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I'm a mom, a wife, a best friend. Sick with CFIDS/ME/CFS and Fibromyalgia since 1975 as a result of a nasty flu while still in grad school, it wasn't until the late '80's that I received a diagnosis. Until that flu I'd never really been ill before. With each year I get progressively worse and add to the bucket load of symptoms I'm living with. I've been blessed with an incredible family and best friend who've stayed with me through my struggles as we continue to find a way out of this monstrous illness and its complications. We've tried seemingly every approach to find my way back to health. Often I think our best weapon in this undesirable and unasked-for adventure has been laughter.

Sunday, April 7, 2013

A Great Topical Gel...

As many of my regular readers know, I've been going through a bit of a rough patch lately. (Falls and the rest are just "rough patches"?  Surely you jest, self!)  I'm getting a bit sick and definitely tired of the CFIDS/CFS/ME and fibromalgia and all the illnesses, conditions and problems that stem from them.

Lately I've had so much hip and buttock pain that it was affecting how I walk and was probably a big factor in some of my falls.  No, somehow I don't think it was responsible for the one where I thought getting out of bed via the foot board was faster and smarter than getting out via the side!  (That colored link will give you a funny -I hope - account.)  

When one of my doctors examined me, he found numerous areas of muscle spasm and even bursitis on both sides.  Local injections with lidocaine (for trigger points in the areas of muscle spasm) and cortisone with lidocaine (for inflammation of the bursa) helped but I still had a fair amount of pain in the hip and buttock area to the point that I was waking up in huge pain.  Usually, if I can finally fall asleep, pain doesn't wake me up, so you can imagine that I was NOT a happy camper - all week.  (And you know what they say, "If mama ain't happy..."  Yeah!  Cheerful place around here, let me tell you!)

I was already taking a maximum dose of Celebrex, which is an extremely safe anti-inflammatory medication, compared to the other anti-imflammatories out there.  I'm getting ahead of myself here, but I've long wanted to point out that Celebrex is much safer on the stomach than the other anti-inflammatories and is well tolerated by most, EVEN the stuff that's over the counter like Advil, Aleve, MotrinIB.   HOWEVER, the one draw-back is that you can't take Celebrex if you are allergic to sulfa-drugs.  (Thank heavens, a problem I DON'T have and it works well for me! Yipee!)  

Another point I've wanted to make is that when you read the side-effects of this gel, as with many other medications, the warning is overblown because it has to be.  That is, in the case of the gel, the same warning goes as for the oral meds, which we'll cover later.  However, you'll see why this is even a bit "deceiving" and certainly alarming.  But then you guys know how I feel about the FDA, etc.  Lyrica and Lunesta on the market despite SUICIDAL ideation and actions, but Vioxx taken off?  Nuts! 

But back on track... I'm already taking a narcotic medication - as needed for pain - along with a few other medications in my arsenal that should work but aren't.  So we got to the point where I've gone for the numerous injections in the hip and buttock area.  It's always worked before but this time we were really having trouble with the pain.  It was helping but not enough.  Mind you, I don't expect to be pain-free, but I can't live at a 9.5 and let the shots or meds get me to a 9.  It's hardly worth the "poisoning" of my body.  So, unfortunately, I was still having significant discomfort.  What's a girl to do?  (That last line seems to be a thread in my posts lately.)

Fortunately, there is a topical anti-inflammatory medication which has been approved by the FDA for osteoarthritis.  Any licensed physician can prescribe a medication "off-label," which as many of you know, means that if a medicine is approved for an indication such as arthritis, the doctor can legally prescribe it for other conditions such as bursitis, tendinitis, etc.  That's what's  happened in my case.  My doctor told me that the topical preparation, Voltaren Gel, might help me since it's effective in blocking the inflammation found in arthritic joints.  I applied Voltaren Gel liberally to both hips and buttock area (lots of real estate going on there!) and noticed a significant improvement in the pain and stiffness.  

So, what is this stuff anyway?

Voltaren is the brand name of diclofenac, an extremely potent non-steroidal anti-inflammatory medication (NSAID). Taken by mouth, it can relieve the pain, swelling and stiffness associated with arthritis.  However, it has major draw-backs. It can cause bleeding stomach ulcers, kidney failure, and liver damage when taken orally.  

On the other hand, the gel form is far safer than the pill form since only a tiny amount of the medication gets into the general circulation.  The bulk of the medication stays in the area where you put it and penetrates the skin to get to the area of inflammation. Therefore, as mentioned above, Voltaren Gel is far safer than any of other anti-inflammatory medications even those that are over the counter, such as Advil, Aleve, Motrin IB, etc.  Furthermore, Voltaren Gel has been around for well over over five years, so side effects have been seen and reported, analyzed, with no cases of stomach, kidney, liver toxicity.

Every year in this country approximately 16,500 people die of gastrointestinal complications due to ORAL anti-inflammatory medications.  I can't stress this strongly enough.  Taken as prescribed, ORAL anti-inflammatory medication can kill you or harm you, especially if you are susceptible to side-effects due to advanced age, have a prior history of ulcer disease, and/or weakened system due to other diseases.  

On the other hand, as my pain specialist explained, the topical gel form of Voltaren is very safe.  The only real problem with using this product is that if you are allergic to aspirin you MUST NOT use this product as its use could trigger a severe allergic reaction.   Otherwise, this preparation is very safe and potentially very effective as was my experience yesterday.  I'll let you know how it goes, but for the moment, I've got a bit of relief!  That's great in my book.

As always, hoping everyone is feeling their best, only better!  Ciao and paka!

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  1. I have Voltaren too! It's sitting in my drawer. I've been thinking about using it on my upper trapezius muscles; I’m hoping it might provide relief and possibly reduce the severity of the migraines which generate from the back of my neck. I like the concept of a pain killer that I don't have to ingest.
    I just reread what you wrote above...I've never taken Celebrex-type drugs but, I'm allergic to sulfa...is that true for all meds in that class? My brain is all over the place.
    It's very frustrating when you hit a wall with pharmacological options for pain management. I asked my rheumatologist if anything new is available - anything since I tried Savella. I wish it didn't cause me high blood pressure and hypoglycemia as it worked absolute wonders for my pain management. The interesting thing about the Savella is that it didn't cause any depression while I was taking it. But, within a few days of discontinuing the medication, I fell into a deep depression - one that was very clearly related to the withdrawal. Most of us living with chronic illnesses are not exactly Mary Sunshine but, the depression from Savella withdrawal was scary.
    My Yorkie started his insulin yesterday; today was his first day with both doses (AM and PM). It's likely that the dose will have to be increased a bit. I’m so painfully sleep-deprived. For days it was to take him out every hour; since yesterday afternoon, it's been to watch for any ill effects of the insulin and to monitor his water and food intake and his need to go out. The rheumatologist wrote me a script for valium because it can stop muscle spasms. He gave me a low dose but, he's hopeful - as am I - that it might help with the aforementioned upper trapezius muscles.
    However, I can’t take the valium until my Yorkie is set on the correct insulin dose and until I'm sure he's okay. I can’t risk any possible difficulty in waking up quickly. I had to take Advil during the night last night because the migraine broke through the adrenalin that was keeping it at bay. I try not to take Advil because I'm pretty sure I'm just 1 pill away from bleeding from every orifice (pleasant, I know). But, when the migraine worsens, I wind up very nauseated so it's not worth holding off.
    I thought I was used to sleep deprivation. I can count on one hand the number of nights I’ve slept more than 4 hours since 6 months after my gallbladder surgery. Between Fibro, RLS, and nerve damage pain, sleeping longer than that is rare.
    But, starting when my Yorkie first showed symptoms of something not being right (maybe a week and a half ago), I'm down to 2 interrupted hours at night. I nap a bit during the day when I know my mom is watching him. The lack of sleep at this level has more-or-less disconnected whatever connections were working in my brain. I've given up trying to find the word I want to say and I don't even try to think of a synonym - I just stop talking mid-sentence.
    I feel like what I’m writing has been one giant run-on sentence. I hope you’re doing better! I’m going to attempt to sleep a bit after checking on my dog. People with non-furry babies must get zero sleep when the babies are little and/or sick. It would be nice to have 1 of my own, if someone else would go through the pregnancy, birth, diaper-changing…things that require energy, etc. But, I’m also sure I’d shake like a Chihuahua from anxiety over the baby’s welfare. I give moms a lot of credit!

    1. If you're allergic to sulfa, Celebrex is the only NSAID which is counter-indicated in the anti-inflammatory family. But it needs to be a real allergy, not an intolerance.

      You're talking about Voltaren gel, which is not an issue w/ sulfa. So you may get a break there!

      This isn't medical advice, this is simply what is out there! Check w/ your rheumy.

      So sorry to hear that you're going through all these problems, Melissa. I hope your darling Yorkie gets straightened out. Some day I'll tell you about our "million dollar cat," which is not to be confused w/ my son's "9/11" rescue cat w/ the diabetes. I soooo want a cat myself because I get so lonely and our Misty was such great company. However, I know I couldn't handle one at this point.

      Please feel better!!! xxx

  2. In my experience arnica gel works better, but I guess it depends on what you're treating. Cortisone injections almost always do more harm than good. Bromelain is very helpful for bursitis, generally taken orally, but also available as creams.

    1. Hi Maija,

      I've used arnica gel on my kids when they were growing up, having discovered it on a trip to England, so I'm quite familiar with arnica. However, I don't think you appreciate the sort of pain that I, along with many, many others, have to endure. I've had 3 10-pound babies, many emergency surgeries and all too many near-death experiences, so I'm pretty good with pain. (Look up compartment syndrome surgery and get a load of what THAT's like!) But arnica is NOT enough for what I and many others have been going through.

      I'm all for alternative medicine and have gone that route extensively and have written about it a bit. So, please don't think I'm knocking it down.

      However, I simply can't allow your statement, "Cortisone injections almost always do more harm than good," stand without a response since it is so outrageous and possibly dangerous. Tell this, regarding the cortisone, to the person with Giant Cell Arteritis whose sight was preserved by taking oral cortisone. Tell this to the arthritic patient who could not walk without cortisone by injection and by mouth. Tell this to the patient with pulmonary fibrosis who could not breathe without the use of cortisone. There's a reason why the Nobel Prize was awarded to the doctor who came up with cortisone treatment.

      As far as Bromelain is concerned, are you kidding me? Again, it's a great preparation for use for relatively MINOR problems, compared to vasculitis, lupus, etc.

      I understand your passion, Maija. But you really do have to watch what you say. There is enough junk info out there. You don't want to add to the mess, confusion and misinformation.

      Thanks for reading my blog and writing. xx

  3. Also forgot to say that in many countries there's a drug called etoricoxib (Arcoxia), which is much longer-acting and even safer on the stomach than celecoxib, but it's not available in the United States. However, there is contradictory information as to whether it can be used in cases of sulfa allergy.

    1. Yes, Maija, Europe often gets medications much earlier than we do here in the States. Even the dose recommendations differ at times. I think of it as medical politics where, unfortunately, all too often the patient gets the short end of the stick. xx

  4. I discovered Voltaren gel on a trip to Germany about 6 years ago. At that time it wasn't available in Canada so every year I'd bring home half a suitcase full of the stuff. Now we can buy it here. It works for me, always has. Germans love the stuff. I also take the pills, I know I know, I risk the stomach bleeding but what the heck, they work too...ciao

    1. Hi Rositta! So thrilled the Voltaren works for you. Another example of Europe usually getting meds before we do here in North America! Thanks so much for writing in! xx