![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 30. Go back in thread:
Posted by JeffH on October 28, 2001, at 12:10:05
In reply to above msg directed to JahL also intended for JeffH (nm), posted by Elizabeth on October 28, 2001, at 10:55:46
Thanks for your responses.
Elizabeth, I have responded to codeine. Other than that, I have no other experiences with opioids.
I will try to contact Dr. Bodkin in hopes of getting a refereral. Massachusetts, Paris, Rome ... I'd go all those places if needed. All I need is one visit where the doc says, "Yes, opioids are worth a try in your case. Tell your doctor to try **** or ****, starting out at ....."
Thanks for your help. I'll let you know how it goes.
Posted by Elizabeth on October 28, 2001, at 16:29:18
In reply to Thanks Elizabeth, Jahl, JohnX2, posted by JeffH on October 28, 2001, at 12:10:05
> Elizabeth, I have responded to codeine. Other than that, I have no other experiences with opioids.
You found codeine helpful for your depression, though? Can you tell me about your experience?
Something you might consider is Ultram. It's a weak opioid, not a controlled substance, and (IME) has milder side effects than other opioids such as codeine and morphine (and buprenorphine, for that matter). It's not well-suited to use for acute pain because it takes about 3 hours to kick in after you take it, but I think it would be useful for chronic pain (or chronic depression) because it has a long-lived active metabolite (O-desmethyltramadol) that builds up if you take it regularly. The down sides of Ultram are the cost(it's pretty expensive if you don't have a prescription plan) and the limit on what dose can be used (at higher doses it can cause seizures). I found that it wasn't effective for me at safe doses (and even doses a bit higher than the recommended maximum), but I know that depressed people who need opioids often do respond to Ultram. (I also didn't find codeine effective, but that probably has to do with a metabolic quirk -- most of codeine's therapeutic efficacy is due to its active metabolite: morphine.) Anyway, doctors are much likelier to be willing to prescribe Ultram than other opioids, which are controlled substances.
> I will try to contact Dr. Bodkin in hopes of getting a refereral.
I think it might be better to ask your pdoc to call him.
Best of luck to you.
-elizabeth
Posted by JohnX2 on October 29, 2001, at 1:12:15
In reply to memantine, etc. » JohnX2, posted by Elizabeth on October 28, 2001, at 10:53:47
I was a bit confused about the definitions of
preventing tolerance/sensitization and addiction.
If I was a lab rat and I grew completely tolerant
to amphetamine, then I probably wouln't press the
amphetamine level. But if a medicine kept me from
building the tolerance, I probably would press the
amphetamine level a lot.
Does that mean I am addicted?They've down these kinds of studies on cocaine,
etc. and found that the meds kept the stims from
pooping out, but that didn't solve the psychological
addiction. In fact to address the psychological
addiction people are coming up with approaches
to *prevent* the effects of the meds like the
cocaine "vaccine".My thinking is that they can prevent tolerance
and sensitization and the patient needs to use
good judgement not to abuse the med from a psychological
standpoint (which is what the rats don't do
in their cages, they keep pressing the level).What do you think?
-john
> > There is a medication
> > called memantine, available in Europe, in clinical
> > trials in us that can help prevent opiod addiction.
>
> Memantine is an NMDA receptor antagonist. It may slow or prevent the development tolerance and dependence. I'm not clear that it prevents addiction, but the elimination of tolerance and dependence would solve many of the problems associated with addiction. Delta-opioid antagonists were also being looked at, last I heard. If anyone knows anything about these drugs, I'd be interested.
>
> Methadone is merely a substitute, and while it is the best treatment available at this time (and I'm all in favor of harm reduction), it does have significant problems. (The implementation of MMT programs in the US is also problematic, of course.)
>
> -elizabeth
Posted by JeffH on October 29, 2001, at 14:13:15
In reply to some suggestions » JeffH, posted by Elizabeth on October 28, 2001, at 16:29:18
I played Secretary of State and tried to call Dr. Bodkin to see if he or one of his colleagues would do a consult with my doctor. He was out, but I talked to a doctor who works closely with him. Amazing. Friendly man, could have been talking to a plumber about what kind of pipe to put in my bathroom.
He's going to talk with my doc by phone -- maybe I'll avoid some travel. He also knew a pdoc in Tucson who might help.
This doctor told me the news that within the next six months, the FDA will approve buprenex (which is buprenorphine, right?) so it is readily available.
The codeine I got as a result of some dental work -- I remember it taking away some of my apathy/adhedonia for a short time. I also remember having my wisdom teeth removed as a teenager. Though I wasn't given an opiate, the gas I was administered as an anesthetic was so beautiful that the dentist threatened to stop the procedure if I didn't calm down. I remember my rapid breathing - I was in total ecstacy.
Ultram, how is that different than Tramadon? These other opioids are worthy options because I'm finding out quickly how unfamiliar doctors are with buprenorphine.
I find myself almost totally unable to be even remotely passive now in finding a treatment, yet I am discovering being too aggressive is as bad as being too passive when dealing with doctors.
Posted by Elizabeth on October 29, 2001, at 18:58:27
In reply to Re: some suggestions, posted by JeffH on October 29, 2001, at 14:13:15
> I played Secretary of State and tried to call Dr. Bodkin to see if he or one of his colleagues would do a consult with my doctor. He was out, but I talked to a doctor who works closely with him. Amazing. Friendly man, could have been talking to a plumber about what kind of pipe to put in my bathroom.
Cool -- did you get his name, by any chance?
> This doctor told me the news that within the next six months, the FDA will approve buprenex (which is buprenorphine, right?) so it is readily available.
No, Buprenex has been FDA-approved for some years now -- but only for pain, and it's illegal to use it for treating opioid dependence except in a special clinic (just like methadone or LAAM). A new law needs to be passed in order for doctors to be able to prescribe buprenorphine to regular outpatients for maintenance treatment of addiction.
> The codeine I got as a result of some dental work -- I remember it taking away some of my apathy/adhedonia for a short time.
When I had my wisdom teeth out I got hydrocodone, and that's how I found out that opioids work for me. I'd had codeine before but that didn't do much (didn't help much with the pain, either!).
> I also remember having my wisdom teeth removed as a teenager. Though I wasn't given an opiate, the gas I was administered as an anesthetic was so beautiful that the dentist threatened to stop the procedure if I didn't calm down. I remember my rapid breathing - I was in total ecstacy.
I'm guessing that the anaesthetic you got was nitrous oxide. I got a very fast-acting intravenous general anaesthetic when I had my wisdom teeth out -- all I remember is starting to count backwards from 10, and then waking up to find it was all over.
> Ultram, how is that different than Tramadon?
Ultram is the US brand name of *tramadol*.
> These other opioids are worthy options because I'm finding out quickly how unfamiliar doctors are with buprenorphine.
Give them a copy of the article by Bodkin et al.
> I find myself almost totally unable to be even remotely passive now in finding a treatment, yet I am discovering being too aggressive is as bad as being too passive when dealing with doctors.
Yes...you have to walk a fine line to work with them well.
-elizabeth
Posted by Hattree on October 30, 2001, at 13:21:16
In reply to Re: some suggestions » JeffH, posted by Elizabeth on October 29, 2001, at 18:58:27
Um, a question. Doesn't everybody get high on narcotics? I'd like to go through life on percocet, myself, and on the rare occasions I am given some, it does not lounge in my medicine cabinet for long. Is this saying something about my stripe of depression, or do I just like euphoria?
> > I played Secretary of State and tried to call Dr. Bodkin to see if he or one of his colleagues would do a consult with my doctor. He was out, but I talked to a doctor who works closely with him. Amazing. Friendly man, could have been talking to a plumber about what kind of pipe to put in my bathroom.
>
> Cool -- did you get his name, by any chance?
>
> > This doctor told me the news that within the next six months, the FDA will approve buprenex (which is buprenorphine, right?) so it is readily available.
>
> No, Buprenex has been FDA-approved for some years now -- but only for pain, and it's illegal to use it for treating opioid dependence except in a special clinic (just like methadone or LAAM). A new law needs to be passed in order for doctors to be able to prescribe buprenorphine to regular outpatients for maintenance treatment of addiction.
>
> > The codeine I got as a result of some dental work -- I remember it taking away some of my apathy/adhedonia for a short time.
>
> When I had my wisdom teeth out I got hydrocodone, and that's how I found out that opioids work for me. I'd had codeine before but that didn't do much (didn't help much with the pain, either!).
>
> > I also remember having my wisdom teeth removed as a teenager. Though I wasn't given an opiate, the gas I was administered as an anesthetic was so beautiful that the dentist threatened to stop the procedure if I didn't calm down. I remember my rapid breathing - I was in total ecstacy.
>
> I'm guessing that the anaesthetic you got was nitrous oxide. I got a very fast-acting intravenous general anaesthetic when I had my wisdom teeth out -- all I remember is starting to count backwards from 10, and then waking up to find it was all over.
>
> > Ultram, how is that different than Tramadon?
>
> Ultram is the US brand name of *tramadol*.
>
> > These other opioids are worthy options because I'm finding out quickly how unfamiliar doctors are with buprenorphine.
>
> Give them a copy of the article by Bodkin et al.
>
> > I find myself almost totally unable to be even remotely passive now in finding a treatment, yet I am discovering being too aggressive is as bad as being too passive when dealing with doctors.
>
> Yes...you have to walk a fine line to work with them well.
>
> -elizabeth
Posted by JeffH on October 30, 2001, at 14:11:21
In reply to Re: some suggestions, posted by Hattree on October 30, 2001, at 13:21:16
Elizabeth, his name was Jonathan Cole. Though I don't think he was directly involved in Bodkin's study, he seem thoroughly knowledgeable about buprenorphine. Frankly, initially I was a bit nervous about getting through so quickly that I may have misunderstood what he said about buprenex. Maybe it did have something to with this drug being available in the near future for outpatient treatment for addiction issues.
Regardless, another friend of mine who is originally from Boston (don't ask how we all ended up out here), was on the staff at Menningers in Kansas, almost flipped out when I told him I had talked to the doctor. He said this doc is a heavy hitter who has been extensively published.
Hattree, I am in no way an authority on the use of opioids in treating depression. I am interested because I have tried almost everything else and I believe there are signs that this may be a "fit" for me. Elizabeth has incredible knowledge and from personal experience, knows that for a certain subset of depressives, it works.
From what I know, if your opiate system is malfunctioning, you need artificial replacement not for euphoria, but for "normalcy". Depressives who may respond need nowhere near the levels that an addict might use. A drug like buprenorphine is attractive because it loses its effectiveness as the dosage is upped, so addiction doesn't seem to a factor.
In my case, it's sure worth a try, even if if doesn't work for me. I have nothing to lose.
-- Jeff
Posted by Elizabeth on October 30, 2001, at 23:14:07
In reply to Re: some suggestions, posted by Hattree on October 30, 2001, at 13:21:16
> Um, a question. Doesn't everybody get high on narcotics?
No, not at all. Some people even become dysphoric on them, and others are indifferent to them. I'm not sure what percentage of people like opioids, but it's far from 100%. (There's a researcher in Boston who's been able to breed rodents that like morphine and rodents that don't like it. Interesting stuff. It must take an amazing degree of patience to do that sort of research.)
I've never gotten high on opioids, they just produce in me a feeling of contentment (although that may just be because I haven't ever taken a high enough dose).
> I'd like to go through life on percocet, myself, and on the rare occasions I am given some, it does not lounge in my medicine cabinet for long. Is this saying something about my stripe of depression, or do I just like euphoria?
(Doesn't everybody like euphoria, by definition? < g >)
I'd say it says more about your response to oxycodone (and probably to opioids in general) than about your depression. Have you taken Percocet when you were depressed, and if so what effect did it have?
-elizabeth
Posted by Elizabeth on October 30, 2001, at 23:24:38
In reply to Re: Elizabet, Hattree, posted by JeffH on October 30, 2001, at 14:11:21
> Elizabeth, his name was Jonathan Cole.
Ahh! He's very well known and respected, and he's spoken at meetings of the depression and manic-depression support group that meets at McLean.
> Though I don't think he was directly involved in Bodkin's study, he seem thoroughly knowledgeable about buprenorphine.
He was listed as an author on the article that resulted from that study, although that could mean anything (or nothing).
> Frankly, initially I was a bit nervous about getting through so quickly that I may have misunderstood what he said about buprenex. Maybe it did have something to with this drug being available in the near future for outpatient treatment for addiction issues.
Well, the other thing about that is that right now it's only available in an injectable solution. A sublingual formulation (it has very poor bioavailability when taken orally) is being studied for treating opioid dependence, and doctors would definitely be much more at ease prescribing that. Sublingual buprenorphine is marketed as Subutex or Temgesic in other countries.
> A drug like buprenorphine is attractive because it loses its effectiveness as the dosage is upped, so addiction doesn't seem to a factor.
I don't think it becomes less effective, but there's a ceiling (a pretty low one) on how much more you can take and get more effect -- if you go past the ceiling dose, it won't work any better. (I don't know where the ceiling is.)
> In my case, it's sure worth a try, even if if doesn't work for me. I have nothing to lose.
I know the feeling. Best of luck to you.
-elizabeth
Posted by Cecilia on October 31, 2001, at 5:10:37
In reply to Percocet stuff » Hattree, posted by Elizabeth on October 30, 2001, at 23:14:07
> > Um, a question. Doesn't everybody get high on narcotics?
>
> No, not at all. Some people even become dysphoric on them, and others are indifferent to them. I'm not sure what percentage of people like opioids, but it's far from 100%. (There's a researcher in Boston who's been able to breed rodents that like morphine and rodents that don't like it. Interesting stuff. It must take an amazing degree of patience to do that sort of research.)
>
> I've never gotten high on opioids, they just produce in me a feeling of contentment (although that may just be because I haven't ever taken a high enough dose).
>
> > I'd like to go through life on percocet, myself, and on the rare occasions I am given some, it does not lounge in my medicine cabinet for long. Is this saying something about my stripe of depression, or do I just like euphoria?
>
> (Doesn't everybody like euphoria, by definition? < g >)
>
> I'd say it says more about your response to oxycodone (and probably to opioids in general) than about your depression. Have you taken Percocet when you were depressed, and if so what effect did it have?
>
> -elizabethI agree with Elizabeth-I think only a minority of people respond with euphoria to opiods-if not cancer patients would all be full of joy instead of seeking out books like Final Exit. The leftover Percocet I had from surgery 5 years ago is still in my cabinet-it wouldn`t even occur to me to take it for psychological effects, which were non-existent.
Posted by Hattree on October 31, 2001, at 9:43:48
In reply to Percocet stuff » Hattree, posted by Elizabeth on October 30, 2001, at 23:14:07
> I'd say it says more about your response to oxycodone (and probably to opioids in general) than about your depression. Have you taken Percocet when you were depressed, and if so what effect did it have?
>
> -elizabethEuphoria may be an overstatement. The absence of depression can feel pretty fine sometimes...cheerful and energetic is pretty novel during a long funk.
Actually I'm much better right now with Lamictal, but I'm curious about this for future reference, and I've always wondered where that line is between pleasure-seeking and just wanting to feel like undepressed people. I'm dysthymic, so I don't have a pre-depressed self to compare to.
Posted by Elizabeth on October 31, 2001, at 22:31:55
In reply to Re: Percocet stuff » Elizabeth, posted by Hattree on October 31, 2001, at 9:43:48
> Euphoria may be an overstatement. The absence of depression can feel pretty fine sometimes...cheerful and energetic is pretty novel during a long funk.
Yeah, it sure is. I understand. ("Euthymia" is the word used for "normal" (happy but not high) mood.)
> Actually I'm much better right now with Lamictal, but I'm curious about this for future reference, and I've always wondered where that line is between pleasure-seeking and just wanting to feel like undepressed people. I'm dysthymic, so I don't have a pre-depressed self to compare to.
I think what matters is how you're functioning. If you take so much Percocet that you're nodding all the time, that's not going to improve your functioning. But if you take enough that you are able to feel optimism, motivation, pleasure, etc. -- that can turn your life around (in a good way).
-elizabeth
Posted by Gracie2 on November 1, 2001, at 6:03:22
In reply to Percocet stuff » Hattree, posted by Elizabeth on October 30, 2001, at 23:14:07
I happened to enjoy Percocet a great deal myself.
I got some after having my wisdom teeth pulled, and I was still in pain but I didn't care.
On the other hand, Darvocet, codeine and even Vicodan have little effect on me, and I still can't understand what the big deal about Xanax is. Several doctors refused to give it to me, and I thought it was some wonderful drug that would just make you float away. All it does is make me tired. On the other hand, I had a great deal of trouble getting off Ultram. (Still clean 8-), hoorah for me.)
So I guess narcotics are like psych drugs, everyone reacts a little differently.
-Gracie
Posted by judy1 on November 1, 2001, at 18:37:45
In reply to Re: Percocet stuff, posted by Gracie2 on November 1, 2001, at 6:03:22
Hi Gracie,
Percocet is the strongest of the meds you mentioned- I'm not surprised you didn't have a positive effect on the others- especially darvocet which is like baby aspirin (to me). Xanax is like a no effect drink- if you don't enjoy alcohol, you probably don't get a good effect from benzos. I can understand where euthymia feels wonderful after depression- I don't think a lot of docs understand that distinction and that's where all the trouble starts. Hope you are well- judy
Posted by Gracie2 on November 1, 2001, at 21:54:01
In reply to Re: Percocet stuff » Gracie2, posted by judy1 on November 1, 2001, at 18:37:45
Oh dear, I guess that's what comes of being a druggie. I don't even bother with Darvocet or Tylenol 3 - again, baby aspirin. I had a pretty good time with some Roxicet -again, after oral surgery - I think that's about the same as Percocet. The only other thing I've had that knocked me for a loop was a shot of Demerol before my son was born, but it didn't last very long.
I guess if I stay clean, the tolerance will go away? That's what killed Sid Vicious. Why am I talking about this.
I'm doing pretty good now, thanks.
-Gracie
Posted by Hattree on November 2, 2001, at 8:45:34
In reply to Re: Percocet stuff, posted by Gracie2 on November 1, 2001, at 21:54:01
Hm. If narcotics still appeal when we're doing well, it might shoot a hole in our argument that they're just to make us feel "normal".
>
> Oh dear, I guess that's what comes of being a druggie. I don't even bother with Darvocet or Tylenol 3 - again, baby aspirin. I had a pretty good time with some Roxicet -again, after oral surgery - I think that's about the same as Percocet. The only other thing I've had that knocked me for a loop was a shot of Demerol before my son was born, but it didn't last very long.
> I guess if I stay clean, the tolerance will go away? That's what killed Sid Vicious. Why am I talking about this.
> I'm doing pretty good now, thanks.
> -Gracie
Posted by Gracie2 on November 2, 2001, at 13:04:54
In reply to Re: Percocet stuff, posted by Hattree on November 2, 2001, at 8:45:34
I have a good freind, an experienced RN, who says that serious narcotics like morphine after a surgery or a terrible injury do not make the patient "high". I guess in that case the drugs are busy doing what they're supposed to do - kill pain- instead of inducing pleasure.
I read in a book once - written by a doctor - that he told a cancer patient, "We have drugs that can reach any pain." I don't know if this is true from my own experience of having to watch my aunt die at home (as she chose to do), she seemed to be in a good deal of pain a lot of the time and it was terrible. The problem was that, after her colon resection, she could not keep down any food or water, and she would often throw up her morphine pills. She also had morphine patches, but the doctor said that they probably weren't working well because by that time, she was so emaciated, she had no fat on her body and I think this is necessary for transferance of the pain medication. I felt strongly that she should be in a hospital on an IV with a morphine button,
but since I was just her neice and her family disagreed with me, there was nothing I could do.
I'll tell you what, if I get cancer, there's no way I'd die at home. No way.
-Gracie
P.S. Gee, how cheerful was THAT post?
Posted by Hattree on November 2, 2001, at 14:10:04
In reply to Re: Percocet stuff, posted by Gracie2 on November 2, 2001, at 13:04:54
Thats the rap--if you use it "legitimately" you don't get high. After major surgery, while still under the miserable influence of anesthesia, I definitely did not feel high on morphine (didn't feel so painess either). However, by the next day percocet was killing the pain AND making me pretty cheerful. I think they just say that so people who need narcotics won't be afraid to treat their pain.
Sorry to hear about your experience with your aunt.
Cancer seems to have its own set of issues.
>
> I have a good freind, an experienced RN, who says that serious narcotics like morphine after a surgery or a terrible injury do not make the patient "high". I guess in that case the drugs are busy doing what they're supposed to do - kill pain- instead of inducing pleasure.
> I read in a book once - written by a doctor - that he told a cancer patient, "We have drugs that can reach any pain." I don't know if this is true from my own experience of having to watch my aunt die at home (as she chose to do), she seemed to be in a good deal of pain a lot of the time and it was terrible. The problem was that, after her colon resection, she could not keep down any food or water, and she would often throw up her morphine pills. She also had morphine patches, but the doctor said that they probably weren't working well because by that time, she was so emaciated, she had no fat on her body and I think this is necessary for transferance of the pain medication. I felt strongly that she should be in a hospital on an IV with a morphine button,
> but since I was just her neice and her family disagreed with me, there was nothing I could do.
> I'll tell you what, if I get cancer, there's no way I'd die at home. No way.
> -Gracie
> P.S. Gee, how cheerful was THAT post?
Posted by Elizabeth on November 3, 2001, at 11:48:02
In reply to Re: Percocet stuff, posted by Gracie2 on November 1, 2001, at 6:03:22
> On the other hand, Darvocet, codeine and even Vicodan have little effect on me, and I still can't understand what the big deal about Xanax is.
The three opioid-containing medicines you mentioned (Darvocet (propoxyphene + acetaminophen [Tylenol], codeine, and Vicodin (hydrocodone + acetaminophen)) are all generally considered weaker than Percocet. Out of curiosity, how much hydrocodone (the opioid ingredient in Vicodin) did you take at once? I was prescribed 10-20 mg when I had my wisdom teeth out; 10 mg didn't do anything for my mood but 20 had a noticeable positive effect.
Xanax isn't an opioid, it's a benzodiazepine, and I don't see what the big deal is about it either. < g > I mean, it's a good anxiolytic, but I don't get high on it, and I take a pretty high dose (2 mg as needed).
> I have a good freind, an experienced RN, who says that serious narcotics like morphine after a surgery or a terrible injury do not make the patient "high".
It depends on the dose -- people in severe pain need to take a much higher dose of opioids in order to get high. If you're taking opioids for pain, and you take only as much as you need to relieve the pain, you're not going to get addicted because you won't be getting high.
> I read in a book once - written by a doctor - that he told a cancer patient, "We have drugs that can reach any pain." I don't know if this is true from my own experience of having to watch my aunt die at home (as she chose to do), she seemed to be in a good deal of pain a lot of the time and it was terrible.
IMO, nobody should ever have to die in pain (if morphine doesn't work, there are stronger medications like hydromorphone and fentanyl) but unfortunately, a lot of people do. The husband of a friend of mine died last year of emphysema and complications. There was a nurse in the hospital who refused to give him the amount of morphine that the doctor had ordered because in her opinion it was too much! Luckily, he had a loving wife who stood up for him. The doctor arranged for that nurse not to be assigned to him. (I feel sorry for whatever poor patient got stuck with her, though.)
> The problem was that, after her colon resection, she could not keep down any food or water, and she would often throw up her morphine pills. She also had morphine patches, but the doctor said that they probably weren't working well because by that time, she was so emaciated, she had no fat on her body and I think this is necessary for transferance of the pain medication.
Yes -- opioids are lipophilic (fat-soluble).
> I felt strongly that she should be in a hospital on an IV with a morphine button,
Actually, patients can have PCA machines in their homes if they don't want to stay in the hospital.
> I'll tell you what, if I get cancer, there's no way I'd die at home. No way.
Some people prefer to, and I can understand why.
-elizabeth
Posted by Elizabeth on November 3, 2001, at 11:54:59
In reply to Re: Percocet stuff, posted by Hattree on November 2, 2001, at 8:45:34
> Hm. If narcotics still appeal when we're doing well, it might shoot a hole in our argument that they're just to make us feel "normal".
It depends how much you take, of course.
> Thats the rap--if you use it "legitimately" you don't get high.
The pain sort of "eats up" the drug. If you're in pain, you'll need more to get high than when you're not in pain.
> After major surgery, while still under the miserable influence of anesthesia, I definitely did not feel high on morphine (didn't feel so painess either).
You probably weren't getting enough to treat your pain.
> I think they just say that so people who need narcotics won't be afraid to treat their pain
That probably has something to do with it, yes. OTOH, a lot of doctors and nurses seem to *want* patients to be afraid to treat their pain!
-elizabeth
Posted by MB on November 3, 2001, at 12:29:25
In reply to memantine, etc. » JohnX2, posted by Elizabeth on October 28, 2001, at 10:53:47
There are both positive and negative sides to the use of the drug methadone. However, methadone alleviated my mood problems better than any other pharmacological agent. Had the methadone maintenence bureaucracy been able to lessen its steel grip on my treatment (i.e., had they worked with me to tailor my treatment), I would probably be in full remission today. I think the main problem with methadone is the program, not the drug. Hmmm, and you didn't even ask my opinion, I gave it to you au gratin (that's a pun). LOL!!
> Methadone is merely a substitute, and while it is the best treatment available at this time (and I'm all in favor of harm reduction), it does have significant problems. (The implementation of MMT programs in the US is also problematic, of course.)
>
> -elizabeth
Posted by Gracie2 on November 3, 2001, at 18:29:20
In reply to Re: Percocet stuff » Gracie2, posted by Elizabeth on November 3, 2001, at 11:48:02
If people can have PCA machines (I'm assuming that's an IV drip) set up at home, I can't imagine why Hospice didn't arrange for my aunt to have one. That really makes me angry...I just figured that if you wanted an IV, you had to go to the hospital -
because a nurse had to moniter the IV, or some such reason. Her dying at home was okay at first, since she always enjoyed being surrounded by family and friends. The trouble started after the cancer took her mind, and she was unable to communicate. My cousin, who is an LPN, always insisted on giving my aunt the minimal dosage of pain medication recommended, and we would fight
bout this because my aunt would just curl up in bed and groan. I believe, by that time, that her soul was already gone, but her body was still in pain and I couldn't stand the thought.
-Gracie
I love you, Aunt Judy
Posted by JahL on November 4, 2001, at 18:57:25
In reply to Re: memantine, etc., posted by MB on November 3, 2001, at 12:29:25
> There are both positive and negative sides to the use of the drug methadone. However, methadone alleviated my mood problems better than any other pharmacological agent.
Hi.
Can you tell me at what dose Methadone begins to lighten your mood? Did you have problems with sedation & if so did these resolve with time?
Thanks,
J.
Posted by Elizabeth on November 6, 2001, at 14:55:21
In reply to Re: memantine, etc., posted by MB on November 3, 2001, at 12:29:25
> There are both positive and negative sides to the use of the drug methadone. However, methadone alleviated my mood problems better than any other pharmacological agent.
I've never taken methadone, but if it were more available (i.e., if I thought I could get a doctor to prescribe it for me long-term), I would definitely consider trying it. It would be nice to have something I could take just once or twice a day -- with buprenorphine my energy level is constantly going up and down throughout the day.
> Had the methadone maintenence bureaucracy been able to lessen its steel grip on my treatment (i.e., had they worked with me to tailor my treatment), I would probably be in full remission today. I think the main problem with methadone is the program, not the drug.
Yes, me too. Can you tell me about your experience with MMT?
-elizabeth
Posted by Elizabeth on November 6, 2001, at 15:07:27
In reply to Re: Percocet stuff - Elizabeth, posted by Gracie2 on November 3, 2001, at 18:29:20
> If people can have PCA machines (I'm assuming that's an IV drip) set up at home, I can't imagine why Hospice didn't arrange for my aunt to have one.
(PCA = patient-controlled analgesia, where the person can push a button (or turn a knob or whatever) to adjust the dose to what they need, within set limits)
I think it's probably expensive. Also, of course, lots of times doctors and nurses choose not to give patients options that they *could* give them, based on prejudices or on fear of the government or of the state licensing board.
> That really makes me angry...I just figured that if you wanted an IV, you had to go to the hospital -
> because a nurse had to moniter the IV, or some such reason.Well, there are risks -- I'm not sure what needs to be done to allow a patient to control IV medication at home, but one reason I said I thought it might be expensive is that a doctor or nurse might need to make house calls every so often to check on it. And changing the dose limit would almost certainly require a doctor's orders.
> Her dying at home was okay at first, since she always enjoyed being surrounded by family and friends.
Yes, that is what I meant when I said I understand why people prefer to die at home.
> The trouble started after the cancer took her mind, and she was unable to communicate.
That is hard! I have some vague memories from when I was on a respirator when I was in the hospital this past spring, and it was very frustrating not to be able to speak. (I was pretty foggy so writing was difficult too.)
> My cousin, who is an LPN, always insisted on giving my aunt the minimal dosage of pain medication recommended, and we would fight
> bout this because my aunt would just curl up in bed and groan.A lot of nurses seem to have this kind of attitude! It really bothers me.
> I believe, by that time, that her soul was already gone, but her body was still in pain and I couldn't stand the thought.
My belief system isn't much like yours, but I think she probably still had some level of consciousness or awareness. I'm sorry that she -- and you -- had to go through that.
> I love you, Aunt Judy
:-) < hug >
-elizabeth
This is the end of the thread.
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