Hmmm I did not see the file that I thought I had attached - so in the interest of avoiding confusion, I am just excerpting the key elements of it below into the message itself. The table does not render well - there are four columns and you can tell what the column headings are, so interpret it in that fashion.
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1. As to be expected, the very worst pain was in the initial urinations after the procedure; I asked for and got two microdoses (25 micrograms each as I recall) of fentanyl and it did help but of course did not fully alleviate the pain. Thinking about this retrospectively, if permissible, it would be desirable to have had those doses automatically before the first urination without having to request them.
2. Early in the recovery period (for approximately the first 24 hours), the urination pain seemed to come in three stages:
a. At the start of urination, very sharp pain
b. During the urination, a severe burning pain in addition to the sharp pain
c. After the urination, a severe burning pain and general feeling of discomfort in the bladder itself – not exactly muscle spasms but felt close to that sensation, without the spasms themselves.
3. What I noted was that during the two days following the procedure, the pain in a. above (at start of urination) was the first to abate. This was interesting and, in a way, a good thing because psychologically I had prepared myself immediately for severe pain, but it did not come – just during the urination per b. and c. above. The initial pain in a. abated mostly after about 24 hours.
4. I took steady doses of oxydocone pretty precisely every four hours, occasionally every 4 ½ hours. It occurred to me after the fact that since each dose has 5mg of codeine, it would have been desirable to allow the initial doses to be taken every 2 or 3 hours instead of every 4 hours. As a quick assessment, the biological half life for immediate release oxycodone is 3.2 hours, so look at the following table:
Period (in hours) Serum level Period (in hours) Serum Level
0 5 0 5
4 7.1 2 8.2
8 8.0 4 10.3
12 8.3 8 9.3
16 8.5 12 8.9
20 8.6 16 8.7
24 8.6 20 8.7
24 8.6
N(t) = N(0) times e raised to the power (-t divided by tau)
Tau = 3.2 hours/ln(2) = 4.616624
So, the first column represents serum levels of codeine over the first 24 hours taking oxycodone 5-235 every four hours, whereas the second column represents serum levels of codeine over the first 24 hours IF the patient were to take a second additional dose at the two hour point.
There are two important conclusions from this table. First, as would be expected, serum levels asymptotically reach 8.6 mg at 24 hours since the extra dose at the two hour point is attenuated by that time. And, serum levels with the extra dose are higher in the first several hours as expected (peak of 10.3 mg), but only by a few mg which is much less than what I understand to be permissible doses at higher levels (15 mg or 30 mg of immediate release). Those few extra milligrams could mean the difference between a lot of pain and an intense amount of pain.
Based on this, would it be acceptable to take that second dose at the two hour point, in between the “once every four hours” dose?
5. I drank copious quantities of water. The recommendation was six eight ounce glasses per day (48 ounces); I kept a partial log and for the first 24 hours, consumed over 110 ounces; on the second day, over 140 ounces. My process was simple: every time I urinated, I drank, sometimes more than I urinated. This reached a point where I was urinating almost every hour; yes it did make it difficult to sleep soundly but psychologically I was o.k. with that since it abated the pain and since it gave me the satisfaction of knowing I was flushing the chemo from my bladder.
6. Being on the oxycodone, I did not want to have to get up for every urination and do it in the toilet out of fear of losing my balance. Instead, I used a urinal which my loving wife emptied. Actually used two urinals – no waiting lol – since the volume I was producing was so high.
7. I kept a mental log of when each dose of medication was needed – basically just remembered the last dose and added 4 hours for oxycodone and 8 hours for pyridium. In retrospect, I should have written this down. One time I could not remember whether I had taken a dose or not (I was just on the cusp of needing one I thought), so I counted the pills in the container, divided by the interval and determined that indeed I needed a new dose; which was confirmed when the pain worsened before the new dose made it in to my blood stream.
8. Since I used a urinal, almost all of my urinations were done while I was reclining and on my side with the penis inside the mouth of the urinal. I found that this was the most comfortable position, I was able to relax my muscles most fully. When I did get up to urinate in the toilet after about 48 hours, it was a bit more painful and I noticed a few blood clots (brown not red) had passed, so I assume that gravity had done the job of collecting them but they had not been pumped out when I was on my side, they came out only when they were at the “bottom” of the bladder when I was on the toilet.
9. One other point on the use of the urinal – initially I always reclined on my left side to use it. However, the tumor was on the left side of my bladder. After a while, I concluded it might be better to recline on my right side; I changed at about the 24 hour period. Hard to tell whether that made a difference since the pain was beginning to abate at that point anyway.
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