a maximum 7200 mg daily, taken in 3 equal doses. For pain management, I now take:

Dilaudid 4 mg every 4 hours
Percocet (Oxycodone/Acetaminophen) 20/650 mg every 4 hours
Ultram (Tramadol) 100 mg every 4 hours
Neurontin (Gabapentin) 1800 mg three times a day
aspirin 320 mg one daily

I also soak my foot in cold water once or twice a day for 10-30 minutes, which also seems to help. I can get my pain level down to a 6-7 most of the time, though it increases as the medications wear off.

From what I have read, Dilaudid should have a much larger effect than it does on me. From what I remember about Morphine injections from 2 years ago, they had a larger effect than the Dilaudid injection did last week.

I noticed my right foot and ankle was swollen on 4-24 in the areas of pain. I started wearing my support hose (30-40 mm compression) to minimize the swelling. See the pictures I have included.

I am trying to get an appointment with Dr. Miles Belgrade, a pain treatment specialist working from the Pain and Palliative Care Center in Minneaoplis. I have heard very good things about him. I really need a doctor that is willing to work with Dr. Leitch and me on the treatment of this condition and the associated pain. I hope this is the doctor for me.

4-13-09 pain

I woke up last night every 3-4 hours with pain spikes at 8-9. With my existing pain meds, I can only get my spikes down at a 7-8. I spike every few minutes and, other then meds, nothing seems to help alleviate the pain.

The spikes are a sharp stabbing pain located on the top of my right foot, centered over my 3rd and 4th tarsal. I also have a base pain level of 5-6 which feels more like more of a skin irritation and ache.

notes from 4-12-09

My pain level has been up in the past 3 weeks or so. I have no ulcers but pain radiating on the exterior of my right foot. It started near my ankle 3 weeks ago and felt like I had been hit hard with a sharp object. I did not have swelling or anything in that area. The pain moved down the outside of my foot and now is located down near my toes. My pain level has been 4-6 as a base with spikes at 8-9. I have treating with Ultram and Percocet but can only get the spikes down to 7 or so and the base down to 4-5. I have an appointment with my dermatologist to discuss pain management and what we can do to bring the level down further. I would like to get the spikes down to 5, with a base at 3-4 if possible.