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.