GP pain management appointment

I saw my GP this morning about my pain medications and dosages. I booked a long appointment so we could discuss everything.  He started off very hard line,  but quickly softened.  I looked like poo.  I had about two hours sleep last night. Tired. Very foggy.  And we could both hear all my joints crack whenever I moved anything.  I’m convinced he’s under pressure to lower my doses, and it’s not coming from him.  He was very understanding, in fact.

So the plan is:

• Try to keep to only two 20mg targin (slow release oxycodone and naloxone) per day. I regularly take three per day, because they don’t last the full 12 hours.  More like eight hours.
• Try to keep to three 10mg oxynorm (immediate release oxycodone) per day. I usually take four, and on knockdown days, up to six. He just asked me to try.  He wrote a script for four per day so he has covered me if I can’t stick to the lower dose.
• I told him that Naprosyn really does help, especially with my spinal pain. He agreed that I can take Naprosyn 500mg up to twice a day, and
• He has added in another blood pressure medication to get my blood pressure lower. It is a little high – he measured it at 145/95 this morning – but not dangerously so.  We would both be more comfortable with it lower, especially as before I started biologicals, my ‘normal’ BP was 110/60.  He said we could expect Naprosyn to raise it by ten points, so the second medication is needed to keep it better controlled. I’ll have it checked again next month and we’ll see.
• He has prescribed Stillnox for sleep. I prefer Valium, because when I have horrible PMS Valium calms me down most effectively.  And I find it excellent for sleep, so it does double duty.  I only take it about for about a third of the month, but he won’t budge on not prescribing benzodiazepines and opioids together.  Fair enough, I’ve read enough about the dangers not to argue.

All in all, an excellent appointment.  I’m in a better frame of mind today (hard to believe after two days of crippling pain and no sleep) but there you go.  I’m happy with the plan, and he’s happy with the plan.

We also discussed prednisone, and he agreed I have adrenal insufficiency from long term prednisone use. While there are ‘better’ corticosteroids for adrenal insufficiency, he couldn’t see a huge benefit in switching. So I’m going to try tapering at a quarter of a milligram per month now.  He told me when the wheels start falling off, to come and see him and we’ll reassess from there.  He also reminded me that I need a bone density scan.

I also had paperwork that he needs to fill out every year to say that I am capable of driving, which he did.  So I am roadworthy for another year.

And he tried to get the results from my Lumbar Puncture.  All he could get was the high protein levels (High Albumin, high IgG) in the Cerebral Spinal Fluid.  There are more results, but they weren’t faxed through.  I’ll have to chase them myself, or wait until next week when I see my neurologist and get a copy from him.

It was a long appointment, very thorough.  We even discussed joint hypermobility, and my kids and their current medical issues.  He took all the time we needed, and didn’t rush.  I’m happy. He’s happy. The plan is workable for us both.  Win/win.

And now, a nap.