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PostPosted: Sat Feb 11, 2012 3:14 am 
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I NEED YOU ALL TO HELP ME AGAIN BECAUSE I AM WORRYING MYSELF SICK AGAIN. PLEASE READ AND TELL ME WHAT YOU ALL THINK. I SO RESPECT WHAT ALL OF YOU HAVE TO SAY.

Okay I am having a peak and trough done next Thursday. The doc is doing it himself (femoral artery draw) as I am a hard stick and there have been attempts made in the last two years that led to no blood draw and he says he is not going to let them stick me ten or eleven times like before. At dose 160mgs they tried to draw my blood several times to no avail, but eventually they got one and my peak was 881 and my trough was 226. Now in preparation for this draw before it was important that:
1. I dosed in front of the nurses at the same exact time every morning for three mornings in a row.
2. I had to sit in front of the nurses for twenty minutes after I dosed to make sure I did not rid myself of my dose.
3. On the third day 30 minutes prior to dosing they drew the trough blood then I dosed and had to sit in front of the nurses for twenty minutes then I was allowed to leave the clinic.
4. I returned back at the clinic three and half hours after I dosed and they needed to draw my blood at the fourth hour mark exactly. And they did.

I guess the reason they do things like this....is so no one can fool the test etc...Well this time around I am not having to do any of the above (being monitored). Which seems odd to me (but I am not complaining) but it has pissed the nurses off that he is not allowing them to monitor me for the usual process and he is drawing the blood. One confronted me (the rude one) and said she was going to be changing this she had a nursing license to protect and could not stand by and allow this to go on and she would call me with the procedural dates and times and then confronted him...he told her to not be questioning him and his reasoning...she called me back and told me he was doing it his way regardless of the dangers etc...and of course she gave me a long list of why he should not do a femoral in that office etc...but I for some reason feel okay with it dangers and all because I watched the doc thinking everything out in our last two meetings and I have begun to trust him. Not totally but more than before.

He says he has to do the test due to I have higher qtc's than they like (526 is my qtc/ekg reading) and in order to facilitate him in allowing me to increase, he has to monitor me more closely with more EKG's than most and peak and troughs. Why would a peak help him validate my dosing needs in regards to my qtc's? Especially since everyone I talk to in and about methadone tell me P&T are not an accurate way to determine dosages etc...The two isomer issues do not afford the test to be an accurate way to determine increases and in fact people have been decreased many times due to results.

Now unlike before he has me on split dosing which would make it near impossible to have me monitored for three days so closely in regards to taking my dose at the same time and taking all my dose and not part of my dose (or throwing my dose up like they made me sit for twenty minutes before) etc...but anyways the real question here is how can they determine the proper peak if I am doing split dosing and now my dose is 210mgs (not 160mgs like then) So in all actuality I will have dosed 12 hours before this peak dose instead of 24 hours?

So its safe to say I have more in my system at the time of the blood draw is that not going to hinder my results and make my peak higher? Which panics me as I would be so upset if he felt a need to decrease me (because even though I still have some withdrawals and cravings I am much better after this 40 mgs increase). I don't want my peak to jeopardize this and I feel I will show more in my system since I added more to my system just twelve hours before. Since I hear rumors that Peak and Troughs are unfair in determining someone's need for increases and I have seen people get decreases before because of higher peaks. What I had going in my favor the last time was my trough level he said my peak was not low at all in fact he said 886 was high...he would have liked to have seen it lower, but my trough certainly showed a need for split dosing.

I can not help but question and wonder about some if not all of this situation though like he is not concerned about drawing a trough only a peak.(he said he might down the road do a trough but he is just wanting the peak. Why would that be? How will he get an accurate Peak when I do split dosing? Will the split dosing put me danger of the peak being too high since I have more in my system throughout the whole 24 hours because I dose twice in a day?

What do you guys think. I will be so upset if I lose my increases. I am feeling so much better. But I don't trust the results process etc...HELP ME.

Below is a article explaining that peak and troughs can not determine if we are toxic or under medicated etc...

There may be some validity for the peak and trough test to help make the case for split dosing, but it should not be a requirement for increasing past a certain dose -- this is known as a silent dose cap and goes against regulations. The best use of SMLs would be to help convince the patient (not the doctor) of the need for a higher dose or for a split-dose.

More and more, the SMLs (or peak and trough tests) are being used to deny increases. This is unacceptable and goes against the standards of best practices. The doctors who would be good at interpreting the SMLs are very often the same doctors who don't see a need for the test in the first place because they understand that patient-reported symptoms are the most important indicator of adequate dosing (how much and how often).

SML testing is problematic because the methadone used in the US has two parts to it -- these "isomers" look the same, except they are mirror images (like your right and left hands). The important thing is that only one of the isomers is active (l-methadone), the other is inactive (d-methadone). Everyone metabolizes the two isomers at different rates, but the SML test does not differentiate between the two forms. It's possible to have what looks like an acceptable level, but your active methadone could be low and your inactive could be high. The test is misleading because it does not tell you how much active methadone you have.

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 Post subject: answers
PostPosted: Sat Feb 11, 2012 4:15 am 
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Answers to the question(s)
yes
no
maybe
yes
hell no
okay
should be
alrighty
nah
hoopty
DISCLAIMER- I am not a medical professional and don't know all the correct answers.


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 Post subject: femorial?
PostPosted: Sat Feb 11, 2012 4:20 am 
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just curious, is that the artery next to the crotch? for some reason im not too horney...........


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PostPosted: Sat Feb 11, 2012 5:59 pm 
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Ive followed your posts and i keep noticing a common trend. I will be honest with you and this is not meant to upset you in anyway. But you are so focused on your dose and getting increases and keeping your increases that you are not giving the medication a chance to work. I mean you are so caught up with the numbers and test that i have not seen u mention your recovery once! Im trying to help you realize that you need to maybe start focusing on other aspects of your recovery not the numbers.
Ps
What is this test u talk of anyways my clinic does nothing like this.

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PostPosted: Thu Feb 16, 2012 8:41 am 
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I do not think they do peak and troughs for suboxone, but it is called serum blood level testing and a lot of clinics use it to determine several things. Dose increases and dose decreases. If your peak (4 hours after dosing) is high you can be toxic from methadone so they will immediately decrease you. If your trough is low and there is a 2 times or more difference between the peak and trough then you are a fast metabolizer and may need split dosing and increases. My clinic requires this test in order to increase beyond your dose cutoff that they doctor determined at admission such as mine was 150 mgs. In the last few years or so there is evidence that these test may be able to determine if someone is a fast metabolizer but there is no way to determine if someone is receiving too high of a dose making them appear toxic and the new evidence is that the united states uses a form of methadone that has inactive and active isomers along with racemic and non racemic R and S methadone. One can mirror off the other creating false results in blood levels. Making the patient to appear with toxic levels when in all actuality the patient could be in withdrawals so on and so on see the below link for a more clinical summary. My peak and trough three months ago was 881 peak 226 trough. I was lucky that it showed up in my favor but it was a unnecessary risk as it could have shown results contradictory to my metabolism etc...

http://atforum.com/SiteRoot/pages/addic ... Enough.pdf

Now with all this I have QTC Prolongation which makes doctors want to keep patients on low dose methadone which has been researched and found that this also was started by one Doctor named Krantz and it is untrue. Yes methadone can elevate someones QTC's but...there is only one case in 40 years that resulted in sudden death "TdP" and this patient was taking three other medications for HIV that are known to be associated in QTC elevation. A Dr. Andrew Byrne has many articles etc...trying to put this theory to rest that you need low dose or no dose methadone because one's qtc's are high. Mine are 526 which is why I am being monitored with EEG's and Peak and trough test and this is not medically necessary nor is it even useful and in fact both these problems that I have can put my treatment in jeopardy by showing resuklts that simply are not accurate.

I LEARNED ALL THIS FROM THE STATE METHADONE AUTHORITY NICK RUETER who has me in contact with PCSS who are compiling research and documentation for me to give my doctor or they themselves have agreed to call him and get him up to par on these issues which I have declined that offer as I do not want to offend him but I am in fear and I wish I did not have all these issues and I could be just a normal everyday patient.

Now I do things to productive to my recovery despite NA's ideas of methadone I attend the program and I try to practice the principles but I am a chronic worrier. It's a defect I know I need to get under control. Believe me I hate being this way. I am controlled by fear regardless of how much work I do on my recovery etc...MMT is the only thing I have ever had any success with for my addiction it scares the hell out of me to lose it.

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PostPosted: Thu Feb 16, 2012 4:42 pm 
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Finnalyachance im on methadone, I meant my methadone clinic.

I have clinical ocd i know a lil bit about worrying all the time. And i know the fear of losing methadone is scary but at the same time you are going to hurt yourseof come the future. If you keep telling your self u cant live without methadone and be clean. You are stamping this into your brain so come one day you may want off it is going to become almost impossible to get off bc of what u r doing now that your body has its interal mind set on no methadone no life type thing. This may sound weird but it can and will happen.And im not above you im doing the same thing. But im working on it with my counselor just something to think about.

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 Post subject: finallyachance
PostPosted: Sat Feb 18, 2012 9:01 pm 
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has got to be two people logged into one handle. Those post were obviously written by two different people. I'm guessing husband and wife? one of you should make a seperate handle


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 Post subject: answers
PostPosted: Sun Feb 19, 2012 1:11 pm 
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remember this is a forum for responses and debates. this is no personal attack. How in the hell do you expect the people of this forum to give you an answer to any of these questions? You worry too much. Worry causes a lot of energy. Think about how your life would be with out the worry. serious. i used to worry my ass off, about everything. one day my shrink said, If I want to learn how to worry, I'll come to you. We both started laughing and till this day that was probably my biggest breakthru from any thereapy. close your eyes, and imagine what life would be like without all that worrying, all that unnecessary stress. it's pretty fucking great

i know this disease has got you by the balls and taking it's toll. I'm assuming you have been a heavy iv user, hence the femoral artery. give your body a break. youve suffered like all addicts enough. take some time for you. try a new hobby. yoga, meditation, breathing exercises, walking. your body can produce wonderful calming affects on it's own. you need to learn how to utilize them. if you want to live a life of stress and worry,... you already know how to do that. try new techniques, i promise it will help. lifes to short and precious to worry about a couple teeth being pulled next week. and we, on the internet, have no idea if that is going to hurt.it seems as your life and hobby is the clinic. there is much more to life than methadone. and embrace recovery. good luck


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PostPosted: Sun Feb 19, 2012 3:57 pm 
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Yea im with indigo hear you really need to try to stop worrying all the time. Like indigo and yourself i use to worry all the time to, it literally controlled my life in every aspect. Im still trying to not let worrying control my life and i have made big strides with this and just over these past two month life has been so much better. I cant begin to tell u what life is like just waking up with my stomach not being in knots about what i have to do that day. And hes def right there is so muh more to life than just methadone at first i let my life revolve around the clinic and getting increases but once i realized i was doing this. I came to the serious conclusion that living like that was no different than active addiction. And that my main dislike of how methadone clinics work is bc the clinic is your dealer in a sense, you have to be there by a certain time if u r not you are dope sick and u dont pay your bill u get no meds. All im aying is you got to realize this and learn not to let your treatment become that way or it will control you not the other way around. And once that happens you are stuck in a place i like to call methadonia!

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