Monthly Archives: November 2012

Life After Morphine

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Cover of "Pain: The Science of Suffering&...

Cover of Pain: The Science of Suffering

Things have been a little disappointing lately. You see, a couple months ago, I decided I was starting to feel good enough that I could afford to remove morphine from my daily medications. So I came up with a plan to taper off of it with my doctor, since I have been taking it long enough for my body to depend on having a lot of opioids in my system and therefore would feel withdrawal when it was taken away. Tapering makes the withdrawal less bad than stopping it all completely, which is so painful it creates unnecessary health risks. I have spent the last two months slowly and agonizingly reducing my dose, living for the day when all the withdrawals would be over and my body could recover and feel healthier than ever before, without the side effects of morphine and with effective breakthrough medication for pain flares..

If I had been thinking, I could have predicted the situation in which I am finding myself. But I wasn’t thinking critically, so much as hopefully (and, sometimes, desperately) about the end of my morphine taper. I think that part of me realized that things would take some time to level out, and I would need to recover from all that pain and stress from putting myself through withdrawals. But I had just a touch of rose-tinted glasses on about my morphine taper. I think I needed to have that hope that things would be better as soon as I got rid of all that morphine in my system.

The self-critical part of me speaks up to say that it COULD have been all sunshine and roses. If only I hadn’t taken vicodin to cope with the withdrawal pain. If only I’d been stronger-willed and stuck it out without breakthrough medication. But you know what? The smart part of me knows that that is a load of horse manure.

Pain management isn’t just about suffering. Pain is only good for us in small doses, in response to discreet events. CRPS is pain gone wrong. Our society has some funny ideas about pain. We seem to believe that experiencing pain makes us better in some way. Stronger, or stronger-willed. It builds character. It is something that we can fight against, and a pure and good person would be able to handle pain without any drugs. Horse manure, I tell you, as I tell myself.

See, they’ve done some studies on this. And it turns out that chronic pain makes your body heal slower. It raises your blood pressure and your heart rate, making you more prone to cardiac problems. It fills your body with stress hormones that reroute the things your body needs to be doing to live longer to put it in fight or flight mode so it can survive an emergency–but it isn’t an emergency. Chronic pain is bad for you, and no beneficial effects of chronic pain have been found.

(Want to know more about this? Read the book Pain: The Science of Suffering by Patrick Wall)

So I took my vicodin, another opioid medication, to cope with the pain that originated from morphine withdrawals but continued with my CRPS (which, as I’ve said before, loves a party). Despite my cultural training, it was the right choice. Now, I’m done with morphine. Forever, I hope. But I’m still taking as many vicodin as my label lets me.

At first, I tried to remove one pill a day. Guess what? Withdrawal agony, of course. But the great thing about vicodin is that you can cut the pills into pieces–morphine is slow-release, and when you cut them you mess up the coating and you get too much early and too little later. It’s okay to cut vicodin, so I tried taking a half away, and finally went down by a quarter of a pill.

I’m finally getting some of my energy back! I still am not feeling all that great the majority of the time, and I think until I get all this opioid medication out of my system for a little while and then get myself more active again, I won’t be feeling all that great. But I cleaned my car, which I’ve needed to do for three or more months. I’m doing training sessions with the dogs again. I folded some laundry. All in the last few days. Things are looking up.

While I’m not skipping through fields of daisies at the moment, this  is a huge improvement over the last couple months. It’s a little disappointing that there is no skipping quite yet, but it’s a perfectly reasonable place to be, cleaning my car and folding laundry. Skipping isn’t entirely off the table, either. Maybe next month.

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Cuddle Dog Day

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Crackers Green Toes

Crackers is having a heavenly day today. I’m in the thick of my expected low point of the week (adios, morphine!) so today has been all about hydrating, stretching, and distraction. Usually, Harriett wants the snuggles and she is bigger and more dominant, so poor Crackers gets shoved to the periphery. But for some reason (probably its just that she’s cold, or maybe because she’s been having some allergies lately), Harriett burrowed under the Big Red Fuzzy Blanket and decided to hibernate today. One of Crackers’s Favorite Things is to lie down on the couch next to me and rest his head on my arm, and today I could feel he was cold so I even got him a blanket so he could cuddle AND be warm. He has his back to me right now, head on my upper arm, and one leg resting on my lower arm as I type this. Doggy Bliss. The human in this equation is pretty happy too–it helps exceedingly to have company that just wants my honest presence. There’s no question of trying to put on a good face for him–he knows how much pain I’m in, he loves me just the same, but he doesn’t come with any attachment to me feeling better. He is here for me and thrilled to be loved after his hard-knock life. He certainly wishes me the best, but I don’t feel like he would be happier if I were not in pain, because he’s about as happy as he can be to have a human who loves him. It’s a comforting company to have today.

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What Is It Like?

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I was asked recently what morphine withdrawal feels like. When I am experiencing pain from CRPS or, like recently, the physical withdrawal symptoms that come with tapering off of morphine, it can be so difficult to try to imagine what it’s like to have never felt something like this so that I can explain it properly. I think of things like shards of glass embedded in all my joints, acid slowly eating through my bones, the hottest hot pepper burning into the skin around my ankle.

All these abstract metaphors made me realize that I’ve not yet described how I feel when I’m in pain on my blog, and how difficult those descriptions are. It made me want to describe a little better how I’ve been feeling lately.

Today I had a hard time getting up. I had the dogs trained to my schedule, with their first walk around 11 or noon and their second at 8 or 9 pm. But over the last week when I was having such bad days from my morphine taper that my sweetie was walking them, they became accustomed to getting up a bit earlier, and today they decided they just couldn’t wait. I am usually awake by 7, but I normally have a chance to get a little caffeine in me and let my body catch up to my brain before I get moving. Today our schedule was wonky and it felt like my arms and legs were full of sand. It wasn’t that I was sleepy, but like I couldn’t get the motor running fast enough to get moving. I got myself downstairs for food and coffee, but the dogs still had to wait another hour and a half for their walk before I felt like I could do it.

Before I got CRPS, the closest experience I’d had was the aches and pains of a very bad flu, where all your bones and muscles hurt from the fever. That’s still not all that close, although if you take that pain, spread it out a bit more so it occupies more of your body tissue, make it sharper, give it some hot-pepper kind of heat, and turn the level of pain dial up more than you previously believed possible, you get closer to what a CRPS full-body flare feels like to me. The opioid withdrawal symptoms add a spiky sharp jabbing, cutting feeling to each joint in the body. CRPS joins in over any pain–withdrawals, stubbed toes, healing wrist–it gleefully joins in for a pain party with any excuse. It lives in my ankle and foot, at times seeming to hibernate down to just a boring, nagging, drilling ache in the tendons and bones of the top and outside of my foot, muscle soreness on the outside of my lower leg, and heat of the skin on my ankle. That is the best it gets, and it never stops, sometimes bringing me to the point that I will bang my knuckles on something just to pull my attention away from that never-ending ache in my ankle, because with a flash of new pain I get a moment of not noticing the old.

When the CRPS wakes up, because of other pain, or because of emotion, or lack of sleep, or myriad other things, the first thing to hurt is my right hip, since it makes my leg muscles tense and tighten and pulls on that side of my body.  Then the heat seems to spread, radiating from my ankle, and at some point of no return, as the pain increases and increases in intensity, my elbows and knees begin to hurt and then the full-body flare breaks like a wave over the rest of me. It can be impossible to stay silent when the pain is at its worst, as much as I would wish to be a better stoic, and am embarrassed by the whimpers, groans, or tears that may happen despite my best efforts. It isn’t a call for attention, just a failure to keep it inside.

My maintenance medications turn down the dial. Every success with a new medication or dosage has felt like someone found my volume dial for the pain and turned the knob down a notch or sometimes even a few notches. The goal is not to feel no pain–while that would be wonderful, it isn’t necessarily realistic, and luckily, it isn’t what I need to enjoy my life. My goal, instead, is to have may pain controlled. Pain patients and doctors use that word a lot, “controlled.” To me, my pain is controlled if I can concentrate on something else more than how much my ankle hurts, and if I have something I can do to avert a full-body flare. It means that I have choices with what I do with my time and when I do it–when the pain is in control, my choices are much more limited.

I’m looking forward to one week from now. In that time, I will have stopped taking that last bit of daily morphine, and had time to go through the withdrawals from doing so. I should be starting to get some energy back, just a little, and will know that as my body continues to recover from the painful seven weeks it has had, it will feel better and better. It’s been a long and difficult time to get myself off of this medication. It will be wonderful to get back into feeling like I’m making progress in my life, instead of just waiting and doing my best to just outlast the reactions of my body to the lack of this medicine. I’m glad I had it, because it let me live more comfortably, and I’m even gladder I don’t have to take it any more. I’m not entirely sure how my body will do without it, but I’m very hopeful that it will do well, maybe even as well as I was doing when I decided I didn’t need it any more.  At the very least, I will have no more withdrawals to look forward to, and that is a wonderful thing.

Wish me luck!

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Being Responsible For Everything

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Regions of the cerebral cortex associated with...

One of the things my pain condition is leading me to do is to become as healthy as possible. When small lapses can cause such magnified consequences, it pays to put a lot more of my effort into keeping as well as I can, instead of digging my way back out of a pain flare. Mental health is no exception to this rule. Chronic pain is hard to live with, hard to get up and face every day. My psyche needs to be in its best possible shape to handle this extra load. So, even though I feel like I’m dealing pretty well with the pain condition mentally, I’m still going to therapy so that I can fix everything else that makes my life more difficult than it has to be.

 

My brain thinks everything is my fault. It’s ridiculous when I step back and look at it, but part of me truly believes I am responsible for everything. I think this is actually one of the reasons why I like operant conditioning theory so much and it resonates so well with me–it is all about recognising the consequences of your actions and making them as deliberate as possible in order to reach your goals, and in doing so the trainer gets to be responsible for all of the behavior of both the trainer and trainee.

 

It is a magical sort of mentality when one is caught up in it. Someone is in a bad mood? My fault. I’m having a bad pain day? I caused it myself. Why did I fall down those stairs in the first place? I know I shouldn’t, but a small part of me believes that it was not the lack of railings but the fact that I was rushing through my list of things to get done that is ultimately responsible for my injury, and thus, my pain condition. It’s not a very flattering view of myself, to see this grasping for power over circumstances that this complex boils down to. But it is not an unusual problem either, and I take comfort in the knowledge that many other humans have had to work their way through this psychological hurdle as I am right now.

 

 

Taking the whole world personally is not helpful when I’m coping with CRPS. I worry about the effects my pain has on the people I love, and the more help I ask for, the harder it gets to ask. The more pain I experience, the more I slip into blaming and scolding myself for the choices I made that may have contributed to my added pain. I skipped my yoga, or ate pizza instead of a balanced meal I was too tired to prepare–if I had just been better,I would not be hurting so much. It’s been especially challenging during the high-pain days of my morphine taper. Lately, I catch myself thinking these types of unhelpful thoughts and correct myself, repeating “I am not responsible for everything,” as I work to rewire over three decades of thought patterns. I know that I’m getting better because I am catching and correcting my thoughts instead of just believing them, but it takes practice and time to learn to think in a new way.

 

I’m grateful that I need to fix this issue. Without my CRPS, I may have lived my whole life believing that I was responsible for everything. Pain gave me the necessary push to create new, healthier thinking. It isn’t a lot of fun, and of course it isn’t something I would choose for myself given the option, but I am glad that, some day soon, I will be a person who is only responsible for the things that are truly under my control. A healthier person. Maybe even a happier person than the one I would have been without having had to cope with chronic pain.

 

 

 

 

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Pawdicures!

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As promised, I have photos of the dog nail polish. They really do look spiffy with their nails done up to match their harnesses and leads. Crackers, like a toddler at the barbershop, is not convinced that having his nails painted doesn’t hurt. He’ll be calm for a while, then start to worry, and finally yelp like I’ve stepped on him or something. It’s a bit disconcerting for me, but I think it’s great handling training for him to get used to, and it will make his nail trimming much less traumatic since he’ll be more accustomed to having the nails handled.

Harriett had Neon Purple on her first try, and now she’s rocking classic Red nails.

Harriett Red Toes Bow

Harriett Red Toes Bow (Photo credit: Chiquita Rosita)

Red Toes Close-up

Red Toes Close-up (Photo credit: Chiquita Rosita)

Crackers Green Toes Stylin'

Crackers Green Toes Stylin’ (Photo credit: Chiquita Rosita)

Crackers Green Toes

Crackers Green Toes (Photo credit: Chiquita Rosita)

The Pawdicures pens are pretty cool–they’re a paint pen where you have to press or pump the tip to get the paint to flow. The flow is rather uneven, but it’s way better than trying to deal with a brush around your dog. The nail polish reminds me of colored white-out in opacity and consistency, but doesn’t get lumpy. It’s water-soluble until it dries, so if you get some on yourself you can wash it off, and a single coat (I prefer thicker coats) dries in about a minute. With one heavier coat you don’t need multiple coats, and although they recommend painting black nails with a base coat of white, I didn’t find this necessary with Crackers, who does have a few little black nails.

Harriet doesn’t mind having hers done much at all, except for some of the holding still part. And yes, Crackers is completely back to his normal self after his traumatic toad incident last week. They are happy and very stylish-looking little doggies.

Harriett Red Toes

Harriett Red Toes (Photo credit: Chiquita Rosita)

 

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