Sunday, 17 January 2010

Back to Gabapentin From Lyrica

January 2009 - Nerve pain is as severe as ever. Intense burning from just below the knees to the toes. A cross between burning and 'pins and needles' or perhaps if your limbs were submersed in very hot soda water with the thousands of bubbles bursting as 'pin-pricks' each and every second of each day of the year. There is that constant tingling element to it.

With my latest prescription renewal I abandoned my experiment with Lyrica and have gone back to Gabapentin although neither did much, if anything for the nerve pain. The Lyrica distorted my vision and induced sleepiness. Gabapentin is cheaper than Lyrica and although covered by my private insurance so I guess it's preferable to take an ineffective drug that has less side effects and doesn't erode the profits of the insurance company's CEOs.

I continue to take the medication simply because I feel as if I'm doing something, even if not very effective.

Voluntary Brain Disease

No Brain Spammers

Paraplegia may result by several pathways, the usual being damage to the spinal cord or brain injury. While both are debilitating, perhaps the saddest injury of all is that of voluntary brain disease. The world is full of brainless morons who decide to display their self inflicted idiocy at every opportunity. Like a dog that has to raise it’s leg and piss on every post it passes, spammers have found their way to this blog and began daily postings submitted as comments.

My hope was that someone might benefit from my experiences and I welcomed shared discussion and legitimate comment and feedback on my posts. However, as of late I’ve received ever increasing posts of nonsensical babblings, come-ons, and self serving links to unrelated products and topics.

As a result of these idiot spammers, I’ve found it necessary to instigate ‘word verification’ in order to reduce the messages posted by ‘bots’. Those idiots who have more time than brains and post personally, I will continue to delete their spam immediately as they may appear.

It’s tragic that idiots voluntarily give up their brains in order to feed spam to the uninterested masses.

Get a life!

Saturday, 16 January 2010

Tell Me Again Why I Need A Doctor…

Sometimes I wonder how the medical profession has really helped me.
Just a few examples although others exist.

1980 (December) - Just out of University and having found part-time employment in medical related research, I began experiencing severe and debilitating ‘attacks‘. Attacks so sudden and severe that at each episode (usually daily), I thought I was surely going to die. Doctors (at least 3) could not provide a diagnosis nor offer effective treatment. Various sedatives and tranquilizers were prescribed with no effect - the attacks continued. This went on for 5 years, until 1985 when I became aware of a particular prescription drug as well as a ‘source’ for it. Conducting my own experiment, I took the drug and almost immediately the attacks stopped. I approached my doctor about having the drug, a mild anti-depressant, prescribed legitimately to which he agreed. I never again experienced those ‘attacks’ which now the medical community refer to as “anxiety attacks”. Years later I find I no longer need the prescription but I lost five years of my life to a living hell in the interim. Thanks Doc…

2006 (April) - Severe back pain from what I believed was a sprained back (probably started that way). With my doctor having recently given up his practice, I had yet to find a new family physician. Went to a ‘Walk-In Clinic’ to see a doctor. No examination or tests, just received a prescription for an analgesic (pain pills) and a muscle relaxant. By the end of the month I became a paraplegic due to a Staphylococcal infection on the spinal cord. Thanks Doc…

2006 (May through December) - While in the hospital my left ear plugged up to where I was virtually deaf on that side. Pushing behind the earlobe where the eustachian tube runs all I could hear was a watery squishing sound. Three doctors over two institutions examined my ear with a otolaryngoscope declared me healthy. They found no problem although I continued to remain deaf. Months later, on my discharge from the hospital I obtained some cotton balls soaked in hydrogen peroxide and kept infusing the fluid into my ear. Within days large amounts of dark material began to ooze out of the ear canal and as it lessened, my hearing returned. Thanks Doc…

2007- present - severe burning neurogenic (nerve) pain from the injury sustained in 2006. Told by each doctor that nothing can be done to relieve this particular type of pain other than the ineffective drugs already taken. Told to live with it - nothing can be done. Thanks Doc…

Sciatic nerve pain from some muscle imbalance resulting from the same injury. Told by various doctors that nothing can be done. On describing the pain to one doctor, his response was to tell me in some detail about his own bout with sciatic nerve pain. That makes me feel better, thanks Doc…

Other than the doctor that slapped my ass when I came into this world, and perhaps the one who neurosurgeon who performed my back surgery(1) , I can’t think of how my health has been better by being in the care of these professionals.

* * *
Remember - out ever every graduating class of new doctors, someone finished at the bottom of their class. Doctors are human too and have all the frailties that the general population has.

(1) Still wonder why I could move my toes right after surgery but not later in my recovery.

Thanks Doc...

Sunday, 10 January 2010

Physiotherapy “Lite”

Physiotherapy “Lite”

With Ontario (Canadian) hospitals experiencing major operational funding challenges, most institutions have, through their own Board of Directors and/or government agencies (1) pared down the services offered. In April of 2008 the ‘private/self pay’(2) arm of the hospital physiotherapy department I was attending, closed it’s doors. The reasoning was that ‘private/self pay’ services were available in the community and therefore it would be redundant for the hospital to continue offering these services.

To preserve the continuity of my therapy, I was transferred to the OHIP (3) arm of the hospital physiotherapy department allowing me to continue treatment uninterrupted for another 16 weeks. (Shhhhh - As an employee of that same hospital, I believe this was done as a professional favour)

As September approached, I found myself discharged from the hospital physiotherapy program as the self pay service was no longer offered and I had exhausted my limit on the government funded plan. Also with September’s arrival, I returned to my job at that very hospital at which I could no longer receive therapy. (It would have been so convenient for me to be able to continue therapy during lunch hour or after work had the service continued.)

After having eased my way back into the working world and with winter fast approaching, I went in search of a community physiotherapy clinic where I might continue therapy, particularly practicing walking with a walker. My goal was to regain leg & core muscle strength along with better balance providing me the stability and resulting confidence to venture out on my own neighbourhood sidewalks once summer returned.

My options were either to take the public disability transit bus (TransHelp) to some clinic in the community right after work or to find a clinic close enough to work that I could motor over with my wheelchair right after work eliminating at least one, often lengthy wait or bus ride there and home again afterwards. Although grateful for the bus service offered the wait and trips often add 2 hours to my 8 hour workday. With an hour of physiotherapy twice a week, my day away from home frequently comes closer to 12 hours. A long time to sit!

I did find a private/community physiotherapy clinic in a ‘Professional Building’ across the hospital parking lot and decided to give them a try if for nothing more than convenience. Convenience in not having to take another bus trip however wheelchair navigation to the building had me crossing a busy roadway at the end of shift with hospital employees eager to leave the grounds. Crossing a torn up parking lot in the midst of renovation the professional building has a narrow ramp and double actuated swing doors leading into the foyer. Inside the six story building, the two public elevators are so small that they will accommodate my chair and perhaps two other persons. The chair can barely turn around inside the elevator cab. One floor down (basement) the physiotherapy clinic does not have an automatic door opener and I find it a struggle to enter the corner of the waiting room with chairs lining the walls at right angles along both sides. (I usually end up taking a chair or two with me as I enter!)

It was always my fear that in spite of the claims of “redundancy”, the private community clinics might not be able to provide the therapy and expertise that can be offered in a hospital setting. Right away I notice that much of the equipment that was instrumental in freeing me from having to be hoisted out of a bed/chair with a lift was nowhere to be seen. No tilt tables, no sit-to-stand units, no parallel bars - not even an aluminum frame walker was to be found. While a hospital physio clinic has to be prepared to offer therapy to traumatic spinal cord injuries, brain injuries, strokes and such, the private clinic seems to concentrate on jocks who have sports related injuries, minor automobile & workplace related injuries and perhaps women who have fallen off of their high-heel shoes. Clientele is different so supporting equipment and expertise is different.

After an initial assessment, the physiotherapist thought she could assist me in the goals I had set and we mutually decided to give it a try. I would come over after work about twice a week as our schedules permitted.

The physiotherapy clinic rented a frame walker for my use (as my own would be too cumbersome to bring along) and therapy began in mid-October. We shall see…

* * *
Due to government regulations, the private physiotherapy clinic is not allowed to bill my private insurance company directly for services rendered. Patient confidentiality or some other such nonsense. Unlike the hospital physiotherapy clinic which submitted claims on by behalf, I must pay the private physiotherapy clinic for each session, accumulate the receipts for whatever time I determine, then submit the invoices personally (by mail) for reimbursement at yet a later date. Does make a dent in the credit card balance prior to reimbursement.

* * *
(1) It is my understanding that the decision to discontinue various therapies or close departments is made by the hospital administrators (C.E.O.s & Board of Directors) in conjunction with L.H.I.N.s (Local Hospital Integration Network), a government “arms length” agency brought in to slash operational costs (and subsequent government funding) yet deflecting the wrath of the public from the politicians). Rural hospital emergency departments and medical clinics have been forced to close angering affected residents as they have to drive greater distances for essential services.

(2) Private/Self Pay Clients - Community hospital’s mandates were originally to provide medical services to all residents of a particular community, often in one integrated and convenient location. These services were offered to both ‘Inpatients’ and ‘Outpatients’ covered under the government health plan. For extended, additional or elective therapy covered by one’s private insurance provider, or out of one’s own pocket, an additional branch of the department might cover these ‘Private/Self Pay’ outpatient clients.

(3) O.H.I.P. - Ontario Hospital Insurance Plan - our provinces government funded social health insurance. My original hospital stay, surgery, physiotherapy and just about everything ‘in hospital’ was covered by the government plan. Once I had been patched up and discharged, I was entitled to limited physiotherapy on the government plan, or additional continuing physiotherapy as my private insurance permitted. My good fortune was that I was entitled to unlimited physiotherapy in the plan my employer had negotiated with it’s private insurance carrier.

Saturday, 9 January 2010

Re-evaluating Nerve Pain & Pain Medication

Re-evaluating Nerve Pain & Pain Medication

It has been 3 years almost to the day that the inflammation in my back from the initial infection and subsequent surgery subsided. A two-way street, so to speak, as it allowed both signals through to regain motion in my legs but also the signal of pain to be my constant companion from mid-January, 2007 to present.

Burning, searing pain that is a cross between sensations of ‘burning' and ‘pins & needles’. Or perhaps a constantly fluctuating sensation as if my limbs were immersed in very hot club soda (soda-water) with painful effervescent bubbles rapidly bursting along those limbs.

Initially prescribed 300 mg of Gabapentin three times a day along with 25 mg of Nortriptyline once per day, I felt that there was little if any relief yet lived with that pain for about 2 &½ years.

About a half year ago I persuaded my doctor to prescribe Lyrica (Pregabalin) as an alternative to the Gabapentin. It is my understanding that Lyrica was “stronger” and therefore a lower concentration was needed to achieve relief. I started at 25 mg three times per day for 3 months and at first I thought that I did notice an immediate slight reduction of neurogenic (nerve) pain. However, I now believe that was simply a coincidence - for whatever reason I had a slightly better weekend after changing to Lyrica. Within days the pain seemed to be as before (or at least my perception of it was) and the constantly searing and distracting pain was as before.

On renewal I asked my doctor to double the dosage to 50 mg three times daily (It is my understanding that some people can tolerate as much as 600 mg daily). Living with the 50 mg dosage for another quarter year has lead me to the conclusion that the increased dosage does little if anything to ease my pain but does distort my vision and I find myself very sleepy by mid day.

Vision may become blurred, with multiple images especially with illuminated objects such as stop lights. The tiredness is felt mostly at mid-day in spite of my having sufficient sleep each night. A drugged tiredness where my head swims leading to a disorientated feeling, at times even feeling ready to nod out. Having weaned myself off the drug slowly, I feel that pursuing Lyrica at an even higher dosage would only lead to more pronounced side effects.

As renewal of my prescription approaches, I will either go back to the Gabapentin or perhaps do without nerve pain medication as it seems to have little or no effect at the intensity that I experience that pain. These are basically the only drugs that are available for nerve related pain and I’ve come to the conclusion that they are ineffective on the pain I experience.

It is difficult to accept that this constant and rather extreme pain will be with me for the remainder of my life. I’m reminded of how animals, ceaselessly tormented by biting insects, frequently plunge into deep water to escape their suffering.
How soon before this pain becomes too much for me to bear?…..and where is my river?……