lumbosacral A Few Questions

[KHJH]

My husband was admitted to a VA hospital for low heart rate, low B/P and kidney failure. His heart rate was 46, B/P was 71/38 and his lab work for Bun was 130 (normal is 10-20). His lab for Creatin was 5.5 (normal is .7 - 1.4), and was close to needing dialysis.

He was released yesterday and all his labs looked fine they were just a little above normal.

Before he was realeased they sent in physical therapy to check his mobility, and he was given a walker and a wheelchair to take home. He was only using a cane at the time. The physical therapist said it would eventually be upgraded to a power chair.

He currently has a combined S/C rating of 80% IU PT for

PTSD 70%, Chronic Lumbosacral Strain with painful left hip 30%, & Chondromalacia of the left Knee 20%.

Question #1: Should he file for an increase for his back, hip and Knee?

After he was discharged yesterday we got home about 6:00 in the evening. Around 11:00 pm he was feeling weak, dizzy, said he was cold and felt like needles were sticking him all over. I checked his temp and it was fine. So he went to bed, then stared having chest pain, shortness of breath and wheezing. He took a nitro then went to the bathroom and starting vomiting. The VA is 1 hour, 45 minutes away so I called the VA ER and they said because of his medical history I should take him to the nearest ER.

His medical history is:

PTSD S/C

Back, Hip and knee S/C

DJD

Esophageal reflux

Peptic Ulcer

Conjestive Heart Failure

Hyperlipidemia

Angina pectoris

Cor Atheroscl

Aortocoronary Bypass

Renal Insufficiency

DMII - (Pre-Diabetic)

I took him to the nearest hospital 50 miles away. By the time we got there he was feeling better and his labs were fine. His ECG was abnormal (ST & T wave abnormality, Consider Lateral ischemia). I believe this is the result of all his ECG's lately. He was discharged and sent home.

Today he is still weak, chills, Vomiting, can't even drink water without getting sick, chest pain, heart rate went up to 103. Will probably end up taking him to the VA ER.

Question #2: He was on methadone for a month and has not took any for over a week. Could these symptoms be withdraws from the methadone?

Question #2: What do I need to do to get the VA to pay for this ER visit and will they still pay for it since he was sent home. I took him there because the VA told me to.

Thanks

Kathy

[Guest Namvet6567]

Here's what I found on Methadone Withdrawal Symptoms:

Methadone Withdrawal symptoms include but are not limited to:

sneezing

yawning

tearing of eyes

runny nose

excessive perspiration

fever

dilated pupils

abdominal cramps

nausea

body aches

tremors

irritability

[john999]

You can add insomnia to that list as well. While you are kicking the drug you can't sleep either if it is a sudden withdrawl.

[KHJH]

Must be why he was awake most of the night last night. How long do these symptoms last and could they be life threatening?

Kathy

[Guest allanopie]

I went through a similar situation with medications being suddenly withheld.

I ended up at an ER. VA billing assured me they would pay it. Around $4000 has gone to collections. I get calls & bills sometimes. This happened a few yrs ago. I wouldn't look for them to pay it.

Allan

METHADONE DISPERSIBLE TABLET - ORAL

Pronunciation: (METH-uh-doan)

BRAND NAME(S):

Methadose

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WARNING:

Take this medication by mouth only. Although the methadone in the tablet will dissolve in liquid, the tablet contains ingredients that will not dissolve. Do not attempt to inject this medicine after dissolving it. Keep this medication in a childproof container out of the reach of children to prevent accidental poisoning.

Methadone is a man-made (synthetic) narcotic. People who are physically dependent on narcotics will experience withdrawal symptoms if given the usual dose of a narcotic blocker (e.g., naloxone). The seriousness of withdrawal symptoms is related to the level of dependence and dose of the narcotic blocker. If possible, these people should not receive narcotic blockers.

Withdrawal symptoms may also be caused by using certain narcotics (e.g., pentazocine, butorphanol, nalbuphine) after using methadone. Tell your doctor immediately if you develop symptoms such as anxiety, agitation, trouble sleeping, sweating, and diarrhea.

This medication has caused abnormal heart rhythm (prolonged QTc) and serious irregular heartbeat (arrhythmia). Tell your doctor immediately if you have symptoms such as unusual dizziness, fast/irregular heartbeats, or sudden fainting.

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USAGE:

This medication is used to treat narcotic (e.g., heroin) addiction as part of an approved program. Methadone is a man-made (synthetic) opiate-type narcotic that is long-acting. It acts on certain centers in the brain.

OTHER USES: This medication may also be used to treat severe pain in patients who take narcotics routinely.

HOW TO USE

Dissolve the tablet in 120 milliliters (4 ounces) of water, orange juice, or another acidic fruit beverage for one minute. Take this medication by mouth, with or without food, as directed by your doctor. If nausea occurs, consult your doctor or pharmacist about ways to reduce it (e.g., antihistamines, lying down for 1-2 hours with as little head movement as possible).

The dosage is based on your medical condition and response to therapy.

If you are taking this drug for narcotic addiction, your doctor will gradually reduce your dose. Be sure to follow your doctors dosing instructions closely.

If using this medication for pain, remember that pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has significantly worsened, the medication may not work as well.

Use this medication exactly as prescribed. Do not increase your dose, take it more frequently or use it for a longer period of time than prescribed because this drug can be habit-forming. Also, if used for an extended period of time, do not suddenly stop using this drug without your doctor's approval.

This medication may cause dependence, especially if it has been used regularly for an extended period of time, or if it has been used in high doses. In such cases, if you suddenly stop this drug, withdrawal reactions may occur. Such reactions can include diarrhea, restlessness, widened pupils, watering eyes, body aches, cold sweats, and hot/cold flashes. Withdrawal symptoms may take three to four days to develop, may worsen over the first week, and may last for two weeks. Report any such reactions to your doctor immediately.

When stopping extended, regular treatment with this drug, gradually reducing the dosage as directed will help prevent withdrawal reactions. Consult your doctor or pharmacist for more details.

Though it is very unlikely to occur, this medication can also result in abnormal drug-seeking behavior (addiction/habit-forming). Do not increase your dose, take it more frequently or use it for a longer period of time than prescribed. Properly stop the medication when so directed. This will lessen the chances of becoming addicted.

When used for an extended period, this medication may not work as well and may require different dosing. Talk with your doctor if this medication stops working well.

Inform your doctor if your condition persists or worsens.

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SIDE EFFECTS:

Nausea, vomiting, constipation, lightheadedness, dizziness, dry mouth, drowsiness, stomach upset, blurred vision, flushing, and increased sweating may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water or use a saliva substitute.

Remember that your doctor has prescribed this medication because the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur: mental/mood changes (e.g., unusual elevated mood, agitation, depression), hallucinations, difficulty urinating, fainting, rapid heart rate, shaking (tremor), confusion.

Tell your doctor immediately if any of these rare but very serious side effects occur: irregular heartbeat.

A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching, swelling, severe dizziness, trouble breathing.

If you notice other effects not listed above, contact your doctor or pharmacist.

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PRECAUTIONS:

Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: severe breathing problems (e.g., respiratory depression, hypercapnia), diarrhea due to infection (e.g., Clostridium difficile colitis), stomach/abdominal problems of unknown cause.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, difficulty urinating (e.g., enlarged prostate, urethral stricture), alcohol use, drug dependency, lung disease (e.g., asthma, chronic obstructive pulmonary disease), head injury, low blood pressure (hypotension), dehydration, seizures, heart disease (e.g., congestive heart failure, recent heart attack), heart rhythm problems (bradycardia, history of QTc prolongation), mental/mood disorders (e.g., depression), mineral imbalance (low magnesium or potassium blood levels), gallbladder disease, overactive or underactive thyroid, a certain endocrine disease (Addisons disease), severe headaches or changes in vision.

This drug may make you dizzy or drowsy; use caution while engaging in activities requiring alertness such as driving or using machinery. Avoid alcoholic beverages because they may increase the risk of this drug's side effects.

To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position.

Before having surgery, tell your doctor or dentist that you are taking this medication.

Caution is advised when using this drug in the elderly because they may be more sensitive to its effects, especially the decreased breathing and drowsiness effects.

Caution is advised when using this drug in children.

This medication should be used only when clearly needed during pregnancy. Participation in a detoxification program is not recommended for pregnant women. Pregnant women in a methadone maintenance program should receive prenatal care from the program or an approved doctor. Use of illicit drugs (e.g., heroin) may result in withdrawal symptoms or other complications in a newborn infant. Infants born to mothers who take methadone while pregnant may have a higher risk of sudden infant death syndrome (SIDS). If used during labor, newborn infants may have breathing problems. Discuss the risks and benefits with your doctor.

This medication passes into breast milk. Breast-feeding is not recommended while using this drug. Consult your doctor before breast-feeding. Methadone can cause serious side effects and toxic reactions if used by someone other than the person for whom it is prescribed.

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DRUG INTERACTIONS:

Your healthcare professionals (e.g., doctor or pharmacist) may already be aware of any possible drug interactions and may be monitoring you for it. Do not start, stop or change the dosage of any medicine before checking with them first.

This drug should not be used with the following medications because very serious interactions may occur: naltrexone, drugs which may affect the heart rhythm (QTc prolonging drugs such as bepridil, droperidol, halofantrine, mesoridazine, pimozide, sertindole, sparfloxacin).

If you are currently using any of these medications, tell your doctor or pharmacist before starting methadone.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: amphetamines, blood thinners (e.g., warfarin), drugs affecting liver enzymes that remove methadone from your body (such as azole antifungals-including itraconazole, cimetidine, efavirenz, fluvoxamine, macrolide antibiotics-including erythromycin, nevirapine, protease inhibitors-including ritonavir, rifamycins-including rifampin, St. Johns wort, certain anti-seizure medicines including phenytoin) MAO inhibitors (e.g., furazolidone, isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, selegiline, tranylcypromine), certain nucleoside analogues (e.g., didanosine, stavudine, zidovudine), pentazocine, water pills (e.g., furosemide, hydrochlorothiazide).

Other drugs besides methadone which may affect the heart rhythm (QTc prolongation in the EKG) include amiodarone, dofetilide, erythromycin, moxifloxacin, procainamide, quinidine, and sotalol, among others. QTc prolongation can infrequently result in serious, rarely fatal, irregular heartbeat. Consult your doctor or pharmacist for more details, and for instructions on how you may minimize the risk of this effect.

Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: anesthesia drugs, certain antihistamines (e.g., diphenhydramine), anti-anxiety drugs (e.g., diazepam), anti-seizure drugs (e.g., carbamazepine), medicine for sleep (e.g., sedatives), muscle relaxants, other narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., phenothiazines such as chlorpromazine, or tricyclics such as amitriptyline and desipramine), tranquilizers.

Check the labels on all your medicines (e.g., cough-and-cold products) because they may contain drowsiness-causing ingredients. Ask your pharmacist about the safe use of those products.

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OVERDOSE:

If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include: slow breathing, slow heartbeat, loss of consciousness, pinpoint pupils, cold/clammy/blue skin, muscle spasms/weakness, low body temperature, deep sleep.

NOTES:

Do not share this medication with others. It is against the law.

Laboratory and/or medical tests (e.g., EKG-QTc interval) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

This medication has been prescribed for your current condition only. Do not use it later for another condition unless told to do so by your doctor. A different medication may be necessary in those cases.

To prevent constipation, maintain a diet adequate in fiber, drink plenty of water, and exercise. If you become constipated while using this drug, consult your pharmacist for help in selecting a laxative (e.g., stimulant-type) and stool softener.

MISSED DOSE:

If you are prescribed this drug on a regular schedule and you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE:

See also the Warning section.

Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.

Source:

http://www.rxlist.com/drugs/mono-1194-METHADONE+DISPERSIBLE+TABLET+-+ORAL.aspx?drugid=2671&drugname=Methadone+Oral

[john999]

I have taken morphine, methadone, and other strong narcotics. I have the damndest reactions. Sometimes I get very irritable and paranoid. It does not sedate me. I told the VA about the paranoia and I wonder when I am going to hear back about it.