I’ve mentioned my rather disappointing pain management clinic appointment which led to my GP changing a few of my meds and on Friday Jack and I had an extremely successful appointment with the gastroenterologist at Durham hospital leading to more new meds. It’s certainly a busy time for my pharmacist!
Firstly I had an appointment with my GP to discuss the pain clinic and where we’d go from there. As the pain clinic appointment hadn’t gone as well as either of us had hoped she was a little stuck on what to be doing, nothing new there! The two suggestions that had been included in the clinic letter were our starting point, the first was a tens machine which I will have fitted at the hospital in a few weeks time, the second was swapping the Fluoxetine I’ve been taking since February to Duloxetine as this is both an antidepressant and helps aid with pain relief apparently. I’m a little nervous about this swap as I have to stop taking Fluoxetine for seven whole days before beginning Duloxetine, I’ve been prepared to expect withdrawal and to spend a lot of the next week crying, I hope the change in tablet is worth it! As the guy I saw at the clinic hadn’t been overly helpful in actual pain medication suggestions we agreed to keep the morphine and codeine as normal for now and to increase Nefopam from 30mg three times a day to 90mg three times a day, as a temporary measure until she had chance to discuss my case with my other GP as I’m quite the mystery to them… Never mind, they’re trying their best.
The gastroenterologist was absolutely wonderful, it’s the best appointment I think I’ve ever had. He was so aware of all of my conditions, he totally understood the severity of them and he took the time to fully explain everything he said. If anyone would like to hear more about this appointment, let me know and I’ll do a full post. After reading my notes and referral letter prior to our arriving, he went through the list of each diagnosis I have, all the medications I’m currently taking and each individual new symptom I have and how long I’ve had them for. This and a short examination was all it took for him to give me a definite diagnosis, which he fully explained with Powerpoint slides and everything! After going through these and managing to fully explain other things that no other doctor had yet managed to find a reason for, he wrote out a prescription, explained there were other options we could try if these don’t work, which was a huge relief for me, and told me to come back in three months to see how the meds were going. Why can’t all doctors make my life so simple?! Anyway, the first new med I have to try is Naloxegol, this is an opioid receptor antagonist which stops the opioids in my meds from causing a blockage in my bowels yet still allows the opioid receptors in my brain to work so I continue to get pain relief. The second is Lubiprostone, or Amitiza, which is predominantly prescribed to women suffering from Irritated Bowel Syndrome (IBS), constipation type. The consultant explained this will somehow help my stomach to contract and empty which is something it has decided it can no longer do on its own. And finally I have a ginormous dose of Ranitidine, a medication that reduces stomach acid production, along with the Omeprazole I have already been taking for years, this should help to reduce the horrific acid reflux and heartburn being caused by non ulcerative peptic dyspepsia. I have never heard of either the medication nor the condition so I’m going into this new stage blindly and just hoping beyond all hope that there are many benefits and minimal side effects from any of these! As mentioned before, there are other meds available should any of these not work or make me feel worse. This is definitely reassuring me after finding out that Naloxegol can, and is, able to make the severity of my PoTs symptoms worse. I’m currently spending much time trying to stop myself from passing out, thank goodness this is the only side effect so far!
Have any of you had experience stopping Fluoxetine or starting Duloxetine? Did anybody find it an unhelpful swap or was it a good experience? How about the gastro meds, any experience with the three meds above or this brand new diagnosis I’ve been given? I’d love to get some information about them from “real” people, similar to me.