Friday, November 03, 2006
A week and a half after my last visit, the pain clinic finally called with my new med instructions. Apparently, they'd been playing phone tag with another of my posse of health professionals. I was pretty sure that was the problem, but I resent that nobody saw fit to tell me that. I called them a half a dozen times, but couldn't get a status report until just this morning. In my profession, if I told a client I was going to take a specific course of action, but failed to do so and failed to explain that to the client, I would be subject to professional discipline.
Anyway, the plan is this: 1) stay on 40 mg Cymbalta, but try taking in the morning instead of bedtime; 2) add 10 mg of amitriptyline at bedtime, increasing by 10 mg/week up to 30 mg; and 3) decrease to 300 mg of Serzone now, then drop by 50 mg per week until I get down to 200 mg. This is all to get me better-quality sleep at night (the amitriptyline is supposed to help with bladder stuff) and to ensure that I don't develop serotonin syndrome. If it goes well, then we can talk about increasing the Cymbalta to further reduce the pain.
Initially, I thought, Wait, this plan looks like gives more weight to helping me sleep than it does to actual pain relief. But then I remembered how last nite I got up to pee 8 times and how, when the alarm went off a 6:15, I just about cried. So I think maybe it's just fine if we're focusing on sleep first. It certainly seems at this point like it might be the easier problem to solve.