This is why I hate going to the doctor

[WhyNot]

@usedtobe

Are you diagnosed as psycho?

Tylenol is Acetaminophen - which causes liver disease, is NOT as effective as Morphine, which is what I require for any degree of relief (Osteoarthritis).

I do hope you are not involved in the practice of medicine anywhere this page can be read.

Tylenol does not cause liver disease, Tylenol can cause liver damage. Keep your dose under 4 grams a day (3 grams if you’re in a high risk group) and ask your doctor to check your liver enzymes regularly if you take it regularly. Don’t take it after drinking alcohol to excess, and don’t take other medications, including over the counter cold and sinus remedies that have acetaminophen in them.

I absolutely believe you that Tylenol doesn’t help you, personally. People are all different in their reactions to medications, and Tylenol doesn’t provide relief for everyone; that’s why it’s a good thing that we have so many options after that one.

I am positively gobsmacked that you would imply that Morphine should be used as a *first *line pharmacologic intervention for mild to moderate OA, however. That’s not good for patients in the long term, with a very high risk of dependence and growing tolerance that leads to an extremely narrow therapeutic window before respiratory depression sets in.

[GrumpyBunny]

I believe you that Tylenol doesn’t do anything. It doesn’t do a thing for me either. Not for a headache, not for toothache, not for anything.

And it’s entirely possible that your knee pain is beyond Tylenol, NSAIDs, and braces.

So the next step would be PT.

And then joint injections.

Possibly arthroscopic surgery, if anything were seen on films to indicate it might help.

Viscosupplementation can help a lot as well.

@usedtobe

Are you diagnosed as psycho?

Tylenol is Acetaminophen - which causes liver disease, is NOT as effective as Morphine, which is what I require for any degree of relief (Osteoarthritis).

I do hope you are not involved in the practice of medicine anywhere this page can be read.

Why not? Psychobunny’s response is reasonable based on current medical standards.

If you need morphine, or some kind of opiate, you need to communicate to your physician. You also will need to see an orthopedic surgeon, not a GP. (Frankly, and no disrespect to any GPs on the board, but I find GPs useless; most of the ones I’ve seen lately refer you to a specialist if you have anything more than a cold.)

I suggest this conversation with an orthopedic physician:

“Yes, I understand that a lot of people get relief with Tylenol. I have tried Tylenol and/or NSAIDS and received little to no relief. I’ve also tried braces and PT, with no improvement. When I tried [opiate], I did receive relief and was able to sleep through the night. Without the opiate, I wake up X number of times.”

And the doctor may or may not write a prescription for opiates. S/he may suggest joint injections and/or viscosupplementation. Or an arthroscopy. Or some combination thereof.

It is possible to have very bad OA at a comparatively young age. You do need to go through a process to have a doctor diagnose that; they don’t just hand out morphine on a first visit. Doctors do not like to be used as drug dealers, it pisses them off.

[GrumpyBunny]

@RivkahChaya

In fact, a few years ago, it became illegal for drug companies to give little premiums to doctors, or to take them to lunch. They used to give out trinkets, Post-its with the company logo, pens with the company logo, and cater brunches for entire departments in hospitals. All gone now.

One year, the drug reps for Prozac gave out those singing Billy Bass plaques.

Six of us sat around trying to figure out what the hell the significance of a Billy Bass was, and how it tied in to Proazc. Never did figure it out.

[PorchePine]

@GrumpyBunny

One year, the drug reps for Prozac gave out those singing Billy Bass plaques.

Six of us sat around trying to figure out what the hell the significance of a Billy Bass was, and how it tied in to Proazc. Never did figure it out.

Prozac is nothing more than GNC fish oil. From what I hear, that stuff cures everything.

[PorchePine]

@WhyNot

Tylenol does not cause liver disease, Tylenol can cause liver damage. Keep your dose under 4 grams a day (3 grams if you’re in a high risk group) and ask your doctor to check your liver enzymes regularly if you take it regularly. Don’t take it after drinking alcohol to excess, and don’t take other medications, including over the counter cold and sinus remedies that have acetaminophen in them.

I’ve long avoided Tylenol for this reason (and the fact that Advil works so mycg better for me). I don’t consider my drinking to excess, but my SO and I have been known to polish of a bottle of wine with dinner–I don’t like the risks.

[WhyNot]

@PorchePine

I’ve long avoided Tylenol for this reason (and the fact that Advil works so mycg better for me). I don’t consider my drinking to excess, but my SO and I have been known to polish of a bottle of wine with dinner–I don’t like the risks.

Totally fair, but you should also be aware that Advil carries risks - bleeding risks, including GI bleeding, stomach irritation (that can also lead to stomach bleeding) and kidney damage. Ain’t nothin’ that works got *no *risks… Working with your pharmacist, doctor or another person trained in risk/benefit analysis (something that most of us are utterly crap at, particularly when it concerns ourselves) is a good idea when choosing your go-to painkiller of choice. If your particular, specific risks of bleeding or kidney damage are higher than average (based on your personal and family medical history, your medication list and your blood test results), NSAIDS are not for you, and Tylenol should be your choice, even if it’s not quite as effective for you. And vice versa for your personal risks of liver damage.

If a person does drink and use Tylenol, it’s better to take the Tylenol an hour before you start drinking, and be prepared to be impaired a little longer than you normally would - those limited enzymes will break down the Tylenol first and eventually more will be produced to deal with the alcohol. Alcohol in your system isn’t as damaging as unmetabolized Tylenol in your system. (Or so I’ve been told by a pharmacist; can anyone confirm or refute?)

[RivkahChaya]

@WhyNot

I am positively gobsmacked that you would imply that Morphine should be used as a *first *line pharmacologic intervention for mild to moderate OA, however. That’s not good for patients in the long term, with a very high risk of dependence and growing tolerance that leads to an extremely narrow therapeutic window before respiratory depression sets in.

Yeah. I’ve never met anyone who didn’t have end-stage cancer who had daily morphine. I know people who don’t respond well to OTC pain meds, and have daily use of narcotics, but not specifically morphine.

As far as using it as a first-line treatment, that’s a little like using amputation for virtually any limb problem-- paper cut, hangnail, closed fracture, rug burn-- just get rid of the limb.

[7e42]

@GrumpyBunny

I believe you that Tylenol doesn’t do anything. It doesn’t do a thing for me either. Not for a headache, not for toothache, not for anything.

And it’s entirely possible that your knee pain is beyond Tylenol, NSAIDs, and braces.

So the next step would be PT.

And then joint injections.

Possibly arthroscopic surgery, if anything were seen on films to indicate it might help.

Viscosupplementation can help a lot as well.

Why not? Psychobunny’s response is reasonable based on current medical standards.

If you need morphine, or some kind of opiate, you need to communicate to your physician. You also will need to see an orthopedic surgeon, not a GP. (Frankly, and no disrespect to any GPs on the board, but I find GPs useless; most of the ones I’ve seen lately refer you to a specialist if you have anything more than a cold.)

I suggest this conversation with an orthopedic physician:

“Yes, I understand that a lot of people get relief with Tylenol. I have tried Tylenol and/or NSAIDS and received little to no relief. I’ve also tried braces and PT, with no improvement. When I tried [opiate], I did receive relief and was able to sleep through the night. Without the opiate, I wake up X number of times.”

And the doctor may or may not write a prescription for opiates. S/he may suggest joint injections and/or viscosupplementation. Or an arthroscopy. Or some combination thereof.

It is possible to have very bad OA at a comparatively young age. You do need to go through a process to have a doctor diagnose that; they don’t just hand out morphine on a first visit. Doctors do not like to be used as drug dealers, it pisses them off.

I was so glad Fish Oil prevented from doing the joint injections and surgery

[susan]

Tylenol is the NSAID allowed for pain for some people with liver problems (e.g., hepatitis) because despite its potential for harming the liver, it is less bad for the liver/in relation to hepatic treatment than ibuprofen or aspirin.

[twickster]

Moved to IMHO, home of medical threads, from MPSIMS.

[outlierrn]

@susan

Tylenol is the NSAID allowed for pain for some people with liver problems (e.g., hepatitis) because despite its potential for harming the liver, it is less bad for the liver/in relation to hepatic treatment than ibuprofen or aspirin.

Tylenol is not an NSAID.

[Idle_Thoughts]

@usedtobe

Are you diagnosed as psycho?

I realize her name has that word in it, but using it as an insult/potshot is still not allowed.

[AnaMen]

@WhyNot

I by no means possess the mindset that by definition, the doctor did everything right all of the time. I am of the somewhat informed opinion that, based on what the OP wrote in Post One and subsequent posts, his doctor did everything right according to the best standards of her industry at this particular visit. Maybe otherwise she’s a crap doctor, I don’t know. Goodness knows there are plenty of them. I have a list of doctors who are not allowed to touch me unless we are literally the last people on earth and I’m actively bleeding from my eyeballs, and that list grows weekly. Pretty soon half the doctors in Chicago will be on it, I’m sure. I’m actually laughing out loud here, because I’m pretty anti-doctor, in general, which is why I’m in a field of nursing that limits my contact with them. It’s kind of surreal to be defending one, even in the abstract on a message board.

But to suggest that *this *doctor, this time, didn’t do “everything right”, is an extraordinary claim that requires extraordinary evidence.

I don’t think the doctor did anything particularly alarming or incompetent. Rather than advise using Tylenol though, she should have asked whether he had tried it already, as nearly everyone is already aware it exists. This could have opened the door to a discussion about the OP’s opinion of its potential efficacy and possible further solutions could have been discussed. Of course he could have brought this up himself, but it isn’t rare for doctors to be quite obnoxious when their advice is questioned, so some patients learn not to repeat the error and just go home and ignore what they’ve been told if they think it won’t work.

[Hey_Hey_Paula]

@7e42

was it GNC brand?

Just curious, why must it be GNC brand? I’m more of a Vitamin World gal, myself.

[7e42]

@Hey_Hey_Paula

Just curious, why must it be GNC brand? I’m more of a Vitamin World gal, myself.

Because the other brand, Nature Made did nothing at all

[GrumpyBunny]

@Magiver

possibly because it’s linked to a 44% increase in prostate cancer.

Only half the population has a prostate.

Well, when you factor in surgery and women living longer than men, slightly less than half.

[GrumpyBunny]

@7e42

I was so glad Fish Oil prevented from doing the joint injections and surgery

I hope it continues to work.

[GrumpyBunny]

@PorchePine

Prozac is nothing more than GNC fish oil. From what I hear, that stuff cures everything.

So Billy Bass…is in GNC fish oil?

Do the fish oil caplets sing?

Because I might buy those.

[WhyNot]

@7e42

Because the other brand, Nature Made did nothing at all

My irony meter just exploded.

Nature Made (or rather, Pharmavite) are one of the more reputable supplement companies out there. They’re huge, they’re watched like hawks by the FDA, and their brand is one of the most often used in clinical trials because what they say is in there tends to actually be in there. The only time I can find that they’ve been so much as wrist slapped by the FDA for any problems was when they wrote a letter of intent that they were going to make some claims on their products that the FDA didn’t approve. A letter, not actual labels in market. These guys are as squeaky clean as it gets in the seedy underworld of supplement marketing.

They’re also the brand of fish oil that I take, at my doctor’s recommendation. :smack:
(Not for OA, for a potential reduction of cardiovascular risks, her second line recommendation after I refused statin drugs.)

[7e42]

@WhyNot

My irony meter just exploded.

Nature Made (or rather, Pharmavite) are one of the more reputable supplement companies out there. They’re huge, they’re watched like hawks by the FDA, and their brand is one of the most often used in clinical trials because what they say is in there tends to actually be in there. The only time I can find that they’ve been so much as wrist slapped by the FDA for any problems was when they wrote a letter of intent that they were going to make some claims on their products that the FDA didn’t approve. A letter, not actual labels in market. These guys are as squeaky clean as it gets in the seedy underworld of supplement marketing.

They’re also the brand of fish oil that I take, at my doctor’s recommendation. :smack:
(Not for OA, for a potential reduction of cardiovascular risks, her second line recommendation after I refused statin drugs.)

if it was for OA you would be in trouble lol