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Saturday, December 10, 2011

Nerve Pain: Email Followup as Patient Attempts Increasing Neurontin

Good morning, Rich/Dr. Blake,

I hope all is well with you since our last appt.

Here's an update of this past week of being on 500mg of neurontin, which
started Fri, Dec. 2nd, at 8PM.
Dr Blake's comment: Christine had been on 100mg Neurontin three times per day and it was helping some of the tarsal tunnel (nerve) symptoms in her ankle/foot. I am having her initially add 100 mg more just to the evening dose. So for one week she went to 100mg am, 100mg afternoon, and 200mg as soon as she would get home. Then the week in question is 100mg am, 100mg afternoon, and 300mg evening, with the total at 500mg. 
Good news: Overall, my pain has been reduced in my foot to about a 2-3 on
the scale. There have been a couple of times that the pain has been at a
4-5.5, based on standing, but the pain doesn't linger. Aside from the pain
while standing, I'm working ever so slowly (only did it 1x thus far) towards
wearing sneakers and sketcher winter boots; I know that the discomfort in
this case is simply a result of using different muscles.

Here are a few notes for your review:

Friday 11PM - As I was falling asleep, and a couple of times throughout the
night, I felt sensations deep in my Achilles area in my left calf. The
sensations were in the meaty part of my calf muscles, about 2 inches above
the ankle. I felt a constant discomfort for a few minutes, then the
sensations would abate, and then they'd return. The pain was only about a
3-4 on the scale, but noteworthy since I've never felt anything before in
this area. Did I mention that overall this stuff knocks me out and I sleep
for up to 5 hours without waking? WOW... it's quite difficult to shake the
exhaustion during the day, but I love the deep sleep at night!
Dr Blake's comment: This is why we try to get the patient to take Neurontin or Lyrica as soon as they are going to be home for good. By the next morning, I want as much of the drug out of their system. The nerve symptoms with Neurontin/Lyrica take affects their day to day functioning normally is going seen as they try to get use to the drug so most docs push them through these small doses quicker than I
Sat. day - Went to view art with a friend in an old school building. Was so
uncomfortable - couldn't stand for more than a couple of minutes, leaning
into things didn't do the trick, couldn't sit for too long.... my friend was
aghast at my level of pain. Ended up lying on a sidewalk to stretch... what
fun! This pain could have been unrelated to my foot since when I saw my
chiro on Monday she said some joint was out, causing bone to meet bone.
Symptoms have shifted since having a couple of adjustments. And, what's
noteworthy is that standing and sitting are worse than walking.
Dr Blake's comments: This patient is a real trooper, but it shows how dedicated to the process you have to be before starting, or else you would give up. 
Sun 11PM - Similar discomfort deep in my calf while falling asleep and on
and off while sleeping. Again, the pain wasn't too bad. I've framed the pain
to signify that the effects of the neurontin are finally moving to that area
due to the additional dose. ??
Dr Blake's comments: I believe that is correct, but unsure.
Mon night while sleeping - Woke a few times with sensations at my ankle
bone. They were a combination of compression right at the most sensitive
spot (like someone pressing his thumb on the tissue right at the curve of
the joint, where there's consistent tenderness) with a slight
fingernail-like discomfort. I tried to weave this sensation into my dreams,
but finally woke up because the dreams couldn't quite do the trick.

Tues - Good news! Went to a xmas party/benefit gathering and wore my squishy
sketcher winter boots. Stood for a few minutes at a time, leaned into things
on and off for 20 minutes at a time, and sat for about an hour and did
pretty well! No lingering discomfort as a result.

Tues night while sleeping - First time ever that I've woken as a result of a
massive twitch happening in both legs at the same time. Who knows if it's
important info for you, but here it is!

Wed, Thurs, Fri - nothing to note that was new or unusual. Acclimating to
the meds. Still have prolonged exhaustion.... Not sure what comes out of my
mouth during business meetings that have a lot to do with my future
livelihood and can only hope it's intelligent or at the least entertaining!
Good news! I do notice that, with the increased dose, I'm putting more
weight on the left foot which is helping my sacrum stay in place and thus
reducing my back pain. I clearly see the link between habitually placing
most of my weight on my right leg and my lower back instability. My chiro
says my discs (L4/L5, L5/S1) have been in place (no bulge) for the past 7
days - which is fantastic news, and which feels great because I'm in way
less back pain. Still tough to sit for long periods.

Good news! Have gone on two 15 minute walks - on grass or earth... can't
help myself. I have to move and it's been such sublime weather!
Also, walked 4 city blocks - on pavement - once when I dropped my car off
and once when I picked it up. Doesn't sound that thrilling, yet for me it
is!!

FYI, forgot to increase my dose last night to 400 before sleep. Will do so
tonight.
Dr Blake's comments: So, here we go. This week the increase is to 100mg am, 100mg afternoon, and 400mg evening (for 600 mg total). Want to get her to a pain free dosage, level that out for 3-4 months, then gradually wean off (carefully watching for return of symptoms). 
Please let me know if this is adequate info, too much info, or if you want
different feedback. My scientific mind will adjust!

I hope you take a chunk of time to enjoy yourself this weekend.

Thanks so much for your time and support, Rich.

Best,

Christine



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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.