new pain doctor

I met with Dr. Miles Belgrade and his intern Dr. Andy Schakel yesterday and an associated pain psychologist in the same clinic. The four of us discussed my pain experience and the history of my Livedoid Vasculopathy diagnosis. We developed a slightly different strategy for my pain management, which we will try for a month and then reconvene for review.

I will be decreasing the dosage of Neurontin from 5400 to 3600 mg daily. This should decrease some sexual disfunction I have experienced, which has been due to decreased skin sensitivity. I started using a Neurontin gel on the tops of my feet this morning, which is where I have experienced neuropathic pain. This should counteract the decrease in oral dosage and ease the burden on my liver, while maintaining or increasing the medication's effectiveness.

I will start taking longer acting Oxycontin instead of shorter acting Oxycodone. I will be taking 10 mg TID whether or not I have high pain levels. The theory is to even out the large swings in dosage from 80 mg daily to none. This should decrease the confusion I have experienced.

I will use 10/650 mg of Percocet every 4-6 hours for breakthrough pain, with a maximum of 100 doses per month.

Additionally, I will use a Morphine gel on my ulcers TID when they are present. This will preclude the use of Duoderm dressing, which I have left on for 3-4 days. I will try standand Band-Aids and see how that goes.

The Neurontin gel is only available from one Pharmacy locally as is the Morphine gel.

The overall plan is to even out the dosages of narcotics and use localized topical pain treatment to minimize oral narcotic use as well.

I talked to both Dr. Belgrade and his pain psychologist about my addiction concerns. It was their opinion that I posed a low risk for addiction with this course of treatment and my current mental, emotional, and physical state. This put my mind at ease.

It was troubling to realize, during the course of our discussions, that I have experienced high pain levels for 19 of 40 weeks so far this year. That's nearly half the year. Last night this led to feelings of sadness, inadequacy, loneliness, emotional pain, powerlessness, and anger. I was able to work through some of these feelings with my girl friend Kalyn, whose support has been unwavering since this spring. This morning, some of these feelings linger, though are not nearly as strong.