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keyser · 01-07-2008, 06:12 PM

Doc,
my dad got into a bad car accident some odd 30 years ago, he lost one kidney. About 4 years ago (when he was about 56), he wasn´t feeling too good, and the docs found out he had hepatitis c which he had gotten from infected blood from when he got into the car accident, i think his liver was in bad shape, and that was damaging his one kidney too. They put him on interferron and got rid of the virus(but he suffered through massive side effects at the time). Now a few years after the interferon therapy, he´s better, but he has massive pains in his feet(worst under his feet), the docs don´t know what it is, gout has been ruled out and they think it´s nerve damage. They put him on gabapentin, and it didn´t work(and his kidney doctor then told him that his one bad kidney couldn´t handle that drug). So now he´s trying amitrybtilin, he says his foot pain is better, but he feels very slugish on that drug.

He´s currently taking:
1. for pain, amitrybtilin
2. for high blood pressure and his kidney(don´t know what does what) candesartan cilexetil, ramipril, allopurinol, furosemid and because his blood acidity is way too high he´s taking sodium bicarbonat caps, and he´s taking calsium with vitamin D tablets, as they say that lowers pottasium absortion(he has way too high pottasium I think.. and can´t eat food like bananas etc.)

He has a few doctors(one for his kidney, another for his blood pressure etc.), and they don´t really communitate between them, so sometimes he´ll get one drug from one doctor, and then the other one says he can´t take it.

So my questinos would be if you know of any better drugs than he´s taking, especially the pain one as it makes him slugish(doesn´t lexapro also work on nerve pain?). Do you reccomend any supplements for his high blood pressure, bad kidney, bad liver(it would still be bad even though they cured the hep?), high acidity?, foot pain?

**dinoiii** · 01-08-2008, 04:28 PM

Quote:

Originally Posted by keyser

Doc,
my dad got into a bad car accident some odd 30 years ago, he lost one kidney. About 4 years ago (when he was about 56), he wasn´t feeling too good, and the docs found out he had hepatitis c which he had gotten from infected blood from when he got into the car accident, i think his liver was in bad shape, and that was damaging his one kidney too. They put him on interferron and got rid of the virus(but he suffered through massive side effects at the time). Now a few years after the interferon therapy, he´s better, but he has massive pains in his feet(worst under his feet), the docs don´t know what it is, gout has been ruled out and they think it´s nerve damage. They put him on gabapentin, and it didn´t work(and his kidney doctor then told him that his one bad kidney couldn´t handle that drug). So now he´s trying amitrybtilin, he says his foot pain is better, but he feels very slugish on that drug.

He´s currently taking:
1. for pain, amitrybtilin
2. for high blood pressure and his kidney(don´t know what does what) candesartan cilexetil, ramipril, allopurinol, furosemid and because his blood acidity is way too high he´s taking sodium bicarbonat caps, and he´s taking calsium with vitamin D tablets, as they say that lowers pottasium absortion(he has way too high pottasium I think.. and can´t eat food like bananas etc.)

He has a few doctors(one for his kidney, another for his blood pressure etc.), and they don´t really communitate between them, so sometimes he´ll get one drug from one doctor, and then the other one says he can´t take it.

So my questinos would be if you know of any better drugs than he´s taking, especially the pain one as it makes him slugish(doesn´t lexapro also work on nerve pain?). Do you reccomend any supplements for his high blood pressure, bad kidney, bad liver(it would still be bad even though they cured the hep?), high acidity?, foot pain?

Ok, so in review allopurinol --> Why is he taking this; are they still assuming treatment for gout.

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Amytriptylin is an interesting pain choice; no depressive states, etc...in your dad? Sometimes the antidepressants are used for this too, but I am not necessarily encouraged that patients I am aware of using this therapy are any better off - perhaps less depressed. Lexapro too is more of an antidepressant (different class though and one that seems to harbor less side effects). At the 2005 Baltimore chapter American College of Physician Conference, I was part of a group that presented a case of hyponatremia (low sodium) as a result of the Syndrome of Inappropriate Anti-Diuretic Hormone (ADH). I guess what I am saying is that there is potential for excess, which would sort of be counter-productive for the diuretic therapy.

I don't really care for opioids in this scenario and because this isn't restricted to the trigeminal nerve (in the face) explicitly, this limits our options further.

I would suggest that if your dad has not that he first try and employ concurrent Transcutaneous electrical nerve stimulation (TENS) as a nice adjunct to augment pharmacotherapy. You can actually purchase your own device and while they are somewhat expensive in some instances for a quality device, the results could prove extremely significant and perhaps even do more overall for your dad's pain than a lot of the pharmacy stuff.

I still don't think that pharmacotherapy should be abandoned, but realistic expectations in this scenario should accompany its employment. In essence, aiding your dad's overall quality of life and improving his activities of daily living is the primary goal, you will not in many instances ever find a true "cure."

So, here's what I think can be used in addition to the TENS...

Topical agents offer the advantage of local relief without systemic toxicity. Capsaicin cream, which contains an extract of chili peppers, is sometimes used to treat neuropathic pain. It may act on unmyelinated primary afferent nerves by depleting substance P, a peptide thought to be involved in pain transmission [I gave a decent write up of it in my Yellow nEuphoria log on DA]. Depletion requires repeated and consistent use of capsaicin. The most common side effect is a burning sensation that decreases with consistent use, but I would say that your dad will likely welcome the trade-off.

You may be able to get away with a drug called carbamazepine, which may be the next try if he feels he as at last resort. But I cringe because of his liver history - though some remain unaffected...it could prove difficult to administer here. More often though, you simply have to watch his white blood cell (WBC) count and absolute neutrophils for better monitoring.

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Potassium overload can be the end-result of a diuretic use (i.e. - furosemide), which is my assumption.

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As for supplements, SAMe, B Complex, and CoQ10 would all likely have a place here. Again, I ask that you run this by one of his physicians prior to employing these agents though.

Hope this helps. Neuropathic pain is something I see a lot with diabetics, but your dad's scenario is certainly enticing to the medical nerd, so I thank you for the presentation.

D_