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A Pain Doctor's review of having my morphine pump removed.
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NavalVeteran posted:
NavalVeteran posted: I have been suffering from chronic pain for the past 15+ years, due to sever arthritis in all my joint, due to hepatitis-C; and for the past 14 years, I have had a Medtronic's morphine pump implanted in me. All was going well, until the hospital where my pain doctor worked, decided to get out of pain management, so I had to find a different doctor. Everything was fine for several years, but about one year ago, I had went into a diabetic coma. I spent two weeks in the I.C.U. and another week in a regular room. During the entire stay, I never ate one thing, or had any desire to eat. When I asked my liver doctor about this, I was told the stage four cirrhosis of the liver can cause a person not to be hungry ( I contacted hepatitis-C, while I was in the navy, back in the 1970's, when they did not use disposable syringes or needles). Yet once I got home, I still had no desire to eat, and was worried about my diabetes. So out of desperation, I asked a friend if I could take a puff off some marijuana, so see if it would help make me hungry, which it did. I told my pain doctor's nurse about this, and she went and told my pain doctor. He then had me drug tested for marijuana, and the test came back negative. Yet ever since then, my doctor refused to give me break-through pain medication any more; instead, all he would do is keep increasing the flow rate of my pump, putting me way out in left field, and I can not stand that feeling. He never even said anything about not driving. The VA paid for one of the "Tame the Pain" devices, that is supposed to give you a bolus amount of morphine, but my doctor had it set so low, that it did nothing for me. So at that point, I decided that I did not want the morphine pump inside of me anymore, as I like to be aware of what is going on around me. I finally found a doctor, who agreed with me, and had been wheeling me off the morphine pump for the past 8 months. Yet, the only thing he will give me is Vicoden, for my pain, and this just does not do one thing for me. I am the one who wanted to be taken off the morphine pump, but not because I was no longer in pain, as I still suffer on a daily basis. The VA has a psychologist that comes to my house every week, and she asked me to ask my pain doctor for a treatment plan, as we both want to know what he intends on doing with me, once I am off my pump. I see my pain doctor every three weeks, and that gave him three weeks to provide me with a treatment plan. When I went in for my last visit, I asked him if he had a treatment plan that I asked him for, and he told me NO. What is so hard for a doctor to provide a treatment plan? Does he expect for Vicoden to take the place of what I was getting from my morphine pump? In addition to my pump, I was getting 200 mgs. of morphine X 4 daily for my breakthrough pain, prior to me confessing to taking two hits off some pot. Prior to having a morphine pump implanted, I was on a massive does of eight 80 mgs, of Oxycotin, X 4 daily for my pain. This would kill the average person, and while I was on the pump, this spared my liver from having to process the pain medication, as it went from my pump, directly into my spinal region. So I am at a loss, as I have no idea what my doctor intends on doing with me, but I have a feeling that he is going to leave me hanging. If he does this, then life quality will suck so bad, that there would be no reason to keep going. This does not mean I will harm myself, but the doctor will put me in a spot, where I cannot handle the pain I am in 24/7. Is it that much of a problem, to ask a doctor for a proposed treatment plan, and what he intends on doing with me? My concentration rate of the morphine, is now so low, that is might as well be pure saline solution going into me, and having that pump, sticking out of my stomach, where is looks like I went to a hockey game, and got hit by a puck, and it stuck in me, is rather sickening looking. Thank you for your time to read this long post.
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cweinbl responded:
Never a good idea to tell a PM doctor you're using another (illegal in most states) drug. Use small amounts and make sure that it is not additive (something that can add to the potency of what you're already using).Keep such things to yourself. Many thousands (likely hundreds of thousands) of people use marijuana to manage chronic pain. THC is a hallucinogen, so it does not add danger (act as an additive agent) to an opioid, anti-depressant or anti-convulsant). If you live in a state without medical marijuana, ask your doctor to prescribe Marinol (Elan Pharmaceuticals). The active ingredient is THC. Many people use it off-label for chronic pain. If your doctor won't prescribe Marinol, and you find that THC helps manage your pain, you can consider moving to a medical marijuana state. Fortunately, the undeserved stigma attached to marijuana has been seriously diminished. It has become a largely socially acceptable drug for recreation and especially for chronic pain.

Many chronic pain patients have better luck using a family doctor or internist for all medications, including pain meds. In most cases, this is a doctor who knows and trusts you. And you'll not risk using contraindicated medications because one person controls all.

One can safely use opioids for a lifetime, as long as they are used as directed. Yes, tolerance is a factor. But when you reach maximum safe dosage of a drug that helps, your doctor will rotate to something different for several weeks. After that, you can return to the original drug at a lower dosage.

In your case, I'm wondering if you have tried Fentanyl Transdermal (Duragesic). It added nine awesome years to my career. Fentanyl is the most potent pain medication, (about 80 times more powerful than morphine). Because it's transdermal, it's easy on the liver and digestive system. And because it's so powerful, tiny dosages are used (it's measured in micrograms, not milligrams).

I could chew Vicoden all day like candy and not feel less pain. I can imagine what you've been dealing with. Chronic pain patients typically do better using one powerful long-acting drug as the mainstay (Oxycontin, Fentanyl Transdermal, Kadian, etc.). Then a short-acting drug (Fentora, Hydrocodone, Oxycodone, etc.) can be used PRN.

I hope this helps you, at least a little. We all often have one powerful pain medication that works best with our unique body chemistry. It is therefore critical to find a doctor who will rotate you on and off of at least a dozen major pain drugs; it can take months or even years; but eventually you'll know which long and short acting medications work best for your unique body chemistry. That knowledge is extremely powerful and can significantly improve the quality of your life for its duration.

Good luck.
cweinbl
csw2@bex.net
 
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annette030 responded:
Thank you for your military service. I was in RN school in the late 1960s and they had disposable needles and syringes ( and they were not a new item back then), but who knows about the military, they come up with a lot of the newest trauma care, but are stuck in the Middle Ages in other areas.

Tell your PM doc again to make you a treatment plan, or have the psychologist ask him for one. Tell him if he doesn't have one for you to just say so, but you need to know ahead of time what the plan is so you can relax and get through the coming days. Better for you to know what will happen.

The point of the pump is to take lower doses of morphine, it doesn't sound like you are doing that??? What is you current daily dose of morphine via the pump? Not counting any breakthrough meds you take.

Take care, Annette
 
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NavalVeteran replied to annette030's response:
Hi, I just found out that nothing but saline is being run through my pump, there is no more morphine. When I complained to the pain doctor, that Vicoden does nothing to help with my pian, is reply was "If it does not do anything, then stop taking them". What a prick! I have had a morphine pump implanted in me, for the past 15 years, and I am on my fourth pump. I guess he thinks that my hepatitis-C, and stage four cirrhosis has also went away, I only wish. My privious doctor, stopped giving me breakthough pain medication, and all he would do was keep increasing the flow rate of my morphine pump. This put me way out in left field, 24/7. I could not stand feeling that way all the time, and I just wanted breakthrough pain, for when my pump was not doing the job, but he refused. He had me so wacked up on the pump, that I totaled my car; never once did he say anything about not driving. So that is why I wanted the pump to be taken out, so I could have some medication, that I could take, then lay in bed, and not worry about having to drive. Yet, to be weened off the pump, and only given Vicoden for my pain, was a slap in the face. Thank you for your reply,
Sincerely,
Lee
 
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NavalVeteran replied to NavalVeteran's response:
Prior to having my pump put in, I was on eight 80mg. of Oxycotin, X 6 a day; that is enough to kill some people. Now I have to deal with the VA's pain management. The whole thing about the pump, was nothing was going through my liver. It was a straight shot, from my pump, to my spinal region. Now I have no idea on what they plan on doing. Thank you for your replies, I don't have internet service at my house right now, to it takes me a while to get on line.


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