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Suggest treatment for Cirrhosis caused due to Hep B - Online Doctor Chats

Date : 26-Mar-2014
User rating for this question
Very Good Posted in: Liver and Gall Bladder
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1773 Questions
User:i have cirrhosis due to hep b i never knew i had i am 42 and moving to the area i take a small dose of pain medication specifically 10mg oxycodone 2 times a day i have been warned of the pill-mill situation and i want to avoid all that and continue my medication is this viable with your group?
User:hello Dr.
Doctor:Have you checked your liver function tests recently?
User:my main concern is a swift change to avoid withdrawls but ive heard pain meds are very difficult to come by and yes enzymes were pretty good i take baraclude every day
User:the pain is a constant ache and occasional breakthrough
Doctor:If your liver functions are good, current dose of oxycodone has had less effects on the liver. In this situation, if the pain is occasional you can consider lowering the doses gradually and withdraw from it.
Doctor:Yes, opioid withdrawal is difficult especially in presence of pain. However if you can strictly follow the regimen of pain medicine doctors you can be off this drug over a period 2-3 months.
Doctor:And since oxycodone has no major effects on liver functions now, you may use it occasionally as and when needed to control the pain.
Doctor:Did I answer your question?
User:would a pain medicine dr gradually ween me down?
Doctor:Yes. Opioids are better to be withdrawn gradually.
Doctor:The time duration of withdrawal will depend upon how you react to withdrawal.
User:so what type of dr should i seek to continue the meds then begin an as needed prescribed dose?
Doctor:I am not sure what type of pain you have. But if I were to be your treating physician I would recommend that you work closely with a gastroenterologist and pain medicine doctor.
Doctor:Gastroenterologist monitors the liver function status while pain medicine doctor manage this chronic pain.
Doctor:Hope it is clear.
User:do u know of a reputable pain medicine dr in the southern ohio region
Doctor:To be honest, I practice far away from your location and I have no personal reference of doctors at Southern Ohio.
Doctor:I am sorry for not being able to refer you to a reputable doctor, but I do not wish to misguide you based on google informations.
Doctor:You might consider asking your local physician for a reference the next time you see him/her.
Doctor:Do you have any more questions?
User:so search out a pain management dr and have them work with my gastro
Doctor:May I ask who is managing you medical problems currently?
Doctor:Is he a physician or gastroenterologist?
User:dr XXXXXXX houghton-gastro dr XXXXXXX mcginnin general practice
Doctor:I would suggest that you talk about your intentions with the gastroenterologist and ask him for reference.
Doctor:I am sure, both these specialist will co-ordinate between themselves to work with your interest.
User:he referred me to mcginnis and im not to happy with him
Doctor:If your gastroenterologist is not willing to refer you to a pain medicine doctor, you can book an appointment with a specialist yourself.
Doctor:Let him work on you individually, he/she can then take a call whether or not to discuss with your gastroenterologist.
Doctor:The bottom line is I feel if a patient isn't happy with a particular doctor
User:theyre al pain mgmt here n most use alternate medicine and blocks
Doctor:he should be given equal rights to take a second opinion.
Doctor:Since you are not on high dose oxycodone to manage the pain
Doctor:I don't feel you will require therapeutic blocks.
Doctor:That being said, you haven't discussed about your pain with me.
User:i agree and thats all i want but i dont want co-payed to death trying to find one
User:upper right quad constant ache and occasional shooting pain to mid left
Doctor:Since you have a localised pain over abdominal area, it is unlikely that you are going to receive nerve blocks.
Doctor:your doctor may try withdrawing you off 20mg per day oxycodone.
Doctor:Bring it to the lowers possible tolerable dose.
Doctor:And take them as and when need basis.
User:only thing is the 2 10 mg give me no relief at night so i wake up in pain quite a bit
Doctor:With regular follow ups, as you bring a doctor into confidence, he should understand your intentions well.
Doctor:If the current oxycodone isn't relieving the pain, why do you wish to be tapered off it.
Doctor:Not all pain killers are acceptable by cirrhosis patients.
User:well i get no help lying im always honest w my dr...especially now
Doctor:It is best to work with the drug which has less effects on the liver.
Doctor:Opioids are one such class of drugs.
User:what about methadone?
User:also receptionists arent too willing to say the dr prescribes opiods
User:by the way may i ask where you practice?
Doctor:Methadone and oxycodone both have almost similar effects. I don't find much difference between them.
Doctor:I practice in my country in India.
User:oic yep lil too far of a commute
Doctor:The difference that i find is some people prefer to be on methadone since they tolerate it much better.
User:yes i take a 1mg dode of xanax daily but i dont see that being much different than the mixture w oxycodode if not abused
Doctor:I would prefer to use good pain medicine rather than increasing dose of xanax.
Doctor:At this instance since your unhappy with the treatment, I give two options to you.
Doctor:1. Call the customer support team that provides your insurance
Doctor:and ask for other pain medicine doctor who accepts your insurance.
User:no ive been on the same xanax dose for increase intended
Doctor:Consult this specialist and he may work on you individually considering your liver function status.
Doctor:That's right. Increasing Xanax is not allowed.
Doctor:2. Which I am not sure you would accept is asking the current general practitioner for a reference to pain medicine doctor.
User:my gastrointerologist will give me one
Doctor:He should consider your request if you aren't happy with the current GP's services.
User:im sure he will
User:thank you dr i feel much better now
Doctor:Talk to him and once you are with a new specialist discuss about options of trying long acting opioid preparations for better pain relief.
Doctor:I am glad that I was of some help.
Doctor:Is there any thing else that you wish to discuss now?
User:youve given me a tremendous head start nothing else to ask till i get more info you take care and ty so much
Doctor:You are welcome.
Doctor:Thanks for consulting me.
Doctor:Take care.
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