discouraged | Arthritis Information

 

I finally heard from my RD tonight. He asked me what was going on and I told him everything I told him in the letter again.
He agreed it was not good but although I expected him to increase my MTX or prescribe a medrol pack I hear people speak of he told me to increase my prednisone to 6 mgs a day and he is prescribing ultram for me to take on a regular basis. He wants me to keep my MTX right where it is- he thinks it maybe was the cause of my gum infection (?) and the cold I got a couple of weeks later (?) He really thinks I should be on a biologic and when I come in for my appointment on the 26th we'll see if things infection wise and such have calmed down and we'll talk about starting the biologic. ?????????
One flipping infection and MTX is to blame? A cold?
I don't know what to think.
I had two other stressful phone calls prior to his so I was off guard and I know I didn't ask the questions I should have.
I really don't want to go back up to 6 mgs of prednisone a day until....whenever? Took me forever to taper to 2. 
This will be one of those nights where I'll really need my relaxation program in my ears while I try to sleep...
OK- now I just looked up Ultram. He specifically said it was good to use because it's non- addicting and I read the exact opposite on the drug's website! He said take it regularly not as needed!
I'm really starting to lose faith in this guy and he was my savior! He got me out of a very bad place a little over a year ago. Was it just by chance that I turned the corner the same time I met him?
Tramadol can be addicting, but it is thought to be much less so than regular opiates.  It also acts as an SSRI, which may provide additional relief from chronic pain.

He probably wants you to take it on a regular basis because you need to get the pain under control and keep it subdued.  This is a common practice and works well for many chronic pain patients.  If pain is left to fester, it is much harder to control.  It's hard on your whole body, and it needs to be stopped.

Take the tramadol.

Maybe you need to slap him around a bit or something.   You've said he was pretty old a few times maybe he's losing it?   Prednisone sucks, but I'd sell my kidney on ebay to be at 6mg's right now.   Oh just forget about the relaxation program and go straight for the stoli for relaxation. 

ROFL! Straight for the stoli! Bob you know me too well. If I had it in the house I would.
JR- thanks for the encouragement and putting it into perspective.
[QUOTE=wanttobeRAfree]ROFL! Straight for the stoli! Bob you know me too well. If I had it in the house I would.
JR- thanks for the encouragement and putting it into perspective.
[/QUOTE]

It sounds like you definitely need a break from the pain, and steady tramadol dosing may just do the trick.  Is he prescribing the extended-release version (Ultram ER) or regular old Ultram/tramadol?  Ultram-ER might be a better choice (once-a-day dosing, steady blood levels), but it is quite a bit more expensive than generic immediate-release tramadol.
I think I did hear him say tramadol and him saying something about 3 or 4 times a day. I was so surprised at what I was hearing I wasn't very focused. God I wish I had something for the pain.  Sleep is my best friend these days.  Not many docs here in WV want to give out any pain meds anymore since people here tend to sell the damn things!  The deadbeats screw it up for us all sometimes!  I've given some to a friend on occassion but this was when the guy had a motorcycle accident and nearly had his entire ear ripped off his head.  They put him back together in the ER and only gave him enough pain meds for 2 days!  [QUOTE=bob_h76]God I wish I had something for the pain.  Sleep is my best friend these days.  Not many docs here in WV want to give out any pain meds anymore since people here tend to sell the damn things!  The deadbeats screw it up for us all sometimes!  I've given some to a friend on occassion but this was when the guy had a motorcycle accident and nearly had his entire ear ripped off his head.  They put him back together in the ER and only gave him enough pain meds for 2 days!  [QUOTE=wanttobeRAfree]I don't know- in my letter to him I told him I was pretty much trying not to take pain meds unless my joints were aching steady like toothaches. For the most part they only hurt when I move them so I stay still  [/QUOTE]

Well you need to get moving!  There is no sense in suffering, or in being immobile for fear of the pain.  Don't let it win.  If you get some pain relief, you'll be able to be more active, which will benefit your body AND mind.  Painkillers are not a long-term fix, but it CAN be a bridge to help you get over this current flare.  Laying dormant is not good - you need to be able to move about!
JasmineRain2009-02-09 21:10:49Hopefully the extra prednisone will kick the swelling out and the ultram will give you some backup relief. My doc started me on Ultram regular prescription, but said she would prescribe the Ultram ER if I responded to it like JR suggested. She said you want to make sure it works well because the ER is expensive. It's no fun when you hurt so bad you don't want to move. If you are taking Ultram or Tramadol, it works better if you take Tylenol with it according to my doctor. Pain can increase fatigue levels so that is something to think about too. I was stubborn about pain medicine at first too, but getting some relief won out and if I hurt I take something. Think about the ways the pain invades your day. Give yourself permission to get through this with some help from the meds. Just my two cents. I hope you feel better. [QUOTE=graciesmom]If you are taking Ultram or Tramadol, it works better if you take Tylenol with it according to my doctor.  [/QUOTE]

That may be true for acute pain, but not necessarily for chronic pain.  Besides, someone on methotrexate probably shouldn't take acetaminophen around the clock.I think your doctor has a good plan.  He said you may need a biologic, as that's the next step.  Tramadol/Ultracet is a good choice to use on a regular basis to try and stop the pain process.

I know that you've been holding off on the biologics, but it may be time to discuss the pros and cons a little more with your doctor.  While you've been coping pretty well, it seems like your RA isn't quite under control, so it may be time to take that next step.    Hope today is a better day for you.

Cathy

I take tramadol...2 in the morning and 2 at night. I wouldnt get out of bed without them. I try not to take anything else and during the day if i need I use my tens machine or hot and cold packs. I am due a steroid injection soon ( I cant wait). Maybe adding a biologic would be a good ideaWTB,

I'm glad you finally got to talk to your doc.  When is your next appointment? 

Personally, I'd do what the doc said.  Sounds like he's trying to get you out of pain until your next appointment so this would be a temporary solution.  Increasing the methotrexate right now wouldn't give you immediate relief like upping your prednisone and adding the tramadol would do.

I hope you feel better real soon.
After reading everyone's responses (thank you for your input), I'm thinking maybe I have been a little stubborn about taking pain meds. I'm not quite sure why. Part of me wants to say I'm reluctant because I had such a hard time getting pain relief during onset. After living through that kind of pain what I have now pales in comparison. Yet bearing it I do believe has worn me down. I do feel fatigued. I am getting depressed that I hurt just because I want to pick up a binder at work or twist a cap off of a water bottle or I can't open my can of soup, etc. [QUOTE=wanttobeRAfree]After reading everyone's responses (thank you for your input), I'm thinking maybe I have been a little stubborn about taking pain meds. I'm not quite sure why. Part of me wants to say I'm reluctant because I had such a hard time getting pain relief during onset. After living through that kind of pain what I have now pales in comparison. Yet bearing it I do believe has worn me down. I do feel fatigued. I am getting depressed that I hurt just because I want to pick up a binder at work or twist a cap off of a water bottle or I can't open my can of soup, etc. wantto!!  I go to bed and wake to this painful thread!!  So sorry you're having such a tough time!! You have told me that kweenb. Are you just on Enbrel now? Are you still enjoying no pain for the most part? Do you take the sure click or the syringe? Is it twice a week? Be honest with what it's like to inject- does it hurt?  Yikes everybody knows I am such a needle phobe. Plus so many people complain that it really hurts. Others say it is worth the pain to feel so good over all but..... wanttobeRAfree2009-02-10 07:09:24[QUOTE=babs10]wantto!!  I go to bed and wake to this painful thread!!  So sorry you're having such a tough time!! [/QUOTE] [QUOTE=wanttobeRAfree]You have told me that kweenb. Are you just on Enbrel now? Are you still enjoying no pain for the most part? Do you take the sure click or the syringe? Is it twice a week? Be honest with what it's like to inject- does it hurt?  Yikes everybody knows I am such a needle phobe. Plus so many people complain that it really hurts. Others say it is worth the pain to feel so good over all but.....

the increase of mtx can work and sometimes even help for quite sometime.

Babs,

Do you inject in your leg? 
  nope.. belly.  Babs- sorry I flitted off to do some work at my job! Shame on me for spending time here! WTB,

That's an interesting question.  I actually take my shot right before I go to bed, so I'm usually in a half-reclining position.  Why?

I was in the same mind-set as you and Kelstev when the MTX wasn't working and talked my RD into the increase.  I've read that increasing dosage works for some people.  If you decide to do that, I really hope it works for you.  I wished it had for me since the MTX is much much cheaper.  I just wasn't one of the "lucky" ones.  I asked about position because the sure click seems large and cumbersome to use at an angle. I'm pictureing sitting in a chair. [QUOTE=wanttobeRAfree]I asked about position because the sure click seems large and cumbersome to use at an angle. I'm pictureing sitting in a chair.

I think no anti inflammatories because of the MTX and the possibility of stomach bleeding?..... I t sure sounds like no one else's doctors think that way but both both RD's I had did. Maybe because I don't get much visible swelling?

oops and I missed your other post. That makes sense to recline back. Yeah I don't know if I could do a JAB! My dad had diabetes and he thought nothing of it. He would just give the old belly a slap and stick it right in.ok.. my reason for asking that is...... [QUOTE=wanttobeRAfree]

I think no anti inflammatories because of the MTX and the possibility of stomach bleeding?..... I t sure sounds like no one else's doctors think that way but both both RD's I had did. Maybe because I don't get much visible swelling?

[/QUOTE] I take my shot standing up facing the bathroom mirror so that I can SEE myself doing it better and keep it straight....WTBF, you need to talk further with your RD about an increase in MXT, possibly starting a second DMARD to take with MXT instead of starting a biologic, and please have your RD explain to you why it's better for you to take extra strength Tylenol instead of a NSAID.  Tylenol is infamous for damaging one's liver and MXT also causes liver changes - that's why we have lab work done so frequently so the RD can keep tabs on our liver.   A NSAID can be safely taken if your doctor prescribes a drug like Protonex to protect your stomach.   I'd much rather take a NSAID than Tylenol.  You may not need any other pain relief except for a NSAID.  You have some options and they all need to be discussed with your RD.  If he says no then you need to be armed with the right questions to ask him.  Remember there are options.   Pain can wear you out.  Sometimes I wonder if the pain causes the extreme fatigue or is it the pain, or a combination.  Now that I'm in clinical remission I don't have the fatigue.  It's lifted along with the pain, so who knows.   Take care.  LindyLike Babs stated, if you use inject. MXT it bypasses the stomach.  I use inject. and have no side effects from MXT and am inject. 17.5 mg.  LindyLin B- good questions to pose to my RD! Is Advil an NSAID? I used to love Advil but I was told NO ADVIL! Tylenol has never done a thing for me plus I always wondered why they themselves posted warnings about it causing liver damage yet both RD's I had insisted I use it exclusively. I have briefly scanned this thread so forgive me if I repeat or miss something. I agree with the one post about narcotics. If you need narcotics, your DMARD is not working. I was on MTX, plaquenil and mobic. The MTX stopped working so I added Enbrel. I was able to stop everything else, over time.

Narcotics have their place - for the poor souls who cannot find any effective treatment.

I know the biologics are scary but they can change your life for the better. As soon as I got off those other drugs I had more energy, was virtually pain free and was no longer in that brain fuzz state MTX can induce. Narcotics will do the opposite.

Enbrel removed the majority of my joint pain. I was able to get back into my exercise routine which has basically elimnated all pain. I don't think narcotics is a good exercise motivator.

Don't be worried about the injections (I actually don't recommend the Sureclick as I think it stings and you can't control the speed of the injection). I was always a big baby too but I wouldn't give up my Enbrel now.Narcotics have their place - for the poor souls who cannot find any effective treatment.

That's what I thought too! I think this is just til he can get me in at my regularly scheduled appt. in 3 weeks...

 

I'm not tough...