Month: August 2021

Moments in my life #2: Withdrawing from opioids

~ Roger JG Albert ~ 8 Comments

It’s now 5:11 AM on Friday, August 27th, 2021. I just came downstairs to my recliner/writing station. I’ve been awake since 2 AM in a dexamethasone induced insomnia and decided that it was unproductive to just lie there thinking about nothing in particular (or a multiplication of musings about my life and career) when I could be downstairs at my computer where I could retain in writing some of the musings that had come to mind as I was lying in bed with my hands behind my head in a position not particularly inducive to bringing on sleep. So, if I had no possibility in my Dex determined insomnia to fall asleep, I might as well come downstairs. Princess Pretty Paws seemed to have no objection so here I am. She does expect that if I come downstairs, I will give her some “kitty crack”, marketed as cat treats or whatever. She’s addicted to her treats and will not be denied so I obliged and before sitting down I laid out a few bits of her favourite crack to munch on. She was appreciative if I can deduce that from her silence and aloofness. She’s now sitting in the kitchen awaiting another few bits of crack, but they’re not coming. She isn’t complaining so I won’t pay any more attention to her. If she meows a lot I may get up and indulge her. Oh wait, she’s just come over and is threatening to march all over my keyboard, so I’d better get up and give her a few treats. So, that’s that. Now I can get to the topic at hand, that is, withdrawing from opioids.

Some readers of this post might consider this offering as a confession of failure. It may be viewed that way, I guess, but it’s more, in my mind, a reflection on the vagaries of life and responses to unintended outcomes and life-threatening events. I was first diagnosed with multiple myeloma (bone marrow cancer) in the fall of 2019. It was clear to Carolyn and me that I had been suffering from the effects of myeloma for many years and the resulting MRIs and CT scans confirmed that: for one thing, my femurs were being excavated by myeloma and my left femur had a ‘lytic lesion’ of 10 centimeters in length at the distal end closest to my knee and that the whole-body chronic pain I was dealing with which was clearly an effect of myeloma. That explained why I was in such constant pain all the time and increasingly unable to engage in the kinds of wonderful activities I had anticipated being able to engage in after my retirement in 2012. Of course, age plays a huge part in a body’s preparation for death, its entropy. We inevitably get weaker and have age-related physical symptoms that preclude strenuous activity. I don’t think that evolution had in mind (so to speak) that we would live so long. So now most of us over seventy have back and neck problems that tell us it’s time to slow down and forego the strenuous activities that were the hallmarks of earlier life. 

When I was finally diagnosed with myeloma, I was prescribed pain medications on top of the chemo meds I would be taking for the foreseeable future to deal specifically with my cancer. One of those meds was hydromorphone, a synthetic opioid much stronger than morphine. After some time, I was also prescribed other meds to deal with the neuropathic pain I was suffering brought on by myeloma. I was offered and take gabapentin. I was offered, took nortriptyline, then stopped taking it a few months back because I couldn’t stand the side effects it produced: unable to taste my food, enjoy eating, and I had dry mouth all the time. Enough of that. 

So, I’ve been taking a low dose of hydromorphone in two forms since late 2019. One form is a slow release 3 milligram tablet taken in the morning and 6 milligrams in the evening. It’s designed to produce ongoing relief from pain. I was also prescribed 2 milligram tablets of hydromorphone as a ‘breakthrough’ med if the pain got out of hand. I did take the breakthrough hydromorphone occasionally especially after I had indulged in some activity more strenuous than was good for me. It always worked if I took enough of it. The most I ever took was 18 milligrams, and that was only a couple of times. Taking the hydromorphone in that form eliminated some of the more egregious types of pain I endured, mostly in my thoracic area, lower back, neck, and legs, well in my whole body is what I’m saying.

Lately I’ve been feeling that I might be able to forgo some of my pain meds because I’ve been feeling pretty good. My neck pain is still nasty and prevents me from painting and drawing. Sculpting, especially with a chainsaw, is out of the question. I tried backing off gabapentin and soon realized that that was a mistake. My neuropathic pain returned with a vengeance. I’m now taking a bit more Gaba than I had been. The reality is that every med I take has side effects. None are purely capable of producing pain relief without negative consequences. Dexamethasone, for example, one of my chemo meds, is a powerful pain killer, but has huge negative consequences over time resulting in severe bone deterioration. It’s a glucocorticoid (Google it). It is not to be taken lightly although in my desperate state over the pain in my neck, I will go to the Pain Clinic at the Nanaimo Hospital in October and have some Dex injected into my neck. According to the doctor there, it may help, it may not. What have I got to lose at my age by giving it a try?

Anyway, getting back to hydromorphone. Of course, I knew that taking an opioid was fraught with issues, not the least of which is addiction. However, faced with severe chronic pain in most parts of my body, hydromorphone produced some relief and allowed me to resume some of my former activities. I can still write. Problem is that there is a balancing act when taking opioids for pain relief. Take too much and you become brain-addled and incapable of much in the way of coherent thought. Take too little and the pain relief objective is undermined.

In the face of the negative consequences of taking a powerful opioid like hydromorphone, I decided recently that I would try to withdraw from it. I knew that I shouldn’t try going cold turkey, so I decided to do the right thing and go cold turkey. Go figure! I stopped taking it last Sunday. I figured that since I was on such a low dose, how could I possibly be addicted? Well, I am addicted and the proof of that was how my body reacted to the withdrawal. I’ve never experienced in my life the effects of withdrawal. I didn’t experience some of the more horrific effects like vomiting and diarrhea, but after a while I just couldn’t stand the overall drastic body dysphoria that was the outcome of withdrawal. There’s no way I could sleep. I was agitated to the point of distraction. I could not relax or stay still. I paced. I sat down. I paced again. It was awful.

Consequently, Carolyn and I decided that I should probably resume taking hydromorphone in the usual way until my appointment at the pain clinic to see what my cortisone injections might produce in the way of pain relief. At that time, I will consult with my family doctor to develop a proper plan for withdrawal. I am prepared, though, for the possibility that I will not be able to live without some chemistry enabling a life with a modicum of relief from the grinding chronic pain that is my constant daily companion. My pain meds, so far, have proven effective. It may be that I’m suffering from some sort of moral panic. I’ve done some self-psychotherapy and have concluded that there is a distinct possibility that I may be in a moral existential crisis. How could a big, strong guy like me need opioids? The answer to that question is still blowing in my mind’s wind and may be the subject of another blog post. 

 

Moments in my life: Princess Pretty Paws

~ Roger JG Albert ~ 8 Comments

The cat, Princess Pretty Paws*, has been sleeping with me quite regularly lately.

She hasn’t always done so. At times I never saw her at night because she tended to hang out in the crawl space upstairs and only come out in the morning for breakfast. So, a few nights ago she and I had a talk and she told me that she was taking over half of the bed, the lower half. Well, I’m not averse to sharing my sleeping space with a cat but it would have been better, I think, if she had chosen to sleep on the right or left side of the bed. I like the left side so I would have gladly given over the right side. But, no, she was adamant that she would take the lower half of the bed. Fine. It’s a big bed, so why not? She wasn’t asking for exclusive use of the lower half, but predominant use. 

The first night of this new arrangement was okay. We got along quite nicely. I could stretch my legs all the way to the bottom of the bed, and she didn’t complain about that. She did sidle up to my legs though and slept pushed right up against them. This was fine because I still had lots of room to move my legs into a better position. 

The second night, a couple of nights ago now, she was determined to lay claim to the lower half of the bed. If I stretched my legs down to the bottom of the bed, she immediately and aggressively pushed up against them. If I moved, she moved. Soon, I found myself on the outer edge of the left side of the bed, she in possession of the whole queen size bed except for a small sliver of it on the left edge. 

Look at this picture of her. She doesn’t look particularly nasty, does she? She’s quite sweet sometimes. She’s not a cuddler at all but she doesn’t mind being carried around if she’s in a good mood. However, she is prone to biting and clawing if she doesn’t feel things are going her way, or just to assert her dominance. 

She doesn’t get along with the dog (Tilly), but they haven’t really tried very hard. Tilly tends to want to chase Princess and that doesn’t go over very well with the Princess nor with me. I don’t know what Tilly would do if she caught Princess and I don’t want to find out either. It’s obvious that Tilly is afraid of Princess. 

Cats are generally weird and she’s a good representative of her species on this count. 
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*Given this name by my granddaughter, Ailey Vines. 

The Kindness of Evolution.

~ Roger JG Albert ~ 2 Comments

Lately I’ve been reading books by Kim Stanley Robinson. He’s a contemporary science fiction writer who ranges freely into dystopia and utopia. I first read his Mars Trilogy and I’m now following that up with New York 2140. Imagine New York fifty feet deeper in water than it is now. Half the buildings in Lower Manhattan are partially submerged and roads are now canals. Flooding has not stopped the rapaciousness of capitalism, however, which has gotten worse in the next one hundred years. It may just get its comeuppance though. Robinson’s work, although not high literature, is prescient in my estimation and is a fun read.

Most people would consider the drowning of coastal cities a disaster, and it undoubtedly is, but we don’t have to wait until 2140 to find out what coastal flooding can do. We’re getting a taste of it now. We’re also getting a taste of what fire can do as well as tornadoes, hurricanes, volcanoes, etcetera. Reading the news these days, and you’ll be introduced to fires in British Columbia, dams bursting in China, and floods ravaging Germany. So, disasters are not uncommon, and the News media are only too happy to tell you all about them. 

Still, we don’t seem to be able to get prepared for natural disasters so as to mitigate the worst of the damage they cause. Recently, Angela Merkel, the German Chancellor, opined that they would have to do better in the future regarding disaster preparation. I might note that disaster preparedness is only going to happen if there is money to be made in doing it. That may seem cynical, but history bears me out, I think. 

One thing we have to recognize is that there are many kinds of disasters, and they don’t all unfold at the same rate. A volcano usually happens at a very fast pace, but climate change, which must be considered a high magnitude disaster, unfolds are a glacial pace although some of its effects unfold as quickly as any natural disaster because, in effect, that’s what they are.

Something very interesting about human psychology is the surprise or denial we all experience in the face of disaster. Flooding? Well, we didn’t expect that now did we. Cancer? Surprise, surprise! Why me? Climate change? Nah, it ain’t happening. 

Robinson has an explanation for our reactions to disaster or catastrophe:

“…you can’t really imagine a catastrophe will hit you until it does. People just don’t have that kind of mental capacity. If you did, you would be stricken paralytic with fear at all times, because there are some guaranteed catastrophes bearing down on you that you aren’t going to be able to avoid (i.e. death), so evolution has kindly given you a strategically located mental blind spot, an inability to imagine future disasters in any way you can really believe, so that you can continue to function, as pointless as that may be. It is an aporia, as the Greeks and intellectuals among us would say, a “not-seeing.” So, nice. Useful. Except when disastrously bad.” (from “New York 2140” by Kim Stanley Robinson)

So, Robinson argues that natural selection has kindly provided us with a “strategically located mental blind spot” when it comes to disasters, including death. Death for all of us is the ultimate, unmitigated disaster, but we deny that it’s coming, or we just turn the other way and hope for the best. We just can’t believe or accept that a disaster is happening. I expect that other species have much the same reaction to disaster that we do. It would be impossible to be anticipating disaster all the time. As Robinson points out above, if that were the case “you would be stricken paralytic with fear at all times”. 

As Robert Sapolsky notes in Why Zebras Don’t Get Ulcers*, zebras are stricken with fear when they are chased by a lion, but if they avoid getting killed, they return to grazing on the riverbank as if nothing had happened. Humans, on the other hand, can imagine future catastrophe, but not in a way we can really believe. For example, as I drive down the highway, I don’t expect that around every curve an oncoming car will skid into my lane and crash into me head-on. If that were the case, I think I’d have to give up driving. Same goes for death. If I thought about my death every minute of every day, I would be unable to function in life. 

Thanks to evolution, we have a “mental blind spot” when it comes to catastrophes and disasters. Life would be impossible without it. Still, we must deal with the generalized anxiety that the possibility of disaster engenders, hence our proneness for getting ulcers and/or visiting psychiatrists.

*Sapolsky, Robert. 2004. Why Zebras Don’t Get Ulcers, New York: Henry Holt.