Harm Reduction I'm back (for good this time!): GP advice

[cj]

I've gotten myself into some shit this time Doc. I may have endocarditis or some other kind of infection.

I relapsed on heron a week ago after 2 months softly clean. I contaminated the shot with my own saliva and used a nasty cotton to filter with. 2 days (a week ago today) later i began having chest pains, running a temperature of 99.5F measured rectally and feeling sick overall. This has continued for almost an entire week. Yesterday I went to a local walk in clinic. After explaining my symptoms and getting a brief exam he decided to send me on to the Emergency Room. For he felt like I needed immediate lab work and an ultrasound of my heart to rule out endocarditis. So he called the ER and I went.

The doctor at the ER was a dick and dismissive but whatever I just wanted to be checked out. So they did an EKG and a CBC blood test. He said they both came back normal (specifically mentioning white blood cell count) and that I was not running a fever or if I was it was a very low one. So they discharged me as healthy. My chest pain is still there and I feel vaguely sick as well. Like I'm not curled up in the fetal position but I just sense that something is wrong. Do you have any advice? Should I get a second opinion? If I do where should I get it at? ER or a normal doctors office? I have insurance but I am just loathe to waste the time of the emergency room and I hate hospitals anyway.

In the meantime I got an appointment to establish a primary care doctor on September 1 but that's of no use right now. I am scared as the first doctor I saw yesterday said if I was his son he wouldn't be satisfied until they performed an ultrasound of my heart! To rule out endocarditis. I dunno wtf to do man. Right now I'm just waiting to see if I get sicker or not.


Also could you speak on the differences and warning signs of slow progressing endo vs fast progressing. And anything else you feel is relevant and helpful to the discussion. I had a lot of trouble finding reliable info on the subject. Which sucks because it's a common and very dangerous complication of all IV drug use.

 

[Mad Dash]

did you tell any of these docs what you did? shooting up with spit?

 

[cj]

did you tell any of these docs what you did? shooting up with spit?

Yes I was 100 percent honest. But I didn't fully shoot up with spit. I ripped a
Piece of fabric off a washcloth with my front teeth to use as a filter. That's how the saliva could have gotten in the shot.

 

[ShadowedLight]

Hello, it's nice to have you around! Thanks in advance as I'm sure I'll annoy you with some things in the not so distant future hehe

 

[cj]

Update. I ended up being ok.

 

[DixiChik]

Hello...Nice to "meet" you. I'm seeking opinions on chronic pain management. My history of injury/disease that lead to lifelong pain is documented in my threads/posts of course, under DixiChik. I wouldn't expect anyone to trudge through the mayhem that is my life.

I will try to present a short version. Please bear with me.

1.) Stage 4 Endometriosis, treated with 3 surgeries including TAH/BSO, Lupron injections in 1993-94, followed by 7 years of Megace to suppress tumor/lesion growth. Pain never subsided. I have severe pain in peritoneal cavity, vagina and rectum more days each month (than not).

2.) Severe Osteoarthritis, with Osteoporosis, arthritis in spine, joints. Receive Synvisc One injections in both knees. Facet injections/epidurals in cervical/lumbar spine have been ineffective in reducing pain.

3.) Herniated discs in C4/5 thru T1 and L4/L5, S1 with annular tears and multiple hemangiomas present along spine.

For decades, I've taken only Darvocet and infrequent Decadron shots for pain. I've used NSAIDS, both OTC and prescribed. I have extensive GI issues due to surgery to remove disease. My stomach pouch is altered and routed directly into small intestine. I suffer inflammation, constipation with IBC. I use Miralax and Senna.

I have NEVER used recreational drugs, including weed. I don't smoke and rarely drink a Sangria. Previous attempts in 2005-06 in PM were not successful, so I pushed through years of pain with little relief. When Darvocet was banned, I was prescribed Tramadol followed by Lortab. My GP referred me to PM, as did GYN, GI, URO, Neuro, Ortho, in early 2014.

I have metabolism/absorption issues, so genetic testing was FINALLY performed. I had failed trials of MS Contin, Oxycodone, Fentanyl, and now back to Oxycodone. I can post the results of GT verbatim if necessary. My understanding is that I am slow to metabolize "codone" meds. It suggests "morphones" as an alternative. Now I hit the proverbial wall of COST for the "newer, better boutique meds" that even my PM says could "change my life IF I could afford them". Well, I can't spend thousands out of pocket monthly for meds, even if I could tolerate them.

This story doesn't end well, I know I'm screwed. I'm 54. I need some semblance of relief without sedation and drool. I work and maintain my home life with my husband of 35 years. I have a sub-human threshold for pain, but it's worn thin after all these years. The failed efforts with PM have deepened my severe depression. I continue Yoga stretching and swim laps daily, because a body in motion stays in motion and a body at rest...well, you know.

FWIW, Diclofenac and Toradol are amazing for the inflammation, but I can't take them regularly.

I would appreciate your thoughts and suggestions. I don't expect perfect, just possible.

Thx.

 

[DixiChik]

Hello...It's me again. I'm going to post the results of genetic tests for metabolism, in hopes this information might be helpful.

This patient has genetic variations within the CYP2D6, CYP3A4 and CYP3A5 genes that predict a decrease in the CYP2D6, CYP3A4 and CYP3A5 enzyme function.

Reduced CYP2D6 enzyme function is expected to decrease the conversion of Codeine, Hydrocodone, Oxycodone, Dihydrocodeine or Tramadol to its active form.

Reduced CYP3A4 and CYP3A5 enzyme function is expected to reduce conversion of Ketamine to its active form and slow clearance of Codeine, Hydrocodone, Dihydrocodeine, Oxycodone, Tramadol, Merperidine, Methadone and Fentanyl.

Consider alternative medications such as Morphine, Oxymorphone, or Hydromorphone if not otherwise contraindicated.

Analysis of the CYP2C19 gene predicts normal CYP2C19 related enzymatic function.

I desperately need my PM to be more invested in my "wellness", but that's not happening. I don't understand the science or chemistry. Otherwise I would not have been dragged face down through a year and a half of failed med trials and ALL that implies. I need someone to decipher this information for me.

PLEASE HELP ME!

 

[Mad Dash]

Wow... That really fucking sucks. Plain and simple. However, you do realize hydromorphone is available in generic form and to my knowledge is rather inexpensive. That should be one of the first things I would look into. I am no doctor so I don't understand a lot of this, but I do know most of this is talking about different liver enzymes that would normally convert certain medication into their metabolites and your body is having a difficult time doing that with the above medications. Have you tried hydromorphone?