Saturday, May 24, 2014

My Journey Through Pain Management - Dilaudid (05/24/14)

Hello Folks,

As I currently stay off the Susquehanna River during the "Closed Bass Season", the timing for me to withdraw from my pain medication that I have been taking for the past three years, could not have come at a better time. This, I must say, is one of the most important things I have ever written about over the past years on this blog. It is more important than any citation bass I've ever caught or exciting trips I've ever taken onto the river to explore new territories with friends.

I have been in and out of so many hospitals since I was four years old for numerous health reasons. I even spent several months in "Heart Haven" at the age of five when I was diagnosed with "Rheumatic Fever". Rheumatic Fever occurs when the streptococci virus invades the body's blood stream, possibly through "Strep Throat", and often causes serious heart damage. Some heart damage can even cause death among patients who contract this illness.

I was a very lucky boy since I only had a slight heart murmur develop. With the help of bi-cillin (double strength penicillin), I was saved from any serious heart defects. I spent years not being able to participate in sports or normal child activities like bicycle riding or roller skating. Those days past and by the time I reached high school at J.P. McCaskey (Lancaster, Pa.), I was pretty much doing what most young men my age were participating in and being very physically active in sports like baseball and even Judo!

Yes, modern medicine was a definite life safer for me.

As years passed by, I was involved in numerous surgeries that required medication to manage the severe pain associated in the healing process. During those rough times, I was able to ween myself off those medications rather easily. Then along came the past three years... five medical procedures that required anesthesia and a lot of pain medications.

I had my left knee replaced back on July 26, 2011 (Dr. Tim Tymon). Within the third day after the replacement, my knee was "frozen" in a 78 degree position and I was put through physical therapy that was extremely difficult, painful, and rather torturous.  So painful that it had a negative effect on my usaully strong, but now weakening heart, and caused "a-fibrillation". That alone required a new medication for care called "Metroprolol Succ ER" to control.

The Lancaster General Hospital "Pain Management Team" jumped on board to help me. They tried several medications to control the pain that I was experiencing. The three-man team settled on 6 mg of Dilaudid . Dilaudid, mg to mg equals 7.5 mg of Dilaudid for every 30 mg of Morphine. I was prescribed 6 mg of Dilaudid (a 2 mg and a 4 mg pill) every 4 hours, or as needed. I was pretty much able to control the severe pain with about 18 mg in a 24-hour time period. That was during the initial left knee replacement and the two manual manipulations under anesthesia which followed.

On February 11, 2013, I underwent a left knee revision where (Dr. William Parrish) the surgeon removed a portion of my femur bone and replaced the old upper prosthetic of the replaced knee with a new and smaller one. The plan was to give me enough room to extend my knee once adhesions set in. In essence, the plan work to a point. I still have about 12 degrees missing extension from my revised left knee.

Over a year and a half ago, I spoke to Dr. Anthony Mastropietro, Medical Director of the Regional Hospital and my PHC physician prior to his retirement from his private practice. Dr. Tony participates in a local program helping addicts withdraw from drugs. He also assists patients, like myself, who are dependent on pain medications due to major surgeries and injuries. During our meeting, Dr. Tony, my wife, and I discussed the need for me to improve the extension to my left knee and to help my aching lower back. He gave me a couple of physicians to make appointments with for my left knee revision and for the spinal care.

I followed through with his advice and ended up having surgeries for both the left knee revision and the spinal fusion [L5 (L6)/S1] (December 3, 2013). The spinal fusion required me to stop PT for my knee revision. So after three months of recovery from the spinal fusion surgery, I returned to PT for the work on my left knee extension. I was now taking between 24 and 30 mg of Dilaudid in a 24 hour period.

I had a follow up doctor appointment with Dr. Parrish on April 29, 2014 regarding my knee revision and his future plans. He told my wife and me at this appointment that he will not be doing anymore surgery on the left revised knee.

This allowed me the opportunity to now get off the pain medication that I had been taking since August, 2011!!! There are now no more surgeries in my near future and I can safely withdraw from the dependency without fear that I will soon need to be back on more pain medication.

The need to withdraw from drugs has been driving me in a positive direction. Some withdrawal processes can last a patient from  few months to years depending on the type of drug(s) and the amount of drug(s) one uses.

There is a difference between an addict, who craves drugs, and a dependent user, who uses to eliminate pain. For the past year and a half, the nurses and doctors described my use as a patient with a "dependent's  need". I will explain this in a few moments...

So, on Thursday, May 15, 2014, I visited the drug withdrawal program called the "RASE Project". Dr. Tony Mastropietro is a physician trained in the withdrawal process and works directly with the "RASE Project". In order to participate, I had to pay $200 upfront and each month afterward, $100 per month, or until I no longer have the need to participate. This does not include the costs for my doctor appointments and the drug, itself, needed for the withdrawal process. Suboxone, the drug chosen by the project, helps handle the patient's wthdrawal symptoms.

When I was on the 6 mg of Dilaudid dosages, I would start to experience withdrawal symptoms... i.e. physical sweating, anxiety, inability to sleep, vomiting, etc... within a 7 to 10 hour period from my last dosage. My "last prescribed dosage" of 6 mg Dilaudid was at 11:00 a.m., Thursday, May 15, 2014. I had a doctor appointment with Dr. Mastropietro that afternoon at 12:30 p.m. when he discussed the importance of the 8 mg Suboxone twice daily to prevent the withdrawal process... a non-opiate drug. I needed to be in the withdrawal process before safely taking the Suboxone. Therefore, I took my first Suboxone at 8:00 a.m. on Friday, May 16, 2014. It's prescribed as a sub-lingual (under the tongue and absorbed through the two main veins) medication and tastes "TERRIBLE".

I assume that this type of medication falls along the Catch 22 syndrome lines. You can also become dependent on Suboxone if you stay on it too long... So, do they make the medication taste terrible to "possibly" prevent or discourage the need to continue... My take on this topic is, there are those with "addictive personalities" who will seek out even Suboxone to use no matter how terrible it may taste... "Ugh!"

Since I have been off the Dilaudid, I have not had a desire or craving for my pain medication. This takes me back to the difference between addiction and dependency. An addict will often use a drug to seek "the high", pleasure, etc. The person using Dilaudid for pain management did not become dependent by seeking out pleasure or "the high". Their need for using was to control the serious pain associated with the surgical procedure they had experienced,

Starting on Friday, May 16, 2014, I became extremely nauseous and vomited throughout the entire day. I could not hold down any food or drink I was trying to taking in. I called the clinical nurse at my doctor's office and she said this was not a normal symptom since I was in the withdrawal process and taking the Suboxone... "Great!"

The vomiting could have also been caused by several reasons other than the withdrawal process from an addictive drug... 1. There has been a severe stomach virus making it's rounds, and 2. I also have Gastroparesis, or stomach paralysis, that may be caused by my diabetes or other, yet identified, reasons. Gastroparesis will not allow the stomach to digest certain foods if it is physically taking place. The drug, Reglan, has helped me jump start my stomach into functioning. Reglan can have very bad neurological side-effects (tremors, etc.) if taken for too long a period of time. Those of us who experience Gastroparesis along with pain often take Zofran to relieve that stomach pain or nausea. It's a vicious chronic illness that falls on a continuum of severity. There are those who have Gastroparesis who have had J-tubes inserted in their stomachs for feeding and even those who have had their stomachs removed and feed through tubes into the intestinal tracts. Even more serious cases have caused death in patients... This disease has been recently diagnosed not only in diabetics, but also teenagers and younger children. No cure has been found, but we have hope.

As you can see, it is not as easy as "1,2,3" in determining causes for certain symptoms I experience due to some of the chronic illnesses I have... Diabetes, Liver Disease, Gastroparesis, Degenerative Arthritis, and even Dependency on Pain Medication!

The last time I vomited was last evening after coming indoors from doing yard work. I took my evening medications and headed straight upstairs for a quick shower to prepare for bedtime. As I was taking my shower, I started to feel rather queasy. After showering, I spent the next half-hour wrenching and vomiting at the bathroom toilet... Oh, Boy!

Despite this terrible feeling of sickness for well over a week, I still have no need to ask Julie for any of my pain medication. I have not craved for the relief found in the Dilaudid. In fact, I have actually been experiencing less physical pain in my left knee and back now than I am off the Dilaudid... Go figure. There is one thing that I am totally aware of and that is Suboxone does have a "slight" pain reliever in it... But it is nothing like that found in the Dilaudid,

I want to thank all my  family and friends who have been there to support me over the past three years. I have experienced such terrible pain from the five surgical procedures I went through starting in July of 2011. I have had support from some who, they themselves, are experiencing dependency from prescribed pain medications. These "supporters" have and are fantastic in describing what I was physically experiencing and what I am now facing once I came off the pain medication. Even though some of my friends have had their own personal experience during personal withdrawal, I hold that information close to my heart knowing what I am now facing since I last took my pain medication.

God bless each of you for being there and helping me, especially those who understood what was hapening to me and did not turn your back on me... Thank you!

Take Care and Be Safe