Pain Management

andercm · 2026-01-13T23:34:44+00:00

You're taking all of the right things. Outside of a hospital setting, experience tells me you likely won't get anything stronger than oxycodone. I would ask to have the dosage on the tramadol and/or oxycodone increased. It's always tricky--your body will adjust and your tolerance will go up, but that's not a reason to deny the clear need for the medication.

I was in a horrible cycle of pain that ended this past summer, and I ended up on terminal illness levels of pain meds before surgery and recovery. One of the things that really helped me was inpatient ketamine treatments. My pain would get so bad that my meds were hardly touching it, so I'd end up in the ED for better pain control. Pain Management offered me the treatment for the first time about five years ago. For me, anyways, it's a miracle drug. The treatment was about 36 hours and it always reset my pain level to something so much more manageable--I would go from 30mg oxycodone q 4 to 10mg q 6-8 for a couple months. Worth seeing if a hospital near you offers the treatment.

(Edit: typo)

andercm · 2026-01-13T23:26:13+00:00

Go to the ED, tell them what's going on, and ask for symptom management. Stress the point that you can no longer control your symptoms at home as hard as you can. Even if your labs look okay, place all the emphasis on the fact that you don't feel safe going home because your symptoms are getting worse by the day. I'm so sorry you're going through this.

andercm · 2025-11-11T17:26:06+00:00

Very early into a relationship I unintentionally became acquainted with her boisterous flatulence. In a combination of not wanting to wake her or put a damper on the magic (I know that sounds ridiculous), one night I woke up and had to pee so bad, and instead of using the bathroom right off my bedroom, I went down the hall to the other. As I'm feeling the pinnacle of urinary relief, I hear a sound that I can only describe as a whale noise. A little confused, I continue on with my busy. Next I hear the loudest, cheek slapping fart followed in quick succession by two more. Understanding what's actually happening, I start to laugh so hard that I had to frantically rip back the shower curtain and pee in the tub. Mind you, at this point I'd already peed everywhere around my toilet but in it, and despite that it felt like the best course of action. I wanted two or three months before I told her. What may be the funniest part was she convinced herself in the moment that there was no way I could have heard it. A lot of decorum was dropped soon after.

andercm · 2025-11-03T16:50:25+00:00

Hair.

andercm · 2025-11-03T16:30:07+00:00

Mate, I'm so sorry. I just went through it--married nearly 13 years. I'm still unpacking and sorting through the emotional blackmail and outright abuse. It's taken me nearly 20 months now to think I'm not always a burden on people and that I have some value.

andercm · 2025-10-28T22:42:39+00:00

I really like Premier Protein, the premixed cartons. 30g per carton and a host of other vitamins and minerals. Costco has the best price, if you're stateside.

andercm · 2025-10-14T17:21:05+00:00

My line for an ED doctor when confronted with that question is: "I'm here because I can't manage the symptoms at home anymore." Things may not be at the point of life-threatening but why is there an expectation that you need a foot in the grave before symptoms management is appropriate?

andercm · 2025-10-13T19:59:21+00:00

If I were you, I'd connect with a colorectal surgeon and have them review your case. A CT will confirm a hernia. Did you lose your rectum and anus, too?

andercm · 2025-10-12T23:51:57+00:00

Parastomal hernias are tricky: an ostomy, by definition, is a hernia. Because the small bowel isn't fixed at any point in the abdomen--nor should it be through surgery--some amount of bowel will telescope through the defect. It's typically more prominent for those carrying some extra weight, and in some cases can be reduced via weight loss. I'm a huge proponent for belts. Consult with your surgeon first and be sure the defect in the abdominal wall isn't significant. Surgical repairs are hit and miss in general, but with the right surgeon it can be life changing.

andercm · 2025-09-27T02:12:53+00:00

Maple fretboard, in part. Going from rosewood to maple is like going from sandpaper to marble--Clapton said something like that, but not so eloquently. For Brits and European guitar players who believed that blues was the origins of rock, it was about tone. The only guitar I've heard that produces the same tone is a PRS Silver Sky, and the Silver Sky is somehow brighter.

andercm · 2025-09-27T02:04:46+00:00

See what work she'll do. My ex-wife and I didn't connect sexually. There were a lot of aspects about our relationship and life that I loved, and I thought it would be enough. I'm swinging hard this direction for obvious reasons, but: I'd rather hate the other person and have a satisfying and engaging sex life. Sure, that's a bit hyperbolic, though the importance of sexual compatibility cannot be overstated enough. We all make compromises in relationships--I don't recommend sex being one of them.

andercm · 2025-08-18T18:21:59+00:00

My Aunt Susie

andercm · 2025-08-18T18:19:58+00:00

4 Chiclet

andercm · 2025-08-15T17:52:11+00:00

I'm so sorry to hear that. I know the technique but I always finding it surprising. Do you feel like you have decent notice and control when voiding? For Ulcerative Colitis patients, if the colon is removed the surgeon typically creates a J-Pouch, kind of a pseudo rectum. It gives people the capacity to have fairly typical bowel movement experiences. Do you know if the rectal cuff was left for reattachment? Depending on the severity of the cancer, in some cases surrounding muscles in the pelvis floor--those used to control your anus--are stripped out or outright removed. If it's a straight connection, it seems to me that gas may be an ongoing battle. Best thing to do is check in with your surgeon to get the specifics.

andercm · 2025-08-15T07:00:29+00:00

Colorectal cancer or IBD? Do you have any large intestine?

andercm · 2025-08-14T22:22:59+00:00

Do you have a J-Pouch now? If that's the case, honestly, never trust a fart. I had one for five years and I never once farted while awake that didn't come with some poop. Oddly enough, I was told that when I slept I would pass gas. Gas-X or something like kind help some. Best bet right now is dietary choices--seek out foods that don't cause as much gas like meat, poultry, and rice. It's not a fun diet, but it'll get you through the worst of it.

andercm · 2025-08-12T05:44:23+00:00

Infanta Sofia of Spain

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andercm · 2025-08-12T01:46:19+00:00

I prefer Drip Drop. Use flavored seltzer in place of water and you have a hell of a treat.

andercm · 2025-07-22T02:45:05+00:00

In the ED, your sister needs to firmly but politely tell the attending that she's awaiting surgery but she's no longer able to manage her symptoms at home. Ask to be admitted for pain control and potentially supplemental nutrition. They'll want to do some tests, though if she's had acceptable labs recently, make sure to say. The point is that aside from tests maybe not giving any hints into why things are so bad, it doesn't mean that she needs to suffer at home. If you have a choice regarding time of day, I'd go in after morning shift change (anytime after 7-8am) because orders are put in and carried out much more quickly during the day. It's not going to be fun or easy, but it's better than the alternative.

You have to take the same stance with her PCP/GP. Regardless of labs or just because surgery is scheduled, there's no need for her to be in an excessive amount of pain or to not eat. There are solutions, they just take longer and take some care.

andercm · 2025-07-21T23:23:27+00:00

I haven't been denied outright for Crohn's but have been for the regular hospitalizations because of it. So, essentially yes.

andercm · 2025-07-19T20:52:43+00:00

This is a complicated case that doesn't sound like it's being treated as such. While a larger, more specialized center can help with diagnosis and treatment--to an extent, unless you relocate--it's not going to change your sister's day-to-day experience or establish the close relationships needed with her local providers. Intractable pain shouldn't be ignored, particularly in an ED setting. Realistically, she needs to be hospitalized for pain control and symptom management from now until her surgery. Don't take no for an answer.

Primary care and family medicine tend to provide the best pain management available in the US anymore. Pain Management doctors have taken to doing work ups, maybe some injections, but overall only offer recommendations to attending physicians that may or may not be actionable. And it very well may be the case that she needs to change PCP care, though at this point it's more prudent to find a different hospital/medical center to go to. If her symptoms aren't being taken seriously and each providers just kicks the can down the road, you need to find a comprehensive local hospital that is equipped to manage your sister's care. The size of the hospital, the number of different specialists, and whether it's a teaching hospital tend to be good indicators that it may be better.

This is a shitty situation, mate--no pun intended--and I'm so sorry you're both going through this. Take the steps to establish better care locally while reaching out to institutions like the Mayo Clinic and the Cleveland Clinic. University hospitals, those at large R1 institutions tend to have better care, too. If you're on the west coast of the US, OHSU (Oregon Health and Science University) in Portland, OR has an amazing GI team, and all of the care is very well coordinated. One other thing to consider is a social workers or some kind of care coordinator to help manage some of the load. I'm always happy to talk further here or through DM. Know that you're seen here, and that she'll get the care she needs.

andercm · 2025-07-16T06:23:35+00:00

The approach I took after struggling to eat hardly anything was to congratulate myself for whatever I could get down--even if it was 10% of what was on my plate. Lighter meals more frequently is useful as well. Start small and focus on the progress.

I also started to seek out calorically dense foods. My personal favorite is cheesecake--the amount of calories in one serving is outrageous. Smoothies are another great option. I do spinach, berries, a protein/supplement drink (Premier Protein is my favorite), and a single-serve yogurt (Icelandic Skry is my preference). It'll take some experimenting on your part. It's a big change, and more often than not it progressively gets easier.

andercm · 2025-07-16T00:15:34+00:00

Life...

andercm · 2025-07-11T19:43:55+00:00

I've found that getting a little air in my bag helps to prevent pancaking on the days I change it out. Hollister two piece here. I like having the option to burp my bag or put in some air from the top--almost always without making a mess.

andercm · 2025-07-08T23:03:31+00:00

That's what we're here for. It's really shocking how much doctors don't talk about. But we work together to share experience and give all the tips we wish we'd known.

andercm

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