In the last blog I told you all about the vitamin D deficiency
which many people have now a days but it also seems to go hand in hand with
UCTD.
The first medication to be prescribed is non-steroidal ant
inflammatory drug, ibuprofen being first in line to be tired. When I did not
get pain relief from this, I was put on Hydrocodone. It was already established
from past experience that I was unable to take Voltarol without having immediate
and violent gastrointestinal reaction. I had been given Hydrocodone in the past
for an episode of sever lower back pain and had tolerated it well. This time,
however, within half an hour I was severely dizzy with diarrhoea and vomiting.
Based on this allergic reaction I was left with the option
of ibuprofen or nothing for pain relief as well as reducing inflammation. While
I was to take 800mg thrice in the day, I found that there was considerable
breakthrough pain before the next dose was due. So, I started having 400 mg
every 4 hours and that gave a more even pain relief. The pain levels on a scale
of 1 – 10 always hovered around 6 at the lowest despite the high dosage. The
other thing that comes along with high doses of ibuprofen is its annoying side
effects. This list is as long as your arm but the ones that are most common are
the gastrointestinal issues. They are:
·
abdominal pain
·
acid or sour stomach
·
excess air or gas in stomach or intestines, belching,
passing gas
·
bloating and full feeling
·
diarrhoea
·
difficulty having a bowel movement (stool)
·
heartburn, indigestion
·
nausea and vomiting
·
weight gain.
It can also lead to ulceration in the stomach if antacids
are not taken alongside. Initially, I
was given ranitidine which is a histamine-2 blocker and works by reducing the
amount of acid your stomach produces. Ranitidine also treats gastro -oesophageal
reflux disease (GERD) and other conditions in which acid backs up from the
stomach into the oesophagus, causing heartburn. I was actually experiencing a
lot of heartburn and acidity. For a few weeks 1 tablet twice a day was
effective for me but since I was having the maximum dose of ibuprofen possible,
800mg three times a day, it soon did not
provide adequate cover.
So the next visit to the rheumatologist the ranitidine was
off the list and omeprazole was added on. This is a proton pump inhibitor and
also used to decrease the amount of acid production in the stomach. It is not
to be used for immediate relief from heartburn. This is to be taken once a day.
This was a much better option and for the first couple of months I had this
daily but after that it was to be taken as needed. Once I stopped taking ibuprofen
regularly I also take omeprazole once in a while when I can feel the rise of
acidity and heart burn on the way, after all I take plenty of drugs that
impacts on the stomach. It was amusing to note that side effect of omeprazole
can be muscle and bone pain! Also it does tend to make one constipated so have
the laxatives handy.
A not so common side effect but one I am afraid I have
propensity towards is tinnitus. I developed tinnitus as a young adult and after
extensive investigations it was decided not to have any physical cause. I learnt
all the ways of controlling it and masking the sounds. With such high doses of
ibuprofen, tinnitus came back with a vengeance. The noise can get from a soft
buzzing to actually screaming levels and this can have a serious impact on the
rest, relaxation and sleep. It affects my left ear more than the right and the
noise level can be considerably diminished / obliterated (depending on the
original intensity) if I turn my head to the left. It is a hard position to maintain.
I have to consciously deep breath and relax while I keep my head turned to left
to bring the tinnitus under control. This had to be done several times in the
day and sometimes the noise actually woke me from my sleep.
I went back again to using all the masking techniques – letting
shower water drum on my head, listening to music with headphones, relaxation.
In fact I was tempted to dig out the masking aid that I had somewhere. However
I did know that the aid was set to mask the original lower levels of noises and
so would not be very effective. The
problem diminished once I managed to reduce the ibuprofen intake. Now I still
have occasional tinnitus, which also occurs when I have needed to take
ibuprofen. There is nothing more that can be done but to tolerate it.
When pain levels were considerable it also hinders sleep
which then becomes a vicious cycle of lack of sleep – increased pain – lack of
sleep. For this I was given some amitriptyline which acts as a muscle relaxant,
mild mood enhancer and sleeping aide. While I did not want to get dependent on sleeping
pills I could see the need for breaking the lack of sleep / pain cycle. It does
feel like a drugged sleep and hard to shake off the hangover feeling but the
sleep helped considerably more than expected. Since then I have a supply of it
and use it when pain levels get high and impact on my sleep. I just have it for
3 – 4 days maximum. I have not needed it in the last couple of years as my
symptoms are better controlled.
However, I do have a cycle where I have a few days of
insomnia and manage maximum 6 hours of sleep. This peaks when I feel utterly
exhausted and unable to function. Then it swings around and I just sleep up to
10 hours a day. I think the worst sleepy time I had was about 16 hours in the day.
Now that I know there is a pattern it does not worry me. I go with the flow
rather than force my body to do something it does not want to and get stressed,
as this only makes the matters worse.
I shall the saga of ibuprofen impact here and continue in
the next blog with development of anaemia and new symptom of difficulty in swallowing.
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