Thursday, 20 August 2009

Morphine vs Fluoxetine

I've been wanting to post something about this for days, but I haven't been able to because it's all so confusing. So I thought I'd chew it over, as it were, on here, in the hope that the answer would come to me. Or it would come to someone else and they could tell me.

So, here's the situation:

Ever since I started the morphine, I've still been getting the 'anti-Tramadol' muscle spasms in my back. I thought it was because the 10mg morning dose just wasn't enough to last the day, but even on 20mg, it was still happening. So I started to think the Fluoxetine was inhibiting it, and I moved that to the evening to see if it helped. It did, but then I was so off my face that I could barely remember my name. I talked to my doc about it, and he said it sounded like the morphine was just too much for me, and suggested a different one. His only thought about the back pain was that my back's now really weak from inactivity.

A friend, though, said she'd had similar problems when she'd tried taking Fluoxetine in the evening instead of the morning, and she wasn't on pain meds. So rather than immediately change the morphine, I decided to try putting the Fluoxetine back to the morning, but stagger it and the morphine, instead of taking them together, to see if that made any difference. The first day I had really bad muscle spasms till a couple of hours after the morning morphine, but I wasn't as spaced out (I actually managed to write an article!). The shoulder pain wasn't great though, and I lost most of the morning waiting for the morphine to kick in. I had a pretty bad headache by the evening too.

The second day (today) I took the morphine a bit earlier, though still after the Fluoxetine - the spasms were a bit worse, the shoulder pain was a lot worse, I've been more out of it and I developed a screwdriver headache tthis evening hat required a morphine top-up (so 45mg today) and still hasn't gone. It didn't help that the voice activation software was totally offline today, so I've had to type everything. And I walked further than I should have (will I never learn!).

My questions from all this were:

Why am I still getting anti-Tramadol muscle spasms, even though I'm not on Tramadol?
- Because morphine is also an opiate and that's the cause (hence the second dose of morphine eases it)?
- Because it's actually caused by Fluoxetine inhibiting the pain meds? BUT I had those pains long before I started Fluoxetine - when I tried to stop Tramadol and when I was late with doses

Why am I totally spaced out if I take the Fluoxetine in evening, but not if I take it in the morning?
- Because the morphine is uninhibited and it's wiping me out? BUT it didn't happen from the evening dose when the Fluoxetine was in the morning
- Because of the Fluoxetine itself? BUT I had similar to the zonkage on the immediate release
morphine (which always happened straight after taking a pill, so that was definitely the cause)

I could draw some conclusions, but they didn't actually solve the puzzle:

Taking morphine first thing, with Fluoxetine:
- gives the morphine time to kick in before I get up - better for my shoulder
- means the muscle spasms build throughout the day so they're really bad by the evening
- I have no muscle spasms at night
- I'm less spaced out all day

Taking Fluoxetine at 7am and morphine at 9am:
- means I lose most of the morning waiting for the morphine to kick in
- the muscle spasms only ruin half the day
- I get bad headaches
- I get bad muscle spasms in the night

Taking Fluoxetine in the evening:
- means I get no muscle spasms in the day, but they're bad at night
- I'm off my face all day

I'm a very 'visual' person - I need to see the patterns behind things in order to be able to understand them, and I realised that just writing about all this wasn't helping - all I was ending up with was a list of facts / theories that meant nothing. I needed some sort of visual representation. I've always used Pro/Con lists to organise my thoughts (I am the consumate Virgo!), but there were too many variables here, so it had to be a spreadsheet.

Now I know it sounds supremely anal to be using spreadsheets to figure out what's happening with my meds, but you can laugh all you want, because it worked. I think, I think, I've cracked it:

Morphine makes me zonked, but Fluoxetine can also make you zonked if taken at the wrong time of day; taking it in the evening is a double whammy - Morphine Zonk + Fluoxetine Zonk.

Tramadol is an opiate, just like morphine. The muscle spasms are triggered by my body's opiate-dependence; when levels run low, the pains start (either that or it's actual pain that only the opiates are strong enough to deal with, but I don't think so).

The Fluoxetine affects my body's ability to absorb the opiates (I started it a couple of months before I stopped the Tramadol - I think it contributed to, though didn't cause, the Tramadol failure). If I take them together, I'm therefore only getting partial benefit from the morphine and THAT'S why the spasms are bad until I take another dose. Taking the morphine after the Fluoxetine helps, but the latter's presence, fresh in my system, still limits what I can get from the morphine a couple of hours later.

The net result of all this is:

a) I have to take the Fluoxetine in the morning, so I need to find a way to make the morphine work around that
b) any morphine is an opiate, so the muscle spasms are likely to persist
c) any other type of morphine could be affected by the Fluoxetine in the same way
d) before changing morphine (and getting a whole new bunch of SEs), maybe I should increase the morning dose of what I'm on now, to offset the loss of absorption caused by the Fluoxetine
e) any increase has to allow me to take the Fluoxetine and the morphine together, because losing half the day waiting for the morphine to kick in is not an option; it's much better if I can take it, then get up an hour later when it's already working. Otherwise, I can barely even get out of bed.

And if you think all that sounds complicated, imagine trying to work it out when you're drugged up to the eyeballs!!!

Monday, 17 August 2009

I'm sick of this. I'm sick of balancing pain against mental acuity.

These pills are turning me into fucking zombie, and the pain's still there. I'm an intelligent person and I want my brain back.

Why am I even taking them? Being so off my face that I don't notice the pain isn't a solution.

I've had enough of this.

Saturday, 15 August 2009


I've been on 40mg of slow release morphine for 5 days now, and I'm starting to see a bit of a pattern with the increases. Not only do I have the resurgence of side effects on day 4-5 (am pretty zonked today), but I also seem to get a short (at the moment, anyway!) period of total emotional meltdown. Both when I changed to the slow release, and a few days after the increase, I had a night where I was suddenly completely and utterly furious. Ostensibly, I was angry at ordinary stuff, but really it was stupid little things that in no way merited that level of emotion, and I knew that what was really happening was that all the anger, fear and sadness I'd felt as an abused child was suddenly exploding back into the present. Even the nature of the anger was different; it was a child's anger - unreasoning, uncontrolled and completely without limits. It was a full-on temper tantrum time and the magnitude of it was terrifying!

The first time it happened, I managed it on my own, but this time I had to call a friend because I just didn't know what to do. Or what I would do. It was like this angry little girl inside was suddenly in control, and I had no idea what was going to happen (christ, I sound schizophrenic!). Not that she doesn't have the right to be angry - she quite clearly does - but being suddenly slammed with that, out of nowhere, was pretty bloody horrifying. And just when it seemed like it was easing, then the breathing problems and the panic attacks started...

It all ties in with what happened the last time I tried morphine though. Then, I was having a lot of therapy as well; if this drug somehow opens the doors on old feelings, and you're also having treatments like hypnotherapy that are designed to do the same thing - it's no wonder things went so badly wrong! I didn't find this with the immediate release stuff, though, so whatever causes it, its seem
s to be specific to the slow release stuff.

And as if all that wasn't enough, I'm also investigating another theory at the moment - that the anti-depressants somehow inhibit the morphine and limit its efectiveness. I've always taken my anti-depressant in the morning, and initially I found that the morning dose of morphine that I took at the same time wasn't enough to get me through to the evening dose. I thought it was because it was the smaller of the two, but once they were equal, it was still the same - I didn't really get proper pain relief till I'd taken the evening dose as well. So I've been trying taking the anti-depressant later, to see if the morning morphine works better. I'm only on the second day of the experiment, but early indications are that it does. But then last night I had trouble with the evening dose feeling like it hadn't worked. I can't win.

Monday, 10 August 2009

Steeling myself . . .

Big day tomorrow - upping the slow release morphine to 40mg a day.

Had to top up with immed release on Friday and Saturday, then felt awful yesterday - zonked and spaced and out of it, like the morning's pill was once again reactivating everything else. Should have done the increase today, but needed to be able to drive, so had to delay it.

Not looking forward to this, because 40mg is where the evil depression hit last time (5 days in) and the side effects are probably going to wipe my brain out for a week. I hate that.

But the pain's bad, so I have to do it. Not that I hold out much hope of it helping - pain's been worse this evening since I took the 20mg dose.

Wish I didn't have to do this. Any of it.

Friday, 7 August 2009

Walking a tightrope

Wierd day today - I woke up feeling OK, but noticed when I actually got up that I was feeling really stiff all over, just like when I was on the Tramadol. As soon as I started moving around, though, I realised it was a lot worse than that. The pain was totally off the chart - I've never had that kind of pain getting up before, it's only reached that level during the course of the day. It was all through my shoulder, my neck, back and all across the top of my chest. It was excruciating, I felt like I hadn't taken any meds for days, and I have no idea why. I started to wonder if I'd accidentally taken two of the anti-nausea pills first thing, instead of one of those and one morphine (the only difference between them is the tiny writing on the side), because I've already confused them a couple of times. But it can't have been that, because I started to feel zonked a couple of hours later. So I thought maybe the morphine was just taking a really long time to kick in, but three hours after taking it, the pain was still unbearable.

I ended up having to do the 'topping up' thing, with the immediate-release pills, for the first time.

I was worried about this, given how the stuff was making me feel last week, but the pain was so bad, I had no choice. It took about an hour-and-a-half, but eventually it did start to ease. It didn't last long though - another couple of hours and it was already wearing off. I know I could easily have taken another one, but I didn't want to, so gritted my teeth to get through to the time for taking the evening dose. I made it - and this is the larger of the two doses, so it's helped -but even so I'm getting a lot of pain heading off to bed, so god knows what tomorrow's going to be like.

This is all such a balancing act - I don't want to increase my basic dose yet, because the side effects still haven't settled (though they seem to be improving), but if the pain's so bad that I'm having to take the other pills as well, then I'm going to get those side effects too. So which is worse - more side effects because of a high dose of slow-release, or more side effects because of a lower dose of slow-release plus occasional immediate-release? If I could be sure that the higher dose of the slow-release would work, I'd say that would be better, so I didn't have to go through what I did today, but I can't even guarantee that.

It's like trying to build a wardrobe with no instructions and wearing a blindfold!

Tuesday, 4 August 2009

M-Day 23

New side effect, or rather, existing side effect gone mad...

I've been getting breathing problems since I started taking the morphine - nothing major, just feels like I'm at altitude and the air's too thin. It tends to be worse at night when I've taken the larger dose.

Last night, though, I also had panic attacks. Over and over, it got really hard to breathe and I started to feel panicky - though not about the breathing; I've lived at altitude, so I recognise that feeling and I know it's not a problem. No, this was like being perpetually in the moments just after you've woken up from a really bad nightmare - your heart's pounding, you can't breathe, you're on hyper-alert in case the monsters weren't just in your head . . .

I had this once before, that night after I increased the dose to 30 on the immediate-release stuff, but it didn't last nearly as long. This just went on and on, all night. I tried putting the light on, reading, doing puzzles, watching TV, nothing worked. And as soon as I stopped concentrating on something else, it happened again.

I'd already not been able to go to bed till 1am because the damn stuff was making hyper, and then this.

Oh, and I nearly broke my toe at the weekend tripping over a footstool - it's now all swollen and blood-blistery (my toe, not the footstool!). And yesterday I burnt my hand on the oven . . .

Monday, 3 August 2009

Morphine - day 22. Or is that day 4?

So, a few days after my last post, exactly what I was afraid of, happened.

I posted the day after I increased the morphine to 30mg, and I was having these horrible ‘shut down’ moments, where I was feeling completely zonked and just seemed to ‘switch off’ in the middle of things. It was happening at fairly unimportant moments, but I was worried it might happen when I had the gas hob on, or was in the car or something.

The first couple of days after the increase weren't nice, then things seemed to improve. But then all hell broke loose.

Four days after the increase, I was so zonked after taking the first pills of the day that I couldn't even get out of bed. The next day I thought I was doing better - the zonked feeling seemed to be wearing off - but 2 minutes into a conversation, my friend told me I sounded really drunk. Things went downhill from there - I started feeling more and more out of it and decided it would be best to wait a while before trying to get to the office. When I finally went out to the car 2 hours later, I felt like I was fairly OK, but two minutes into the journey I realized that I really wasn't; the ‘shut down’ moments were happening again, whilst I was driving, only they were worse - I was completely 'blanking out', then suddenly realising that I was in the car! It was terrifying! Obviously I turned round and came straight home again, then spent the next 4 or 5 hours feeling like I was on a completely different planet.

It seems like each time I took one of these immediate-release pills, it reactivated all of the morphine that was already in my system; every pill I took, the worse I felt. It was like the dosage was way too high for my body, but not nearly high enough to actually do the job I was taking it for, and kill the pain. Either that, or I have some weird 4-day-side-effect problem, where things get really bad 4 days after I increase a dose. (It was 4 or 5 days after an increase that everything went so bad the last time I was on morphine.) I thought if it was a side effect thing, maybe it would pass, but when I spoke to the doctor we agreed it would be better to change onto a slow-release morphine, just in case.

So now I'm starting all over again, on the same stuff as certain high-profile celebs who shall remain nameless . . .

So far (4 days in . . . ) the zonking isn't as bad as on the old stuff, but I did have to delay going to the office by two hours today because I wasn't safe to drive. I'm still taking 30mg (10 in the morning 20 in the evening), but I'm having a really hard time because the 10 isn't enough to get me through the 12 hours it's supposed to last. It was fine over the weekend - I could just take the morning dose a couple of hours late, then carry on sleeping. That didn’t work today though, because it turns out that it does still make me very zonked, about 1½hr after I take it; not a problem when I'm lazing around in bed, but very inconvenient when I’m trying to work! So I need to take it at the right time in the morning, but that means I'm going to have several very unpleasant hours in the evening before I can take the next dose. Unless I ‘top up’ with the immediate-release stuff, which the doctor told me I could do. But I really don't fancy that, given the problems I’ve have already had!

Of course the other option is to increase to 20mg twice a day, which I'm planning to do eventually, but I was on 40mg when the awful depression hit last time and to be honest I don't want to. I will get there, but I just need to take my time, because if it all goes wrong like that again, I don't know that I have the strength to try it a third time.

One thing, though, I really and truly do not get, is why people do this for fun . . . I think I'd sooner stick spoons in my eyes.