A not-so-brief Introduction in which Our Hero describes His Journey to this Point.

Phil Gordon said it most concisely about an entirely different subject:

I want to puke.

I have felt nauseated for almost 18 hours now, save the six or seven hours of sleep I managed to get when I finally passed out. I haven't had a painkiller free day in over 10 weeks. Due to my pain management doc's refusal to prescribe narcotics, I'm having one now whether I like it or not. It's been nearly 20 hours since my last dose of vicoprofen, a medication that was becoming less effective. After 10 weeks, I'm surprised it was working at all. Looking back on it as I try to find a comfortable position and measuring how long my TENS unit has been on in hours (almost 4 hours straight now) instead of minutes, I'm painfully aware of how effective it really was and how ineffective the prescribed remedies seem.

Let me backtrack for a few moments here. Let's get to the backstory so all of this can make some sort of bastardized, munged-up sense in the world of pharmacology, pain management and state and federal legislation and action. And forgive me if not everything is spelled right. I'm shaking a bit, I feel cold and am exhibiting some classic symptoms of withdrawal at the moment. Give me a pass on the grammatical bits.

I am a 33-year-old male. I've never had what anyone would consider good health. Chronic bronchitis which my doctors still hesitate to call chronic obstructive pulmonary disease. Sinus problems that have required three operations to date. The shit that runs in my family, including suicide, fibromyalgia, diabetes, cancer, arthritis of all sorts, heart problems, thyroid problems and so forth, is so bad that I had a vasectomy about six or seven years ago so that I wouldn't risk passing any of these genes on to a kid. Instead of debating the point, my family physician congratulated me for having the proverbial balls to take such decisive action. I have never regretted my decision. I never will.

I have had back problems for the past several years and am currently undergoing my sixth round of physical therapy since 2000. I had four rounds in San Diego between 2000 and 2002. I moved to Illinois for work and had a series of facet-blocking injections in 2003. In 2004, I was back in physical therapy after missing two non-consecutive weeks of work with back spasms. That's when I was diagnosed with degenerative disc disease, a diagnosis confirmed by another doctor. And everything was fine until February.

See, in February, I was knocked out of commission for a week with back spasms which were treated with vicodin and 800 mg tablets of prescription Motrin three times per day. By March, I was missing time due to the side effects of the Motrin. I staggered through the rest of the month until April rolled around and all hell broke loose. I missed work on a Monday, barely made it through seven hours on Tuesday and, by the time I left after six hours on Wednesday, couldn't stand up. I left work and went immediately to the doctor's office and my doc put me on disability on the spot.

That was more than 10 weeks ago.

That is also about the number of times I've been able to go outside since all this started.

See, the MRIs revealed that three discs in my lower back are all but gone. There are black spots where those smooth white ovals used to be and my neurosurgeon says there is nothing she can do surgically to help. They also showed what my neurosurgeon called striations pretty high up the spinal cord and what my pain management doc told me were lesions at C2 / C3. Based on what they've said and what I've experienced lately, I strongly suspect that my neurologist will officially diagnose me with multiple sclerosis next week. Two docs have told me that I'm showing symptoms of it. Third time's the charm.

Those two doctors haven't mentioned any other conditions that could be causing these problems. The only thing they said was MS.

And typically, docs don't say shit that is likely to freak a patient out. Call me crazy, but doesn't the possibility of having MS put most people on edge? I mean, sure, Annette Funicello has done all those commercials, but what about that poor SOB who kept saying that Larry Walker got him $2.8 million? He did commercials too and he was paralyzed from the neck down. Doing a commercial doesn't equal quality of life for me.

I'm a gambling man. I used to pay for trips to Vegas by playing poker. Based on what I know and what my doctors have said, I'm betting on MS. I'm just hoping that my bet on one of the milder forms pays off.

So that's where I stand. I was supposed to get married this year. I was starting to think about graduate school. I was starting to feel like, after three and a half years of inertia in Illinois, I was beginning to move forward.

And now I just shift restlessly from sitting to laying down, trying to find a position that hurts less while praying for unconsciousness since it's the only time I don't hurt at all.

I had another appointment with my pain management doctor today which is what sparked the official beginning of my contribution to this blog, since I feel like the only ally I have in all this is my primary care physician, a wonderful Canadian woman who gets the holistic approach and likes patients to be actively involved. Sadly, we've been in the realm of specialists - neurosurgeons, physiatrists, pain management doctors, neurologists and so forth - for two months and there doesn't seem to be much she can do to help. Based on today's appointment, she can't even continue the vicoprofen, the only med that was yielding any noticeable relief, because my pain management doctor has taken over all prescriptions and does not prescribe opiates.

Instead, I've been on 300 mg of Lyrica daily for a month since, even though its primary use is as an anti-convulsant, it has shown some clinical results in relieving pain. I mentioned that I've been shitting blood lately. Neither the doctor nor the nurse seemed especially concerned. Instead, they added 30 mg of Cymbalta, an anti-depressant, to my regimen since it has shown some results in relieving pain. They also both have some interesting side effects, including suicidal ideation and mania.

While I understand that medications can take time to work, I feel worse now than I did before I began seeing a pain management doctor. In other words, the doctor who specializes in helping people in my situation has had the least effect and I'm feeling the worse for it.

The pain was so bad tonight that I nearly took a friend up on her offer of a friendly smoke-out. I've been sick all night, presumably from withdrawal from the painkillers. I can't sleep, I can't get warm and I can't stop sweating. I also can't take another painkiller to ease the pain, especially if no more are coming. If I have a choice between kicking now or delaying it for 7 tablets or so, I might as well kick now. In light of the nausea and excruciating pain, marijuana seemed like it might help.

Philip spent several hours on the phone with me tonight while I've been coping with it and I finally was able to get lucid enough to realize that smoking out would directly conflict with my long-term goals and also eliminate my moral and ethical credibility in advocating reforms for pain treatments at the state and federal level. Someday, I'd like to be a lawyer, a prosecutor, even. If I'm going to do that, I need to uphold the law now, no matter how much pain I'm in at the moment. And, on the balance of things, it seems to be much easier for elected officials to listen to someone who suffered from playing by the rules but played by them anyway.

But what hurts more than that is having to delay plans - to get married, to apply to law schools, to become a stepfather, to begin moving forward in my life.

And what hurts more than that is not being able to go to work for more than 10 weeks. In the past, I went to work if I could get out of bed. It took a doctor's note and a diagnosis of bronchitis or better to keep me home.

But the thing that hurt most today was talking to my fiancee tonight and hearing her tell me that I sounded like a junkie.

And what hurts more than all of these together is the pain of not being able to pick up her daughter when she lifts up her arms, looks up at me and says, "Hold me."

And I keep looking at the side effects of these meds and all these Web sites about how Cymbalta and Lyrica can both lead to suicidal thoughts, and I wonder if the effects stack - if I'm 5% more likely to try to kill myself as a result of one of these meds, is it 10% now since I'm on both? It is strictly additive or multiplicative? How do they interact? Perhaps it's exponential?

And then I think about my mom, who killed herself in 1997. She suffered from fibromyalgia and, back then, it seemed the only treatment was vicodin and lots of it. It took 60 500 mg tablets chased with half a decanter of scotch to do the job - I don't know if that was her tolerance or if she just kept going long after she had hit the magic mark. What I do know is that I found dozens of bottles of vicodin in cupboards - 100 tablet prescriptions in stacks. And as I read about these drugs and their side effects, as I look at what they're approved to treat and what they are treating and how they treat it, I have to wonder ... do they really cause or contribute to suicide? Or is it just that the patients on these meds are tired of hurting, tired of living in constant pain and being on medications that don't help?

My experience with Lyrica is limited to one month. In that month, my sleep schedule has been shot to shit. When I can sleep, it is usually in the middle of the afternoon. When I can't, which is most of the time, I hurt. It is clear to me now that vicoprofen was the only medication offering any relief, and that its interaction with the Lyrica is what knocked me out for 16 hours at a stretch. I do not see any effectiveness at all and, after a month, I damn well should since I feel an improvement within 20 minutes after taking a tablet of vicoprofen.

If my experience with Lyrica is typical for people with chronic pain, if the medication shuffle for pain management is the same as it is for mental health, I can hazard a guess at why people kill themselves while on these meds.

We are, after all, animals. And considering that a wolf will gnaw off its own paw to escape a trap, is it any wonder that we might exercise more permanent means to relieve pain that we simply cannot escape? Is it any wonder that we see what looks like an endless cycle of medications that don't work and unabated pain - whether physical, metal or both - and choose the only relief left to us, the only relief that places us beyond prosecution for trying to alleviate our pain with treatments that are anecdotally effective yet outlawed in most states, the only relief that breaks the cycle of new hopes and seemingly inevitable letdowns of new miracle drugs that promise to fix it all for good and with no side effects, the only relief that we know - once and for fucking all - will finally end the pain?

I need some mercy from the medical establishment right now, not moralizing about the problems associated with opiates. I need to not hurt. In my mind, the Hippocratic Oath has been violated - if the first rule is do no harm and a doctor is refusing to continue prescribing medication that offered relief, than harm has been done because I am now in worse shape than I was before. I need help and sympathy from my doctors, not lectures and overpriced new prescriptions for drugs that may have some dubious effect.

And if I can't get that mercy, then I'll behave like the wounded animal I am, revert to base instincts and visit wrath upon those who are the source of this pain.

There's an old African proverb that some friends of mine put on a t-shirt - to paraphase, until lions have historians, tales of the hunt will always glorify the hunter. If I don't get the mercy I need, I intend to hunt the hunters.

And, generally speaking, when lions hunt something, it tends to get bloody.

Posted by Puckett at June 29, 2006 05:34 AM
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