Hi Jayne

I believe I have found a kindred spirit in you!  It was so weird reading through your reply to my last post I was laughing, wanting to cry & almost hiccupping at the same time!  LOL

I have a feeling you are are touchy feely kinda person prone to wanting to give generous hugs to those who you tink need them, & I am betting that you don't mind chatting over a cuppa or well maybe two or three right?   My husband used to proudly announce he married me because I talked enough for the two of us!  LOL  Tomes have changed though, and now I have to work hard to find a gap to put in my 5 cents worth in a conversation (well we have been married 18 years and together 20yrs...)

I am very fortunate to have this specialist team at the Royal Women's Hospital in Sydney looking after me.  They see hundreds of women in similar circumstances to us each month, so you can imagine the sense of relief and feeling of fresh air I get when I am with these wonderful people.  The clinic is headed up by Dr Theirry Vancaillie and I will be forever grateful to Helen Dynda for pointing me in his direction.

The team run three different clinics and of-course being the difficult chook that I am, I get to see someone from all three!  LOL The pain specialist is a wonderful lady who is a teaching Professor at the Sydney University and works with interns and lectures on pain management and the use of pain medication in treatment.  She holds a clinic one afternoon a week, and only see's maybe 4 or 5 patients in that afternoon session.  Prof. specialises in the pain management of cancer patients and has an uncanny ability to read a person and tell them what she has discovered after a 10 minute chat.  Shane almost choked when she described me to a T after reviewing my notes from our first interview and after her careful, yet brief questioning.  It was amazing.

Now, to answer your questions about oxycodone and oxycontin.  Oxycodone is equivilent to morphine and is dispensed under various brand names in other countries.  Here in Australia it is called Endone and is a restricted medication and only prescribed under strict guidelines.  Oxycontin is the slow release version of oxycontin and is the preferred medication to use in a chronic pain situation.  As I explained before, the oxycontin builds up in your system over a number of days and then provides a more even spread of pain relief.  Oxycodone works over a shorter period of time, works within a short space of time and then it's effectiveness deminishes quickly.  That is why oxycodone is used specifially for breakthrough pain.  The advantage of opiad medication is there are no side affects to organs and does not affect kidneys, liver or cause ulcers. So it is certainly worth talking to Mark about both medications as an alternative to what you are currently using.  I also have to take paracetamol twice daily, in the USA they would have iboprofen, I'm not sure what you would use in Canada.  It is an over the counter medication though.  At night I also take amitryptaline...I think the spelling is right...it is usually used in high doses for depression but has proved to be effective in lower doses for pain management at night & assists with sleep.  It is the cyst that is stopping me from sleeping at the moment.

Now...bladder and incontinence, this is another of the clinics available at the women's hospital.  Physiotherapy is useful for a number of reasons.  Originally I had very evere bladder pain & incontinence problems until my ovaries were removed in April last year.  They had been tethered to my vagina, bladder, bowel & abdominal wall and caused me indescribable pain.  When they were removed, pathology revealed that both ovaries were covered in endometriosis.  The doctor explained to me that when we experience severe abdominal pain, it causes our pelvic floor muscles to become tense and unable to relax.  This irritates the bladder and promotes incontinence and pain.  The outside of my bladder is completely covered in adhesions and therefore has a restricted capacity to add to my woes.  Before surgery it was planned that I would be taught certain excersises that would help me learn to relax my pelvic floor muscles and hopefully reduce my bladder urgency.

After the removal of my ovaries, the symptoms and problems shifted and new problems emerged.  I still have to a lesser extend problems with incontinence and urgency, but not nearlly as severe as prior to surgery.  It is of-course a very undignified way to find out how well your pelvic floor muscles are working, but by now, who has any dignity left, am I right?  Well While giving me an internal examination, the physiotherapist will repeatedley ask me to tighten my pelvic floor muscles, and then relax them.  There is also a machine that can measure the intensity of the flexinf muscles, but my vaginal area is very sensative & I was unable to tolerate this part of the procedure.  What resulted was a finding that my pelvic floor muscles on the left side (where I experience constant pain) are very strong, and on the right, there was almost no tone at all.  Three times a day I have to concentrate on tightening my pelvic floor muscles and work to increase the length of time I can hold them before relaxing.  The optimum goal for me is a slow count to ten.

I also have to stop & start the stream of uine as I am voiding to increase my control over this action.  Occassionally when pain is severe (as it was last night) my bladder will spasm & I am unable to void.  I then need to catherterise to empty it, and I actually needed to do this twice yesterday.

Now, bowel, there is a way of massaging your decsending colon to improve bowel movements.  Starting in the bottom right side of your  lower abdomen, rub with the flat of your hand straight up towards your ribcage.  Then across just below the ribcage to the left side.  Then rub straight down on to the lower left side of your abdomen finishing at your pubic bone.  I do this for around 100 rotations each morning in the shower, if I am feeling a bit sluggish, I repeat it in the evening.  Also when you sit on the toilet to open your bowels, your knees should actually be raised just above your waist, so use a telephone book or something to rest your feet on at the right hight.  It is also important to relax the stomach muscles, we are so used to holding our tummy muscles in and we quite often will even push a little to encourage things along.  This in fact closes off the colon and makes it more difficult to defficate, we should also be sitting with our backs straight.  It takes some getting used to & I am still finding myself having to make a concious effort to follow these instructions.

Well, I think that covers all of your questions, oh yes & thnx for the prayers, it rained last night over 50 points and all but put out the fires in the mountains & Sydney, the South Coast still suffers though.  Yes, there is also a large number of native animals that suffer as a result of these fires and thankfully we have a very good volunteer organisation called WIRES that looks after injured and ill wildlife.

Well, I have quite a few emails here to answer tonight, and I am already starting to feel uncomfortable....sitting is one of the things that cause pain!

Thanks for reading/listening, I look forward to many more interesting letters....

love & gentle hugs

Jo (Australia)

P.S. The health system here in Australia is pretty good too..... I couldn't imagine being anywhere else.