Sunday, March 28, 2010

"One that won't go away"

I meant to write an update to my Resolution and Lent post but wasn't in the mood until now. 

1) Pain management: I've been taking a short-acting pain med for 4 years now. It lasts ~3 hours and then the pain and mental dysfunction/cloud comes back. So, I had a light-bulb moment - my pain med is not making it through the night so I wake up in pain (duh!). I guess taking control of my pain since January has led to brilliant deductions I never thought of before. Feeling stupid? Yes.

2) Morning wake-up time: Well, this change is not going as planned (sorry Jesus). Some of you, including hubby, would say 'of course not', but I was determined. So, I did well for 2 days of the first week then I got sick for three days. Early waking worked for another 2 days and then I overslept two days. I tried for another week or thereabouts and then gave up. Not a good thing to choose for Lent, I guess, but I thought such a motivator would kick my butt into gear. Turns out my butt needs the gear it is already in. 

Early into the second week after getting sick, I had an acute care appt with my MD due to that bug. While she was seeing me for that issue, we talked about my pain problems during the night. I've tried everything short of waking up every 3 hours to take pills, which would be ridiculous considering the level of fatigue I have. So she said we need to try a longer acting medication. I was not happy about the options, which are both in the controlled-substances category. Better way of saying it is that I was scared of the options. 

I'm not afraid of the med, I'm afraid of the name. Morphine. It seems unreal to need something that we are taught as very potent and used in major cases of pain. Granted, I am on the lowest dose, so there is a reality to the situation that I am not severely ill. But still... I am more likely to call my new medication by its brand name than the generic we are so familiar with. It doesn't seem to be a stigma issue I am dealing with either. I know... I think it also has to do with the looks people give me when I explain to them I have a chronic painful disorder (if I am wearing braces or am limping, etc). I don't like the sympathy and immediate concern they feel they have to express, though I am guilty of doing the same to others who might struggle with other stuff. I am not ungrateful, I don't like the attention. Add to that the sound of morphine and the concern doubles. It is hard to explain, I am finding. So, I suppose there is an internal and external level of anxiety about the new drug. I don't want the attention that comes with other people's perceptions of what I must be going through if I am on morphine, and it is hard for me to acknowledge that I cannot control my body/pain. It comes down to quality of life, ultimately. 

When I was initially diagnosed in 2006, my doctor at the time discussed the different types of pain medications with me. I was anxious about opiate meds so I accepted tramadol, a short-acting med that helped tremendously in combination with OTC naprosen. The doc called tramadol a "baby"-narcotic with a similar action to the big guys. The naprosen helps with inflammation that the other meds don't cover. 

For pain, there is no huge difference with how I feel on this med vs the tramadol; I just don't have to take pills every 3 hour, which is very nice. At the follow up that I had, we discussed my pain status after 4 weeks on the ms contin. The new med lasts the 12 hours and helps bring the baseline pain down from a 5/6 to a 2/3. Add tramadol (and aleve if needed) to that and I have a 0.

The only problem that doesn't go away with the ms contin is the brain fog, which typically manifest as confusion, spaciness, forgetfulness, and word loss. Tramadol makes me feel like my old self before the constant pain. I can't explain how horrible it is to feel like you used to be moderately intelligent and a good, reliable employee, and now you are incompetent, unreliable and mentally clumsy. So, my doc asked me several questions and suggested that I take the tramadol when I feel this fog come on; that it is that 2-3 level of pain that is still distracting my body/mind from working optimally. It really does help to combine the drugs as she suggested. The only concern she has is the level of seratonin inhibitors in my system between the cymbalta and the tramadol - that I should back off tramadol as much as possible, which is the benefit of adding the ms contin. I went from 6-8 tramadol a day down to ~3, as needed. 

So, I am doing well on my New Year's resolution to manage my pain properly, even though I might be having adjustment issues. Next year, I'll try cutting back on chocolate or some other temptation for Lent. Though difficult, I will have a much easier time managing my chocolate intake than my sleeping schedule (insert big smiley face here). You lose some, you win some. 

Monday, March 1, 2010

Resolution and Lent

This is the year of Control. It is so easy for life to get out of control and for chaos to take over. I've found a few places in my life that I can have power over with the hope of increasing my quality of life. So, I made a New Year's resolution as well as a commitment for the 40 days of Lent that I think I can actually achieve!

1) New Year (and hopefully every year thereafter): Don't chase the pain. Manage my pain level so it doesn't interfere with my marriage, my friendships, my hobbies, and general quality of life.

Lent: Get up at 5:30am EVERY day. 
Self denial - pushing myself out of bed instead of hitting snooze for another 90 minutes. Getting up early when I am NOT a morning person. Fasting from self-indulgence regarding morning snoozing. 

If I make myself get out of bed as soon as the alarm rings, and I do so between 5-6am, I can stay awake (mostly - still require 2-3 cups of black tea and some rest time, but noooo sleeping). I can be a responsible adult and get to work on time and perhaps get some more hours in the day, including nice ones with my husband who IS a morning person. 40 days of 5:30am might actually reset my internal clock for the better - including more restful sleep (more hours does not always equal more restful sleep for me). On the weekends, I can take naps; my hubby does anyway. Might as well join him and the cats.

Issues 1 and 2 are closely tied together. If I wait to wake up until a more reasonable hour during the work week, it is much harder to get up due to pain (snooze button to the rescue) and/or not hearing the alarm AT ALL(!). I am not sure what it is about those extra couple of hours that makes a difference?  Mind you, the pain is there even when I wake up at 5:30, but it is easier to have more power over it at that time. No clue why. But I do have to take my pain meds when I get up regardless of the time. Hmm, I hope that makes sense. When I let myself sleep on a day off, I will naturally wake up at ~8:30am, though it is soooo easy for me to sleep until noon or later! Ha ha!