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Oh, I can assure you that my pain is "that bad". Just hit "search" for DixiChik. It will make you cross your legs and wince just reading.

I can't follow this conversation...USER FAILURE...don't compute terminology.

Don't get me wrong, folks. I am impressed, yet depressed, because I'm getting even more confused.

I think I can adapt to dealing with increased dosages of softeners/laxatives. There is also Linzess, which is very successful for me (samples from Ortho) It's $258 per month. I take a daily regimen of Miralax, Senna, and Ducosate. I just would prefer to avoid hospital issue enema bag (32 oz. multiples) from OIC.

I am so grateful for your input and will check in again later. My 89 year old Mom is my responsibility. She expects me to visit the NH and tuck her in every night. I'm late. She'll be agitated.

I'll be back. Please help me figure this out. I see my GP tomorrow. I think if we could figure out what works for me, SHE would prescribe. SHE's the one who ordered genetic testing. My PM said it was a waste of time/money. WTF? Two years of suffering through HELLACIOUS TRIALS has wasted my energy, my hope, and my will to live.

DixiChik
 
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Seems like your main problem is constipation. If not for that, then oral morphine would seem to do the job for you. Your doc has probably already discussed this with you but have you tried say incorporating more fibre into your diet in an attempt to avoid OIC?

Have you tried rectal administration of morphine? That might help.

I heard there are oral formulations of oxycodone which you could try? They might be absorbed better.

Have you explained to your doc that IV morphine works really well?

This probably isn't very good in terms of harm reduction but if you're pain is really as debilitating as you say it is, then maybe you could administer IV morphine yourself (illicitly I guess...) as a last resort? Obviously you'd need to have loads of precautions if you'd want to continue that long term...
 
http://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm

Here is what the DEA says about quantities. And I was,wrong, no federal regulation on days supply. It is very likely your state has limits though and that would take precedence. Many doctors are hesitant to prescribe large quantities of controlled drugs because of increased scrutiny, but for Gods sake, you are about as difficult a case as they come. Good record keeping and communication with you and your pharmacy is all it would take.
 
Linzess (linaclotide) is one of those drugs that I mentioned being used in treatment resistant cases. If you're below a certain income and are uninsured, the manufacturer may provide the medication at no charge if you meet certain criteria. If it helps you, it is certainly worth looking into.

http://www.allergan.com/products/patient-assistance-program

Check out that link. Allegran manufactures Linzess, you may find something useful from them.
 
Okay, I'm back.

Rectal administration? I guess that should be obvious, but I must ask...suppositories of Morphine or do you have to insert the pill into your rectum?

IV Morphine, as in shoot up...not happening. I can't even give myself B12 injections twice weekly. My husband gives them to me. I've heard there's liquid Morphine. Which provides best bioavailability? Oral? Rectal? IV, I'm sure.

KC...I read the link. Yep, my PM doc uses the "watermark" 8.5x11 prescription paper for opiates. He prints individual sheets for instance (AUG) (SEP) (OCT) 30 day supply each. Then I see him the 4th month. My lifelong pharmacy is locally owned. The pharmacist attended University with my oldest brother. There is no lack of trust there.
 
Morphine suppositories are a pretty good option from my quick read through of your case, and may be one of the few situations where your slow bowels are a plus. Ever looked into cannabis? Its another angle you can approach for anti-inflammatory effects, might make you a bit more constipated though. Plus with the weird laws you have down there you may be able to get some free cannabis from a dispensary or CBD only extracts which seem to be legal in the majority of Dixie.

Also, please for the love of your god tell me the Miralax is dirt cheap and you're not being screwed for brand name drugs. Stuff is just PEG 3350 which you can grab at Costco or order as bulk powder from whatever reputable supply house you go to.
 
I believe morphine suppositories are available. A lot of people just stick ecstasy pills right up there bum to be fair so I'd guess it'd work with the morphine pill as well but definitely not as effectively.

IV administration gives 100% bioavailability as it is administered directly into the bloodstream with no hindrances. Rectal provides better bioavailability than oral administration in most cases.

The liquid morphine would still cause OIC. Do the injections of b12 hurt? Your husband could do the morphine injections for you as well if needed couldn't he?
 
Ketamine is used increasingly to aid with severe and/or treatment resistant pain. There is evidence that it potentiates the analgesia of opioids and has distinct efficacy on its own. It's usually given oral for this case, but if you're not hesitant to do that, intranasal use of ketamine gets much better absorbed and doesn't have to pass the GI tract, also in pharmaceutical quality it's not that irritating and painless to use (as someone reported here on BL there is actually a clinic holding a patent for intranasal ketamine to treat resistant depression, and practicing that). The physical downside is that extended use can be hard to the kidneys or especially the bladder even if this usually happens only with insane (non-therapeutic) dosages, with regular checks it should be reasonable.

Additionally, it can have strong antidepressant (maybe the term positivity-promotive fits better) / stress relieving effects. Don't let the "trip reports" of recreational users irritate you, the therapeutically used dosages are way lower.

Did you try fentanyl via a nasal spray (ok, lasts too short, but to manage acute pain it gets prescribed this way)? Sublingual buprenorphine?

I'm not a professional though and maybe it is hard to find a doctor who's experienced with ketamine for pain management.
 
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Eps...Yes, I'm using the store brand of Miralax. My GP just told me this morning that I can use it twice a day (try with apple juice).

I DEFINITELY need "anti-inflammatory effects" for the severe arthritis and for peritoneal, vaginal, rectal pain. TMI, but true...My GP tried to perform annual pelvic exam/pap smear this morning. She could not get the SMALLEST speculum inserted without primal screams in my throat. She was unable to perform a manual internal exam of pelvis, because of tightness, pain and inflammation. "For the love of god", I'm still hurting. She had tears in her eyes because she "had to hurt me".


We discussed my PM doctor's response to genetic testing, which was NADA. We talked about the Oxycodone. She thinks I should take it, period. She added Arthrotec, which is like Voltaren with tummy protection. She wants me to take this in conjunction with Oxycodone. She told me not to be afraid of the Oxycodone, taken as prescribed (15 every 6 hours). She said she took it post surgery earlier this year. She donated a kidney to her mom. Yea, she's a keeper.

I wish she would handle my pain meds, but these new regulations have her gun-shy. She got burned by a former nurse who was diverting her meds. Damn shame.

I've never tried cannabis, even recreationally. I am willing, as long as I don't have to smoke it. I've read about the pain relieving properties, but don't want to be "Cheech and Chong" stoned and craving Doritos. As stated, I have to be sharp minded and as active as my ravaged body will allow.

CBD extracts? Is that the oil stuff that you put under your tongue? Is it expensive? I cannot convey in mere words how much I want to ditch my PM doctor forever. He's been little to no help with relieving anything, except my bank account. You said this "seems to be legal in the majority of Dixie". God help me, please. I can't exist this way anymore. Ole Dixi is burnin' down. Somebody grab a hose...that's not attached to an enema bag!

I'm here. I'm listening. Thanks.
 
Dixie, can you elaborate on the type of gastric bypass you had? Ive been trying to come up with answers and that info could help.
 
Sorry, I'm just seeing this...Don't wanna lose you! :)

Yes, KC...I had Gastric Bypass in 1987, which was also referred to as "stomach stapling". My tummy pouch was literally stapled off with a tiny capacity. Then my small intestine was attached to the "pouch".

My Bariatric surgeon did a cut and run, literally. Yes, I lost the weight and have kept it off. I almost died several times over those first 3 years. Had it not been for my lifelong (delivered me from womb) GP who has since retired (died) I would have died from starvation, literally.

Six years later...BOOM...Stage 4 Endometriosis. My cancer surgeon gutted me to clean lesions/adhesions off internal organs. The Lupron savaged my bone health and left me with bone structure much like another century called "Rickets"...

Unfortunately, I am nutrient deficient even now. But that's a whole 'nother story. Thank you for trying to help me.

(cont'd)
 
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Ok, thanks. I will dig around some more to find some info. One thing I have seen over and over again is that liquid formulation may be the way to go as bypass surgery has a dramatic effect on the dissolution of solid dosage forms (tabs, capsules) Both morphine and oxycodone are available in liquids.
 
I'll look forward to hearing what you come up with. This damned Arthrotec prescribed today for 30 pills is $115.00. That's way more than generic Voltaren. I know the variable factor is preventing ulcers. Voltaren helps for several days, until the pouch becomes irritated and angry. So it's not something I can take indefinitely.

TORADOL is also SUCH a good med for inflammation, but not for long-term, regular use. Shame.
 
If you're trying to stretch a dollar, there's a study that shows omeprazole (Prilosec), may be equally as effective, actually maybe a little more effective, as the misoprostol (the stomach protecting agent) in Arthrotec. [ref]

I know omeprazole is OTC and availiable as a generic in the US, and then you can just take generic diclofenac, (or ibuprofen, or whatever you can ease your aches and pains with.) Should save you a few $.

If you have had gastric bypass, then taking medications as liquids, or suppositories are good ideas. If you're missing some of your gut you want to make it as easy as possible for your body to absorb the drug. You can crush and pre-dissolve pills (if you can get them significantly cheaper or easier than liquid) in a little juice or water to increase absorbtion.

Taking drugs as suppository/"microenema" will also work excellent, it's known informally as "plugging" and relies on the fact that your rectum is an excellent organ for absorbing liquids back into your bloodstream - sort of a super sized version of your sinuses, full of blood vessels and easily accessible. Drugs are absorbed faster and more completely than oral or nasal usage. And you probably aren't missing any of that half of your GI tract ;) There's guides to preparing and administering drugs that way on these boards, the long and short of it is you pre-dissolve them in between 1 and ~10mL of water, and use an oral syringe to squirt it up your butt.

I don't know about taking NSAIDs that way, it's usually most effective with opioids and their potentiators.

Oh, speaking of potentiators, there's also drugs like orphenadrine you can try taking that can enhance the pain killing effects of opioids+NSAIDs.

As for cannabis, you should give it a try. Smoking it is actually probably the best way to try it at first because it allows you to control your dosage a little easier than oral usage... if you don't want to be stoned as s#$%, you should probably not start out with pot brownies or you can be overwhelmed. Orally administered cannabis can take a while to kick in (hours), smoking peaks within minutes.

If you limit yourself to only one or two puffs (most cannabis is pretty crazy strong these days, especially if you have no tolerance) you shouldn't get too messed up. Or, as others have said, find a strain that has low THC and high CBD... that will minimize the psychoactive and maximize the painkilling/anti-anxiety effects.
 
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DixiChik said:
I DEFINITELY need "anti-inflammatory effects" for the severe arthritis and for peritoneal, vaginal, rectal pain. TMI, but true...My GP tried to perform annual pelvic exam/pap smear this morning. She could not get the SMALLEST speculum inserted without primal screams in my throat. She was unable to perform a manual internal exam of pelvis, because of tightness, pain and inflammation. "For the love of god", I'm still hurting. She had tears in her eyes because she "had to hurt me".


I've never tried cannabis, even recreationally. I am willing, as long as I don't have to smoke it. I've read about the pain relieving properties, but don't want to be "Cheech and Chong" stoned and craving Doritos. As stated, I have to be sharp minded and as active as my ravaged body will allow.

CBD extracts? Is that the oil stuff that you put under your tongue? Is it expensive? I cannot convey in mere words how much I want to ditch my PM doctor forever. He's been little to no help with relieving anything, except my bank account. You said this "seems to be legal in the majority of Dixie". God help me, please. I can't exist this way anymore. Ole Dixi is burnin' down. Somebody grab a hose...that's not attached to an enema bag!

I'm here. I'm listening. Thanks.
Click to expand...

First it would help to know what state you live in, as it really varies on a state level. Here's a quick guide google lead me to though please look into it yourself
http://www.celebstoner.com/news/mar...our-states-on-verge-of-passing-cbd-only-laws/

CBD is generally thought to mainly be sedating and not overtly psychoactive. But, do look into it with your doctor. I've seen it used in pill but I suppose it could be consumed as a slowly passed food would be possible.

Perhaps a more comprehensive pain history would be useful for us. Also, what do you eat with all these issues?

Ever try a PPI like siekio suggested?
 
Thanks, Sekio for those suggestions to consider. I will do some reading on those. :\

Eps...I never know what will/won't digest. Meats are almost impossible. Broiled fish isn't problematic. I can eat eggs, non-fibrous vegetables, or at least cooked to a very soft, tender stage. I eat fruits like tomatoes, blueberries, watermelon. Breads are difficult. NO DAIRY. I have to chew everything til it's liquid, before swallowing. There is not gastric acid to aid in digestive process.

I tend to projectile vomit when foods just won't digest. I tried some very tender smoked chicken slices last week. It took almost 2 days for them to digest. Food often just stagnates in the pouch, causing painful chest pain and belching. When my stress levels are peaked, I can't swallow my own spit.

I live in Mississippi. I just looked at that link, which seems to say that CBD Oil is legal in my state. I'm not sure if I need a script from PM or if I can just purchase it. Guess the best way to get answers on that one is to continue research.

I think you will find thorough documentation of my history of injury/disease/multiple surgeries/chemotherapy if you type DixiChik in search. You are welcome to read those posts, if you dare. They're long, with no happy ending...yet. I'm so hopeful you guys will be able to help me solve this misery...um, mystery.

No, the only meds inserted via anal were for prolapsed hemorrhoid and anal fissures (Lidocaine/HC suppositories) Oh, and Phenergan, when I'm nauseous. It sounds awful gross, but if it increased bioavailability of meds to ease my pain, then I'd need to learn.

I can't thank y'all enough for you time and efforts to help me find some pain relief. I don't expect perfect...just POSSIBLE!
 
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:( Mornin' folks...No luck with Arthrotec last night. I took it after meal. It caused "heart attack" grade chest pains, as oral meds--especially NSAIDS--often do. I sat upright taking Gas-X meltaways until 3 a.m. before it settled.

If only I could take the IV biologics for Rheumatoid Arthritis. Of course, RA says my immune system is already too compromised.

Looks like I'm doomed to suffer, huh? Do any of you think it's realistic to even try the generic OxyContin? My PM doesn't think my GI system will absorb the medicine...It will just pass through, due to pill structure. Is this true?

I just don't know what to do next. I feel like a "medically abused" Guinea Pig throwing money at the doctors and pharmacy. :!
 
Ever looked into parenternal nutrition to bypass your GI entirely? Other options might include a gastrostomy tube feed which could be a constant slow liquid feed if needed.

BTW ask your doctor about CBD, its antinausea and anti-inflammatory. No idea about how to aquire it down there but may be worth a shot. Its definitely prescription only outside of the fully legalized states.
 
He probably is correct about the Oxycontin but maybe trial it and see. Why cant you take biologics like Humira or Enbrel. I was going to suggest that but wasnt sure if you had RA or not.
 
According to RA, risks vs. rewards with compromised immune system, basically non-existent. My understanding it's infusion only? So I would not be able to try a couple days of dosage. I'd be fully committed like the pig is to breakfast menu once biologic was infused...no turning back. At least that's my understanding.

PM would have to write script for trial of OxyContin. I've asked "Why can't you write for a trial of 5 days?" when he talked about name brand only. He says "That's not how it works. My hands are tied because you cannot afford".

Tell me about it...I've got an 80 ft tall Pine tree threatening my house. We haven't been able to afford tree surgeons for 2 years, because we were putting all our money into PM. Why? I'm no better off than when I started. In fact I'm worse, with SHINGLES in my eye. On this, the 10 year anniversary of Hurricane Katrina, we had to call in a crew. They're taking down this monster tree as I type. There goes $2,000 we don't have.

WTF you ask? Well, Katrina took down 22 pine trees total, along with our barn and my wood shop. This tree remained standing, but it's beginning to lean toward our house. IF it falls, we lose our home and possibly our lives, as it hovers over master bedroom. Sorry OT, but goddamn it...It's infuriating to be told point blank..."there are meds that can change your life if only you can afford them". If I keep paying these prices for med trials (that haven't worked), we WILL lose our home, but not to a Pine tree!

Sorry for the rant. I feel reamed from yesterday's pelvic/pap smear episode, gutted from first dose of Arthrotec, bloated and distended from tummy issues, half blind from shingles. Oh, and my Dalmatian died. It sounds like a country song, huh? "The only time I feel the pain is in the sunshine and the rain". Right, Dwight? =D
 
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