Friday, February 26, 2010

Another specialist...

Well, the knee doc can take his grumbling of "no pain meds" and stuff it. This morning I received a call from a pain specialist. At last, I'll be able to sit and discuss my pain issues with someone willing to actually formulate a plan, rather than me saying, "Just write for these meds," then walking out with a pain script.

I've discussed it before, but I think it's time to review my pain issues, as there's now some insight into what's going on in my left foot.

I have one REALLY big pain issue. That is, it encompasses about 80% of my exterior. Diabetic neuropathy causes a burning sensation in my skin about 99% or the time. When my blood glucose rises, the pain gets worse, almost to the point where clothing causes me to whimper.

Next, the complication of the complication known as neuropathy, Charcot's foot. Until the recent MRI revealing the tear in my knee, I thought it was Charcot's joint irritating my left knee. It would seem, however, that it is mostly my feet in which it's occurring. X-rays have shown my feet are already changing shape. I wish they were tranforming so that I'd have little bony wheels that would pop out on command and speed me along, but that isn't the case. In fact, I'm willing to lay odds Charcot's foot is responsible for the bone spur that has developed in my left foot, somewhere near the vicinity of the left great toe. My feet ache all the time.

Let's not forget the severe osteoarthritis in my right big toe.

Then we have my knees. Rumor has it that my right knee is okay. The x-rays and MRI revealed nothing...or so I'm told. But I'm experiencing similar pain in there as the left, although not as severe. My guess would be that there might be micro-tears in there, or at least one, and that's causing me minor discomfort from time to time.

Ah, but finally we have the left knee, with its tear of the medial meniscus. This has been discussed most recently, along with the literally bone-jarring relocation of my tibia when I straighten my knee from an extreme bend. (Idiot Rob isn't wearing his brace at this moment, and I've managed to sit like an idiot...again.) It's the repositioning of bones that has me convinced this will require surgery.

Now to the pain management stuff. Morphine and percocet have been my standbys for the last two years. I am not happy that it has come to this. I wasn't happy then, and I've become increasingly less happy over the years. The body adjusts to such meds, and in two years I've gone from a dose of 15 mg. morphine and 5/325 percocet to 60 mg. morphine and 10/325 percocet. For the latter, that first number represents the milligrams of narcotic in the pills. The doses have gotten higher, and my pains are still becoming greater. Something needs to be done.

But what? I can't receive steroid injections; they mess with diabetes control, which is already a fight for me. I've tried non-steroidal anti-inflammatory meds, and reacted with acid reflux for my troubles. Surgery to correct the issues with my feet is dangerous. I don't heal well when it comes to my feet, (and it seems to be only my feet), and then there's the fact that attempting to reshape bones surgically can have no beneficial effect. The deformities can grow right back. What's more, the bones can become more easily infected when traumatized like that, and one case of osteomyellitis is more than enough, thanks.

Ultimately, I'd like to see myself on three pain meds, each with a specific goal in mind. First, I'd like to get the morphine reduced back down to my 30 mg. three times a day. I think I was good there. Continue the percocets specifically for breakthrough pain when it comes to my feet and the like. These two meds are very good when dealing with the physiological pain issues I have.

When it comes to the neuropathy, my best bet would be a drug called Ultram. I was on this stuff for 10 years before I had to switch over to the "real" narcotics, and my opinion is that it works wonders on neurological pain. For me, anyway. All this time, doctors have told me not to take all three painkillers at the same time. My opiate receptors would be dancing a jig inside me, since the Ultram is a NON-narcotic that still works on said receptors. The problem, however, is that I don;t think the percocets work as effectively on my neuropathy as the Ultram. Still, I've been told to take the former for all pains, and leave the Ultram out of the picture.

But I'll tell you a secret. (Some secret, posting on a public forum.) After taking my regular doses of narcotics this morning, I was still feeling neuropathy pain. Instead of taking another percocet, I took an Ultram. I am not pain-free, but I am far more comfortable at this moment than usual. The worst of my pains right now is my left knee, and that's to be expected. This, however, is how I'd rather handle my pain instead of reaching for a narcotic all the time.

Now for my greatest fear. I said a little earlier that the body adjusts to those narcotics, right? I also said I'm fairly certain I'll need surgery. Well, what's going to happen AFTER the surgery. How am I going to handle the pain of recovery when all the pills that can be prescribed aren't nearly as effective? I'll probably end up lying in my room, weeping and praying for death.

Ah, but if it leads to less pain in the end, I'll endure. I have in the past. I just hope the surgery is as simple as I imagine it, because if this requires the removal of the meniscus, I'm going to be in absolute agony. And pain and I...? We're not friends. Never have been, and never will be.

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