More Drugs

I thought that I'd update everyone on how the new regime has been working.

The cocktail of codeine, paracetamol and ibuprofen was nothing short of revelatory, at first. I say "at first" because after a couple of days it was apparent that there was a shortfall in the efficacy. In fact it sort of highlighted another issue.

The problem was that the dose I was given meant that I had four occasions per twenty-four hour period when I was to swallow the cocktail. The dosage was based upon an assumption that my waking hours would follow a fairly normal pattern. Four doses would probably provide enough relief during fourteen to sixteen waking hours following a normal period of sleep. The problem is that my sleep patterns are not normal.

As I've mentioned, my bladder wakes me regularly. These days it's become routine that no matter what time I go to bed at night or how tired I may be, I will be woken at hourly intervals needing to pee at least three times. I may then get as much as two hours further if I'm lucky but more often, owing to the time that it takes to get started let alone accomplish the mission, after the third visit I'm so awake that it's just not possible to return to the land of Nod.

It isn't just being awake, it's that the pain that accompanies urinating in these circumstances isn't dulled by the cocktail. It doesn't just end when I've finished peeing either. So when I've had a few hours sleep, by the third of fourth visit I'm no longer sleepy enough to block out the discomfort and return to sleep.

I usually get up, plug-in my iPod, slip my earphones on, sit with a book and listen to music for a couple of hours. At some stage after waking I need to take the painkillers for the other sources of discomfort. I'd then, later in the day, find that my ration of pills is not fully covering the need.

Well, last week when I had my scheduled hormone blocker injection, the GP practice nurse (Karen) asked how things were going as usual especially with regard to the added codeine and paracetamol. I outlined all the above and she said that I should speak to the doctor. She mentioned that he'd just recently completed further training in pain management and was now the leading GP in the area on the subject.

I've since seen him and as a result my prescription has been increased to cover my waking hours. He explained in some detail how the various painkillers I'm taking work. Codeine and paracetamol both work by blocking the pain receptors in the brain. The brufen does too but also works as an anti-inflammatory which is useful in combating the pain from the secondary cancers in particular.

He said that the pain I'm getting in the region of the perineum which extends through the urethra and it has to be mentioned (sorry for those who don't like anything scatalogical) to the rectum too, is of a different nature and needs a different pain control method.

I asked if the neural pain killers would be affected by the patient's mental condition, stress, depression or tiredness. The answer was yes and that's why he wanted to work on the other pain because left alone it would probably reduce the efficacy of the pain killers.

He has prescribed Gabapentin (Neurontin)  http://en.wikipedia.org/wiki/Gabapentin

If you read the above link you'll find that it has been found to combat neuropathic pain associated with cancer.

It's now been twenty-four hours since I started on the new cocktail of 400mg Ibuprofen, 500mg paracetamol, 30mg codeine and 100mg Neurontin. Just before bed I substitute the 400mg Ibuprofen for the 800mg brufen retard that lasts most of the night. I've been taking this combination for only a day so far so I'm loathe to say that it's the answer but this is the first time for many months that I can remember feeling relatively pain free. Dr Campbell said that the Neurontin might not work, that I can safely raise the dose if there was no obvious relief but as I write, it seems to be doing the job. It is nice to know that if I need to I can take more.

I can report that on the minimum dose the constant discomfort in the region of the primary cancer is reduced significantly and so far (last night) urinating wasn't as uncomfortable as it has recently been but it's still not pain free.

A return appointment has been made for the 27th January to discuss and review the pain management regime.

We also discussed the chemotherapy option. I'll have made up my mind whether to go ahead with it by next month when I'm due back at the oncology department.

Fingers-crossed, this uplifting feeling I have of being in less discomfort will last. I'll admit to becoming a bit low in spirit in the past few months from time to time. Today has been the first since I can remember that I haven't been given a sharp reminder by Charlie that he's lurking.