I'm lost or the threading is messed up, so I'm copying your original and Mike's
reply here
{start}
Hi there
My name is hans and in live in south australia.
I hope to correspont with you to share my experiences with cancer and to
discover wether someone else has had similar experience to mine. I had my
primary cancer in '94 (hepato cellular adeno carcinoma). this was
followed by bone metastasises in '98 on my T1 &T2 vertabraes. Next came 2 more
in my cranium. in '99  2 more in my femur and my pelvis. currently i suffer
lympho edema and a continiously discharching wound where my hip used
to be. hip relacment has resulted in infection, so it had to be removed again
and i finished up with a shorter left leg . palliative care is provided which
dislike when it turns me into a zomby from time to time. i wonder wether someone
has had a similar battle and could advice regarding further expectations,
treatments or anything relevant.
i am not quiet sure about the procedures for a news group and would appreciate
some hints or shortcuts..

sincerly yours                           Hans

Hans,
  Palliative care is a two way thing; the medics provide the answers
(hopefully) and you provide the parameters for them to work within.
  Symptom control is usually quite simple and relatively free of side effects
but occasionally people do have what they consider unacceptable side
effects.....being like a zombie for instance. Sometimes changing to a
different drug regimen settles this, sometimes just persevering for a few days
or a week until your body gets used to the drug is all that is needed (I had a
patient on 2000mg morphine daily still doing intricate beadwork!).
Sometimes, however, the symptoms are so resistant that you end up being very
sedated with all the drugs, then you have to make a decision about which is
worse, the sedation or the symptom and make some sort of compromise. The
decision should always be yours...all the palliative care team do is give you
the choices. Always remenber you should be able to get a second opinion by a
palliative care specialist; just occasionally they come up with
something new or different that the regular nurses and doctors haven't been
aware of.
MIKE {end copied text|

Perhaps Mike has nothing to add to the above. We'll see.
J
PS if Endep is Elavil, that's a big dose (to me) and has side effects of dry
mouth and very sedating. Talk to them about possibly cutting back a bit on the
dose. Also some take a bit around dinner time, then the rest at bedtime. (so in
theory there may be a bit more sedation in the evening, but less during the
daytime)
It's good for sleep, pain and depression but holy crow, do you really need that
high a dose esp with the others?
And http://www.rxlist.com/cgi/generic/amitrip_wcp.htm it's had a warning about
blood sugar levels on it.

I wouldn't worry about the late response, I've been away for a few weeks r&r
in souwest WA...mucho driving.
Your med chart suggests you have had a lot of pain of mixed variety for
which you are taking a mixed bag of medicines.
If this controls your pain adequately then I have nothing to add. You are
going to suffer a certain level of sedation with this lot, nodoubt about it.
Rule of thumb dosage of opiates for breakthrough (b/t) pain is 1/6th (4hrly
equivalent) which in your case would be
560/6 = about 93 mg = about 20 mls @ 5mg/ml so if your b/t dose doesn't work
here is the reason...get your doc to r/v this.
If current dose does work then ok don't change anything.
I'm presuming the endep is for neuropathic (nerve) pain and not depression.
It is very effective for both, usually, but very sedating.
Anti epileptics like Tegretol and Gabapentim (Neurontin) may be as effective
and less sedating but if your pain is reasonably well controlled I wouldn't
rock the boat by changing anything..knowing what works is 9/10ths of the
battle in symptom control.
Is Vioxx the strongest anti-inflammatory? No. And if you are on NSAIDs
longer than 3 months there is (I believe) no advantage to the newer
brands in terms of gastric upset...maybe Indocid or Naprosyn would be
better.
I'm not sure that paracetamol is doing anything the NSAID (Vioxx) isn't
doing and you are already taking a LOT of meds.
In terms of nerve pain Methadone is accepted as being more effective than
others...is there a reason you are on oxycontin at high doses?
Fentanyl patches would save you taking a few pills.
Curious why the testosterone?
Hope this gives you something to chew on and discuss with your care team.
MIKE