Results from 1st PM visit

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_Christina
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Date Joined Feb 2007
Total Posts : 553
   Posted 3/17/2011 2:46 PM (GMT -6)   
So, I went to the PM today for the first time.
I went in with only my list of medications, because I have not had any MRI/Xray/CATscans or anything done in the last 3 years.
I told him my entire story and how I have progressed, and how the pain affects the bipolar and the other way around too.
He asked me about tests that he thought should have been run, and I didn't remember if they had been, and he was going to have to request them from the rheumatologist.
I told him about how the rheumatologist last said that he felt that the inflammation was under control and that is what the medications were there for and the pain I was still having is separate and he did not feel that he should through any more pain medications at it.  It was not going to go away but, over time, I would acclimatize to it.
I showed him the medications I was taking and told him about how the pain treatment was not working out.
He asked me about other Rheumatoid arthritis-type conditions that I might have been tested for, and the treatment would be slightly different.  He asked me about other treatment options for RA that might create less pain.  I did not have an answer for most of that, but told him what my rheumatologist told me when I asked about other treatments.
He poked at my knees and ankles and elbows and wrists (don't know exactly what he was looking for, because I didn't jump everywhere) He did a vibration test on my knees and wrists. 
He agreed with me that I should pursue a 2nd opinion on RA conditions and treatment options. The office is going to set me up with one that will work with my insurance.
He agreed that the MO+TY+vicodin mix was not working well for me.  I am taking too much MO and TY and not doing enough to protect my stomach.
He suggested (actually made it a condition that I would take it OTC w/o script to get other meds) Omeprazole 20mg daily(generic prilosec?).
He added Tramadol 50mg daily (starting, possibly increasing to 2x daily) to be 1st wave pain med.  This should decrease or eliminate TY and/or MO daily.  I have not taken the first one, or even looked it up yet.  So I don't know anything about it.  I don't know it it will react with the bipolar symptoms yet.
He also added a topical gel to be a breakthrough medication on knee joints only.  It is Pennsaid 1.5% topical soln.  He said 40 drops in palm of hand, rub into each side of knee (front/back/sides each) for 6 hours of pain relief.  He says it is very strong.  Also haven't looked this one up.
I went to fill the scripts and the gel costs $50 after insurance.
It was interesting to note that when the PM walked in the room he immediately recognized my husband, who was with me, from working together at the hospital a few years ago.  Rob likes the PM's reputation, so that's good.
They are going to track down the test results and talk to my rheumy, then schedule a follow-up with me to discuss results.  They are going to refer me to a 2nd rheumatologist for an opinion on condition and treatment.  I continue with the PsyD weekly for now.
I think I am happy with the results, but I feel like I don't know enough about that happened to really make a decision.  I need to gather information and see how these meds work for a few days.  I know that I wanted to walk away with a different pain treatment plan, and I have that.
What is your take on all this?
 
_Christina

straydog
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Date Joined Feb 2003
Total Posts : 16301
   Posted 3/17/2011 5:18 PM (GMT -6)   
It sounds like your appt went very well. He is smart enough to figure out a 2nd opinion is really needed with a rheummy. He is starting from the ground up it sounds like, so he can form a correct treatment plan for you. He appears to have no problem communicating with other drs either, another good sign. It may be well worth the time to give him an opportunity to help you out.

If you have any questions about the medications he gave you, then I would call him or his nurse, should have asked while you were in his office.

Take care.
Moderator Chronic Pain Forum

_Christina
Veteran Member


Date Joined Feb 2007
Total Posts : 553
   Posted 3/17/2011 6:02 PM (GMT -6)   
He or the nurse didn't say anything about complications with bipolar, and I wouldn't really expect them to know. I like to learn all about a medication between accepting it and putting it in my mouth.
She said it was strong and a diffrent classification than MO or TY. That was good enough to take the script.

_Christina
Veteran Member


Date Joined Feb 2007
Total Posts : 553
   Posted 3/18/2011 12:20 AM (GMT -6)   
Wow, It was suggested to me that I should look at the fibro list and wow
lots of things thrtr that I had just chalked up to side effects to other medications plus a few that I wanted to eventually mention to a doctor once the "big" stuff got under control. I Can check off over half the list. I will print it out to bring to rheumy 2nd opinion.
I don't think I don't have RA, but fibro would answer a lot of questions.

nvrthesame98
Forum Moderator


Date Joined Jun 2008
Total Posts : 6706
   Posted 3/18/2011 5:18 AM (GMT -6)   
Hello Christina first let me say I have been following some of your posts as well and I wasnt the one mentioned the fibro forum but I thought it a few times as you were talking about your symptons. I am glad you went to take a look as fibro is one of those things that is diagnosed more or less by process of elimination and your off to a good start as it looks as if your Rheumy has done this for you.
 
The new Doc might turn out to be good for you as it looks like he is at least looking for better answers to some of the questions and problems you have been having.
 
I have to say I am NOT a fan of tramadol and please do your research on it as it certainly has psycotic tendancies associated with it especially in already compromised persons. We use to use extreme care in the elderly and alzheimers patients and I personally noted behavior changes in this age group of folks. Dont want you to not try it just want you to be aware and make those around you aware so that they can watch for changes as we dont always realize when something is different about ourselves,others tend to notive 1st.
 
That isnt a large dose by any means really on the low side but still if you increase it and it would cause those changes to be greater at higher doses. Just wanted you to be aware and ontop of it as you seem to be by checking out new meds yourself and wanting to be prepared for any adverse effects.
 
Good luck to you

Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 3/18/2011 10:08 AM (GMT -6)   
 
 
 
Dear Christina,
 
    Good morning! *hugg* It was so nice to be able to chat with you last night. I wish I could have made it sooner, but yesterday was a bit hectic to say the least. How are you feeling today? Have you begun taking the new medication yet?
 
    It sounds like your new PM wants to begin to start out slow. That is always a good sign. Tramadol is a great med. It is synthetic so it is generally well tolerated. As time goes by I am willing to bet you will be increased in dosage and times per day. Do you take an antidepressant? If so, that might be one of the reasons for the slow increase. When it is taken with antidepressants there are some risks, so it is one of the reasons most doctors will start it out very slowly to catch problems early on. For some reasons antidepressants, analgesics and muscle relaxers all seem to have possible reactions with each other. All of my meds had to be started out at extremely low doses for that reason. A little frustrating because it would take a month just to get to a good "base" dosage that we could increase from that point.
 
     I hope you have some time to rest today. I know you have a lot on your plate right now!
 
*warm hugg*
     dani
 

TWO roads diverged in a yellow wood
And sorry I could not travel both
And be one traveler, long I stood

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_Christina
Veteran Member


Date Joined Feb 2007
Total Posts : 553
   Posted 3/18/2011 4:01 PM (GMT -6)   
I am very used to the "slow increase" on medications, and on the script it said to take 1 each night for 3 nights and possibly increase to adding 1 in am after that if tolerated.
They do this to be careful because I am "treated, but not controlled" bipolar.  I understand what is going on, but cannot control it much at all.  I was put on disability because of it this last fall.
Let me list my *updated* medication list for you.
Lamictal 200mg Daily
Cymbalta 60mg daily
Ambien 10-15mg Daily
Plaquenil 400mg Daily
Alprazolam .13-.25 PRN
Ferrous Sulfate (iron) 65mg Daily
Sulfasalazine 2000mg Daily
Methotrexate 20mg Weekly
Levoucorin Ca 10mg Weekly
Folic Acid 1mg Daily
Multimineral supplement Daily
Docusate Sodium 200 Daily
Zertec 10mg Daily
*adding*
Tramadol 50mg Daily for 3 days then may increase to 1 every 12 hours
Pennsiad 1.5 topical soln PRN
 
So that I won't need Hydrocodone/APAP 5/500mg PRN
Motrin 800mg PRN
Acetaminophen 1000mg PRN
 
Thanks, bye.
(BTW, I started the post at 11am, and had to go, I sthen got back to the list at 4:30pm)
 

Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 3/18/2011 10:50 PM (GMT -6)   

 

   Dear Christina,

    How are you feeling today? Hope your first night with tramadol went well. I see you take Cymbalta, so serotonin syndrome will be something to keep an eye out for during your first few weeks. With a little luck the transition will be a smooth one. Hang in there!

*hugg*
   dani

p.s. Have you ever thought of putting your med list on your signature? Some folks like to list their diagnoses and meds in their signature lines so they don't have to retype it out.


TWO roads diverged in a yellow wood
And sorry I could not travel both
And be one traveler, long I stood

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