Tuesday, June 15, 2010

How the fuck do you people do this?

I mean "you people with chronic pain."

Srsly? You rock.

I ask this because I have what started as a cold and is turning into a sinus/upper respiratory infection that will probably require antibiotics. And, when my doc gives out antibiotics, he throws in a scrip for that stuff that's liquid hydrocodone and promethazine combined, which, while providing a pleasant night's sleep, leaves me unable to do much more than blink for 48 hours after one-half of the recommended dose.

Yet I have friends and coworkers who live on narcotics. I mean, they're unable, due to chronic pain or unresolved injuries, to function without, say, a couple of Lortab in the morning with their coffee. That blows my mind.

We went over this in Pharmacology, and I understand that some of the side effects do go away, with time; yet I can't imagine actually *caring* about stuff with a Lortab or two in my system. I can barely imagine breathing with a couple of Lortab in my system.

And yet people do it. One of my most productive coworkers, the kind of nurse you'd want for yourself if you ended up in the ICU, the woman who catches complications before they're complications, takes four or six Oxycontin during a shift. She does that because she's had two failed back surgeries in ten years and is currently grinding bone-on-bone through at least three vertebral pairs. Meanwhile, I'm sitting in a chair, head lolling loosely, barely maintaining my own basal metabolism, on five hundred milligrams of Robaxin.

Beloved Sister takes Tylenol 3 now and again for migraines and general female troubles. And she does fine on it. Tylenol 3 will make me fall over in a little heap that does nothing but groan, vomit, and sleep--in that order--for sixteen hours.

Narcotics are weird. I remember in high school trying to get stoned (Hi, Mom!) and ending up paranoid and shaky. I remember later, attempting to take some drug or another that would make me mellow and love everyone, and merely being insomniac and organizing my sock drawer compulsively. This is why I no longer follow the Rainbow Trail or hit Burning Man in the summer. It's not the heat; it's the drugs. I am a big walking FAIL sign for anything that's supposed to relax a body or make you feel cool. You want me to be happy and mellow? Give me coffee. You want me to veer wildly between comatose and compulsive? Give me a narcotic.

All joking aside, it makes me wonder about my brain chemistry. Dr. Dink (my shrink) explained patiently to me during my last visit that I would probably never get the answers I seek to the (fascinating to me) questions I have about brain chemistry, simply because they would involve depriving people of/stuffing people full of various chemicals that might harm them. I wonder sometimes if my brain chemistry is just that off.

There are benefits, of course. Too much caffeine rarely makes me shaky; instead, I fall asleep. And I can get a commendable high from non-controlled substances. If I'm given a controlled substance, like Valium or hydrocodone, I can manage a dose or two (or at most three) before I start itching all over and having hallucinations. Tylenol works on my migraines. I'm a cheap date; half a bottle of wine will make me goofy; five glasses of same will make me no more goofy than two, but will effectively erase my memory.

I'm really, really thankful that my shoulder is getting better with massage. I'm really hopeful that I don't have to be on NSAIDs for months on end (because they make me stoned). And I'm amazed by people who can take codeine and go to work on the stuff.


Alpine, R.N. said...

I'm with you on the narcotics. I (very vaguely) remember a morphine drip after my appendectomy, and, without slurring AT ALL remarking to the doctor "oh it still hurts, I just dont CARE! I could DIE and not care!"

On Tylenol 3, I curl up into a little ball of vertigo and don't move. I don't know how anyone can stay UPRIGHT on the heavy stuff.

Humincat said...

Same here. And I'm so thankful.

Brian said...

Interesting! We just covered this kind of thing in my pharmacology class. I was mildly surprised to find that it all gets slapped with the same label. "Idiosyncratic reaction" seems to be medspeak for "um, yeah, heck if I know what's going on there."

Me, I get weak and shaky after one ibuprofen.

Moose said...

People can act differently to narcotics. I know people who get violent from morphine or who have vividly frightening hallucinations from hydrocodone.

Until I lost health insurance my pain drugs were tramadol and morphine. Tramadol ER helped me be able to use my hands in the morning [now this is a luxury] and function throughout the day. Morphine was for the really bad days. When the pain is that bad there are no "fun" side effects, yet I get the joy of "morphine brain", where cognitive functions go to hell. Once after 3 months of MSER I found that I could not read a short story [by the time I'd turned the page I'd forgotten what I'd read] or play solitaire [I couldn't do basic math or realize that black and red weren't the same color]. Cooking was restricted to the microwave because stoves can start fires when forgotten.

Also, oral morphine and IV morphine are very different. I've occasionally gotten a little fuzzy from taking an oral morphine dose when it's been months since the last one. IV morphine, on the other hand, makes me understand heroin addiction. First time I had IV morphine [for a kidney stone] I had the same reaction as Little D: I was in horrific pain and I could care less. Ow, yes, this is a 10 out of 10. Yes, it really hurts badly. Why am I so calm? Must be the drugs.

pinkundine said...

Hi - big fan of your blog, usually a lurker though ;)

I've always wondered exactly the same - if my brain chemistry's off... Caffeine makes me fall asleep, even in small doses, any type of recreational drug (of the few I tried in college) generates the exact opposite reaction it does in most people.

Glad I'm not the only one ;) Hope your shoulder gets better soon

messymimi said...

More than my one cup of regular coffee per day and I have a caffeine induced panic attack. I try to never have anything stronger, I hate the feeling that I am not in control of my faculties.

pita said...

Everyone has different reactions to medications. As someone with chronic pain, let me tell you that can really suck. Nothing like being put on a medication that should help my condition only to have off the wall side effects instead of relief. The Lyrica commercial isn't lying when they list dizziness as the first possible side effect. That crap made me so dizzy that I would barely turn my head and the whole world would start spinning. Not something you want when you have to climb ladders. Migraine medication has given me horrible chest pains or made me so nauseous that I was better off with the migraine. Benedryl makes me wired not sleepy. Even nyquil doesn't knock me on my ass unless I'm already tired. Depending on the dose of a narcotic, it will either make me itchy, or knock me out and wake up itchy later. It's real fun when I still have to function but need to take a pain pill because I have to take the lower dose which takes teh edge off but I end up itchy so I have to take a benedryl and end up wired. It takes a lot of trial and error to figure out what works for you. If you have a chronic condition, you have all the time in the world to figure it out. If it's an acute injury, most docs aren't going to change meds unless you have a severe reaction so you have to keep track of what worked or didn't work this time so you know what to tell the doc next time. We're still working on what meds are best for me.

Brenda said...

I can't do caffeine after 8 pm, or I'll be awake all night.now I'll take morphine in the hospital without incident. yes. the pain is at a 10....morphine. 7..... maybe a tylenol 3. ya learn quickly which one is going to do the job.I don't like taking them at home, because you never know if you're going to need to go out.to rescue a kid....(I have 5 of em - 2 live at home with me).

Anonymous said...

I had a patient this week with Crohn's disease who clearly had been taking a lot of opioids for a long time, building up his tolerance and dosages sequentially. Would you believe... 130mg of MS Contin, TID? That is a TON of morphine, and for him it was not a thing. Crazy.

Anonymous said...

Well, after years working Hospice large narcotic doses don't freak me like they used to. My very first terminal patient was 95 lbs soaking wet and on 400 mg MSContin bid with 70-100 Roxinol prn for breakthrough, and she was walking and talking fine.

Meanwhile, I have ortho problems similar to your co-worker, and have advanced over the last decade from Motrin and Ultram to Oxycontin 60 bid with Norco 10/325 for breakthrough. With this, I work full time, drive, and live a pretty normal life other than moving slowly with a limp for the first hour of each day. It is this or go be an unemployed invalid, which does not appeal to me at all. The biggest drawback is that I have to skip the eggnog at Christmas and Cosmos' on girls' night out....but it beats the alternatives. Besides, I have a five year old grandson and want to dance at his weddking.

Mama Bear, RN


I have spent 5 years having to take a narc based substance for my bowels. At first they had me on double the dose I am on now. By choice I lowered it once the condition stabilised. You do just get used to it, if I miss a dose or take it too late, hello toilet for about 4 hours. No one cn function productively that way.

Once in university the pain became really intolerable, I took another dose so one didnt live in the loo nor have an accident. Unfortunately the pain wore off within an hour, I was left pretty much non functioning for the next 11 hours. The girl who sat next to me saw me nodding and agreeing with the tutor with no real perception of what was going on, she saw my eyes and said "oh my god your off your face!', I was, and it wasn't pleasant. Now I use smaller dosed fast acting meds instead, which wear off after 3-4 hours as a top up.
I had to explain to someone I worked with (whom was medical also) that no I wasnt a stoner, if my pupils were a bit myoptic, that without these meds I would have no quality of life and cant function (would crap oneself to death) they understood.
When on them long term side effects are minimal, one can function and if you are wise you only take the minimal dose needed.
Diabetics need insulin, sometimes if they muck up a dose the consequences can be fatal or coma inducing, however people dont have issues with hiring a diabetic, nor question there productivity.
A chronic disease is a chronic disease whatever body system it effects.