![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 20 to 44 of 48. Go back in thread:
Posted by ed_uk on March 19, 2005, at 14:24:13
In reply to Re: Analgesics » ed_uk, posted by cubbybear on March 19, 2005, at 7:34:32
Hi Cubbybear!
>I also have had major concerns about going for a routine colonoscopy. If the dr. says that it could be done with local anaesthesia and a sedative, I will certainly go that route, rather than with major anaesthesia.
Standard practice in the UK is to give an IV sedative, usually midazolam (Hypnovel, Versed) and an opioid, often pethidine (meperidine, Demerol). You must *not* let them give you any pethidine/meperidine!!!
IV midazolam or on its own would probably provide adequate sedation, it might cause a drop in blood pressure if the dose was excessive. If midazolam causes an excessive drop in blood pressure, an antidote is available - flumazenil. Certain blood pressure elevating drugs such as ephedrine are not safe for patients taking MAOIs.
>local anaesthesia
Some gastro-enterologists use lidocaine (lignocaine, Xylocaine) ointment to numb the anus.
>major anaesthesia
General anesthesia isn't commonly used for colonoscopy. If the colonoscopy is first attempted under sedation but it fails due to pain, general anesthesia may be recommended. Also, if someone is too anxious to have the procedure while they are awake, general anesthesia may be used.
For pain relief during colonoscopy, opioids are commonly given. Pethidine/meperidine is one of the most dangerous opioids for patients taking an MAOI, this is because the combination can cause the serotonin syndrome - this is because pethidine/meperidine acts as a serotonin reuptake inhibitor, a bit like an SSRI!
Other opioids which you should avoid include... tramadol, propoxyphene (dextropropoxyphene) and pentazocine. Low doses are morphine generally seem to be ok although some patients have become oversedated and required the opioid antidote naloxone (Narcan).
Since the data on the interaction between *other* opioids and Parnate is limited, it would probably be safest to perform the procedure using IV midazolam *alone*. If an opioid was necessary, morphine would probably be ok but the interaction has not been well studied.
From dr bob's tips...
'Having observed severe hypertension when an elderly patient of mine on Parnate (tranylcypromine) recieved codeine, I now warn all my patients on MAOIs to avoid all narcotic analgesics.'
This is the only report of an interaction between codeine and an MAOI that I've ever seen!
If the procedure is too uncomfortable and you need more sedation, propofol is sometimes used to induce deep sedation - this sedation is normally performed by an anesthetist. Propofol is a powerful IV sleep-inducing drug. As far as I know, there are no reports of propofol interacting with MAOIs. Low blood pressure might occur.
What is your BP at the moment? Do you get dizzy when you stand up?
If you need general anesthesia for your shoulder, if might be useful to give the anesthetist a reliable list of drug interactions, your pdoc could help you produce this. You could stick it on your drug chart!!
Opioid anesthesia (anesthesia based on a very high dose of an opioid such as fentanyl) might not be suitable, one patient taking an MAOI died after receiving opioid anesthesia. The symptoms resembled serotonin syndrome, fentanyl is related to pethidine/meperidine, it is possible that fentanyl may be weakly serotonergic. The death may have occured due to the very high dose given, low doses are probably ok - again, the interaction has not been well studied.
Most general anesthesia involves the administration of lower doses of opioids, the opioid dose can be minimised by giving higher doses of sedative-hypnotics such as propofol or anesthetic gases such as isoflurane. This type of anesthesia may be safer for you. Low blood pressure may be a problem, the anesthetist must be well informed about which blood pressure elevating drugs ('pressors', sympathomimetics) can be safely combined with MAOIs and which need to be avoided.
The following 'pressors' can usually be combined safely with MAOIs if it is important to elevate the patient's blood pressure. Traditional textbooks will often tell you that these drugs must be avoided, it is true that the blood pressure elevation produced by these drugs may be greater in patients taking MAOIs compared with patients not taking MAOIs. Low doses must be given initially, the dose must be carefully titrated/individualised...........
epinephrine/adrenaline
norepinephrine/noradrenaline
methoxamineThe folowing 'pressors' should generally be avoided in patients taking MAOIs, the response may be unpredictable and severe hypertension may result........
ephedrine
metaraminol.......The are many other 'pressors' which also interact serious with MAOIs, I won't list them here because I don't know which ones are used by anesthetists in Thailand. I can send you some more info if you need surgery.
>I JUST got this brilliant idea--that if surgery were necessary, I would enlist the assistance of my psychiatrist (who obviously knows all about MAOIs) and put him in touch with the gastroenterologist (for colonoscopy) or orthopedist (for shoulder). There *are* many doctors who are familiar with MAOIs here; the more important issue, i guess, is whether the anaesthetists are knowledgeable and willing to work with an MAOI patient.
Yes, this is a good idea. You definitely need to get in contact with the people who'll be treating you in advance.
>Are you serious? Opioids might not be effective in my case? So what alternatives could there possibly be, that would also be compatible with Parnate?
A higher dose of Voltaren or another NSAID might be more effective than an opioid. Have you tried taking aspirin 900mg four times a day?
*Do not combine aspirin with diclofenac*
Aspirin and diclofenac are both capable of causing peptic ulcers, if they are combined the risk is dramatically increased.>Truthfully, I'm scared of the gastro-intestinal risks, although I'm in the low-risk category for NSAIDs.
You could ask your doctor about using a gastro-protectant such as lansoprazole.
>>Have you asked your doctor whether it is safe to take a higher dose?
>Yes, but he said that in my case, I'd best cut it out after a max. of 2 months.You never taken a full dose yet so you've got plenty of time :-)
>Never heard of Paracetamol until I came to Thailand.
Where are you from? Paracetamol is called acetaminophen (Tylenol etc) in some countries.
>Would a combo of Diclofenac and aspirin be as effective, do you think? (come to think of it, I've already tried diclofenac w/aspirin at low doses/as needed and saw no improvement)
Combining aspirin with diclofenac is dangerous, it is toxic to the stomach! Taking a higher dose of diclofenac on its own would be safer. Diclofenac can be combined with acetominophen, but not aspirin or other NSAIDs.
>Can't believe it! After all the posts and info I've been reading, to learn this is quite a surprise.
An opioid might be helpful, I'm not saying it wouldn't be. Opioids are not generally first-line for your type of pain though, because other drugs are often more effective. A combination product such as Percocet might be prescribed if paracetamol, diclofenac and muscle relaxants weren't helpful. Percocet is often very constipating, prepare to purchase some laxatives!
>It's made in Japan. Don't know why the distribution is seemingly limited.
Interestingly, a lot of Japanese psych drugs are only marketed in Japan! Many of them are virtually unknown to the West.
Perhaps you could try an increased dose of Myonal if you're still in pain in a few weeks time. I don't know much about Myonal, can't give any info.
RE the shoulder surgery.....
General anesthesia + MAOIs is 'traditionally' contra-indicated. Some anesthetists now believe that such anesthesia can be performed safely in experienced hands; this is what I posted to ace.
Anesthesia + Parnate is unlikely to be as safe as anesthesia w/o Parnate, you will have to weigh up the risks of d/cing the Parnate against the risks of continuing it. I honestly don't know how easy it will be for you to find an anesthetist who is willing to treat you while you're still taking Parnate. Best of luck :-)
Take care,
Ed.PS. An analgesic called nefopam is available in some countries, it *can't* be combined with Parnate though!!
Posted by Larry Hoover on March 19, 2005, at 17:17:42
In reply to Re: Percodan/Percoset Experiences?? » Larry Hoover, posted by cubbybear on March 19, 2005, at 6:12:15
> Hi Larry,
> Well, you sure gave me the scoop on the injury, and I suspect that what i've got is probably a Garden of Eden in comparison. I can only wish you the best in overcoming this horrendous ordeal.Thanks. And I sure didn't mean to make you think in terms of comparisons. Pain is pain.
> In your case I suppose that the oxycodone and "heavy-duty" meds are all that are viable for the pain, but I was wondering if you' ve ever tried Neurontin and if so, can you assess if it's helpful in any way.
No, I haven't yet been able to get it prescribed. I plan to ask for it when I see my doctor next week. I don't like taking Toradol.
Regards,
Lar
Posted by Larry Hoover on March 19, 2005, at 17:21:59
In reply to Re: Percodan/Percoset Experiences?? » Larry Hoover, posted by ed_uk on March 18, 2005, at 7:29:22
Since you have access to some superb databases....
One of the things that most annoys me about my current situation is how it disturbs my sleep. If I undermedicate, the pain wakes me. But even if I think I get the dose of meds right (little or no pyschoactive effect), I have a hell of a time getting to sleep, and staying there. I already had a sleep problem, for which I've used temazepam and trimipramine for an extended period of time, but even with those meds, the oxycodone and/or the keterolac seems to make my brain active, and induce vivid dreams. Is that consistent with your literature, as adverse effects? I can't find much on that subject. I seem to be between a rock and a hard place, on the sleep thing, and I'm becoming exceedingly worn down as a result, due to chronic sleep deprivation.
Thanks in advance,
Lar
Posted by ed_uk on March 19, 2005, at 18:20:17
In reply to Re: Hey Ed... » ed_uk, posted by Larry Hoover on March 19, 2005, at 17:21:59
Hi Lar!
>Since you have access to some superb databases....
I'm not at University for the next three weeks, I don't have access from home :-(
>But even if I think I get the dose of meds right (little or no pyschoactive effect), I have a hell of a time getting to sleep, and staying there.
I've certainly heard of opioids causing insomnia. Morphine is sometimes claimed to be more sedating than oxycodone, perhaps you could use it as an alternative to oxy in the evening and at night. Oral morphine is less potent than oral oxycodone, the conversion factor is about 1.5 (variable: 1-2). Opioids do sometimes induce vivid dreams, tolerance to this effects doesn't generally seem to occur.
Quite a few CNS reactions have apparantly been reported with ketorolac, including anorexia nervosa! Indomethacin is another NSAID which is known for its CNS side effects.
Just out of interest, have you ever tried flurbiprofen? I once read that it was a more effective analgesic than other NSAIDs, I don't know why this would be though- perhaps it was a load of rubbish!
>I've used temazepam and trimipramine for an extended period of time.
Do they still work as well as they used to? Have you tried zopiclone? It's claimed to be associated with less tolerance than temazepam.
Best regards,
Ed.
Posted by Phillipa on March 19, 2005, at 20:23:16
In reply to Re: Hey Lar... » Larry Hoover, posted by ed_uk on March 19, 2005, at 18:20:17
Hi Ed! I just Babbled you. Are you home for 3 weeks? Does that mean I should continue to Babble you? Thanks Phillipa O
Posted by cubbybear on March 20, 2005, at 4:59:43
In reply to Re: Sedation and general anesthesia » cubbybear, posted by ed_uk on March 19, 2005, at 14:24:13
>> Standard practice in the UK is to give an IV sedative, usually midazolam (Hypnovel, Versed) and an opioid, often pethidine (meperidine, Demerol). You must *not* let them give you any pethidine/meperidine!!!
Not to worry; I've long known about the dangers of meperidine.
>
>>
> What is your BP at the moment? Do you get dizzy when you stand up?It's fine 95% of the time--stays at around 120/80.
I get a little dizziness only when I stand up after crouching low on the floor (of the bookshop) for a few minutes. I think it's called orthostatic hypotension and it goes away in less than a minute.>
>> >Are you serious? Opioids might not be effective in my case? So what alternatives could there possibly be, that would also be compatible with Parnate?
>
> A higher dose of Voltaren or another NSAID might be more effective than an opioid. Have you tried taking aspirin 900mg four times a day?No--that sounds wildly excessive and a bit risky, even if it is aspirin.
> *Do not combine aspirin with diclofenac*
> Aspirin and diclofenac are both capable of causing peptic ulcers, if they are combined the risk is dramatically increased.I'm very glad you told me. I think I tried it on one occasion to see if it offered pain relief. But it didn't anyway.
>
.
>
> Where are you from? Paracetamol is called acetaminophen (Tylenol etc) in some countries.OH, now I get it! I'm from the U.S., and there, the big name is Tylenol, with generic name acetaminophen. And, all this time, I thought that Paracetamol is something completely different. Live and learn.
>
> > Combining aspirin with diclofenac is dangerous, it is toxic to the stomach! Taking a higher dose of diclofenac on its own would be safer. Diclofenac can be combined with acetominophen, but not aspirin or other NSAIDs.Very glad you told me.
>
> >>A combination product such as Percocet might be prescribed if paracetamol, diclofenac and muscle relaxants weren't helpful. Percocet is often very constipating, prepare to purchase some laxatives!This could be a welcome side effect, since I ordinarily have a mild case of irritable bowel syndrome (IBS) which is manifest in occasional, unpredictable, nuisance diarrhea.
>
> >>
>>
> RE the shoulder surgery.....
>
> General anesthesia + MAOIs is 'traditionally' contra-indicated. Some anesthetists now believe that such anesthesia can be performed safely in experienced hands; this is what I posted to ace.
>
> Anesthesia + Parnate is unlikely to be as safe as anesthesia w/o Parnate, you will have to weigh up the risks of d/cing the Parnate against the risks of continuing it. I honestly don't know how easy it will be for you to find an anesthetist who is willing to treat you while you're still taking Parnate. Best of luck :-)Well, shoulder surgery might not even be called for in the long run. I'll just have to pray that this will heal/become tolerable in time.
Thanks for all your great advice. By the way, are you in the medical profession? You seem to know more than a few dozen doctors combined.
cubbybear
>
>
Posted by cubbybear on March 20, 2005, at 5:12:02
In reply to Re: Percodan/Percoset Experiences?? » Larry Hoover » cubbybear, posted by Larry Hoover on March 19, 2005, at 17:17:42
>> > In your case I suppose that the oxycodone and "heavy-duty" meds are all that are viable for the pain, but I was wondering if you' ve ever tried Neurontin and if so, can you assess if it's helpful in any way.
>
> No, I haven't yet been able to get it prescribed. I plan to ask for it when I see my doctor next week. I don't like taking Toradol.Has there been a problem with getting UK doctors to prescribe it? Can't imagine that. . .it seems pretty amazing to me that, here is a drug that is quite viable for certain kinds of severe pain (neuropathic) and it poses a much better/safer risk of habituation/addiction than opioids. I can attest to its efficacy, by how it knocked out my horrific (neuropathic) pain from herpes zoster. I also take advantage of Neurontin's side-effect of somnolence to help me sleep, by alternating it with Xanax, in order to avoid getting dependent again on a benzo for insomnia.
I don't know about the situation with Neurontin in the US, but here in Thailand, where the govt. has cracked down on availability/dispensing of codeine, Neurontin can actually be purchased OTC!! (but then again, you'd be shocked at the number of meds that can be purchased OTC here anyway, that require an Rx in the U.S.). The only drawback I see with Neurontin at present is that the price is a bit steep; the generic gabapentin is not available.>
Posted by ed_uk on March 20, 2005, at 10:05:49
In reply to Re: Sedation and general anesthesia » ed_uk, posted by cubbybear on March 20, 2005, at 4:59:43
Hi Cubbybear!
>No--that sounds wildly excessive and a bit risky, even if it is aspirin.
900mg four times a day is a relatively 'standard' dose of aspirin for pain. 600mg four times a day may provide some small relief. Single doses <600mg are unlikely to provide any relief. 75-300mg/day is used for cardiovascular prophylaxis, these doses provide no pain relief or anti-inflammatory effect. The maximum 24 hour dose of aspirin for rheumatic disease is 8000mg in six divided doses, such high doses are used only under close supervision/monitoring. 600-900mg four times a day is a normal dose for pain.
>By the way, are you in the medical profession?
No, I'm a student.
Regards,
Ed.>And, all this time, I thought that Paracetamol is something completely different.
Lol, people do!
Posted by ed_uk on March 20, 2005, at 10:08:12
In reply to Re: Neurontin » Larry Hoover, posted by cubbybear on March 20, 2005, at 5:12:02
Hi!
>you'd be shocked at the number of meds that can be purchased OTC here
What can you buy OTC that needs a prescription in the US?
Ed.
Posted by ed_uk on March 20, 2005, at 18:06:25
In reply to Re: Sedation and general anesthesia » ed_uk, posted by cubbybear on March 20, 2005, at 4:59:43
Hi Cubbybear!
Just a little PS........
>Not to worry; I've long known about the dangers of meperidine.
I knew you would have, I just thought I'd mention it since it's often used during colonoscopy. Is the drug called pethidine or meperidine in Thailand? Do you know the brand name?
Ed.
Posted by cubbybear on March 21, 2005, at 0:40:26
In reply to Re: Neurontin » cubbybear, posted by ed_uk on March 20, 2005, at 10:08:12
> Hi!
>
> >you'd be shocked at the number of meds that can be purchased OTC here
>
> What can you buy OTC that needs a prescription in the US?
>
> Ed.All pharmacies, down to the smallest, offer dozens of competing brands of topical skin medications, cortisone-based and non-cortisone based for dermatoses of all kinds, including fungal infections. No Rx needed. The package insert is always available for the asking. It's printed in English and Thai.
Most pharmacies have all the major antibiotics, such as amoxycillin, tetracycline, and cipro.
Shockingly, some pharmacies offer anti-depressants Prozac and Zoloft without a prescription, perhaps others as well. This blows my mind altogether and points up the absurdity of government regulation. Misuse of these meds can cause serious, if not life-threatening situations, and yet one can no longer walk into the drugstore and obtain a benzo type drug or opioid. They're available only at hospital pharmacies. MAOI antidepressants Parnate, Nardil and Marplan are prohibited even in hospitals, hence my need to travel to the U.S. to get a year's supply.
Regardless, living here brings its supreme advantages, as when one needs to purchase an anti-fungicidal cream every so often, and can stroll into the pharmacy and purchase a tube of the appropriate stuff without having to phone the doctor. And the prices are a fraction of what they are in the U.S. (I recall that, even at the hospital pharmacy, Zoloft cost exactly one half of what the on-line pharmacies were charging.) Come on over some time, I'll give you the tour of your life.
Posted by cubbybear on March 21, 2005, at 1:18:11
In reply to Re: Pethidine » cubbybear, posted by ed_uk on March 20, 2005, at 18:06:25
>> >Not to worry; I've long known about the dangers of meperidine.
>
> I knew you would have, I just thought I'd mention it since it's often used during colonoscopy. Is the drug called pethidine or meperidine in Thailand? Do you know the brand name?
>
Sorry I don't but you can be sure I'd find out about it and tell them, if need be.
Posted by ed_uk on March 21, 2005, at 9:56:21
In reply to Re: Pethidine » ed_uk, posted by cubbybear on March 21, 2005, at 1:18:11
Hi Cubbybear!
>All pharmacies, down to the smallest, offer dozens of competing brands of topical skin medications, cortisone-based and non-cortisone based for dermatoses of all kinds, including fungal infections.
Here, you can buy hydrocortisone OTC. A few antifungal creams are available: miconazole, ketoconazole, terbinafine (Lamisil) etc. Can't you buy antifungal creams in the US?
>Most pharmacies have all the major antibiotics, such as amoxycillin, tetracycline, and cipro.
Sounds like Spain and Greece! No antibiotics here!
>MAOI antidepressants Parnate, Nardil and Marplan are prohibited even in hospitals, hence my need to travel to the U.S. to get a year's supply.
:-( They seem to be prohibited in a lot of countries, it's sad.
>Come on over some time, I'll give you the tour of your life.
LOL, that would be fantastic!
>Sorry I don't but you can be sure I'd find out about it (pethidine, meperidine, Demerol etc) and tell them, if need be.
I was just worried that they'd give you something and you wouldn't realise that it was meperidine.
Best regards,
Ed.PS. Cubbybear is a cute name!
Posted by cubbybear on March 21, 2005, at 10:39:55
In reply to Re: Thailand » cubbybear, posted by ed_uk on March 21, 2005, at 9:56:21
> Here, you can buy hydrocortisone OTC. A few antifungal creams are available: miconazole, ketoconazole, terbinafine (Lamisil) etc. Can't you buy antifungal creams in the US?
Having been in the Land of Smiles for about 6 years now, I've been out of Western circulation and maybe the laws in the U.S. have changed since '99. But the last time I had a dermatological problem in the U.S. (late 90s) you needed an Rx to get cortisone creams above a certain percentage concentration. I didn't need a fungal cream until I got to Thailand, so maybe I was wrong about needing an Rx for it in the U.S. But I'm sure about the strong cortisones.
>
>
> PS. Cubbybear is a cute name!]Thanx--Forner friends in the U.S. who didn't even know each other coincidentally called me by the same nickname. So it must be something in my appearance. I guess the name fits since I sometimes stick my nose where it shouldn't go and get stung or stuck.
Posted by ed_uk on March 21, 2005, at 13:07:30
In reply to Re: Thailand--pharmacies » ed_uk, posted by cubbybear on March 21, 2005, at 10:39:55
Hi Cubby!
>But I'm sure about the strong cortisones.
Same here, you can only get the low potency steroids. RE OTC antifungals, clotrimazole (Canesten) is very popular here, especially for thrush! You can also buy a single OTC fluconazole (Diflucan) tablet for thrush, it's pretty expensive though.
>So it must be something in my appearance. I guess the name fits since I sometimes stick my nose where it shouldn't go and get stung or stuck.
He he :-)
/Ed
Posted by Ron Hill on March 21, 2005, at 13:21:21
In reply to Re: Percocet » ed_uk, posted by Larry Hoover on March 17, 2005, at 20:56:19
Lar,
> BTW, turmeric is the absolute best COX-type med I've ever used. Beats Vioxx, Mobicox, Celebrex....works better, lasts longer, and costs pennies a dose.
Our dog has arthritis bad enough that it is adversely affecting his quality of life. Our vet treats him with a COX-2 inhibitor (currently using Deramaxx; previously used Rimadyl). Do you think turmeric could help? If so, should I co-administer it with the COX-2 or just use it by itself? What dosage of tumeric should I try on a mg/lb of dog (or tbs/lb of dog)?
On another note, I intend to post my questions about Selegiline as soon as I have time. Thanks for your patients.
I think of you often, my friend. I hope and pray that you can get your long over due surgery and that the bureaucratic red tape will unravel so as to allow the surgery to occur sooner rather than later.
-- Ron
Posted by cubbybear on March 22, 2005, at 1:25:28
In reply to Re: Thailand--pharmacies » cubbybear, posted by ed_uk on March 21, 2005, at 13:07:30
, you can only get the low potency steroids. RE OTC antifungals, clotrimazole (Canesten) is very popular here, especially for thrush! You can also buy a single OTC fluconazole (Diflucan) tablet for thrush, it's pretty expensive though.
>
For a recurring fungus, I am using a cream that combines miconazole with some cortisone. The Canesten seems to have lost its efficacy. In a tropical climate like this, where every species of bacteria, fungus, and other skin parasites lurk, you can make money hand over foot being a dermatologist.
Posted by ed_uk on March 22, 2005, at 8:15:43
In reply to Re: Thailand--pharmacies » ed_uk, posted by cubbybear on March 22, 2005, at 1:25:28
Hi Cubby!
>For a recurring fungus, I am using a cream that combines miconazole with some cortisone.
Ahhh, Daktacort. I hope it's working, I had a fungal infection recently on my leg. I had to use two different antifungals before it went away!
How is the pain? Did you make any changes to your medication?
Ed.
Posted by cubbybear on March 22, 2005, at 9:19:55
In reply to Re: Thailand--pharmacies » cubbybear, posted by ed_uk on March 22, 2005, at 8:15:43
>>
> How is the pain? Did you make any changes to your medication?
>
> Ed.Not yet, I've decided to consult with the orthopedist about that, but more importantly to get his views about getting a cortisone injection/and or MRI scan. The latter will also depend on whether my insurance covers it. What seems to be pretty good in the anti-pain regimen is actually a topical liquid preparation that I obtained at the pharmacy at the Chinese (acupuncture) hospital. It's a 100% herbal/organic-type of liniment, imported from China. There's actually a website for the manufacturer. Of course the odor comes from common menthol, but it's otherwise a completely different animal from the NSAID gel or OTC creams like "Counterpain." The Chinese stuff seems to exhibit analgesic qualities that are more effective and last longer than the others. Meanwhile, I went to see the orthopedist today but the nurse told me he was out sick. Now, that's something I didn't expect. We usually forget that doctors can get sick, too.
Posted by ed_uk on March 22, 2005, at 10:07:07
In reply to Re: pain again » ed_uk, posted by cubbybear on March 22, 2005, at 9:19:55
Hi!
>What seems to be pretty good in the anti-pain regimen is actually a topical liquid preparation that I obtained at the pharmacy at the Chinese (acupuncture) hospital.
That's interesting, what are the ingredients? (not that I'll have heard of them!) It sounds like it's helping :-)
Btw, have you ever tried capsaicin (not capsaicum) cream? Capsaicin comes from the chile. It's occasionally used here (on prescription) to treat the pain of rheumatic diseases or neuropathic pain. It causes a powerful burning sensation at first, you can use a local anesthetic cream to numb the skin though. After regular use, the burning sensation goes away and it helps to relieve the pain.
'Capsaicin is an alkaloid derived from chillies. It first entered European knowledge after Columbus' second voyage to the New World in 1494. There is evidence that capsaicin can deplete substance P in local nerve sensory terminals. Substance P is thought to be associated with initiation and transmission of painful stimuli.'
I thought you would be interested in capsaicin because it's a topical treatment which doesn't appear to have any serious side effects. Without a local anesthetic cream, the initial burning can be severe, you should be able to get a local anesthetic though. After a couple of days, you won't need the anesthetic anymore. Capsaicin cream must be applied at least three times a day- if you use it less frequently the burning sensation may come back! Capsaicin is best used four times a day- leave at least four hours between applications. Don't forget to wash your hands immediately afterwards!!! The cream is applied sparingly- but not just before or just after a bath/shower, this would be uncomfortable :-(
With capsaicin 'pain relief usually begins within the first week of treatment and increases with continuing regular application for the next two to eight weeks.'
Ed.
PS. I take it you've tried the OTC NSAID creams and counter-irritants. Were they any good?
Posted by cubbybear on March 22, 2005, at 22:49:24
In reply to Re: Capsaicin » cubbybear, posted by ed_uk on March 22, 2005, at 10:07:07
> Hi!
>
> >What seems to be pretty good in the anti-pain regimen is actually a topical liquid preparation that I obtained at the pharmacy at the Chinese (acupuncture) hospital.
>
> That's interesting, what are the ingredients? (not that I'll have heard of them!) It sounds like it's helping :-)They're all the Latin names of plants and herbs. I don't carry the bottle around with me, so I can't recall exactly, but one has the word Rhizome in it. I'd rather not get into detail about this because we might find the thread re-directed.
>
> Btw, have you ever tried capsaicin (not capsaicum) cream?No, never heard of it.
Thanks for the advice, but I'm afraid that I am not inclined to go with something like that. Besides, it might interest you to know that here in Thailand, the chili pepper is worshipped as a gastronomic god by the natives; it is an ingredient in 90+% of the prepared food and I personally can't deal with it in any more than modest amounts. I hate the feeling of having my mouth burning. But I wouldn't be surprised, based on what you say about the chile-based medication and the Thais' love of chili peppers, that this stuff is probably considered to have great health values. I've managed to survive six years here and construct a diet that's about 50% Thai and 50% Western while avoiding the chili pepper whenever possible.
>
> PS. I take it you've tried the OTC NSAID creams and counter-irritants. Were they any good?One OTC cream seemed useless; another one, made in Japan called Satogesic Cream (name based on name of company) seems much better; but I think I developed a tolerance to it, if that's possible.
cubbybear
>
>
Posted by ed_uk on March 23, 2005, at 6:48:53
In reply to Re: Capsaicin » ed_uk, posted by cubbybear on March 22, 2005, at 22:49:24
Hello,
>Thanks for the advice, but I'm afraid that I am not inclined to go with something like that....
OK!
Ed.
Posted by ed_uk on March 23, 2005, at 13:52:14
In reply to Re: Capsaicin » cubbybear, posted by ed_uk on March 23, 2005, at 6:48:53
Hi Cubby!
I just wanted to add that I'm really curious about why you moved to Thailand. I was scared to ask though in case you didn't want to say! I expect this will get redirected to social!
Kind regards,
Ed.
Posted by Larry Hoover on March 23, 2005, at 15:50:12
In reply to Re: Status of Selegiline Questions and COX-2 » Larry Hoover, posted by Ron Hill on March 21, 2005, at 13:21:21
> Lar,
>
> > BTW, turmeric is the absolute best COX-type med I've ever used. Beats Vioxx, Mobicox, Celebrex....works better, lasts longer, and costs pennies a dose.
>
> Our dog has arthritis bad enough that it is adversely affecting his quality of life. Our vet treats him with a COX-2 inhibitor (currently using Deramaxx; previously used Rimadyl). Do you think turmeric could help? If so, should I co-administer it with the COX-2 or just use it by itself? What dosage of tumeric should I try on a mg/lb of dog (or tbs/lb of dog)?If you're going to try it, it would have to be instead of the Deramaxx. I have no idea if a dog can tolerate turmeric, and the taste is rather bitter. I use a heaping teaspoon for all 95 kg of me.
> On another note, I intend to post my questions about Selegiline as soon as I have time. Thanks for your patients.
That's an interesting slip.
> I think of you often, my friend. I hope and pray that you can get your long over due surgery and that the bureaucratic red tape will unravel so as to allow the surgery to occur sooner rather than later.
>
> -- RonThanks for the kind support. Unfortunately, bureacracy is creating a Gordian knot, rather than smoothe sailing. You wouldn't believe what I am having to deal with.
Lar
Posted by Ron Hill on March 23, 2005, at 22:08:38
In reply to Re: Status of Selegiline Questions and COX-2 » Ron Hill, posted by Larry Hoover on March 23, 2005, at 15:50:12
> > On another note, I intend to post my questions about Selegiline as soon as I have time. Thanks for your patients.
>
> That's an interesting slip.Oops. With your broken elbow, you're already a patient. What I meant to ask for is your patience.
-- Ron
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