Thursday, August 20, 2009

You get on my nerves! A visit to the neurologist.

So Wednesday I had a visit with my mom's neurologist. The thought was that, since he's familiar with the family's history of chronic pain, he might have some clearer insight into my problems than my other doctors have had. According to mama he's also just a really good doctor - he's helped her a good deal with the nerve pain she's had ever since her radiation treatments sixteen years ago. I actually made the appointment before my health had taken this recent turn, and was increasingly glad that I had made it as things progressed in the weeks approaching the trip to New Orleans.

Well, I had a decent talk with the good doctor. I explained to him what's happened over the past eight to nine weeks, which perhaps I haven't properly explained to you. So now I will. Doctors are always asking you to put your pain on a scale of zero to ten, zero being "no pain at all" and ten being "I can't get out of bed I'm in so much pain". Well, this is a rather hard thing to do, because at its core it's asking a person to quantify something that is essentially qualitative. But after thinking about it for eight years or so, I think I've got a grip on it.

I estimate that my everyday, know how to deal with it, it's there but I can function pain is at about a 3. Sure I get stabs of other things throughout the day, but the constant is about a 3. We can't throw headaches into this because they're a whole other ballgame; we're just talking body pain here. OK. So what seems to have happened is that, for whatever reason, I've popped up to a 4 as my baseline with much too regular bouts of 5 or 6, and isolated but frequent incidents of 7, 8, and 9. This is what we like to call "borderline debilitating". I can't live like this.

So I explained all this to the doc. We talked about my migraines, and he thinks that the 100mg of Topamax I'm on for them is fine. It's a low dosage. He doesn't think I should ever be on any more, though, because it may start to cloud my thinking, and "especially with the work I do" that wouldn't be good. Um yeah. He also thinks that if I can stretch more and get the muscles of my neck to stop being made of rock, it will help. Muscles affect nerves too. More on that in a minute.

He was surprised that I'm on as little medication as I'm on, and I explained that I don't like taking pills unless I absolutely have to. I told him that I have Flexaril for when the spasms come, and he chimed in that but of course I can't take it all the time because it would make me too fuzzy during the day. I mentioned the anti-inflammatory that I sometimes take, "But that will upset your stomach" he said. Yes, exactly. They tear the shreds out of my sensitive tummy.

I asked him if he thought I should be on any medications specifically for nerve pain, and he said no: what I need to do is stretch and get my spine loosened up. I'm having nerve pain because 1) the muscles around my vertebrae are so tight that they're compressing the spaces between the bones causing those bones to put pressure on the nerves, and 2) the muscles are tight enough to inflame the nerves all by themselves. Now, I've long thought this to be true, so it's really interesting to have it come out of the mouth of a neurologist. He believes that by stretching (and he's right, I don't) I can relieve some of it.

I asked him about this damn Lyrica drug, which my mom is on and I recently discovered is an anticonvulsant just like the Topamax. He said that yes, it might help with the pain a bit. But that it would also likely cause me to gain weight and to retain water in my feet and hands - all of which would worsen my condition. Basically he said that it's not the right drug for me, so I'm glad I asked him. Many doctors will just say, oh you want that one? Sure we'll put you on that one. This is not a good thing.

He suggested that I look into the two other drugs that have been "approved for use with Fibromyalgia". People think that they are antidepressants because they work on neurotransmitters, but luckily I've taken plenty of biology. Sure, serotonin affects mood. It also governs little things like sleep, muscle contraction, digestion, and the perception of pain. So it makes perfect sense to me that adjusting serotonin would help with dealing with Fibro.

Both of these drugs, Cymbalta and Savella, are in a new class of drug being called Serotonin and Norepinephrine Reuptake Inhibitors (NSRIs). Basically they convince your brain to keep more serotonin and norepinephrin in there than it normally would. This is similar to a class of drugs that's been around for a while called Selective Serotonin Reuptake Inhibitors (SSRIs). I've been on a drug called Wellbutrin for about five years, and all this time I've believed it to be and SSRI. I guess I never did my homework, which is quite unlike me really. It's actually in an entirely different class of drugs and works primarily on dopamine, and has little effect on my serotonin levels. So really all this time I thought I was boosting my serotonin when I wasn't. Annoying! The good news though is that I could add a low dosage of one of the NSRIs to my regimen without changing the rest, which is what I suspect we'll do.

I go see my doc next Monday. I'm nervous. I want this to get better.

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