8-27-09

I have been at home for the last 2 days with nausea. No fever or other symptoms, just nausea. I have been off narcotics as well for the last 3 days, with pain levels decreasing to 4 now.

notes on addiction

I went yesterday with no narcotics to see how that went. I was in a lot of pain all day, levels mostly around 7-8. I didn't notice any psychological draw to take any narcotics, though I had them available to me all day. There didn't seem to be a physical draw either, except for the pain of course. Other than that, I didn't notice any other reactions.

update

I am back from the trip our week-long trip the mountains of Colorado. I was able to participate in all the activities which included horseback riding, whitewater rafting, kayaking, ropes course, and a 4 mile hike near the top of one of the mountains. My pain level was between 5 and 9 through most of the trip. I treated with 2 Percocet tablets (5/325) and up to 20 mg of Oxycodone every 4 hours. The pain was highest in the morning, when I would take my medicine dose 30-45 minutes before I got out of bed, to ease into being on my feet and walking.

I have never had more then 1 skin ulcer at a time and now have the one ulcer that I have had for a few weeks and also 6 other smaller ulcers for a total of 7. 6 of them are smaller (.5 cm in diameter). I am covering all of them with Duoderm dressing to keep them from developing hard scabs and also minimize the risk of infection. Changing the dressing is extremely painful as is cleaning the area with alcohol prior to putting a new dressing on. I have not had an infection yet with all the open sores I have had.

I have expressed to some close friends concern about addiction again, now that I am taking constant large doses of strong narcotics. I do notice a pleasant psychological effect where I feel almost a feeling of warmth which radiates from my chest throughout my body. It is this feeling of warmth that decreases the pain level. I do not know what addiction would feel like but I did have a recent experience which triggered this concern. When in the mountains and having a high pain level, I was searching through my bags looking for my bottle of Oxycodone and couldn't find it. I had a strong panic feeling because I thought I had lost the bottle and wouldn't be able to take my dose. It was this strong panic feeling that scared me afterwards. Frequently I also have a slight panic that I will run out of narcotics some time and won't have any when I need it to decrease the pain.

I look forward to the appointment on September 9 with Dr. Belgrade and developing a plan to better manage the pain I am living with now and talk with a psychologist specializing in pain therapy about how to cope/manage and about my addiction concerns. I am thankful that most of the time my pain level is around 3-4 and have only had 2-3 outbreaks annually .

I describe my pain as constant with sharp spikes. The pain feels like an deep abrasion, which is consistent with the appearance of the ulcers. The pain is also exacerbated by movement as the skin is tugged and stretched. Accidently bumping an ulcer against something is extremely painful, which thankfully only happens infrequently. I am constantly amazed at the depth of the ulcers and what facets of my body I can see under the skin. In addition to the abrasion pain, I also experience a soreness in both ankles. This pain increases as I walk and move.

I also now experience moderate drowsiness about an hour after dosing my narcotics and I continue to experience confusion though that has decreased in the last 2 weeks.

pain level

My pain level was at 6 last night with spikes at 8. I had difficulty sleeping due to pain and was up until about 2:30. I treated with 2 Percocet tablets and also 10 mg of Oxycodone. If I have similar pain tonight I will treat with additional Oxycodone.

I am back to walking with a cane again and yesterday received a handicapped parking permit, which will allow me to park close to store entrances and not have to walk as far.

pain level is back up

Over the past 2 weeks, my pain level has steadily increased. This morning and last night between medication doses it was a 7. I can bring it down to 4 with 1 or 2 Percocet tablets (5/325). I was taking it in conjunction with 400 mg daily of Tramadol. Tramadol's side effects for me are severe itchy skin, anxiety, sleeplessness. These side effects have increased in severity each time I have gone back to taking it. It is bad enough now that I stopped taking it and am using Percocet exclusively for pain treatment (in addition to Gabapentin [Neurontin]), 5400 mg daily.

I have an ulcer on the interior of my left ankle which showed up about a week ago. My ankle is also swollen in the area of the ulcer. The pain radiates from this ulcer out to my shin. I also have pain in my right shin, which feels like someone kicked me there. I recognize this type of pain which I have had before in the same area. I will try and publish pictures soon of the ulcer and the current status of the discoloration.

I have an appointment with Dr. Belgrade September 9 to develop a plan for now and the future.

I leave this Saturday August 8 for a back packing/camping trip in the Rocky Mountains. I am concerned that I will not be able to fully participate in all the activities. I believe at this point that I have enough medications to manage the pain.

I notice again that I get confused when I take Percocet. The confusion presents in part as an inability to come up with words. I will start a sentence and not be able to think of or speak correct words, or words that would even make sense. I also got started doing a task and can't think of how to complete it. It's very frustrating. I remember this happening last April, but I don't see that I blogged that information. I also found myself twice this morning stopping part way through a simple task (sorting through medications), not being able to think of how to complete it. This is worrisome and will talk to Dr. Belgrade about it when I see him in September.