THE FROG AND ME

My oldest brother took me out to the woods today. He was going to be hunting deer while I brought a camera and a video camera. I’ve never been much of a hunter. I was stationed in an elevated shooting hut while my brother was in a tree stand about a hundred yards away. I climbed the stand and opened the door. One of the first things I noticed was a little tree frog on the back of a chair. I moved the chair to a better position but just left the frog alone. Soon though, he was on the ledge of one of the windows. I took its picture.

Just sitting there is what I did for several hours. Time passed by quickly though as I watched for deer, looked through binoculars, did some texting, and just sat and thought. My brother said, “He does his best thinking in the shower and tree stand: The tree stand uses less water.” That kind of applies to me too. The serenity of being out in the woods is amazing. It gave a lot of time to just sit and think. At times I just sat there and looked at the frog on the ledge.

Soon the sun went down but I hadn’t seen a single deer. It was time to pack up and head back. I guess the little frog had to leave too because I checked on him just before I climbed out of the tree stand. He was gone. My brother drove the four-wheeler with me on the back through the paths in the woods and then on the dirt roads back to the car. It was a great afternoon chatting with my brother and being in the shooting hut for several hours with just the frog and me.

DUAL ENROLLMENT

Our youngest daughter is a senior in high school. She plans on studying business in college with a specialization in finance. During her high school years, she has taken some Dual Enrollment classes which are college classes which give both high school and college credits. Having been preparing for college through high school, she has not only taken several college classes but she has fulfilled all her high school requirements a semester early. Therefore, she has decided to take a full load of Dual Enrollment classes at a local college for her spring semester of high school.

The good thing about Dual Enrollment classes is that it is funded through the high school. Therefore, there isn’t additional cost to the student/parents for the classes or books. Again, the classes are actually college classes so they count both for high school and college. The dual enrollment college classes our daughter will be taking this spring are College Chemistry, Economics, Accounting, Statistics, and Psychology. She’ll have her hands full but she is a hard worker.

Our daughter’s choice to take dual enrollment classes will save her time and money in college. After this spring semester, she will have 43 semester hours of college credit upon graduation from high school. That’s just a strong semester worth of credit hours away from having completed her first two years of college while in high school.

BRIGHT FUTURES

Many state lotteries have sold themselves by advertising that they fund education. Of course what usually happens is that monies made by the lottery are offset by other cuts to educational funding. So, rather that the lottery being a big boon for education it is really a boon to the general fund. Nevertheless, Florida is one of the states that decided to use some of its lottery money to fund a special scholarship program called Bright Futures. It’s one of the few non-needs based scholarships left; it’s achievement based. Originally if a high school student attained a certain grade point average, scored high enough on the ACT/SAT, and did a prescribed number of community service hours, then Bright Futures would pay either 75% or 100% of in-state tuition, depending on the respective achievements. At the 100% achievement level, $300.00 of book expenses was covered too. Those were the guideline when our three oldest children began college. Now things have changed.

A few short years later as our youngest child is about to begin college, the 100% level has dropped to 56%. The 75% level has dropped to 42%. The funding has dropped almost 20% in the last year. It’s not a case that the lottery business in Florida is hurting. Once again the state’s general fund is siphoning off money that was intended for education. It’s hard to trust legislators with finances.

THE DOCTOR’S CALL

I thought about not giving the letter to my family doctor and just wait to talk to him at my appointment in two weeks. I decided that I can just tough it out until then. However, as the weather began to turn again, I decided I better stop being relatively passive about my arm and force something to give. So, after going to Whataburger for coffee with a friend, I drove to my doctor’s clinic and gave the letter to the receptionist. I asked that she makes sure that my doctor gets the envelope. I had put the letter in an envelope with his name on the outside. I wrote “personal” at the bottom of the envelope and underlined it with a yellow highlighter. I then went home to await a call from his office. I don’t imagine he’ll get a chance to see it before lunch so I’ll make sure I hang around the phone until after the lunch hour. If they don’t call by then, it could be later in the afternoon…if at all!!

So, I started this blog post while I wait for the call. While I’m waiting, I want to share part of a conversation I had with our oldest daughter yesterday. She commented about me referring to Gabapentin as my “suicide” medication. She reminded me that I raised them on positive concepts and didn’t tolerate possible negative self-fulfilling comments or thoughts. I laughed when she said that as I thought, “Hey, maybe some of that stuck with the kids after all!!” So, I told her that she was right and that I wouldn’t call Gabapentin “suicide” medication any longer. The point is that if I have to actually take Gabapentin, it’s not a good thing to have programmed my mind that it is “suicide” medication. I suppose I should practice what I preach!!

Okay… I waited by the phone until after the lunch hour. Then I left the house for about an hour. When I got back there was a message on the answering machine from the doctor’s office. I called back but got the voicemail. Later in the afternoon the doctor’s nurse called again. She assured me that the doctor had responded to my phone message but apologized that the office dropped the callback. She said that she was out of the office that day and the next several. The doctor had given the substitute nurse his directions for me. She didn’t follow through in calling me. The nurse again apologized and said that if I ever have any questions to ask for the direct line to her; don’t leave a message with the message center. Then she got down to what my doctor wanted me to do. She said that the doctor wants me to follow the neurologist’s recommendation but come off the Tramadol and Lortab slowly. She said that the doctor himself has taken Gabapentin and was confident I’d tolerate it fine. Since I already have an appointment in two weeks he’d check with me then, unless I develop problems with it. I told her that I was already off the Tramadol and Lortab for a week although I might decide to take one now and then if these withdrawal symptoms don’t go away. The nurse reiterated that the doctor wants me off of it so not to use it too often.

Now I wish that I hadn’t been calling Gabapentin “suicide” medication!! I’ll suppose I’ll probably start taking them once I get my mind right… because I need to do something.

THE SAGA LIVES ON

As you’ve read my last several posts about my medications, you probably think the discussion has run its course. Not quite so fast. Until I get my medications settled, I’m likely to have plenty to say yet!! As I still endure some of the effects of coming off not only Tramadol and Lortab, but coming off both at the same time, I’m not very happy with the way this has transpired. Similarly, I’m not happy to be facing this colder weather without some help. So, I blog on about the culprits in this situation.

First of all, the neurologist: He knew that I had been taking both medications for years. For all he knew, I was desperately taking maximum doses instead of minimal to moderate dosages. If what I’ve been going through in the form of withdrawal is any indication, God help those who are heavier users trying to go off the stuff. Anyway, it sure would have been nice if the neurologist would have warned me or offered me some help. I suppose he didn’t think I’d give the narcotics up, so he didn’t bother. I hope that isn’t the case but I have little else to explain it. I don’t know whether I feel abandoned or like I was sent to slay a dragon with a pea shooter. Meanwhile, I still have my unused “suicide” medication sitting next to me. For new readers, that is what I call the Gabapentin that I’m supposed to take two tablets of three times a day. The reason I’ve labeled it such is because the warning on the medication says: “You should know that your mental health may change in unexpected ways and you may become suicidal (thinking about harming or killing yourself or planning or trying to do so.” Calling it “suicide” medication might be a little too uncharacteristically negative of me, but right now I’m not sure I’d take a Milky Way candy bar if the neurologist prescribed it!!

Secondly, there is my family doctor’s office. I’m still giving the doctor the benefit of the doubt and presume the communication problem is in the bureaucracy of the office. However, I know this kind of poor communication happens to a lot of people and doctors shouldn’t tolerate it from their staffs. As life often presents itself, I have an appointment with my family doctor in two weeks. We’ll have a nice chat then. Meanwhile, if his office would have answered my questions about me going off the Tramadol and Lortab, and going onto Gabapentin, I could have been spared my “cold turkey” drama. Since I followed the neurologist’s admonitions while waiting to get it confirmed by my family doctor, well, I had some unnecessary troubles. Surely, my doctor would have helped me come off them correctly… if he agreed for me to come off them at all. It’s too late though; I’m not inclined to go back onto them until and unless there’s no other way.

Thirdly, there is myself. When things were getting a bit tough, Eileen suggested (several times) that I take a dose to help ease the pain in my arm and the withdrawal. She didn’t use the word “withdrawal” and the word never really entered my head until I was through the worst of it. I suppose it is because the arm pain and stomach pain can make me rather ill. I wish I would have thought of and researched “withdrawal” much earlier than what I did. As usual, I should have listened to Eileen instead of finding a fine time to follow the neurologist’s directive: “Stop taking the Tramadol and Lortab.” Nevertheless, it shouldn’t be left to patients to research and double check their doctor’s pharmaceutical advice. I instinctively don’t like taking medications and I guess I was a bit jubilant in the opportunity to get rid of two medications that were adversely interacting with each other while adding one that didn’t interact adversely with any of them. Only later did I find out what it was that the neurologist wanted me to take instead… and what going off the medications would be like.

Well, life goes on but prescription drugs are pretty serious things to be inattentive about. Chalk it up to another lesson learned at the hand of my doctors.

UPDATE: After another rough night, I decided to write a letter to my family doctor. Tomorrow morning I’ll deliver the letter his office. It’s a very gentle letter as I continue to give the doctor the benefit of the doubt, but it makes the point. I’ll let you know what happens.

DRUG ADDICTION

With great interest I read the article by John Roberts, “Report: Prescription Drug Deaths Skyrocket.” The article said, “In 2008, the most recent year for which there are statistics, there were 20,044 overdose deaths from prescription drugs. Of those, 14,800 were from narcotic painkillers.” “It’s astonishing”, says Dr. Frieden. He adds that many addictions begin innocently.” “Despite modest inroads, CDC researchers say the epidemic of prescription narcotic overdoses has continued to worsen. In today’s report, they caution doctors to only use narcotic painkillers in patients who are carefully screened and monitored, and for whom non-narcotic medications are insufficient.”

There are a lot of people who have terrible pain and they don’t really care if they are addicted to the pain medication or not, as long as they get some relief. However, I’m sure they do care if they die from overdosing because the addiction requires more and more to get the same effect!! I’ve had my share of narcotics and narcotic-like drugs, but I’ve never been to the point where I craved more and more of them. It’s probably because I despise them so much that I’ve taken as little as I could. Nevertheless, coming off my pain killers has not been delightful. Knowing what I know now, I’m sure there was some sort of physical dependency. I wish the neurologist would have given me a little more guidance in coming off the Tramadol and Lortab since I had been taking them for years. Earlier today I read:

“Tramadol withdrawal can be extremely unpleasant. It can be so uncomfortable that people start taking the drug again in order to relieve these symptoms. In order to limit withdrawal, you should not stop taking Tramadol "cold turkey."’

“Even when Lortab is prescribed and used in the correct way, stopping the medication will still involve withdrawal symptoms.  Recovery from these withdrawal symptoms, takes effort and time, and is best done at an outpatient detox facility. The dependence makes it very difficult to stop or dramatically reduce the dosage, due to the occurrence of traumatic Lortab withdrawal symptoms.”

That information might have been useful before I went through the heebie jeebies, cold sweats, palpitations, lightheadedness, shakes and such!! Thank God I have a determined (stubborn) streak!! I’m pretty well over it now but my system hasn’t totally calmed down yet. What’s worse? Although I’m going to give Advil and perhaps the “suicide” medicine a chance, I could be back on Tramadol and Lortab if this is a rough winter. When things get bad enough, addiction is only a problem if you can’t get enough medication or it makes you dysfunctional. It’s too vivid of a memory for me of when I’ve been in situations when I wouldn’t have much cared about being addicted if that is it took to get some arm relief. Having said that… I will endure a lot before going back on them. The above mentioned article is a little scary.  I would be sorely disappointed in myself and my role as a husband, father, and grandparent if things progressed to the point that I lived the life of a drug addict.

PILLS AND A FOOL

Here I still sit waiting for my doctor’s office to return my Thursday call. I say that facetiously as I know they won’t call back. I’ve likely been lost in the bureaucracy that separates doctors and patients. Somewhere in their office are my unanswered questions of what I’m supposed to do with these medications. If the actions I take with these medications are really that important then surely they would have called me by now. Ha, ha!! I might call them again; I might just figure it out myself.

Ever since the neurologist advised me to stop taking the medications I was on, in lieu of the one he wants me to take, I’ve been withdrawing myself from them. I use that word “withdraw” because my body has not liked being without the addictive pain medications it has had for years. So, as my body is getting cleared of those medications, I’m now only taking Gleevec for my leukemia and the anti-nausea medications. Well, that’s all the prescription medications I’m taking. Left to my own ways, I’ve relied on an old friend a few times.

Throughout the years, I’ve been on some incredibly powerful pain medications including Oxycontin and other narcotics. They have only been marginally successful in helping with my arm pain. Oddly and weirdly enough, the medication that has helped me the most is little ole Advil. There is something about my chemistry and Advil that helps. It can often take the edge off the pain and help me get to sleep like nothing else I’ve taken. Nevertheless, on the advice of my pharmacist, I stopped taking Advil over two years ago.

When I got my first oral chemo prescription for Gleevec, the pharmacist said that I absolutely can’t take Advil, Tylenol, or Aspirin while on Gleevec. So, I stopped. My most effective agent to help manage my arm pain was stricken. Well, when the neurologist gave me the paper with the list of all my adverse drug interactions, I noted the website he used. At home, while waiting for my family doctor to return my call, I got on the website.

At this website, the drug interactions are classified as Serious Interaction, Significant Interaction, or Minor Interaction. With the concoction I was on, I had nine drug interactions: One “Serious,” four “Significant,” and four “Minor.” When I took out the medications that the neurologist wanted me to stop taking and added Advil, I’m left with zero “Serious Interactions,” zero “Significant Interactions” and three “Minor Interactions.”

Checking other drug interaction sites, they all said that Advil “Moderately” interacts with Gleevec and to monitor usage closely. Even then, taking Advil with Gleevec would leave me with two moderate interactions compared to two Major and five moderates. The problem is that Gleevec has interactions with more than 300 other medications. It’s hard to find something to go with it. By the way, the drug the neurologist wants me to take does not interact with Gleevec. It just makes one suicidal and everything else!!

Having one website say that Advil interaction with Gleevec is “Minor” while the other websites say the interaction is “Moderate and must be monitored,” I decided to call my oncologist’s, Dr. Tan, office. He may not be willing to sort through the medicinal mess between the neurologist and family doctor but he will tell me whether I can take Advil with Gleevec. I called my “Patient Navigator” at Dr. Tan’s office and left a message. She called me back ten minutes later to tell me that Dr. Tan was out of the office. She said she’d call me back as soon as she gets in contact with him. I think she will.

I very well know sayings such as, “A doctor who treats himself has a fool for a patient.” In this case though, the Fool might be on to something!!

Update: Dr. Tan’s office called and he said that Advil makes Gleevec stay in my system longer than recommended. He said I “can take Advil but take it sparingly.” Well, “sparingly” is not what I wanted to hear.