Thanks raxis *hug*
It seems like they might be already even, I've been put on a stonking great dose of erythro, about as high as its going to get without being in hospital and having it through an I.V drip (good luck, it takes me to find my veins and they'd rather fanny around with ultrasound guidance and eventually stick one in my fucking jugular (something I wouldn't do in a million years, ultrasound or no ultrasound, whereas if they just gave ME a butterfly rig, I'd likely as not get it right in there. Funny how it took THEM an hour, when I needed surgery on something, at least, before they got in the alfentanil drip (which was for one of the fentanyl derivatives at least, rather good stuff. I usually don't care for the family, but alfentanil really wasn't half bad), but earlier that day before going into hospital *I* had managed to get a shot of 5ml saturated morphine solution in me with no special imaging equipment and DEFINITELY not having to constantly rag on the anaesthetist to *change the fucking needle already* because bugger me diagonally with razor wire if I am prepared to tolerate a bunch of tools bearing down on me from above whilst lying flat and trying to shove an effing blunted needle point in my effing neck. Not the kind of place I'd want a vein collapsed thank you very much)
I usually only go to the docs to pick up my regular med refills, and I don't need to actually see anybody but the receptionist for those unless they balls it up and I need to chase something up. All I have to do is walk in, let the receptionist know I'm actually present, take the scripts and go to the pharmacy to pick them up, stock up on dextromethorphan cough syrup (its fairly nasty when drinking 200-250mg worth at a time. A sub-dissociative dose, but not what I want it for. I take advantage of its NMDA antagonist properties to help keep my tolerance to the pain meds as low as possible and prevent as far as I can without adding microdose naltrexone (which I do plan to when I can, one uses a nano-dose hell, no, a femtodose regimen more or less, a few low single digit micrograms per dose with the opiate, say at first 2-5ug at a time, this doesn't block opiate receptors, or rather it does, but selectively blocks a subpopulation of Mu-opioid receptors (Mu are the kind one associates with the typical spectrum of effects exhibited by for instance morphine, methadone (although methadone is also a rather weak NMDA antagonist), desomorphine, ketobemidone, oxycodone/oxymorphone and what have you, although heroin is a bit different a bit of a complex case)
There becomes. with tolerance aquisition, a population, relatively small in relation to the population of native-state bog standard MORs (mu-opioid receptors, there are others, KOR-kappa, DOR-delta and NOP-nociceptin, as well as a putative epsilon opioid receptor, I've also read of an iota receptor, iota signifying 'i' for 'intestine/intestinal' the journal article I saw that mentioned in suggests its responsible for inhibition of intestinal peristalsis, constipation etc.
But anyway the MOR tolerance-induced subpopulation in the CNS becomes excitatory through a shift in the intracellular molecular switches called g-proteins that couple to various intracellular second-messenger systems responsible for the transduction of effects of ligand binding to targets such as receptors, ion channels etc. that lie outside the cell on the exterior side of the cell membrane, such as synapses, and on the cell itself, ion channels. These excitatory MORs cause quite the opposite effects when activated, agitation, overstimulation, noradrenaline release in the locus caeruleus and from what I understand of their nature pretty much simulate opioid withdrawal. Naltrexone, much more commonly known as a MOR antagonist, blocking the effects of (mu agonist) opioids binds to these little buggeredlyfuckpots (technical term there y'see;)) with a far higher affinity than it does with typical MORs (which are coupled to the intracellular effector Gi/o (two separate G-proteins, Gi and Go, which are inhibitory in nature with regards to cAMP production intracellularly) whilst if I remember rightly, its GγS and possibly Gβγ that the excitatory, nasty little subtype of Mu-opioid receptors switch to coupling to triggering intracellular cAMP (cyclic adenosine monophosphate) production, which produces excitatory effects)
And additionally, ultra low dose naltrexone (a typical dose is some 25 to 50mg, rather than the 1-5micrograms initially, potentially moving up to 10 with time on the regimen) also blocks a protein called filamin A, in a specific regulatory region thats involved in opioid tolerance. I've read some firsthand reports from people that have gone ahead and tried this, and the effects were astonishing. One guy managed to taper off a habit of some MINIMUM dose of 60-70mg intravenous hydromorphone, a very potent if short acting opiate indeed, starting dose is around 4mg for a nontolerant or mildly tolerant patient, using codeine when he felt it getting a bit much. And he was shooting that much hydromorphone, given its short half life and duration of action of a few hours (4 hours or so on average although I haven't ever tried it myself) every few hours. And he dropped over a couple of weeks or less. Which is absolutely.....jesus H is all I can say. That without the naltrexone would have put him in hospital with the withdrawals easily.
As for going to see the doctor myself, I do if I actually need to. I've never called him out for a home visit before, and he has a good idea that I wouldn't do it if I didn't truly need to, that I wouldn't do it out of laziness. But of course with my foot like it is I can't even get to the kitchen without intense pain, even with the morphine and the oxy put together.
He came out though of course, and looked me over, scripted some antibiotics straight away, told me he'd write me up some painkillers as well. Sent my old man to the pharmacy to pick the scripts up and found only the erythromycin (antibiotic). Phoned the surgery, with my heart sinking somewhat, only to find that the only reason the painkillers hadn't been faxed over is because the script is for controlled drugs.
Going to ask my old man to bring me my propionyl chloride and some benzoyl chloride from the lab (I can't GET to my lab currently....and dammit its been less than 24 hours and I'm already suffering laboratory-withdrawal symptoms! Not opiate withdrawal, its definitely not that because my dr quite deliberately made sure that whilst I might be feeling somewhat sorry for myself then, I'd be left in the lap of luxury (and unconsciousness should it be too sore any time and I desire to be put out cold), because he left me a large enough script, and I'm picking up the same again come monday. plus many other things useful for this problem such as strong muscle relaxers, tranqs etc. to cover the following two days, that I'd usually use over a WEEK. I'll say this much for my assigned GP (I can see others, its just that he is judged personally responsible for my care, all patients get a GP assigned to oversee their cases), whilst he wouldn't go in for people fucking him about, if I. or anyone else. is in actual need he does make sure they do not get left wanting, left suffering and miserable because some
scrotum-cancerweasel is too much of a pussy to give enough medication to actually perform the job that it is needed to perform. Hence pretty much leaving me doped up to so far behind the eyeballs the morph is starting to get on ebay, order a set of pillows, a comfy quilt and make a little warm nest and tuck itself in around my medulla oblongata and brain stem.
And I've got another prescription for more oxy to pick up (or have picked up for me, rather) tomorrow. I reckon he knew given its moderate duration of action, that even though I care relatively little for oxy I'd be both grateful for it nevertheless and it would get used preeeety quickly. The good thing about it though, is its rapid time-to-onset and lack of any need for some bedside chemical jiggerypokery. Not sure how much my old man is going to appreciate my needing to get him to fetch me my gas mask, protective elbow-length gloves and goggles and one of my flasks, a bit of bicarbonate and my bottle of propionyl chloride, or for that matter me using the lounge coffee table to prepare some of heroin's bigger, beefier, longer lasting and far, far FAR more euphoric big sister. Especially considering I kinda partially carbonized one of the kitchen chopping boards with a minor spill and that it fumes off hydrogen chloride gas like a bitch.
Time for my next oxy dose, and I think, since I've not been able to go out and SPEND any of my money, of which I've got several hundred pounds in the bank, I'm going to go shopping for the lab. More glass and further supplies of solvents especially since I am running critically low. Hell my last methanol order, the last jug is about to get refilled. With piss:P
