I saw Andy Schakel, the intern working with Dr. Belgrade, yesterday afternoon and discussed the ineffectiveness of the pain management plan that we came up with last week. We want to decrease the consistently high pain level and yet decrease the amount of short acting narcotics taken for breakthrough pain. We also want to decrease the severity of the side effects that I have experienced when on such high doses.
The new plan is to take 60 mg TID (three times daily) MS Contin for baseline chronic pain and 10 mg every 4 hours Oxycodone for breakthrough pain (up to 100 doses monthly) not managed by MS Contin. For neuropathic pain I will continue the 1200 mg TID doses of Neurontin and Neurontin gel TID on my feet/ankles, though administering the gel to a painful area of my skin three times daily is an excruciating experience. I will use Morphine gel TID on the existing and any new ulcers starting tomorrow when I pick it up. We will continue this course of treatment for a week and meet again at that time for a status check. I continue wearing support hose on my left foot/calf to minimize swelling and its painful effects.
One side effect I haven't blogged about much is a sexual dysfunction when using heavy narcotics. I have had trouble achieving orgasm during high pain cycles. I don't yet know if it's due to the decreased skin sensitivity from medications or the pain effects themselves. Though I don't specifically remember, I have been told that this problem happens more during pain cycles than not. I will try and track this issue better using this blog. I haven't achieved orgasm in roughly 2 weeks though have had sexual activity almost daily. This has left me feeling emasculated and frustrated. I do not want to tend to avoid sexual activity because of this problem nor do I want to have this worry in the forefront of my mind. Self fulfilling prophesy syndrome is certainly a possibility in that case.
After starting MS Contin yesterday, I was very tired today and slept from last night until 1:30 pm today. About 30 minutes after my first dose of MS Contin and a simultaneous does of Oxycodone yesterday, my pain level was down to 5 and I was able to walk without my cane for the first time since early last week. It was a welcome relief to have my pain level that far down. It had been at 6 or above since last week, with which is difficult to maintain my active lifestyle. It has stayed below 7 since then except for a little while today due to being late with my noon dose of Oxycodone. I am optimistic that we have settled on an effective plan.
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