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toe
Pooh-Bah
Reged: 10/09/02
Posts: 1422
Loc: MidWest USA
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I'm going to admit to a big no-no. I am going to paint stripes on the white elephant standing in the living room. Does anyone ever actually acheive relief-as in the smiley faced 1 on the stupid pain scale-from taking their meds as prescribed? I have a hard time believing anyone who makes such a claim.
Most of the time I drag along on the schedule trying to remember if it's been 6 hours since I took Med A, 4 hours since I took Med B, 8 or 12 since I took this or that. (I have a sinus infection right now, so there's a couple of extras in there). I watch the clock, count the minutes until I can make a little dent in the pain again. Most of the time.
But I admit, here, before you and god and dog and everyone, that once in awhile I can no longer stand to watch those minutes drain away my life and I take enough medicine so it doesn't hurt anymore My tolerance is such that this means taking, uh, many, pills. 2 or 3 days' worth at a time. And then, only then, can I bend my knees without pain, fool around with my partner, fathom getting our new apartment unpacked and decorated. I can give her a good, long massage, like I used to be able to, I can move things and lift things and squiggle around. The icepacks stay in the freezer, the heating pad stays (wherever it was that I sent it to punish it after it gave me 2nd burns on my back after falling asleep on it) crutches stay in the back of the car, the TENS unit has only itself to tickle and my backbrace has camoflauged (sp?) itself amongst my socks and underwear.
Well, I did that once for 2 or 3 days with hydro. Eventually it was totally impossible to ignore the edema- my ankles are nearly as slender as my wrists, and my anklebones were invisible. Arggh, I know edema.
I was also on morphine. And when I went in to see the doctor, he said he could really only attribute it to one thing- (because he only knew about) the morphine. I was a little surprised that such an effect would appear after I'd already been taking it that long, I said, but that's one of the reasons I want to try some of the other medications like duragesic or methadone. He replied that the same reaction would probably pop up with any opiate I took.
I was just wondering about that today and my PDR isn't unpacked, but I'm pretty sure the edema was caused my personalized regimin of hydro pain management, not by the morphine I was taking pretty much by the book. We all KNOW that different opiates have differing degrees of side effects. 200mg codeine might produce the same analgesia as 20mg of hydro or oxy or whatever (I'm making this up as I go along), but the codeine will make you itch a LOT more (not making that up).
Anyway, I'm just wondering who here has experience or knowledge of opiate edema and can compare. Now I get paranoid every time I imagine my feet look swollen. I'm wondering if this is something I'm going to have to be on the lookout for or if this is one of the secret signs PM docs look for: "4/16/03 Patient has fat ankles but denies misuse of medication."
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"It's the end of the World as We Know it. . ."
-REM "and I'm seeking asylum in Canada"-toe
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antique
Banned
Reged: 09/01/03
Posts: 215
Loc: east coast
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I know nothing about opiate edema, but I'll bet - judging from your posts - that you know about fluid pills. You might just want to take one the day before. Might work.
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Stacy
Enthusiast
Reged: 11/15/02
Posts: 245
Loc: USA
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Do you ever get kidney stones? It NEVER fells, about week before I have serious pain from a kidney stone, my feet and ankles start swelling. That is with or without hydro. They never swell other times when I'm taking any pain meds.
Also, my mother and my aunt both have a lot of swelling in their feet and ankles and neither of them take any pain meds.
It could be from something else, but if you want to know tonight if it is a side effect of morphine or hydro, why don't you call a 24 hour pharmacy and ask the pharmacist?
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actonbell
Journeyman
Reged: 09/08/03
Posts: 82
Loc: Oklahoma
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Look up congestive heart failure/pulmonary edema in google, Toe. It has been a few years since I worked in the hospital, and I never had to deal with anything called "opiate edema" but I did have to deal with chf suspected from opiate overdosing. The hydrocodone combined with the morphine may have caused this. And then of course there is the apap which we all know is not really all that safe.
What did the doctor suggest?
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All it takes to fly is to hurl yourself at the ground....and miss.
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yawkaw3
Pooh-Bah
Reged: 03/22/03
Posts: 1193
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Peripheral edema (edema is a kind of fluid retention, just for everyone's reference) like you describe can be caused by so many other drugs, there's no way a doctor is going to suspect you as a substance abuser based on opiate use alone. NSAID's, which I assume you're taking too, can also cause this. Same goes for certain psych meds. Some hormone meds can cause it as well. Some medical conditions cause it too, so it is difficult to say what caused it.
As long as your doctor is aware of it, you'll be fine.
And congratulations to you and your partner, may you enjoy many happy years together.
-yawkaw
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toe
Pooh-Bah
Reged: 10/09/02
Posts: 1422
Loc: MidWest USA
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Okay, first thank you all for responding. I'll try to respond in order:
First, my doctor prescribed a diuretic to be taken every day for a week (or more, as needed) It took awhile, but these DID work.
Second, wow, I certainly hope I don't have stones. I don't believe there's a realtive trend in my family of this problem. Of course, if there's anyone to pioneer into new and more painful trouble, it's me.
Third: I was actually just talking about the water retention which causes the dependant extremeties (in this case,my ankles and feet) to swell with water, sometimes to the point where you can poke at them and an indent will remain for awhile. Because of chemical imbalances, anorexics in the beginning stages of recovery will often get severe edema. Pulmonary edema is a whole different ball game. . .I know I've read and heard quite a lot about it from reading adventures magazines and from my father, who likes to fly to distant continents and climb various mountains. For that reason I've always thought of pulmonary edema as attributable to extreme changes in air pressure and oxygen density, although I guess there maybe some people who get pulmonary edema sitting in front of the TV.
Thinking about it, I realize that high levels of codeine (beyond the "ceiling" for analgesia) had caused my hands to swell many times, but this always went away after the drug wore off. I bet this is tied in with the difficulty in urination the is a side effect of most opiates? Since you can't pee it out, it just trinkles down and starts filling up your extremeties as if pouring water into a latex glove. And you're right- it certainly seems like the sort of thing that would indicate poor kidney function.
It's just so frustrating. . impossible to put on shoes, for instance. I am not having this problem right now, but now I know I'm prone to it. It wouldn't be a problem if I could get the strength and dosage of meds that I need prescribed, but isn't that the refrain to every tune we sing here?
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"It's the end of the World as We Know it. . ."
-REM "and I'm seeking asylum in Canada"-toe
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Beetlenut
Threadhead
Reged: 09/09/02
Posts: 764
Loc: Colorado
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Quote:
Third: I was actually just talking about the water retention which causes the dependant extremeties (in this case,my ankles and feet) to swell with water, sometimes to the point where you can poke at them and an indent will remain for awhile.
Hey Toe:
That's called "Pitting Edema."
"Less common or rare side effects of opioids may include:
Allergic reactions, anxiety, blood disorders, constipation, decreased mental and physical capability, difficulty urinating , drowsiness, fear, hearing loss, itching, mental clouding, mood changes, restlessness, skin rash, slowed breathing, sluggishness."
Found at
http://www.ichelp.com/FeatureArticles/ICAndPainPartOne.html:
Possible Side Effects of Opioid Medications: constipation, nausea, itching, edema, sedation, possible respiratory depression.
However, the drug information that is sometimes enclosed with my Norco states that "...you should call your doctor immediately if you have swelling of the face and hands while on Norco..."
My PDR is packed away also...
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Jeremiah
Agape GrandParent
Reged: 07/14/02
Posts: 705
Loc: U.S.A.
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Quote:
The hydrocodone combined with the morphine may have caused this.
I have been following this thread because recently since being discharged from the Hospital,I have experienced the same thing. 3+ pitting edema in lower extremeties. Since my Mom died of CHF secondary to CVA,I have been very concerned.
I was on Morphine IV, 5migs q4, for 4 days. Once discharged,the next day I began my opiate therapy,and that night noticed the beginning of distal edema around the ankles which progressed to lower calf/feet within a 24 hr period. I had begun some new medication,yet after research,found this
should not be the cause. The edema lasted for approximately 7-8 days,then,Poof~was gone,not to return as yet.
Actonbell,I would like to thank you for submitting your knowledge to Toes thread. As soon as I read your post,a light went off in this old brain,and now I understand why I had edema. Thank You!
Toe,I cannot add any insight to the info posted already,so please excuse me for butting in. Personally, I would trust this posters data(Actonbell) as she certainly knows medicine.
J.
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I can't see me lovin nobody but you,for all my life
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toe
Pooh-Bah
Reged: 10/09/02
Posts: 1422
Loc: MidWest USA
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jeremiah- it sounds like you had exactly what I had.
The warning about swelling usually refers to a severe allergic reaction. Your eyelids and upper lip swell, and your throat may begin to swell shut. I've had this before. It was caused by naproxyn. Fortunately, my throat did not swell shut, I just got huge hives all over my body and the the other two symptoms. But it was bad enough that when I went into student health care, they gave me the shot as well as a steroid taper and atarax.
I'm pretty sure that CNS failure is a symptom that is less frequent in patients who fall into the "opioid tolerant" category. Or, of course, in people who happen to be allergic to a substance. . . a tylenol 4 could send a person who is allergic into heart failure. But I'm not allergic, nor am I opioid "naive" at 180mg of MS Contin a day-my blood pressure dips slightly below normal when the dose goes up,
but afterwards it always returns to about 115/75.
So it sounds like someone found the info, edema is indeed a side effect. Normally I would go straight to the PDR with such questions, because I just don't find internet sites to be all that comprehensive.
Thanks for your input guys.
Now I am just wondering if someone knows whether there is a connection between the difficulty in urination and the (one time incidence) of edema?
Doctors? Pre-doctors?
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"It's the end of the World as We Know it. . ."
-REM "and I'm seeking asylum in Canada"-toe
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Jeremiah
Agape GrandParent
Reged: 07/14/02
Posts: 705
Loc: U.S.A.
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Quote:
The warning about swelling usually refers to a severe allergic reaction. Your eyelids and upper lip swell, and your throat may begin to swell shut. I've had this before. It was caused by naproxyn.
Toe,
We appear to have quite a bit in common. I am deathly allergic to any form of NSAID,anaphalactic shock. Same here about steroid and immediate epi the first time. Now I carry an "Epi-Pen" and have a life time supply of the MedPaks,prn refills.
I would agree,you're CNS certainly isn't opiate naive at that dosage. Having been trained only in emergency medicine, I do not have the depth of knowledge or experience as many posters here,but do you think the MS and Norco combination could have caused the edema? I'm not sure about urinary retention,but it sure sounds tied in somewhere. Since this was a one time incident,it would make sense to me the fluid edema may have temporarily caused urine retention,the body has a way of 'over-compensating' when it comes to a fluid imbalance.
This is a good question...Anyone?(sorry guys)
J.
EDITED TO ADD: You know what,Toe? Now that I think about it,which I didnt at the time,I Did have some urinary retention the first few nights home. Normally,I am up 3-4 times during the night,but I wasnt a couple of nights.Wrote it off as being 1)having had decent pain relief for the days inhospital combined with 2) ability to sleep undisturbed throughout the night(you know how they wake you every 3 hours practically for something or another)and 3) being in my own bed at home.
Inhospital I had the Foley Cath,so I wasnt aware of it,but sure enough, I went at least 3 nights without getting up to urinate,and this was in conjunction with the pitting edema.
Waalah~By Golly, have we solved it? Could it be?
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I can't see me lovin nobody but you,for all my life
Edited by Jeremiah (09/19/03 09:31 AM)
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toe
Pooh-Bah
Reged: 10/09/02
Posts: 1422
Loc: MidWest USA
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Quote:
do you think the MS and Norco combination could have caused the edema?
Yes. Thinking back to the experiences I had with high amounts of codeine, it seems that edema is a side effect that I get when I have to take several times the recommended dose of a med in order to get relief. I don't think the normal use of morphine had anything to do with it, really. It was the fact that I took quite a high dose of hydro.
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"It's the end of the World as We Know it. . ."
-REM "and I'm seeking asylum in Canada"-toe
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Jeremiah
Agape GrandParent
Reged: 07/14/02
Posts: 705
Loc: U.S.A.
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I agree Toe. Higher than usual dosage can cause pitting edema.Edema is a known side effect.
Normally,I try to stay on track,but I sure know what you mean about those days that the norm doesn't cut it and I have to double(practically) my usual dose of hydro.
Interesting, I have done this for years and never experienced the type of edema which occurred. For me, it makes sense the combo morphine/hydro was my culprit as I don't take MS on a regular basis. Sometimes the ER,but even they dose me with Demerol IV to break the pain cycle so I can get a grip on it again.
Admittedly,I should go to a PM Doc because the hydro doesn't work as well the more my disease progresses,yet it is my desire(if I can hold on long enough) to save the Mack Daddy meds for later when the hydro will not touch the pain at all.
Those days are becoming more frequent however.
I'm glad you figured out your edema,sure hope it doesn't appear again.
Take care and as always,Best Wishes,
J.
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I can't see me lovin nobody but you,for all my life
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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I've been on STRONG opiates for almost 20 years and have never experienced edema. Itching, nausea, constipation--yes, but never edema. Just my experience.
Regards!
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Never underestimate the predictability of stupidity.
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