Posted 12/18/2007 11:34 PM (GMT -7)
I'm glad I can help!
Okay, let's see, withdrawal. I was taking escalating doses of methadone at the time and they felt that it was having a negative effect on my pain and treatment. How long it takes to withdraw from a narcotic depends on a lot of factors including how long you've been taking it, what dose, and person-person considerations. I've taken (somewhat) a lot of vicodin, tramadol and methadone in the past, the vicodin for about two years. I found that, so long as I had other viable pain treatments available, I was able to withdraw fairly easily. Coming cold off of the vicodin made me very sick for about a week but in the hospital they'll slowly decrease your daily dose and keep you on constant IV fluids, helping your body to quickly flush clean and detox. If they give you some methadone to ease the process, it should really help. Methadone is given in drug clinics as a drug to facilitate easier withdrawal from drugs as strong as heroin. When I detoxed in the hospital it only took a few days (but you'll be going to the bathroom quite frequently...).
I understand the reluctance to stop taking the only thing that's worked. I was in the same position. You might go through some tougher times after you come off, but you'll discover whether your headaches improve without the likely rebound effect you're experiencing and you'll be able to pursue a wide variety of treatments more effectively. When I came off the painkillers, I had also had unremitting headaches for about 3 years. I had been seeing an independent neurologist and other various doctors and tried many treatments but nothing worked. In the following two years, I tried many many more drugs and treatments at Jefferson. They have a ton of options available. In the end, none of them worked for me. Consequently, I recently starting taking narcotic painkillers again, prescribed by Jefferson. They're very anti-narcotic because they want to find a better, safe, more effective option for you. And they'll try very very hard and compassionately to do so. But if they can't find a solution, they'll do what they need to to improve your quality of life. I know it sucks to think of things being worse than they are now (and if you continue to be resistant to treatment, things will) but it's better to try things that could drastically improve your life than to settle into a poor but less difficult one. Even after two years of unsuccessful treatment and going back to the opioids, I know I made the right decision to try. And I'll keep looking for things to try.
Now, hospital logistics. You'll be in the bed a lot, especially if you're given some of the stronger medications. When you can, try to sit in one of the chairs to get a break from the bed or, better yet, talk a (short and repetitive) walk around the headache treatment floor. The activity/getting out of bed will keep you in better spirits and stop you from getting sore. Definitely bring comfortable clothing since you won't be moving around much, nor do you need to impress anyone. Lots of clean underwear! So long as you aren't on continuous lidocaine they'll detach the IV bag and wrap up your arm in plastic (they'll change the IV about every 2-3 days, but they don't want to take it out in between) to let you shower as often as you feel up to it (which, in some cases can be quite infrequent...). They'll provide you with body wash, shampoo, waterless shampoo (for when you can't shower), and any other toiletries that you need. You'll have your own room with a TV with about 30 decent channels as well as on-demand movies and internet access (a bit awkward to use, but nice if you're bored). There's no telling how lucid you'll be throughout your stay but I'd recommend bring a bunch of books if you like to read or whatever you like to keep occupied.
You'll be served 3 meals a day, probably a bit earlier than you're used to. In the morning you'll be given a menu to pick your meals for the next day with breakfast. Food isn't too bad, but it gets old after a while (the menu options repeat every 4 days or so). There are snacks and beverages available in the patient lounge all day and night. Visiting hours are something like 10AM-8PM. They'll probably put you on a no-caffeine diet also, through there's always decaf tea and coffee available with meals. Because of the inactivity you might have trouble sleeping. So be sure to add a sleep aid to the list of medications that you can request from the nurses (they'll give you Ambien or Lunesta). Also, you'll be awoken once or twice a night for vital signs or a change of IV bags. But, in general, the nurses there are great. I'm kinda reaching here for more information but I'm sure more will come to me later.
In regard to the Lidocaine: Jefferson prescribes Lidocaine in three (or four) forms: oral, nasal, injectable (they often do nerve blocks around your neck and face) and IV. You may have just reacted to the specific circumstances in which the lidocaine was used or you might be allergic, obviously I don't know. But 1)if you tell them you've had a reaction to lidocaine in the past they'll either totally avoid it or determine if it's safe to use--I wouldn't worry too much--and 2)they usually reserve IV lidocaine treatment for a separate hospital admission. They'll probably stick to the other drugs I mentioned. In the worst case, if you have a reaction, you'll already be in the hospital and they'll make you comfortable.
Finally, although it's totally up to whether you're comfortable with the admission, I think it's a good idea. When you have such a debilitating problem, it's important that you try every option open to you--especially the ones that have a high probability of helping. It's obviously not going to be fun being in the hospital but in the end it really comes down to trying anything that might make life better. I don't know if you'll benefit from the admission, but I do hope you try.
Feel free to keep the questions coming,
P.S. If you have any questions that I might not know the answer to, I have an appointment at the center tomorrow afternoon and I'd be glad to ask anything for you if you reply early.
DX: NDPH, Recovered CRPS
RX: Lamictal, Abilify, Provigil, Clonazepam, Ambien CR, Emsam, Namenda
PRN: Haloperidol, Zyprexa, Lodine, Zofran, Oxycodone, Skelaxin, Diluadad