Sunday, January 31, 2010

MY New Treatment Plan

So I've devised this new treatment plan for me.
Without my doctor's input or permission, you realize.
He will have his chance to comment when I see him at the end of February and report my findings to him.
Here is what I'm going to do and the rationale for the approach.
My doctor wants me off Cesamet, at the rate of .5mg a day each week but I have already altered that schedule to .5mg a day every two weeks.  I have communicated that change to my doctor and he has not called to tell me not to slow down the weaning schedule.  The reason I slowed it down is because wth each reduction in dose, my pain level is increasing such that I feel I need to let my body adjust to that new level before reducing the dose again and further increasing the pain.  I just figured if I didn't let me adjust to one level of pain before thrusting myself into a higher level, I might never get caught up.  I guess my doctor agreed with me; or at least he didn't see any reason to tell me to stick to his original schedule.
You will recall that the whole purpose of going off Cesamet is to see if my appetite returns.
Well, with the first reduction of dose (from 4.5mg/day to 4.0mg/day) we noticed that by day ten I did in fact have a bit of an appetite.  But I still couldn't eat any amount of food without experiencing the abdominal discomfort and/or pain, the bloating, the gas, the burping, the whole nine yards.  And if I persisted and ate beyond that point, I felt like a stuffed pig (the way one feels after Thanksgiving dinner or Christmas dinner) after eating practically nothing by most people's standards.
But, since the second reduction of dose (from 4.0mg/day to 3.5mg/day) there has definitely been an improvement.  I am, without a doubt, eating more at each sitting and I'm doing it without experiencing any of that discomfort or pain.  Now that is progress.
I can honestly say that as of today, I am eating far more in one sitting than I could have eaten in a complete day a month ago.  Now that is progress.
So, based on that development, I have decided that I will continue at this level for another week as per my originally revised schedule.
But, and here is where my NEW treatment plan comes in, instead of decreasing it further at the next stage, I am going to bump it BACK UP to 4.0mg/day to see if I can replicate the symptoms of discomfort again.
Otherwise, how can we definitively say that Cesamet is the cause of my gut problem?
Why am I conducting this experiment, you might ask?
Because I'm starting to suspect that perhaps the whole problem was caused by a dosage issue.
Just as I can't tolerate Lyrica beyond 300mg per day, perhaps I can't tolerate Cesamet beyond 3.5mg per day (or I can't tolerate it beyond that level because I also take such a high dose of Lyrica).
I hope I'm not lulling myself into a false sense of comfort here but, on a slightly more positive note, I have started dropping pounds again.  So I'm gradually moving closer to my goal weight and I'm no longer concerned about the weight loss because now I'm eating.  It helps that there have been so many tests done recently to rule out sinister causes for this nonsense, making it a little easier to relax about the situation. 
Of course, I also can't discount the role this stupid "bowel protocol" is playing in promoting weight loss, regardless to what I eat.  It's keeping me close to a washroom and in quite a state of discomfort most of the time (different from all my other "pains" -- it's a wonder I can keep them all straight, isn't it?) but I'll continue with it until next time I see my doctor.
By the time of my next appointment at the end of February, I'll have lots of good, helpful information for my doctor.

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