Getting Closer

I have been traveling on this cancer journey for almost 34 months now. However, my experience with cancer pain only started in the last four months or so. In fact, it started after my HIFU treatment in China and I believe it has to do with the dead tumor tissues inside my right abdominal area and also the healing wounds of the tissues and blood vessels after the HIFU treatment. At the same time, I am also learning about the pain from the bone tumors. Dealing with cancer pain is not just about popping in painkiller tablets. Some cancer patients like me are very sensitive to opioid based painkillers. The side effects is as deadly as the pain itself as I found out. So managing the side effects is the key for a happier life, at least for me.

I defied my doctors again. Instead of taking in 40mg of oxycodone hydrochloride every 12 hours as recommended by my doctors, I am reducing the dosage to 20mg for every 12 hours or 40mg every 24 hours. The Untracet painkiller consists of about 8mg of oxycodone equivalent potency and taking 4 tables a day would mean 32mg of oxycodone. The pain score is 3. Also, in the 20mg oxycodone tablet, it consist of 18mg of  oxycodone only and 2mg of it comprises others such as lactose, hypromellose, titanium oxide, iron oxide, macrogol and sorbic acid. So the 40mg oxycodone tablet is actually only 36mg of oxycodone. That's how I came about the dosage of 20mg per 12 hours or 40mg per 24 hours. I started yesterday night and based on my pain experience today, the pain score based on this new dosage is 2. The pain score if based on the recommended dosage of 40mg per 12 hours is 0.5. So, I think to reduce my pain, I would take 25mg of oxycodone every 12 hours. This should be sufficient. Why all these calculation? This is because of the side effects of the oxycodone drug. The lesser the drug, the lesser the side effects and hence the calculation to determine the optimum dosage. Oh, this also translate to RM800 (US$250) a month on painkillers and laxatives at 40mg every 12 hours.

Now the drug dosage has been computed, what about the actual side effects, namely constipation, nausea and vomiting? I managed to move my bowel yesterday but at a price. I was trying too hard and I got piles! My GP told me to just push it back in and gave me some ointment to apply. Sorry for the graphic description. Yesterday evening, I vomited after my dinner. Again this afternoon, I vomited my breakfast. I skipped lunch and went to bed to rest instead. Taking in water even seems to trigger the feeling of vomiting. So, I sort of fasted. In the evening, I took some light noodle soup and so far so good. I am still taking in 40ml lactulose (twice a day) and plenty of fruits. Hopefully, I would be able to have bowel movement tomorrow without much problems. I may have to take in forlax just in case. And not forgetting the prune juice as well. I just hope to be able to settle on the right dosage of laxatives and move on.