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#813393 - 12/10/08 11:24 PM
Re: Hydrocodone and Acetaminophen
[Re: tigersmom]
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GRAND Pooh-Bah
Registered: 05/16/02
Posts: 3528
Loc: NY/NJ
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One needs only to look up the statistics for liver transplants to get a better idea how damaging APAP can be; the opiates are not mentioned at all in the literature that I have read, but tylenol overdose most assuredly is. I think at this point I realize the real reason for the Doctor's "explanation" was to avoid prescribing. Education about the risks of excessive Tylenol is limited mostly to those who have done some self-study. For the patient who is suffering in pain to the point where a narcotic medication is warranted, what are they naturally inclined to do if they are cut off by Doctors fearful of prescribing? They're likely to consume even more Tylenol and achieve far less pain relief. They'll go for the colorful bottles with the huge "EXTRA STRENGTH TYLENOL FOR ARTHRITIS PAIN", etc. emblazoned on them and something about "650mg acetaminophen". They are far less likely to read the vague warning in the tiny throwaway pamphlet inside the box. For that matter, most people don't know what acetaminophen is or associate it with any type of damage whatsoever. After all, if they have hundreds of bottles of the stuff sitting in the aisles, it can't be dangerous, now can it? I think it's obvious what I'm hearing is excuse #305 for not prescribing.... patient2all
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#813842 - 12/11/08 09:42 PM
Re: Hydrocodone and Acetaminophen
[Re: tigersmom]
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GRAND Pooh-Bah
Registered: 05/16/02
Posts: 3528
Loc: NY/NJ
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I would say the same is true of the NSAIDS also; I managed to destroy my stomach lining over the years by taking excessive amounts of advil for severe pain because I didn't read the fine print, and just assumed that because the substance was available OTC that it was "safe." That is true of all of us at one point. My BIL takes 3-4 of every OTC medication on the theory that he's a "big guy" so needs more. I doubt he has a bigger liver though. But no one pays heed to " drug users" like me though... Had you gone to your PCP about the pain, s/he would have freely handed out the latest, greatest NSAIDs like candy. And would happily continue until the medication was taken off the market or you strongly voiced complaints. When doctors are baffled by your maladies, they'll often prescribe some new SSRI. It appears the thinking is that if they can't find a physical cause, it must be in your head. For the most part, doctors will pass out any questionable drug that gets passed across the buffet table by pharmaceutical reps. They give little regard to the long term effects. The only exception is narcotic based medication. APAP, NSAIDS are "safe" in the prescribed amounts for occasional use, but any doctor who says "just take a tylenol" or whatever, to a chronic pain patient is guilty of malpractice, IMO. "occasional" is the key word. What of those who suffer chronic near unrelenting pain? ------ I got the "very dangerous" speech again from the Doctor today. Oddly, the Tylenol is not the concern, but the "damage hydrocodone does to every organ in the body". I asked him to cite references and noted that I could only find relatively rare anecdotal accounts of any "damage" specifically related to the opioids themselves. He couldn't come up with any and changed the subject. When I gave him an "out" and suggested perhaps he was referring to hypogonadism, the doctor replied that was possible. I mentioned that my own research showed that when hypogonadism was medication induced, it was far more likely to occur in methadone patients, steroid users and people taking very high doses of other opioid medications. As opposed to a modest 3 a day theraputic dosage. He then replied, "Yes, but do you want to take the chance of being that one unlucky one?"  No, I suppose, I'd rather skip participating in life and continue to live a life like I'm 40 years older than I am....  I mostly stay home anyway so I avoid other "unlucky" incidents like being hit by a bus or bullet on the street. ------- I suppose I should further retreat from life. When I visited a local PM Center to see about injections, I mentioned right out that I was being prescribed Lortab ("What's that?", the PM Doctor asked.) When I said the word hydrocodone, the doctor became quite hostile. He said I should surrender my driver's license, among other things. ------- For the record, based on a promise to my wife of 33 years, I'm very careful to time my doses so that hours have elapsed before I get behind the wheel. Even though I drive very little as it is. During a recent rare long drive on Sunday where I was stuck in traffic for 2 hours in terrible pain, unable to move freely wearing my uncomfortable decompression brace, I was ready to engage in "road rage" from the pain! I would have been a better driver that day had I taken medication sometime before my drive. But of course, such a notion is generally verboten despite an extensive study that concluded the opioid tolerant CP Patient had negligible, statistically insignificant differences in response time compared to drivers who were "clean". Of course, driving in intense pain creates a true danger on the road, but good luck in anyone but those who live it, ever seeing it that way. JMO, but it's probably still inadvisable to drive after taking any medication with a warning about "operating heavy machinery", etc. ---- Tigersmom, I hope there is some remedy that can help the damage done to your stomach lining by using those "safe" and well accepted medications. I was the same way, though it appears I was spared damage. For years, I felt if I could buy it freely in CVS, it must be safe. In fact, when I had a "traditional job", I lost it for *not* taking stronger medication. Although I was prescribed hydrocodone, I feared taking it during the workday in the belief that "druggie" signs like dilated pupils would be noticed. Instead, I always had a rattling bottle of OTC meds in my pocket that co-workers joked acted as a "cowbell" indicating my proximity. Fortunately, something told me to switch around between tylenol, aspirin and motrin. Then one day the big boss called me in and said "You take too long to rise from a chair and walk too slow - 30 days to shape up or ship out". I resigned with dignity instead. Why if I had taken hydro during the daytime then, I'd still work for the jerk  He really wanted to hire someone younger, cheaper and less knowledgeable. He got it Chronic Pain patients have had the lowest level of credibility I've seen in my lifetime. Thanks, Celebrity Rehab, et al... patient2all
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#833009 - 01/21/09 07:58 PM
Re: Hydrocodone and Acetaminophen
[Re: GregoryS]
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GRAND Pooh-Bah
Registered: 01/24/04
Posts: 2252
Loc: |20(|-|3||35|\/|6 1$ 6@`/
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P2A,
What are your thoughts about oxycodone compared to hydrocodone? My doctor has been prescribing me Oxy 10/325 but recently asked if I wanted to try something more powerful. I kind of balked b\c I figured he was probably talking about Oxycontin and I am not so sure I really like the Oxycodone yet.
Anyway, question to all I guess...hydro vs. oxy...risks, benefits, things to look out for...
oxycontin is no more powerful than oxycodone milligram for milligram. it is exactly the same but time released instead of instant. in fact i think you would find oxycontin weaker unless he upped the dosage quiite a bit. say a 30 milligram IR or 40mg er... he may be speaking of another drug instead of oxycontin. the major benefit of oxycontin or regular oxycodone ir over hydro or percocets is there is no APAP to screw with your liver. a 10 milligram percocet will feel stronger than 10 milligrams of oxycontin due to the fact that the APAP in the perc is a potentiator and oxycontin is released over a period of time instead of all at once. that make sense?
_________________________
When the Boogeyman goes to sleep every night, he checks his closet for Chuck Norris.
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#833012 - 01/21/09 08:16 PM
Re: Hydrocodone and Acetaminophen
[Re: krymsun]
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GRAND Pooh-Bah
Registered: 06/29/08
Posts: 1618
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well, if your problem can be resolved by surgery, of course they will want to do that and get you off the meds. Remember the goal to your dr is to heal and if they cannot do that then they will "help". but they will not just write scrips for the rest of your life if there is a chance that surgery will help you. you really do not have a say in that process. Any successful pain management program will have the same process. they try things, you go along. you report back that it did not help, they try something else. this goes on and on until there is nothing left except the script pad. they want to avoid that for many GREAT reasons. one, you WILL become physically addicted. that is a fact. an unavoidable fact. you are welcome to call it "chemically dependent" or opiate dependent or whatever has the least bad taste. bottom line is that if that is the road that YOU choose either by failing to go thru with surgery or by not getting results, its a VERY HARSH road to travel the rest of your life. This must be thought out on your end because you are choosing to be at the beck and call of the dr office for the rest of your life. PM docs call and want urine within 2hrs. or a blood sample within 2 hrs. They sometimes call you in to count your pills. trust me.Living with PM is just as bad as life with a rotten wife ! they have Rules if you want to stay in and if you break ONE they will close your file and say ccccc---yaaaaa. The point of all this is easy....the PM docs get watched like a hawk and everything they do for you has to be documented three times and again...and then you have your homework to do as well. they make it tough so the wanna be's will drop out and go away so the real patients can get treatment and get taken care of. PM is a hard business to be in with everyone looking over their shoulders. Big Thing is you just got to go along with whatever the doc ask of you. if he says sunrise exercise for you, then you gotta try it.you gotta go along with everyone of their "treatment" programs until they are satisfied that you are not getting any better and that you have now demonstrated the longterm need for opiode meds ona regular basis. if you are willig to do the PM docs dance with him, you will arrive at the pharmacy, legally and with something that WILL help you, even though it will have its own effects. just know, if you get oxy by the tail.....well, i need not say it. you get the idea. Another reason is that using these meds opens you up to all kinds of potential legal problems. like i was telling someone else, NEVER EVER carry your pills in your pocket when you are driving. if you had an accident and the police see that you have the pills on you, they will assume that they are IN YOU as well and a blood test will prove that. Now, if the pill bottle is in the glove box or trunk they have no reason to suspect that you might be DUI> cops love DUI arrest. and taking a narcotic pain pill IS driving Under the Influence. make no mistake. thats just as serious as drunk driving. theres a GREAT reason to get away from pills and see if surgery will help. health, liver, mental depression brought on by long term opiode use, and all other kinds of things brought on by changing brain chemistry. Once your doc decides there is nothing left for you to help except the drugs, then YOU have to make some decisions too. you can hurt less now, and hurt alot more later., or you can take a little of the pain now and that way you will help keep your tolerance low so that yrs from now you will not need the dose that you would normally need for someone thats been in narcotic therapy for yrs and yrs. So taking a little pain now will be doing yourself a BIG favor later. the kind of meds for long term use are EXPENSIVE ...VERY. for now if you are getting 10/325 oxycodone...the next step up would be a roxicodone 15mg with NO TYLENOL. OR Maybe a oxycontin10 or 20mg with a few perc or hydros a day for rescue med. dont get all excited about the oxycontin. when its dosed rigt you hardly feel a thing. thats what its suposed to do. to hardly be felt. that will alkso apply to your pain. it will hardly be felt. That is what makes oxycontin so successful. If major pain comes then take a hydro or a perc. I think hydro works better on top of oxy. the patches are good for some but they are also horribly expensive. you might want to avoid those till your bedridden and down for the count. a 10mg oxy in the morn, a couple hydros during the day, another 10mg oxy at nite. you should be good to go from what you are telling me. YOu CAN still get Hydro online but the Rules are changing faster than a good lawyer can keep up with. you CANNOT get Oxy legally here in this country. its available online but its very illegal and VERY expensive. not worth the time and trouble,... Hydro is a class-3 narcotic. ALL forms of OXY are class-2 narcotics and that is a no no online. good luck. i hope your dr can get you on something thats cheap and effective. what more could ya ask for?
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#833017 - 01/21/09 08:23 PM
Re: Hydrocodone and Acetaminophen
[Re: eluded]
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GRAND Pooh-Bah
Registered: 01/24/04
Posts: 2252
Loc: |20(|-|3||35|\/|6 1$ 6@`/
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well, if your problem can be resolved by surgery, of course they will want to do that and get you off the meds. Remember the goal to your dr is to heal and if they cannot do that then they will "help". but they will not just write scrips for the rest of your life if there is a chance that surgery will help you. you really do not have a say in that process. Any successful pain management program will have the same process. they try things, you go along. you report back that it did not help, they try something else. this goes on and on until there is nothing left except the script pad. they want to avoid that for many GREAT reasons. one, you WILL become physically addicted. that is a fact. an unavoidable fact. you are welcome to call it "chemically dependent" or opiate dependent or whatever has the least bad taste. bottom line is that if that is the road that YOU choose either by failing to go thru with surgery or by not getting results, its a VERY HARSH road to travel the rest of your life. This must be thought out on your end because you are choosing to be at the beck and call of the dr office for the rest of your life. PM docs call and want urine within 2hrs. or a blood sample within 2 hrs. They sometimes call you in to count your pills. trust me.Living with PM is just as bad as life with a rotten wife ! they have Rules if you want to stay in and if you break ONE they will close your file and say ccccc---yaaaaa. The point of all this is easy....the PM docs get watched like a hawk and everything they do for you has to be documented three times and again...and then you have your homework to do as well. they make it tough so the wanna be's will drop out and go away so the real patients can get treatment and get taken care of. PM is a hard business to be in with everyone looking over their shoulders. Big Thing is you just got to go along with whatever the doc ask of you. if he says sunrise exercise for you, then you gotta try it.you gotta go along with everyone of their "treatment" programs until they are satisfied that you are not getting any better and that you have now demonstrated the longterm need for opiode meds ona regular basis. if you are willig to do the PM docs dance with him, you will arrive at the pharmacy, legally and with something that WILL help you, even though it will have its own effects. just know, if you get oxy by the tail.....well, i need not say it. you get the idea. Another reason is that using these meds opens you up to all kinds of potential legal problems. like i was telling someone else, NEVER EVER carry your pills in your pocket when you are driving. if you had an accident and the police see that you have the pills on you, they will assume that they are IN YOU as well and a blood test will prove that. Now, if the pill bottle is in the glove box or trunk they have no reason to suspect that you might be DUI> cops love DUI arrest. and taking a narcotic pain pill IS driving Under the Influence. make no mistake. thats just as serious as drunk driving. theres a GREAT reason to get away from pills and see if surgery will help. health, liver, mental depression brought on by long term opiode use, and all other kinds of things brought on by changing brain chemistry. Once your doc decides there is nothing left for you to help except the drugs, then YOU have to make some decisions too. you can hurt less now, and hurt alot more later., or you can take a little of the pain now and that way you will help keep your tolerance low so that yrs from now you will not need the dose that you would normally need for someone thats been in narcotic therapy for yrs and yrs. So taking a little pain now will be doing yourself a BIG favor later. the kind of meds for long term use are EXPENSIVE ...VERY. for now if you are getting 10/325 oxycodone...the next step up would be a roxicodone 15mg with NO TYLENOL. OR Maybe a oxycontin10 or 20mg with a few perc or hydros a day for rescue med. dont get all excited about the oxycontin. when its dosed rigt you hardly feel a thing. thats what its suposed to do. to hardly be felt. that will alkso apply to your pain. it will hardly be felt. That is what makes oxycontin so successful. If major pain comes then take a hydro or a perc. I think hydro works better on top of oxy. the patches are good for some but they are also horribly expensive. you might want to avoid those till your bedridden and down for the count. a 10mg oxy in the morn, a couple hydros during the day, another 10mg oxy at nite. you should be good to go from what you are telling me. YOu CAN still get Hydro online but the Rules are changing faster than a good lawyer can keep up with. you CANNOT get Oxy legally here in this country. its available online but its very illegal and VERY expensive. not worth the time and trouble,... Hydro is a class-3 narcotic. ALL forms of OXY are class-2 narcotics and that is a no no online. good luck. i hope your dr can get you on something thats cheap and effective. what more could ya ask for? great post and advice...
_________________________
When the Boogeyman goes to sleep every night, he checks his closet for Chuck Norris.
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#906835 - 07/11/09 03:48 PM
Re: Hydrocodone and Acetaminophen
[Re: stevevi]
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Enthusiast
Registered: 03/20/02
Posts: 260
Loc: Need to know basis
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I just posted this on another thread/forum but it needs to go here too: http://nybc.wordpress.com/category/nac-n-acetylcysteine/The Leading Cause of Acute Liver Disease in the USA? Its not alcohol or hepatitis, but rather acetaminophen poisoning. Acetaminophen, the active ingredient in Tylenol and many other over the counter drugs, can damage the liver when taken in excess. And its easy to over-dose on acetaminophen, if you dont carefully read labels of all the products youre taking. But heres the good news (and its a shame its not more widely known in the USA): there is a readily available, simple antidote to acetaminophen poisoning. Its actually added to acetaminophen in many European formulations of the drug, as a preventive measure. Its called N-acetyl-cysteine, or NAC. Using NAC along with acetaminophen-containing drugs could prevent many cases of liver disease or liver damage in the USA every year. For more on this supplement, see the NYBC entry on NAC, or the easy-to-take effervescent version, PHARMANAC.
_________________________
"They call this war a cloud over the land. But they made the weather and then they stand in the rain and say '$h!t', it's raining!"
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