The doctor appointment.

I first have to say: forgive me for any spelling or grammar errors that may be in this post. I haven’t been to sleep yet and am desperately and overwhelmingly tired.

I have mixed feelings about my doctor appointment today. By the time I was called in it was clear that my doctor was running behind and there were already people waiting for their appointments despite the fact that I had 4 appointments booked back to back. At first she suggested I be sent to a pain clinic until I informed her that I had already graduated from a pain clinic program at the Children’s Hospital a few years prior. I told her that I remember all of the suggestions and tools that they gave me and doubted that another of the same experience would be very beneficial (not to mention that the travel is very difficult financially). That was fine and she seemed in agreement.

I handed her the things that I had written out earlier and explained how my concentration difficulties, pain and lack of sleep made writing my thoughts and experiences out the easiest way to explain my situation thoroughly. She skimmed through them – more along the lines of glanced – fast enough that I knew she hadn’t taken in hardly anything that I had written. This was a bit frustrating and insulting. She didn’t even bother to keep the paper to read later, instead she handed them back to me.

My biggest problem with the appointment is this: my doctor seems very intent on pushing Dilaudid on me, as a means of regular pain control (instead of sporadic use). She’s continually done this despite my reasons for not wanting to replace my tylenol 3s with the Dilaudid (Tylenol 3s have been my more regular pain management opioid for many years). My view is this: I’ve been controlling my pain with the T3s for six years now, and have generally been on the same dose without any significant tolerance increase. However, with the Dilaudid my tolerance grows staggeringly fast and compared to the 6 years with the T3s and no tolerance increase, I seem to have to up my dose of Dilaudid at least twice a week (which is just not okay: to go from taking 2mg once a day to having 6mg twice a day hardly work within a few weeks). Now mind you, this happened when my ribs were subluxated and I needed to be constantly medicated because of the intensity of that pain. 

I’ve had a hard time coping with the needed amount of medication since having taken the Dilaudid regularly.  Especially when I’ve been so strict with my medication intake all these years and spent so many days desperately needing more pain relief while not allowing myself to have it. I know that may be confusing to some people – why I wouldn’t just take the medication when I need it – but if you think of the fact that I’m only 19 and will be in pain for the rest of my life, it’s just not a practical solution. My needed dose would increase to an insane amount if I regularly took medication for the rest of my life, and eventually the pain killers lose their intended effect on pain, often causing more of it in the end.

On top of this, Dilaudid also gives me fairly severe nausea to the point where I need to take gravol with it everytime or I just end up throwing up, and even with the gravol my stomach feels dreadful. My Tylenol 3s don’t do that at all. Both this appointment and the last I’ve explained this to her but it seems to go right past her head. She doesn’t acknowledge what I’ve said at all and has both times ended the appointment while still advocating for more Dilaudid use instead. Last time I thought it was just because I was a fit in appointment and she was an hour behind, but the same thing happened this time.

She ended up suggesting that I try what is known as a “drug holiday”. This is when you cease all use of your medication (she said 5 to 6 days should do the trick – I’ve read that 10 or so is around the target number of days), this is fairly effective in lowering your body’s tolerance buildup. Coincidentally I’m actually already on day 7 of the process. After my ribs had gone back into place I did my research on the subject in order to find a way to get back to my previous dosages. The 7 days have been very trying and painful – I’ve come close to giving up several times everyday since the beginning. But, here I am still managing it. It’s cost me my sleep – I can’t be in my bed for much more than 6 hours before it’s too painful to lay there anymore and I wake up every hour or so in significant pain. I’m going to have to buy a mattress in the next few days or so (mine is in horrendous shape). I think that a hospital bed would be highly beneficial (stacking pillows up and sleeping on an angle sometimes helps) but my room is too small to fit one. I’ve been on a steady dose of muscle relaxer in combination with ibuprofen (over the counter) in order to ease the pain whatever small amount possible. It’s got me worried about my stomach but I don’t know what else to do to help me get through the “drug holiday”.

Anyways, all in all the appointment didn’t go too well. It was alright but it had it’s downfalls, though, we did cover a bit of ground. Despite the length of time booked for my appointment I still had the feeling that she was trying to rush through everything. I’m not a fan of going to the doctors and right now I feel pretty “doctored out”.

Headaches: I Hate Thee

The morning after taking my last Cymbalta (the previous night) I woke up with a bad headache, nothing too out of the ordinary. Usually I take my painkillers before it gets too out of control because once it’s really bad it’s also much harder to treat, but because my bladder was still troubled from the Cymbalta I tried not to risk taking anything for as long as possible because narcotics can also cause urinary retention in some people. I usually take two Tylenol 3s (Tylenol, codeine, caffeine) and two muscle relaxers for the headaches. Trying to keep my use of painkillers as sporadic as possible I only take them when the headaches are getting beyond my ability to tolerate, but because of the urinary retention I was advised by the pharmacist to absolutely refrain from taking any muscle relaxers. The Tylenol 3 only really ever just takes the edge off of a nasty headache but without the muscle relaxers it does nothing at all. So, instead I was told to take 4mg of my Dilaudid, hoping that it wouldn’t affect my bladder. It did the trick on my headache for a while and allowed me to relax a bit but when it wore off my headache began to slowly return with a vengeance. Whether this was what some doctors refer to as a ‘rebound headache‘ – a headache made worse by the use of narcotics one they’ve worn off – or just a coincidence the pain eventually consumed my every thought completely. Sleeping was impossible, reading, television, computer were all out of the question. It was all I could do to gently pace or rock back in forth in a feeble attempt to distract my mind in the slightest. I couldn’t take any painkillers again, aside from the fear that I was in fact suffering from a rebound headache made worse by taking anything in the first place, the Dilaudid also made me unable to urinate for 11 hours. I knew any more of it and I’d be in the hospital with a catheter again. The headache was one sided, extending from the back all the way into the front. The worst of it was in my ear and eye. Every time I had to cough or get up it felt like my head was literally going to throb to the point of explosion. Eventually at around 6:30 in the morning I couldn’t take it and ended up in the hospital. At that point I would’ve volunteered without hesitation for a catheter if they’d be able to give me something for the pain, one of the nurses even suggested it. But instead after a quick exam the doctor had mr injected with a medication specifically for migraines. I had low hopes for it working but to my surprise by an hour afterward the pain was significantly reduced to the point that I felt somewhat like a human being again. I was in too much pain to really register much of what was said to me at the hospital so I intend to ask my doctor what medication I was given next time I’m in to see her.

My headaches have been relentless since then. I’m exhausted and becoming increasingly depressed by the amount of pain I’ve been in lately. I’ve always been extremely aware of the negative impact of narcotics on the body, how over time they can increase your pain levels, how quickly you’re body begins to tolerate them and how you’ll eventually need more and more to achieve the same effect. For the 4 or so years that I’ve been on them I’ve made it a point to do my best to keep my use of them minimal. I think it would be harder to do if they worked better on me, but even the modest amount of relief they offer is tempting even on a good day. I only take them on average about 2 or 3 times a week. Sometimes I take them a few days in a row during a bad spell, sometimes I go a few weeks with nothing during the good. I keep a journal detailing my use of them, this way I feel more aware of my habits and even of the pattern that my pain sometimes fluctuates in. Narcotic use is a slippery slope and though I’ve never been tempted in the least to use them recreation-ally I’m also not naive enough to think myself invincible to addiction. That’s why I take precautions, I’m still only 18 and I’ve got a long way to go in life. It is known that those who actually use these types of medications for pain are less prone to fall into addiction but even so it’s not impossible.

Q: “Always fall in with what you’re asked to accept. Take what is given, and make it over your way. My aim in life has always been to hold my own with whatever’s going. Not against: with.” – Robert Frost

{Any medical terms and/or definitions featured on this blog have been thoroughly researched by me as to not lead to any false consumption of information by the reader. Though, that aside; I am not a doctor and the medical information on this site should not be taken as a substitute for the advice of medical professionals. If you’re experiencing any health issues don’t hesitate to contact your doctor.}