#  >  > Living And Legal Affairs In Thailand >  >  > Living In Thailand Forum >  >  > Health, Fitness and Hospitals in Thailand >  >  Health, fitness and hospitalization of the boomers

## Sumbitch

> Originally Posted by wjblaney
> 
> 
> ^ To be a teenager in those days was a real privilege, thanks to pop singer-songwriters like Ms. Gore. RIP
> 
> 
>  That's a shock she was one of my favorites, being of similar age and all.





> That's a shock she was one of my favorites, being of similar age and all.


What's also scary is none of us knows when and how we're going to go. Especially those of similar age and how we abused our bodies and minds with sex, drugs and rock and roll. I finally had my first complete health check up at Chiang Mai Ram and had a ton of tests and exams: ears, eyes, blood, urine, xrays, etc. I had known previously that I had two incurable but not necessarily fatal diseases: osteoarthritis, which affects the skeleton (bones) and is not debilitating, if you exercise or take meds (ugh). I climb mountains and rocks, lift weights and run. So exercise controls the pain  but I also take prescribed tramadol for pain, which I take recreationally. The other disease I knew I had prior to the check up is chronic bronchitis. The symptoms are horrible, when they hit you. The full episodes (maybe twice a year) are similar to a bad cold: sniffy, runny, stuffy nose, uncontrollable coughing. But, actually, you don't feel miserable at all, like you do with a bad cold. Of course, the symptoms can effect your activities but I've climbed mountains with the full blown symptoms in effect b/c mountaineering gives just about everybody the effects of a bad cold, lol, as just one of the obstacles you have to overcome. The bronchitis must have been a consequence of my heavy pot and tobacco smoking. They're not sure of the causes of osteoarthritis and guess it's a result of genetics or aging or both.

Anyways, my complete health check up came back like A+++ (if there is such a rating) so, at this point, I'm really healthy, due to my nutrition and exercise habits, and haven't had hardly any indication or symptoms of my chronic bronchitis for about a year.

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## PeeCoffee

wjblaney ^^^ tramadol recreationally ? Please don't drink and drive...please.

Check with resident pharmacist rickchoppers as I was under the impression that tramadol was for around-the-clock pain relief and not an interim type of drug.

Additionally, I read that tramadol can cause problems with breathing which one would think is not a appropriate for a bronchitis sufferer.

Otherwise, glad to read you're in excellent shape.

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## KEVIN2008

Exercise is the key to good health.....enough said     :Smile:

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## Davis Knowlton

Tramadol is fine for interim use - I use it a few times a year when my knee is acting up.

I rarely take pain meds, as I'd rather gut it out than mask the symptoms. Tramadol works when I need it, but it does space me out. I rarely take it for more than two consecutive days.

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## rickschoppers

Tramadol is prescibed often for general pain and its lack of euphoric side effects like the opioid drugs like morphine, meperidine and hydromophone make it a highly used analgesic. Most ER physicians have adopted this drug for moderate to severe pain because it also lacks an extreme addictive potential.

If you have osteoarthritis, this is a good choice to reduce or eliminate pain prior to recreational activities like mountain climbing. I have the same affliction mainly from too many contact sports when I was young. My back aches all the time so I now use acetaminphen (1500mg twice daily) or aspirin (same high dose as acetaminophen) to reduce my generalized pain. It works well and is much cheaper than tramadol, even though tramadol is a stronger drug.

For those older farts like me, a reduction in strenuous physical activity is another option. As a result, I am down to fishing, motorbike riding and walking as exercise. If I were to snow ski like I used to, waterski, run, jog or play rough sports, I would be a physical wreck by the end of the day. Tramadol would assist me in these recreational sports if I insisted on continuing them, but I have not.

I had not thought of buying tramadol here in Thailand for pain, but I personally feel it is a good option. As for breathing problems, look at the percentage of incidence which may be low. All drugs have side effects and one must try them to see if any surface for you. Every indiviudal is different.

Hope this helps.

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## rickschoppers

> Tramadol is fine for interim use - I use it a few times a year when my knee is acting up.
> 
> I rarely take pain meds, as I'd rather gut it out than mask the symptoms. Tramadol works when I need it, but it does space me out. I rarely take it for more than two consecutive days.


I am surprised tramadol spaces you out. You must have a pretty low tolerance for drugs. I have taken it before and feel nothing other than pain relief.

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## Davis Knowlton

> I am surprised tramadol spaces you out. You must have a pretty low tolerance for drugs.


Quite possibly. I take medication only when there is a real need; Tramadol or other pain killer maybe twice a year for a max of two days usually.

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## Pragmatic

> I am surprised tramadol spaces you out. You must have a pretty low tolerance for drugs. I have taken it before and feel nothing other than pain relief.


 I too occasionally take Tramadol 50mg. I never take more, due to it being addictive. It kills my pains and gives me a feeling of elation. I used to take anti-depressants years ago. If only I'd known about Tramadol then. Anti-depressants didn't work for me.

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## rickschoppers

> Originally Posted by rickschoppers
> 
> I am surprised tramadol spaces you out. You must have a pretty low tolerance for drugs. I have taken it before and feel nothing other than pain relief.
> 
> 
>  I too occasionally take Tramadol 50mg. I never take more, due to it being addictive. It kills my pains and gives me a feeling of elation. I used to take anti-depressants years ago. If only I'd known about Tramadol then. Anti-depressants didn't work for me.


The addiction of tramadol is more psycological addiction than physical addiction due to it relieving the pain. Unlike the opioid narcotics that are both psycologically and physically addicting to a high degree, tramadol will show physical addiction only about 2.7% of the time.

When tramodol was first released, it was marketed as a non-addicing analgesic which gave the physicians a new option to treat moderate to severe pain. It was not a "controlled" drug and was freely prescribed by physicians. For mild to moderate pain, the non-steroidal anti-inflammatory drugs were used.

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## nigelandjan

Good luck with it all WJB ,, sounds like your not just sitting on your arse and whinging about it .

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## Sumbitch

> Tramadol is prescibed often for general pain and its lack of euphoric side effects like the opioid drugs like morphine, meperidine and hydromophone make it a highly used analgesic. Most ER physicians have adopted this drug for moderate to severe pain because it also lacks the extreme addictive potential.
> 
> If you have osteoarthritis, this is a good choice to reduce or eliminate pain prior to recreational activities like mountain climbing. I have the same affliction mainly from too many contact sports when I was young. My back aches all the time so I now use acetaminphen (1500mg twice daily) or aspirin (same high dose as acetaminophen) to reduce my generalized pain. It works well and is much cheaper than tramadol, even though tramadol is a stronger drug.
> 
> For those older farts like me, a reduction in strenuous physical activity is another option. As a result, I am down to fishing, motorbike riding and walking as exercise. If I were to snow ski like I used to, waterski, run, jog or play rough sports, I would be a physical wreck by the end of the day. Tramadol would assist me in these recreational sports if I insisted on continue doing them, but I have not.
> 
> I had not thought of buying tramadol here in Thailand for pain, but I personally feel it is a good option. As for breathing problems, look at the percentage of incidence which may be low. All drugs have side effects and one must try them to see if any surface for you. Every indiviudal is different.
> 
> Hope this helps.


Helps a lot. It's nice to know of its non-addictive qualities as I was thinking of switching to diazeis (val) more regularly. The only side effect I've noticed is that itramies will keep me up all night, unless I take one of my prescribed sleeping pills. I don't really mind staying up because I'm really into what I'm doing; lots of forum (teakdoor) reading and responses, FB, TV, etc. My curiosity poitent is really aroused. But really, I'm way too an experienced druggie (Californi is druggie, druggie, druggie) to start taking any drug every day. That includes tramies b/c it has a low tolerance level for me. So I take massive doses (just took 500 mg) once or twice a week (I won't tell you the total amount I take in a day because I don't want some dummy trying it at that dosage. I trust erowid.org for most of my info on drugs, I stop right there as far as confidence in what and how much to take---250+ mg per day is consider strong).

I also thought of it as a performance enhancing drug b/c of the way I felt. But I noticed that under the influence of tramies at home I stumbled a lot, just like a drunk, but with a clear and normal mind. I know that can be fatal on a mountain. So I might take it the night before bed but not actually on the climb. And that it inhibits breathing is total bullshit. If anything, it helps me breathe (I've already climbed with the drug in my fanny pack) b/c I worry less about the normal pain that accompanies me and the sport, and get more and more involved with what I'm doing step by step. 

As for your back pain can you try this for no more than two minutes per day but hold it without intentional movement at about a 60% angle? (the model is in extreme mode. it's way ok to drop your body to the floor but keep your head and arms like hers---a 60% angle) It's the best physical therapy for lower back pain.
Upward Facing Dog You're doing the right thing if you notice the lower back, either as it streches or actually hurts. The more experienced you become, you'll actually notice your leg(s) getting longer without any attention on your part to strech your legs. This is because your spinal column is coming back into its normal length. The epitomy (for me, anyway) is when you actually hear and feel a pop in one of your vertebrae. It feels real good and could come during any part of the 2 minutes. So don't quit at that point: finish the two minutes.

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## Sumbitch

> Good luck with it all WJB ,, sounds like your not just sitting on your arse and whinging about it .


Yeah, man. Nobody is perfect, however, so I've gotten one little devil off my back by admitting and embracing that I'm an addict (not an alcoholic), so no more guilt. And I don't let the dependencies inhibit my physical activities. Only thing missing is..... :sexy:

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## Boon Mee

For all those aches and pains Boomers get, _Alieve_ is real good stuff.

  Can't get it here in LOS but if you know a "merkin coming over, ask them to bring a bottle.  It really worlks w/out any side effects I've ever noticed.

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## rickschoppers

The well being is probably more due to the fact that the pain has been arrested. I know I am way more productive after taking something for my back pain. As for tramadol affecting anyones breathing, that is more related to repiratory depression. As with any drug, one needs to be cautious with changing dose, frequency or duration of use. I have been taking medication for my back for over 30 years and change the medication frequently due to tolerance or just wanting to change things up.

The information on back pain is interesting and I will give it a try. Anything to avoid surgery. Do you happen to be a physical therapist?

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## Davis Knowlton

^^Can't be much stronger than aspirin since you can get it over the counter in Amerika. AMA and drug companies - and druggies - have nearly wiped out non-prescription meds in the land of the overly medicated.

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## rickschoppers

> For all those aches and pains Boomers get, _Alieve_ is real good stuff.
> 
>   Can't get it here in LOS but if you know a "merkin coming over, ask them to bring a bottle.  It really worlks w/out any side effects I've ever noticed.


Actually Alieve is available in Thailand under the generic name Naproxen Sodium. I have purchased it several times and is a non-steroidal anti-inflammatory which is the class of drugs that ibuprofen falls in. Just be sure to take it after eating something, otherwise it will burn a hole in your stomach.

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## Boon Mee

> ^^Can't be much stronger than aspirin since you can get it over the counter in Amerika. AMA and drug companies - and druggies - have nearly wiped out non-prescription meds in the land of the overly medicated.


I really don't know what the basic compounds are although it works faster than asprin and is akin to some other over the counter meds but I've found it to be the most effective.

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## rickschoppers

If you google a brand name medication, you will see the generic name associated with it. Take that generic name to a Thai pharmacy and chances are, they will have it.

Motrin = Ibuprofen
Alieve = Naproxen Sodium
Ultram = Tramadol
Tylenol =  Acetaminophen

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## Pragmatic

> The addiction of tramadol is more psycological addiction than physical addiction due to it relieving the pain. Unlike the opioid narcotics that are both psycologically and physically addicting to a high degree, tramadol will show physical addiction only about 2.7% of the time.


I have to disagree Rick.




> The widely-prescribed prescription painkiller tramadol has  tricked  doctors, and in turn their patients, into thinking it is a safer  alternative  to what are considered stronger narcotic painkillers, such as OxyContin. 
>  	The truth is, tramadol can produce a morphine- or  heroin-like high,


 Will Tramadol overtake OxyContin Addiction and Abuse?

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## rickschoppers

You are more than welcome to disagree.

The Risk of Tramadol Addiction

I guess you can disagree with the above as well.

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## Pragmatic

Any drug is addictive if abused. I was on anti-depressants for a few years. I was always told they were non-addictive. I came off them cold turkey. That was an experience.

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## rickschoppers

> Any drug is addictive if abused. I was on anti-depressants for a few years. I was always told they were non-addictive. I came off them cold turkey. That was an experience.


Prag, please read up on the differences between addiction and dependence and then rephrase your comment.

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## Pragmatic

Okay, I get your point.

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## Sumbitch

> The information on back pain is interesting and I will give it a try. Anything to avoid surgery. Do you happen to be a physical therapist?


NO, but a physical therapist worked on my wrist for about a week (I had been wearing a removable but very hard brace from finger tip to  elbow for a couple of years to allow me to continue my career sitting at a keyboard (b/c the initial diagnosis had been Carpal Tunnel Syndrome). A specialist finally diagnosed it correctly as tendinitis which has been completely cured by the excercises the therapist taught me in the one or two weeks we were together. They take all of 2 minutes every day.

It was quite obvious, when I tore my Achilles' tendon, what the diagnosis was: (from wiki)



> Inflammation[edit]
> Main article: Achilles tendinitis
> Inflammation of the Achilles tendon is called Achilles tendinitis. Achilles tendinosis is the soreness or stiffness of the tendon, generally due to overuse. Inflammation was thought to be the cause of most tendon pain, until the late 1990s, when scientists discovered no evidence of inflammation.[clarification needed]
> 
> Degeneration[edit]
> Achilles tendon degeneration (tendinosis) is typically investigated with either MRI or ultrasound. In both cases, the tendon is thickened, may demonstrate surrounding inflammation by virtue of the presence of paratenonitis, retrocalcaneal or retroAchilles bursitis. Within the tendon, increased blood flow, tendon fibril disorganisation and partial thickness tears may be identified. Achilles tendinosis frequently involves the mid portion of the tendon, however may involve the insertion where this is known as enthesopathy. Though enthesopathy may be seen in the context of advancing age, it is also associated with arthritis such as gout and the seronegative spondyloarthitides. Achilles tendinosis is a known risk factor for calf muscle tears.[5]


I was of a certain age (over 50) and had/have a serious case of osteoarthritis and had subjected myself to a running regimen of 40 miles/week. The tear actually occurred on an indoor climbing wall. A hard cast (like for a broken bone) was applied from heel to knee and along with crutches I was able to get around for a week when it was removed. Again, the doctor prescribed a physical therapist to fix the injury and a week after that I was back at the crags climbing again. She, basically, taught me 3 exercises to stretch the tendons of both legs every day and took no longer than 6 minutes. This was in 2003 and the tendinitis in my wrist occurred in the very early '90s. For awhile after both injuries, I was religious in doing the prescribed exercises every day. But I haven't felt any pain or other indication that would warn me so haven't practiced my exercises for about 5 years. 

I know there are websites that have diagrams of the exercises I'm talking about and they would prevent as well as cure these afflictions. But I don't know what Thai physical therapists are like at all. However, the two injuries as well as the lower back problem you have, Rick,can all be handled DIY.

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## terry57

I have been retired 18 months now and residing in Thailand

Every 6 months I return to Perth for a few weeks to sort things and stay in the loop.

Whilst there I have all my usual blood checks and what not done.

Doctor says everything is better then when I was working and living in Perth.

Good that innit.   :Smile:

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## Humbert

> I too occasionally take Tramadol 50mg. I never take more, due to it being addictive. It kills my pains and gives me a feeling of elation. I used to take anti-depressants years ago. If only I'd known about Tramadol then.


I've had three operations on my left hip in the last two years. For pain they gave me Tramadol which did not help in the least. I felt no euphoria either. Paracetamol was the only thing that gave me any relief. I still take 10 tablets a day.

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## chassamui

I have decided I am going to become head of the NHS in UK. My first act will be to divide hospitalisation into 2 different hospital types.

Type one - Under 50s only
Medical treatment will be determined by clinical need and you will be treated based on your working life. If you have always worked, and include staying at home to raise children, you will get a business class service. If you have never worked you will get a bed near the laundry or the boiler house and the medical staff will only speak in order to interrogate you.

Type 2 Over 50s

Based on clinical needs, your hospital experience will be akin to a shopping mall. There will be medical services as usual, but this is intended to be a cohesive and holistic experience. Free access to onsite swimming, gym, sauna and spa services in order to accelerate your recovery. Social clubs for the benefit of your mental health and relaxation. Free sports and movies plus in house shopping services and free live weekly Cabaret. Facilities will be provided for prolonged family visits, if desired.

All ancillary services, porterage, laundry, cleaning and pan bashing will be provided by those over 50s needing treatment, but having failed contribute to the system since leaving school. 

All visitors from outside the UK will need to provide adequate health insurance for the duration of their stay. 

These conditions may sound a little harsh but any one not qualified and in need of essential life saving treatment will be treated follwed by repatriation at their own expense or return to their bedsit in Slough. Followed by a medical bill of course.

Job jobbed. Other countries may feel free to use this idea without infringing copyright or patent law.

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## Pragmatic

> For pain they gave me Tramadol which did not help in the least


 Not disbelieving you Humbert but are you sure it was Tramadol they gave you and not Tynanol. Similar names, both used for pain relief.

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## Sumbitch

> I have been retired 18 months now and residing in Thailand
> 
> Every 6 months I return to Perth for a few weeks to sort things and stay in the loop.
> 
> Whilst there I have all my usual blood checks and what not done.
> 
> Doctor says everything is better then when I was working and living in Perth.
> 
> Good that innit.


Very good that it is. I've the feeling Thailand is cleaner than California even. Doctors there have confirmed my Thai doctors' diagnoses, the food just looks, tastes and I like it better in LOS. I breathe easier here. Prolly, for both of us, it's the reduction of stress due to the fucking worries of work that are traditional in the capitalization oriented companies of the Western world.

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## Humbert

> Not disbelieving you Humbert but are you sure it was Tramadol they gave you and not Tynanol.


Absolutely. I was in the hospital for two months for my last operations and they gave it to me every 5 hours. It had no effect but when I took para the pain subsided. I had several discussions with my MDs about it.

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## rickschoppers

> Originally Posted by Pragmatic
> 
> I too occasionally take Tramadol 50mg. I never take more, due to it being addictive. It kills my pains and gives me a feeling of elation. I used to take anti-depressants years ago. If only I'd known about Tramadol then.
> 
> 
> I've had three operations on my left hip in the last two years. For pain they gave me Tramadol which did not help in the least. I felt no euphoria either. Paracetamol was the only thing that gave me any relief. I still take 10 tablets a day.


Not really surprising since people react differently to the same medication, particularly pain medications. I sure hope the 10 paracetamol are not 500mg each which would mean you are taking 5 grams daily. The maximum daily dose is 4 grams and some experts say it should not be more than 3 grams per day due to the hepatotoxicity. If you are taking 5 grams per day you may want to have your liver enzymes checked or reduce the daily dose. I was involved with many acetaminophen overdoses and they are not pretty.

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## Humbert

> Originally Posted by Humbert
> 
> 
> 
> 
> 
> 
> 
>  Originally Posted by Pragmatic
> ...


I've discussed this with my doctor. The maximum dosage is determined by weight. My MD said I should not exceed 12 tablets per day. For months prior to my surgeries and before being diagnosed for an infection in my prosthetic joint I was living in intolerable pain. I think the only thing that would have brought me relief was morphine but they wouldn't give me that so I just lived with the agony.

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## Stumpy

> For all those aches and pains Boomers get, Alieve is real good stuff.
> 
> Can't get it here in LOS but if you know a "merkin coming over, ask them to bring a bottle.


Love that Booners...a "Merkin Coming over"... Want me to bring you a 55 Gallon drum of the little blue pills.  :rofl: 

Rick C is right however, it can already be purchased in TL under Naproxen Sodium. Advil can as well. Ibuprofen. They are Pinkish colored pills and 900 mgs.

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## Stumpy

> Originally Posted by terry57
> 
> I have been retired 18 months now and residing in Thailand
> 
> Every 6 months I return to Perth for a few weeks to sort things and stay in the loop.
> 
> Whilst there I have all my usual blood checks and what not done.
> 
> Doctor says everything is better then when I was working and living in Perth.
> ...


Yeah, same here as Terry and WJ. I was in tip top shape in Thailand when there. Food was better. I ate smaller portions. I had more time to do things right. Stress was gone, no financial worries. Slept better. Rode my bike 10- 15 miles a day. etc. Now....well back here in California and fighting the masses but I see light at the end of the conveyor belt.

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## rickschoppers

> Originally Posted by rickschoppers
> 
> 
> 
> 
> 
> 
> 
>  Originally Posted by Humbert
> ...


Prag, you may want to discuss it with another physician. The only time acetaminophen is dosed by body weight is in children and that should go for all medications given to a child. I doubt you are a child and the maximum daily dose for ALL adults is 4 grams (4000mg). In fact the makers of Tylenol just lowered that maximum to 3 grams (3000mg) per day.

I am just trying to save your liver.

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## Sumbitch

> Love that Booners...a "Merkin Coming over"... Want me to bring you a 55 Gallon drum of the little blue pills. 
> 
> Rick C is right however, it can already be purchased in TL under Naproxen Sodium. Advil can as well. Ibuprofen. They are Pinkish colored pills and 900 mgs.


Being a doper from California, I cannot believe the thread now includes posts about Alieve, aspirin, acetaminofen, Ibupfrofen, etc.

 :rofl:

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## Sumbitch

How did I forget Advil?

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## rickschoppers

More ibuprofen. I found ibuprofen 800mg to work best for my aches and pains. Again you need to eat some food before taking it.

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## Sumbitch

^ I'll take 2000 mg of Tylenol or Ibuprofen (usually for a hangover). Is that dangerous?

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## Boon Mee

> Love that Booners...a "Merkin Coming over"... Want me to bring you a 55 Gallon drum of the little blue pills.


Grab a handful of Lilly F Forties while yer at it too!  :Very Happy:

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## ENT

I like opium.

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## rickschoppers

> ^ I'll take 2000 mg of Tylenol or Ibuprofen (usually for a hangover). Is that dangerous?


No, that combination is fine. There are times I take aspirin along with tylenol. Two different mechanisms of action as is tylenol and ibuprofen.

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## Stumpy

> Originally Posted by JPPR2
> 
> Love that Booners...a "Merkin Coming over"... Want me to bring you a 55 Gallon drum of the little blue pills. 
> 
> Rick C is right however, it can already be purchased in TL under Naproxen Sodium. Advil can as well. Ibuprofen. They are Pinkish colored pills and 900 mgs.
> 
> 
> Being a doper from California, I cannot believe the thread now includes posts about Alieve, aspirin, acetaminofen, Ibupfrofen, etc.


I never take meds. I hate them and if I do have to, I take minimum dosage. Its best to avoid building up the tolerance and requiring you take 3 x the standard dosage. 

The big recent fad addiction in America right  now is Advil, Tylenol, Aleve, Bayer all with sleep additives.  FFS!!!. Every shelf and tons of ads about sleep disorders so drop an Advil PM, Tylenol PM, Aleve PM. Crazzzzzzy drugged up world. I guess its the 12 hour days and all the stress. Can't turn it off.

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## Sumbitch

^ OK, your problem is with meds, whether for pain, sleeping aids or recreation? Let me be clear: everyone reacts differently to every medication. So your or my opinion about potency, effect, duration, dosage, favorites, etc. could possibly mean shit to anyone else who reads this thread.

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## rickschoppers

^
Yep, but there are some general guidelines for all drugs that allow health professionals to work within those guidelines. Some do not like to take a lot of meds which is the healthiest approach. Some have to because they have health issues that require it and some take meds for recreational purposes. 

I think most on this site drink alcohol which is the nastiest drug of all and causes a whole host of problems.

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## Sumbitch

^ The worst being alcoholism, which causes a whole host of problems.

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## Pragmatic

> More ibuprofen. I found ibuprofen 800mg to work best for my aches and pains. Again you need to eat some food before taking it.


Can be taken with a glass of milk. Doctor took me off Ibuprofen. He told me it would fcuk up me kidney's and prescribed Tramadol instead.

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## rickschoppers

Yes, I have moved away from ibuprofen type medications and for the past 6 months, I have just used aspirin and acetaminophen.

As a side note, after being on this thread, I have purchased some tramadol and so far, it seems to be working well. I like to change up the pain killers to avoid tolerance.

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## Sumbitch

> As a side note, after being on this thread, I have purchased some tramadol and so far, it seems to be working well. I like to change up the pain killers to avoid tolerance.


Say, that's interesting. Just curious: how many mg per dose and many doses per day have you been taking? For your other pain killers, same question.

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## rickschoppers

Again, you need to realize everyone is different, but any literature about pain killers will recommend starting at a lower dose and then titrate up until pain relief is achieved. I started with 50mg in the morning and then 50mg at night. Pain is one of the things that keeps me awake at night and since I have been taking the tramadol, I have been sleeping much better. I have increased the morning dose to 100mg since I am much more active during the day.

By changing my pain medication, I should be able to achieve pain relief at a lower dose. I figure over time, tolerance will develope and I will need to increase the dose. When this happens, I will either increase the dose of tramadol, or change to a different pain killer and start titrating again.

I think I already mentioned my past aspirin/acetaminophen doses and I have found ibuprofen 800mg three times a day works for my pain. I have taken various other pain killers, but jo opiates, in the past. My arthritic hand and my back are the best indicators whether a pain killer is working or not at a particular dose.

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## Sumbitch

^ Yeah, you sure have a handle on what works for you. I'm still experimenting. For example, if I felt I could take tramadol every day for more than a week before having to up the dose, I would. Instead I put up with my arthritic pain for most of the week so I'll be sure the tramies work on the weekend. The reason that I do that is that I KNOW tramadol works for me. I have extreme doubts that any of the other pain killers you mentioned are worth mentioning. For example, 50-100 mg of tramadol will not have any effect on me. However, we might disagree on "desired effect". Do you get high on anything?

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## rickschoppers

No ehphoria, but I have a pretty high tolerance for medication.

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## Sumbitch

i don't really get euphoric either. It makes me feel as normal as a hyperactive kid and pain free. And ever since I started this thread the truth seems to be more and more apparent to me: I take tramadol to feel normal, not to get high. And I'm worried it will stop working so I want that other info on painkillers, even though I won't believe it initially (I'm good at fooling myself).

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## rickschoppers

Yes, you are right about feeling normal and how it can raise ones mood. Once you are pain free, you can carry on with life without having to compensate. If you are like me, when I do have pain, I am not the best person to be around and am in a dark mood.

I have had both morphine and meperidine before after a car accident and felt no euphoria. A sense of well being also comes from drinking alcohol. No pain and no worries, which is why so many enbibe. Drinking alcohol is also legal in most countries and easily obtained.

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## Pragmatic

> For example, 50-100 mg of tramadol will not have any effect on me


Medicines affect people differently. Some respond to certain ones whereas others don't. A case of trial and error. With me suffering bouts of depression, the ups and downs of my serotonin levels may play a part in how Tramadol affects me and not others?

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## rickschoppers

Possibly Prag. Best not compare your results to others and only treat your symtoms. I am not possitive seretonin levels have anything to do with physical pain since they are two separate entities. No doubt one would not feel "normal" if their seretonin levels are acting up.

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## Sumbitch

> With me suffering bouts of depression, the ups and downs of my serotonin levels may play a part in how Tramadol affects me and not others?


Why don't you try Zoloft (Sertraline HCL) for your depression. It's easily prescribed if you sincerely have bouts of depression. If not, I can still find a doctor (mine in CM) who will ask you "So what do you want?" Answer: Zoloft or Sertraline HCL. Then he'll ask you how much. The typical dosage is 1 pill every morning for 1 month. After that, you can ask for 2 per day. Make sure they give you at least a month's worth. Like Ricky says: THIS HAS NOTHING TO DO WITH PAIN, unless you want to call it a psychological pain (believe me that can be worse). I wake up suffering from my osteoarthritis every day and I have been on Zoloft (2 pills daily) for 3 months so I know.

BTW, at 1 hour 30 minutes, I noticed I was pain-free from the 500 mg of trmadol I had taken earlier today. However, I was definitely NOT feeling normal yet. I give this drug a full two hours before I decide to take more. It's been two hours now and I haven't decided yet. So far, so good, I guess.

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## Humbert

I see my MD in Bangkok next week for my hip. I am going to ask him to give me Tramadol again. My pain is not as bad as it was before my surgery but it is managable. I am cutting back on my paracetamol intake after reading some of the comments above. When I lay flat on my back at night my leg stiffens up and in the morning I can barely walk, even with a cane, until I have had two pain meds and a cup of black coffee.

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## rickschoppers

Did you have a hip replacement?

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## Humbert

^555. I've had three. Right leg fine, left leg failed twice. There is a thread about my adventures.

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## rickschoppers

OK. You have obviously had some chronic and acute pain. You could probably educate us on that since mine is just arthritic pain and a bad back.

Good Luck

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## Sumbitch

^ mine also

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## Pragmatic

> Why don't you try Zoloft (Sertraline HCL) for your depression.


I quit anti depressants when I came to Thailand. I was on Venlafaxine which can only be given on prescription. Coincidence had it that at that time a women tried to have some monks arrested for beating shit out of her. It's common practice that in rural Thailand people suffering depression/mental illness get taken to a temple where monks will beat out the evil spirits in them. 

So my missus takes me to the only hospital that stocked Venlefaxine 110 km away. On seeing the doctor and asking for the medication the doctor then spoke with my wife in Thai and then burst out laughing and gave me the prescription. On leaving the room I asked my missus what he'd said and why he started laughing. She said he said 'why don't you just take him to the temple and get the monks to beat it out of him'. And that's why he laughed. 
An absolute true story.

I immediately tore up the prescription and have never taken an anti depressant since. Not that I can say they worked for me anyway. I live with my depression as so many people do. Winston Churchill had a name for his. 'Black Dog'.

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## Sumbitch

^ I trust my doctor completely (although I may not tell him the complete truth) and after describing the symptoms that I had that I thought were related to depression (manic/depressive episodes) he immediately prescribed Zoloft. That's that. (what does "that's that" mean? Can I say " end of story" instead? It seems much more relevant to all stories, doesn't it?)

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## Sumbitch

> You could probably educate us on that since mine is just arthritic pain


Rick,
I'd like to go over the pain relievers that, specific to your arthritic pain, work for you, dosages and are available in LOS (pardon if you mentioned any of them in earlier posts). I found this information about the names and associated dangers of various OTC pain relievers (from WebMD) when I googled 'best otc pain relievers':

Would you recommend any of the following categories, which ones work for your arthritis pain, are they available in LOS, what dosages are safe daily and how many days in a row would you take them before switching to another category?
1) aspirin (including Anacin, Bayer, Bufferin, Ecotrin, Excedrin, and St. Joseph). 
2) Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve, Naprosyn).
3) Like aspirin, acetaminophen (Tylenol) is used in many OTC products. And like aspirin, it relieves pain and fever. I took 1000 mg of Tylenol this morning and realize max. dosage per day should not exceed 3000 mg.
4) Tramadol

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## rickschoppers

One more time realizing these are the doses that relieve my specific pain. Doses for you may be different.

Aspirin 1500mg every 4 to 6 hours as needed. You can buy aspirin in different strengths in Thailand and I purchase the 500mg tablets. Side effects to watch out for are GI bleeding and tennitis (ringing in the ears).

Tylenol 1500mg once in the morning and again in the evening for a total daily dose of 3000mg. The recommended maximum daily dose used to be 4000mg due to the possibility of liver damage, but has  recently been lowered to 3000mg per day. I buy the 500mg tablets of paracetamol.

Ibuprofen 800mg three times daily. You should be able to purchase the 800mg tablets, but some pharmacies only carry 400mg or 200mg tablets. Main side effects to watch out for are GI bleeding (take with food or large glass of milk) and kidney damage.

Naproxen Sodium 200mg capsules two (400mg) morning and night. The side effects are the same as ibuprofen sense they are both non-steroidal anti-inflammatory medications.

I have also taken Celebrex 200mg 1-2 capsules twice daily morning and night, but I experienced some GI bleeding and stopped them immediately. They will also need to be taken with food.

I have just recently started taking tramadol 100mg on the morning and 50mg at night. You can purchase 50mg capsules (not long release) in Thailand. The extended release may be available, but the pharmacy I go to does not stock them.

It sounds like a long shopping list, but I only take one class of medication at a time and if I find that I am becoming tolerant to one drug, I will switch to another.

Typically, if you go to a physician, they will start with one drug that seems to work on most of their patients and if it does not work for you they will switch to another drug. Also, they will start at the lower doses and titirate up to maximum doses before changing medication.

Hope this helps.

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## Sumbitch

Excellent, excellent post. Very rare to find such a coherent poster on TD.

You might be interested in this short article about a randomized controlled trial combining ibuprofen and acetaminophen in a single tablet for pain relief as opposed to the typical prescriptions of one or the other at a time. Conclusion: they found the combined drug provided superior relief than either one alone. Mind you, the drug was administered before oral surgery. Make your own conclusions how this might apply to arthritis: Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial

What do you think of the dosages (under "Methods")?

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## rickschoppers

It would make sense that combining pain relief medications, that work through two different mechanisms, would give better results. This strategy is also used for high blood pressure medications since they also demostrate a high incidence of tolerance.

The dosages look reasonable, but one must remember that ibuprofen could cause excessive bleeding. Aspirin would do the same since it works on the blood clotting cascade to slow blood coagulation.

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## Sumbitch

'a high incidence of tolerance' Oh, that's too bad. 

I've made up my mind: I am not going to suffer from arthritis any day of the week, regardless of the tolerance I may have built up to a particular drug. Today I stocked up on ibuprofen and tramadol (already have a good stock of Tylenol) and have taken acetaminophen and tramadol so far today. I won't exceed 3000 mg of acetaminophen but the recommended maximum dosage of tramadol from drugs.com is 300 mg per day in divided doses. I wouldn't give a recommendation for anyone else but for myself, 300 mg/day won't do enough. I think 500 mg to 750 mg is more appropriate for me, although I commonly exceed that. But I'd like more professional opinions, such as those given in the article I posted.

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## Stumpy

Great Posts RickC. Top info and all on the up and up. Should help those in need.

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## rickschoppers

Cheers JP. The house is looking great!

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## Sumbitch

I found a pharmacist who will sell me tablets containing 500 mg of paracetamol and 30 mg of codeine. I read where the maximum single dosage of paracetamol is 1000 per dose and the max dose per day is 4000 mg. I want to take an initial dose of 250 mg of codeine. That works out to 8 or 9 tablets at 500 mg of paracetamol per tablet which equals 4167 to 4500 mg of paracetamol. Ricky: what's your opinion?

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## Sumbitch

^ I had to add a couple more steps to your tutorial. After following all of your steps exactly (however, FF isn't necessary, since it uses Google as the search engine. I used Chrome because it's actually Google's browser), I saved the image to my computer. Then I went to Teakdoor's gallery and uploaded it to my album. After the upload finished, I double clicked on the image and copied the URL from the address line. Then back to here where I clicked on the Insert Image icon (mountain) and pasted the URL. Voila!

But many thanks for getting me started in the right direction!



I posted this unintentionally on this thread. It's actually a sexy gift, innit?

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## rickschoppers

> I found a pharmacist who will sell me tablets containing 500 mg of paracetamol and 30 mg of codeine. I read where the maximum single dosage of paracetamol is 1000 per dose and the max dose per day is 4000 mg. I want to take an initial dose of 250 mg of codeine. That works out to 8 or 9 tablets at 500 mg of paracetamol per tablet which equals 4167 to 4500 mg of paracetamol. Ricky: what's your opinion?


I would't do it. Too much paracetamol.

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## Sumbitch

^ too bad it's a done deal. What side effects might I have to deal with?

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## rickschoppers

Severe liver damage or death comes to mind. Please research Tylenol overdoses on the internet before you continue.

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## Sumbitch

Acetaminophen overdose: Acetaminophen overdose: MedlinePlus Medical Encyclopedia which is a service of the U.S. National Library of Medicine and includes this passage




> You should not take more than 4000 mg of acetaminophen a day. Taking more, especially 7000 mg or more, can lead to a severe overdose if not treated.
> Symptoms
> 
>     Abdominal pain
>     Appetite loss
>     Coma
>     Convulsions
>     Diarrhea
>     Irritability
> ...


According to that synopsis I feel nothing except that my hands are a little shaky which may be due to the codeine. I'm a pretty big dude (85-90 kg) with less than 20% body fat due to very hard workouts. Plus, I'm booked for 3 weeks in Nepal beginning Mar. 27 which will include the hardest physical activities I've ever suffered through (high altitude mountaineering). However, I don't want to make excuses for myself. It's only been about an hour since i took 10 combined tablets plus a little Tramadol. So I have to wait another 5-11 hours to see if I have any of the above symptoms (my appetite has been very good. Conversly, I am walking with a little instability).

Ricksc, do you mind if I say your opinions seem very much anchored to safety first and seem to strictly follow md advice? Personally, I like a little risk in the form of recreation first and follow a Web site called erowid.org (not religiously. I'll disagree with them occasionally). You should read some of the members' posts, both positive and negative: phew! Anyway, I'd like Bettyboo's opinion as well (this isn't the first time I've taken a shitload of acetaminophen to get at the amount of codeine I wanted, before of course, I knew of these recommended max dosages.

BettyBoo, where are you?

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## Bettyboo

> And ever since I started this thread the truth seems to be more and more apparent to me: I take tramadol to feel normal


That's quite contextual, and we can mislead ourselves...

Basically, we have/need a homeostatic balance, when we have problems, be that an illness, old age or temporary trauma (physical or psychological) our body tells us so in the hope that we will rectify the problem. Neurologically speaking, a lot of the drugs we take are trial and error, and they are made by companies for profit. Thus, I'd take what the pharma companies and doctors say with a pinch of salt because they are motivated by profits, litigation threats, etc. You know your body best, but you have to also be smart because your body evolves and your body changes.

You don't really wanna be dependent upon drugs unless there's no other option. Exercise and diet and lifestyle are key, but then take drugs that suit you and your needs; as long as you keep reflecting and asking yourself (and others) intelligent questions, then you are in the best position to know your body. 

Taking doses that work for you is fine. Taking increasingly large doses to get the same affect is a slippery slope...

Some drugs do have problems and side affects, and some drugs are killing you slowly (alcohol may be killing your liver over many years without you feeling it...), so you should check and listen to advice. But, your body can clean itself and balance itself really well given the opportunity (not always...). A big problem is the self-reflective self can undermine and over-run our homeostatic senses; an extreme example may be something like bulimia where we starve ourselves to death because of a social construct - that's a form of modern day insanity in my book, and it's always a risk; we do fool ourselves. We must listen to our body.

Good luck.  :Smile:

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## rickschoppers

BB, some pretty good words regarding how the body can regenerate over time. The bad new is that cirrhosis caused by alcohol is an accumulative situation. Alcohol poisons the liver and once cirrhosis starts, it continues until the alcohol is removed. The liver will not get better and remains in the damaged state until more alcohol is introduced which continues the process until death. You can completely stop drinking alcohol for 10 years and then if you start up again, the liver will be in the same disease state as when you stopped 10 years ago.

As for acetaminophen poisoning, each person will vary slightly,  but the LD50 pretty much stays the same. Once a lethal dose is ingested, there is nothing to keep it from killing you other than administering acetylcysteine as soon as possible, preferably within 8 hours.

WJ, if you think I am erring on the side of caution, you are probably right. I have dealt with many drug overdoses within a hospital and only spend a lot of time on those I think can be saved. Same as walking into a code blue situation when you know the person has no chance. All present go thru the motions, but they also know whether the efforts will succeed or not.

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## Sumbitch

I would simply add that a sense of humor (esp. being able to laugh at yourself) goes miles towards keeping you alive (that is, keeping alive the desire to live). Exercise and nutrition go miles towards a healthy lifestyle. 

BTW, did you hear Markus has left our glorious company? If he wasn't an online dealer, I don't know the meaning of the word.

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## Sumbitch

I just reread this thread and want to comment on some of the *great* posts, not including the two best above (that is, ^^ and ^^^)




> well back here in California and fighting the masses but I see light at the end of the conveyor belt.


Do you mean at the end of the treadmill? OMG




> I never take meds. I hate them and if I do have to, I take minimum dosage. Its best to avoid building up the tolerance and requiring you take 3 x the standard dosage. 
> 
> The big recent fad addiction in America right now is Advil, Tylenol, Aleve, Bayer all with sleep additives. FFS!!!. Every shelf and tons of ads about sleep disorders so drop an Advil PM, Tylenol PM, Aleve PM. Crazzzzzzy drugged up world. I guess its the 12 hour days and all the stress. Can't turn it off.





> ^ OK, your problem is with meds, whether for pain, sleeping aids or recreation? Let me be clear: everyone reacts differently to every medication. So your or my opinion about potency, effect, duration, dosage, favorites, etc. could possibly mean shit to anyone else who reads this thread.





> ^
> Yep, but there are some general guidelines for all drugs that allow health professionals to work within those guidelines. Some do not like to take a lot of meds which is the healthiest approach. Some have to because they have health issues that require it and some take meds for recreational purposes. 
> 
> I think most on this site drink alcohol which is the nastiest drug of all and causes a whole host of problems.





> ^ The worst being alcoholism, which causes a whole host of problems.


Still agree with all of the above. Just want to mention zolpidem as a non-benzo sleep aid specifically developed for insomnia, in contrast to benzo class meds. Also, codeine is readily prescribed (for arthritis anyways) and I have loads but I noticed side effects in two weeks of almost daily use, so discontinued it for a week and the side effects (constipation) disappeared in a day or two. So I put that bottle on the shelf as far as regular usage and will try to live with paracetamol and ibu. Again, I want to praise the merits of tramadol. For me, it's unlikely to become addictive, as I feel 0 effects on the third day in a row. One week without it brings on no withdrawal symptoms. In fact, I prefer it to codeine, which I know could be addictive, if you don't pay attention to the side effects which are similar to the withdrawal effects. Tramadol's major side effect is ineffectiveness. How can you beat that?  :deadhorsebig:

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## Stumpy

> Quote:
> Originally Posted by JPPR2
> well back here in California and fighting the masses but I see light at the end of the conveyor belt.
> Do you mean at the end of the treadmill? OMG


HAHAHA....Nahhh Wj. Its just a term some use like "Light at the end of the tunnel" or "I see the exit doors" etc. I will likely be back to retirement in about 6 months. 

I will say my Dad made this recent trip back with my wife and I (Apr to early May). My Dad is sadly one of those folks tied to a med diet. He had his morning lump of pills he takes and his night and he would freak if he missed them. In fact he dropped one and lost it and was worried about it. I watched him every day swallow down 7 different pills. Cholesterol, Blood thinners, etc and he takes 2 that their only function is to offset the side effects of 2 others he takes. The real pain was with all those meds you have to be close to a crapper as they are ingested they cause immediate bowel activity. While maybe too much info for some the reality is that this is common theme here in the US and its scary. People took very little credence early on in their lives to live with moderation and now in their older years are paying the piper as they say. Not very glamorous 

I realize that some require certain meds to assist them but it is just to easy to prescribe meds to avoid having to be proactive and stay reasonably fit. I also realize I am speaking generally. Just like diets, not all of them work for everybody. Some need to try many to find one that offers results. Same with Meds. Some need many to sustain what they feel to be a normal life.

In the end whatever works. Just depends on what one decides is the quality of life they desire. Sadly this is all driven by mans need to try and live forever. I do not want to live forever. Ive seen enough.

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