Pain Medicine

[lightseeker]

Dig -

Was wondering how things were going for you. Procrastination (aka sloth) is one of my traits that I have uncovered....why do today what you can put off until tomorrow kind of thing. NOT a good thing to do in recovery. If I think that I need to get to a meeting tomorrow then it's a pretty sure bet that I need to get there today. Only we can cry UNCLE and will do so when we are ready I guess. Once I get caught up in a cycle that is harder to do though. I just can't let myself get started. I have strong tendencies towards mood changing whether it is with drugs, alcohol, people, or activities...have to be cautious of it all. I know that I have to stay away from everything in order to stay sober. I'll use food, computer games, people, etc to take my mind off of things and that's not good. I finally have enough "tools" in the bag to use them reliably. It's worth the work with a sponsor and the steps to get those tools. That has helped me even more than getting to a meeting - and the meetings are important.

Relapses are really tough to pull back from - which is way I am scared to even go there. I'm not sure that I would make it back. I think that it gets harder each time. Have you looked into any of Terry Gorski's work? He does a lot of work with c hronic relapsers. My RAH's husband is a relapse prevention counselor and has used his work at lot. It's really helpful. The work is all about getting to a person's core issue and identifying the triggers that lead back to relapse. Thought that you might be interested in looking at that - especially with your medical background. A lot of recovering physicians use that body of work. My RAH went to Talbotts and that is the follow up that they recommended.

Remember - none of this is worth losing your life or your license over...none of it.

Thinking about you!

[Digginit]

I think I'm done with that little escapade. Back on the wagon. My mood is good and hasn't suffered much these last few days, but having been around this block before, I'll not let myself get too confident just yet on either count.

Sometimes...lol...often I over-analyze stuff. Heh. Right now I'm just trying to keep it black and white. I am an addict and I cannot use drugs if I want to stay alive and happy. So today I'm not using. Quit about 22 hours ago.

Speaking of knee rehab...saw my ortho today too. We talked a little bit about this. There are without a doubt more times to face this same thing. I'll not get ahead of myself, but it's bouncing around in my mind.

Rode my bike 16 miles today. But no meeting.

linz

[lightseeker]

good for the mileage on the bike. I hope that next week when I go to a cast and WBAT I can get on a stationary bike. EEERRR....maybe that will help me get some of my ya'ya's out. Was set to go to a meeting but a huge thunderstorm blew in....lightning cracking and torrential rain - didn't want to become a lightning rod so I stayed home.

My RAH (DOC cocaine and crack) says the same thing that you did - "I'm a drug addict and I can't use drugs". End of story. Alcohol was never the big draw for him but it always (eventually) led him back to coke. Until he quit everything he wasn't able to stay sober. He's feeling proud of himself that he is not tempted by my pain meds.

I had to call today and get a refill.....downgraded from the Oxy's to Lortabs though. The nurse said that I probably have another week or so of a lot of pain. When are you thinking about doing your knee? I've seen all the different methods of pain control post op with knees and I tell you - the OnQ works the best overall - you still have function but only a local anesthetic....that is vs. the epidural which is tougher to localize. Let me know when it's all happening.

What are you doing now? I've never found your complete story so I confused about whether you finished residency and will now go into practice or you are taking a break.

Glad that your mood is good - keep taking good care of yourself.

[Digginit]

We're gonna not do another surgery right away. Problem is that there's no cartilage in the anterior compartment (or very little) of my knee, and a lot missing from the medial compartment. I finished residency a week ago and have some down time until August 3rd (I believe that's Monday) when I start my practice. I also work ER one night a week and one weekend a month, and I'm the medical director of an adolescent inpatient psych facility. Knee replacement is inevitable within the next few years. 42's a little young for that, though. We bounced around going ahead and doing it while I'm not busy and while I still have medical coverage (COBRA). No individual plan will ever cover this knee. My ortho didn't like the idea, but based on the state of my knee was willing. With this relapse, and me working hard and coming along pretty good after this surgery, we're putting it on the back burner. I've had my attorney (who is helping me set up my practice) look into group health plans, and it looks like we've worked it out so that I'll be able to keep group coverage....and tend to the knee when it has to be tended to rather than because of insurance issues. That's probably more than you wanted to know...lol.

I don't envy your "another week of a lot of pain." Keep your chin up. If you're anything like me, it's hard to be stuck to the couch. Ugh. What's RAH--I never know what those things stand for. You know what? I wasn't tempted by my pain meds either. But I sure noticed when I found myself running out--even though I could get more just by asking.

Hang in there!

~dig

[lightseeker]

Had to laugh about the pain meds thing - not my thing either but I was certainly counting them out until I got my refill. I don't want to put myself through the detox so I'm pretty safe I think. Definitely will be glad not to be gunked up inside - like they are woe to do. It's definitely hard to be stuck to the couch - not one to tolerate that very well at all. I have this turning knee caddy though that lets me peel along when I feel like it.

RAH stands for recovering addict husband. The r is used very loosely though. He is more like a SAH - sober addict husband! He's got 3 years now which is a pretty big deal when his doc was crack. Major miracle that he got sober - he used crack for 20 years. It's interesting - his primary addiction is sex and he thought that I would go off on his lurid escapades that he dreamed of having - orgies, group sex, swinging, etc. He thought that he could talk me into participating in all his stuff but he knew that I wouldn't tolerate his crack addiction. He knew that he would lose me over it and he thought that I was his ticket to sexual nirvana....so, he gave up the crack. The sex addiction has been quite another story. Even if I were to ever do those things it would never ever be with him because even thinking about it turns him into a frothing maniac. I wouldn't be able to stand him. So, the joke was actually on him. About the time that he finally gave up the ghost of the orgies he had 2 years of sobriety and by then, had enough brain healing to stay sober - even if he couldn't lure me into sexual slavery. It's been quite a ride with him. We dated 18 years ago - broke up and then he reappeared via classmates.com. He fooled me but good when we started going out but of course, that only lasted so long. We have 4 boys between us (ages 10, 13, 13, 14) so quite a lot of testosterone flowing here. He is a general contractor and we are in the middle of a huge rennovation. He became very grandious, hyper irritable, rageful, etc. and snapped in May. Long story short - Mr. RAH aslo is Mr. Bi Polar. He was on Wellbutrin and Strattera and both were jet fuel for his BP. Now is ramping up on his mood cocktails and doing a lot better. Life ain't been easy with this one - but hey, just find me a bad boy addict and I'll marry him. Joke was on me when he got sober! Talk about way more info than you wanted!

No, I'm glad to hear about your knee story. Also, I'm really glad that you can delay it until you are ready. It's awesome that you have the honesty thing with your ortho doc. I put my ankle off until I was ready for it to be done. Even then, I allowed my friend Major Denial to visit pre op so I was rather flu-moxed over what a big deal this has been. Oh well - I'm off until the 1st of September. The variety of your work sounds fascinating. My trauma work takes care of a lot of my adrenalin issues - love the edgy excitement. So, your work in the ER appeals to me. Also, the adolescent psych work is awesome. My nephew had a major bout with coke, depression - all the teenaged angst stuff and the psych people helped him tremendously. He was in training to become exactly like my husband but it looks like fate has saved him from himself for the time being. No more drugs but he is still drinking.

thanks for the details and update. Glad that you did well today.

[Digginit]

LOL....just can't help but laugh about your husband. Heh. Your house must be full of joy and laughter. <snicker>

Your surgery was a REAL big deal. I feel like the windshielf far too often, though, and end up being the bug. Seems like there'd be more of a learning curve in there....

AND honesty with your doctor. I'm not honest with my family doc about drug use at ALL. He has no clue. My ortho doc, on the other hand, is someone I can talk to about anything in the world. He's a good friend, and in fact he's the first person I told about my big nasty relapse at the end of last summer. He's never put it on paper. Never told another soul. We talk about it openly, though he doesn't understand addiction in the least...lol. It's kind of funny.

Keep your chin up!


dig

[laurie6781]

Although all those years I was out their using Alcohol was my Primary DOC, I also used lots and lots of drugs.

In the last few years as my health declined and I have required various surgeries, I have been totally up front with my doctors and they all know about my alcohol and drug addiction. I have been prescribed heavier than my normal pain med (I live with chronic pain now from degenitive disk disease caused by osteo arthritis) I am very careful how I take them. Just a precaution on my part, even after all these years sober and clean I stay vigilant because of the pain meds.

My roommate and dear dear friend is sober 9 years longer than me. She too lives with chronic pain, so we have slid into the habit of telling each other when we take our meds, and it's a good thing because sometimes one of us forgets (senior moments, rofl).

The idea of pain medication is not to take the pain completely away, although sometimes for some folks it does, but by taking it as prescribed it will put a 'blanket' on the pain to make it tolerable and when you miss a dose you mess with the blanket. So Lora and I, who can also read each others actions and faces pretty darn good can usually spot when the other one has missed a dose.

I can tell you Knee Surgeries ARE NOT FUN. I had one in November on the left knee, it was one long tear, Ortho Dr wasn't sure repair would work, but it did and knee is great today. Just had one 13 days ago on my right knee from a fall. After the fall had X-rays, nothing broken, probably just soft tissue damage. Well..................................after 2 more weeks and it was worse, not better, had MRI done and Ortho Dr said it times to go back to the OR. Seems I had 4 tears in this knee, really did a number on it from the fall. It is more painful than the left was and I have a fairly high pain tolerance, but dang this one hurts.

Of course, being the good alkie that I am, it should be healed by now, roflmfao, YEAH RIGHT.

Do..................................I believe it is possible to take pain meds in sobriety, however, even with my years I stay accountable to 'someone.' Fortunately I have a roommate. Before Lora moved down here, I would use my dear friend Norma Jean who lived 3 doors away and I would call her every time I took my meds. Just a little bit extra 'insurance' for me.

I'm glad you are doing better Dig, but don't wait too long on that knee, like alcoholism it will only get worse not better.

Love and hugs,

[Digginit]

Thanks Laurie. We've discussed chronic pain issues too, because it's gonna be there at least until I have that knee replaced, but then the other knee's not far behind. So pain is going to be an issue. Pain meds make me feel bad. And they make me feel even worse when I go pull some stupid stunt like last weekend...lol.

I've been waiting for the bottom to fall out, and it hasn't yet. I think I'm actually keeping my head about me a little bit this time. That's *some* little bit of progress.


dig

[lightseeker]

Hey - some progress is an awesome thing in the scheme of things. I get sick off of pain meds too (new discovery). I'll be glad when the pain decreases to the point where advil does the trick.

All the relapse counselors that my husband has seen have told him that the important thing is to learn something from your relapses. I guess, ultimately, what is learned is that we are powerless to control it - end of story. My addictive thinking always thinks that there is a way around things but deep in side I do know that my "controlled" use will sooner or later take me down. Oh well. End of story!

Heading off to drink my diet coke to settle my uneasy tummy.

[Digginit]

The next step. So now I'm involved with this relapse prevention guy. I think that was a good recommendation. So thanks. That's going well.

My little dilemma right now is my knee. I've gotten into the habit of giving myself a knee joint injection every couple months. After this last debacle, I promised my orthopod that I wouldn't do that anymore without consulting with him first. Well, he's not in town. I hurt. But my perceptions about what is substance abuse are changing. Heck, a steroid knee injection isn't substance abuse....but maybe it is, sort of, if you give them to yourself whenever you want???? Of course I give myself Advil whenever I want too. I don't know. I guess I'm gonna sleep with an ice pack tonight and maybe try to make it until next week, when he'll be back in the office. Or maybe not. I don't have a good answer, but I know that a quick stick would make things better. Ideas?

~dig

[lightseeker]

Diggin -

I was signing on to send you a PM and saw that you had posted. As I think about it, do you have another MD friend/colleague that you know that could oversee the process? Or at least a primary care doc? It's hard when you can do it yourself but what would you do if your weren't a doc? I hate for you to have to suffer and feel like there ought to be a way to manage this without slipping down that slope of questioning whether it is the right thing to do.

I'm still having a lot of pain but got off the pain pills on Monday am. I've been really dope sick but at least psychologically do not want the drug. The pain meds were working on my brain and making me believe that maybe I could drink again and control it. Worked that through and do feel better about that at least.

Take care of yourself - just wanted to let you know that I am thinking about yoU!

[Digginit]

Well, held out for my orthopod and got that injection on Monday. Not doing much. That's something that happens eventually....steroid shots just quit working. So we're back to talking about knee replacement sooner rather than later. October maybe? Having a big sit-down with him either this afternoon or tomorrow afternoon, depending on how long his clinic runs and when I get through flying. Even though I've learned a lot of orthopaedics, this is ME, and I have lots of questions that I can consider and have thoughts about, but somehow I think his thoughts are probably better than mine. What he has told me is no more skydiving. That breaks my heart. But it's also something that we're gonna have to really discuss, in terms of what the big risks are and if there is any way to modify those to make it possible for me to jump while lowering the risk of injury. At least he says he'll give in to snow skiing even though he doesn't like it.

Having been a person who has pushed just about every envelope since the day I emerged from the womb, slowing down will be hard. But this, at my age, is a really big deal. You can't go revising total knee replacements every decade. If this one makes it 15 years, I'll still be younger at the time for revision than a lot of docs like for a FIRST total knee. My ortho says he wants to avoid a revision for at least 10 years. He knows me....lol. I'm devastated, really, right now as the realization of what's ahead really means. Ugh.

Of course it's gonna mean pain management again. Don't know what to say about that at this point, but gonna have to toughen up a bit I think and maybe accept a degree of pain that I've not accepted before. I just may not be able to do post-surgical pain meds easily. Imagine that.

[51anna]

It sounds like you're looking at things realistically Dig. Being very wary of post-op pain meds is taking good care of yourself.

I imagine that you are really disappointed about the changes in your lifestyle and curtailing some of your activities, but you know that it will best in the long run. It's hard, when you're young to imagine that you will still be wanting that knee to work well when you're 60 or 70, but you will, and you have to take care of it.

[Digginit]

I'm NOT doing good. I need things to be settled....to be nailed down...and to know what my expectations should be and how to go about navigating through this whole episode. **** of it is, that there ARE no answers, because there's just no data.

Saw Lytle today, and he's wishy washy. I understand why....because he believes in "First do no harm," and he knows me. He's hesitant to do a surgery on me that carries very high risks...because he knows that I'm not gonna lay in bed for 6 weeks to let myself heal. He knows that even if I tried to do that, it'd be at an extremely high risk of relapse where drugs are involved. He believes it's time to have surgery, but he doesn't trust me. I can't say that I blame him.

He's sending me to another one of his ortho buddies for another opinion. This is driving me absolutely insne. I don't deal well with shades of grey just now. Ugh.

[51anna]

Dig, I think it's good that things are slowing down a bit and giving you a chance to look at shades of grey. It actually sounds like he's really thinking of your welfare and that's good. Maybe you are meant to learn something about patience from this experience. After all, that's why we're here - to learn.

[Digginit]

Slowing down. I am. Slowed down so much that I've just stayed in bed. There's something about a little momentum that works well for me, but right now there is none. Don't work this weekend, so maybe I'll just sleep. Maybe it'll be good for me. As it is, can't bring myself to do much else, so I figure, why fight it???

~dig

[lightseeker]

Diggin -

If you are having a knee replacement the PT's will have you up and going the next day. Generally, we have them doing steps the 2nd post op day and then they go home. Younger people especially tend to go home with crutches and do great. I've had "old men" back on the golf course at 6 weeks. It's a whole lot better than it used to be. The ortho docs where I am all use the OnQ pump for pain management and it is left in for 5 days. I had it in my ankle and it was awesome. Really allowed me to keep the pain meds down. I had several people keep an eye on my pain med use and that helped me a lot.

It's hard not knowing when you are going to do this - hope that it gets settled soon. It sounds like your knee has slowed you down terribly. I know how badly my ankle messed with me. I'm still having a lot of pain but now am only taking ibuprofen.

Thinking about you!

[Digginit]

Do you know anything about this new iDuo bicompartmental knee? Ran across that, and my ortho is looking into it. It's new. No history to base a decision on, but there's not much to lose. This procedure leaves you with next to no bone loss, which would be kinda (note the sarcasm) nice. Any chance you've taken care of someone with one?

He has a rep from the company coming down to discuss the procedure with him and says he can tell me more after he understands the technique better. Could be a good option though. Crossing my fingers that he thinks it's worth trying. Don't know how much difference that would make pain-wise, but I bet it'd make some.

[lightseeker]

I know that you said that you live in Timbuktu.....would you consider going to a major medical center? I work in one and our results are so much better than the outlying hospitals. We do a lot of uni and bi compartmental procedures and they are great. Some of the uni's go home the next day. The main thing that makes a difference with pain management (I know that I sound like a broken record) is the OnQ pump. I've seen a lot of "redo" knees from smaller towns. They wish that they had traveled to get the latest in knees. Where do you live? Keep me posted!

[Digginit]

There IS no orthopod in Timbuktu. The iDuo is a very new prosthesis. On the market less than a year. What LOOKS good about it is that the amount of bone cut away is very minimal. But there's no history to base a decision on.

There's no WAY I'd change orthopaedists unless it was on his recommendation. I trust him. I've operated with him enough that I have NO doubts about how meticulous he'll be with me when he finally trusts that I'll take care of it once it's done. I still have a little mental work to do where that's concerned....just to be ready to say there are some things I'll give up.

I believe you about the OnQ pump. We haven't discussed it, but that'll come next...lol....after he learns how he's gonna put this new thing in my knee. Hee.

~dig

[Fluttering]

Hang in there Dig

Thoughts are with you

[Digginit]

Originally Posted by Fluttering

Hang in there Dig

Thoughts are with you

Don't know if you realize how much that means. Thanks. Besides this whole knee thing, and trying to start up a medical practice, my ex is trying to take custody of our son. It's not gonna happen. But it sure is a lot to deal with. Ever been COMPLETELY stressed out? Somehow I bet it's something we've all experienced at one time or another. But this is a lot at once.

I'm glad that this recent relapse didn't take a bigger toll. Right now it's just not possible to let anything fall through the cracks. There's nothing that I can afford to NOT tend to right now. I think if it weren't for all that's going on, though, I wouldn't have found the mental, spiritual energy to stay afloat.

But now things are coming together a little bit. Staying power IS good...really. Sometimes it's good to realize that the world's NOT imploding, even though it appears to be from a myopic point of view.

Thanks for the thoughts and kind words.

Peace~
dig

[Digginit]

October. Talked to my ortho today, and we're gonna do it in October. After researching it and going over the procedure and technique with the reps, he doesn't like the iDuo. Gonna do a Zimmer patellofemoral joint replacement and be prepared to do a unicondylar replacement of the medial compartment at the same time depending on what he thinks when he gets in there.

So there are two months to prepare. I've promised BIG that I'd take care of it and do EXACTLY what he tells me to. No more. No less too, but that's never really a problem for me. Just thought I'd share.

~dig