Many topics

[Guest guest]

Hot flashes:

I had a hysterectomy but they left my ovaries. However they went on strike

about 6 weeks after the surgery and I've been on a estrogen patch since. I

find that the Estroven (which is OTC) helps a ton. Wal-Mart has a generic

form called Estroblend. We use it a lot in our women's health practice (I'm

a nurse midwife) and women seem to do very well on it. They have a regular

strength and a maximum strength, I started with regular but the maximum

works much better.

Pain meds: (for the person with the elevated liver enzymes)

It is the Tylenol in the Vicodin that is hard on the liver, not the

narcotic. They make an oxycodone tablet which is the same narcotic in

Percocet, just no Tylenol in the preparation. That might be an option.

Also, a Fentanyl patch may be a good option as well.

Divorce:

My husband has never dealt well with me being " sick " , it does take a toll on

a relationship. Now he is in the same boat with chronic pain and

fibromyalgia. Now he knows what it is like and now I know what it is like to

have your spouse hurting all the time. It is difficult, no matter which

side of the fence you are on.

Rae

[Guest guest]

JUST LIKE ANY OTHER DRUG THERE ARE DIFFERENT STRENGTH PATCHES THE PHYSICIAN CAN

PRESCRIBE. I HAVEN'T USED IT IN YEARS BECAUSE I DID NOT LIKE THE FACT THAT ONCE

YOU HAD THE PATCH ON YOU WERE STUCK AT THAT PEAK DOSE FOR THE

DURATION (I CAN'T REMEMBER IF IT IS 2 OR 3 DAYS) TO ME THAT MEANT NO DRIVING-

AND NO WAY TO TITRATE MY DOSAGE DEPENDING ON HOW THE PAIN WAS. I UNDERSTAND THAT

IT IS EXCELLENT FOR CANCER PATIENTS WHO HAVE UNRELENTING PAIN AND YOU CAN

UNDERSTAND WHY. ONCE YOU PUT IT ON YOU CAN'T REMOVE IT EARLY AND REAPPLY AGAIN

AND SO ON, IT DESTROYS THE WAY THE MEDICATION PASSES THROUGH THE SPECIAL

MEMBRANE.I HOPE MY EXPERIENCE HELPS

MICHELLE S. CTNATIVE@...

[Guest guest]

I missed the beginning of this thread. But I can give my experience with

Fentanyl patches -- which I'm currently on.

Joanna is right. Fentanyl is typically used for extreme pain. In my case,

I ended up in the hospital because my PA became so severe due to a massive

flare that they had to put me on morphine for a number of days while I was

in the hospital. My inflammation levels were off the chart (due to a flare

after a surgery six months earlier) and the pain was widespread. Because I

tolerated the morphine so well, my doctors conferred and decided that

continuing me on Vicodin wasn't a good idea. Apparently, you have a greater

chance of abusing Vicodin when you are taking pills every four hours. Over

time, you get dramatic highs and lows -- and end up taking more pills to

alleviate the pain. Because of my level of pain, they were concerned this

could happen long term.

It was at that point they decided to put me on the Fentanyl patch. There

are different patches (depends on the pharmacy and where they get their

supply). But they all work about the same.

I started with a lower Fentanyl patch dosage. That particular patch was

pretty tiny and I was worried it would fall off, so I had to use a special

clear adhesive bandage (approved for patches only) over it.

But it wasn't uncomfortable. For the first time it years, I actually didn't

hurt. It was pretty amazing. I didn't realize how much pain I was in until

I had a few days with little or no pain. It was a miracle for me.

Over the next four months, they adjusted my dose only once -- and I've been

consistently on that dose for more than a year with no side effects. I have

to be careful, however. I can't just stop the patches.

If so, I could suffer serious side effects. So you absolutely must replace

them at the same time every three days. I do get a bit shaky if I'm late

replacing the patch. So I'm pretty careful. It's a clear patch -- so you

can put in anywhere. It sounds goofy, but I usually put mine to the side on

my breast -- and rotate breasts every three days. That spots just works

well for me. I did move it to another location one day -- and it itched for

some reason. I think it was the adhesive on the patch. But that's the only

side effect I had and I only had it once. So that's a plus.

It's also considered a monitored/registered narcotic. So my doctor has to

rewrite the prescription by hand (in triplicate) each month for me. You

cannot get automatic renewals through the pharmacy. We've worked that out

so I don't have to have an appointment to get my prescription each month.

That's because I'm a long-term user. But be prepared -- and get to the

doctor BEFORE your patch supply runs out.

My side effects are pretty mild -- if any. I can drive and do everything I

need to do. That's because my tolerance is so much higher than normal.

Most people have no idea that I'm on the Fentanyl patch.

I probably suffered a bit of dizziness and nausea at first. But that was

pretty mild. Remember, I was on morphine for at least 72 hours before they

tried the patch. So I could tolerate a high dosage of pain meds.

If someone just decided to put on a patch without having already been on

morphine or high doses of Vicodin before taking it, it could kill them. Or

they could suffer some serious effects. That's why no one in my family can

even touch a patch besides me. I have to dispose of them carefully. They

even warn you to make sure pets don't get a hold of them accidentally --

because they could die if they ingest one.

Once in a while, I will still have bad breakthrough pain -- and for that, I

will take a Vicodin on top of it. But at this point, I use fewer than 50

Vicodin every 4-5 months (and usually only on days when I'm really hurting

because of the weather or I overdid it).

I've also been dealing with PA for many years. So I know my pain tolerance

level pretty well.

Additionally, you absolutely shouldn't drink alcohol on Fentanyl. The last

time I did (thinking I could have just one), I got pretty sick. So no

alcohol. I also don't take any other pain killers or ibuprofin (except

Vicodin periodically for breakthrough pain).

This month, I approached my doctor about reducing my dosage. She was

cautious and told me to wait one more month -- and then we could slowly

reduce the patch for one three-day cycle and see how I felt.

If the pain was worse, I could easily go back to my regular dose.

Unfortunately, I overdid it last weekend. Then I got kicked in the butt by

a horse and bruised -- and a flare kicked it. Now my fingers are swollen

and inflammation levels are up. So I have to wait before reducing the

patch.

Interestingly, my doctor seemed to feel it was better for me to remain on

the same dosage (since it was working for me) and not fool around with

reducing the dosage just yet. I had been worried about addiction -- but

because of the consistency of the dose and the fact that it hadn't needed to

be adjusted for more than a year, my doctor isn't concerned. I also don't

have any side effects -- so that's a plus.

In case you're wondering, I'm on Humira and methotrexate. I'm also on Lasik

to reduce water retention (the inflammation causes me to gain 5-10 pounds

per day in water weight/fluid). I'm on an anti-depressant (mostly as a

precaution). I also take folic acid and potassium (because of the Lasik).

Overall, I feel much better. The Humira/MTX combo is important for me and

works well. I still have problems with my joints, but at least I have days

with little or no pain.

I wouldn't automatically recommend Fentanyl to anyone. But if you are at

the stage when you are increasing Vicodin at an alarming rate or on

morphine, it might be worth a discussion with a doctor and/or pain

management expert. In my case, I was in the hospital -- and no fewer than

five doctors (including my rheumy and a number of specialists) made the

decision to put me on it.

Feel free to email me if you have any other questions. I just realized it's

been three days (thank goodness for computer calendar reminders!), so I'm

off to change my patch!!

Patty

(from California)