I’m so wired I don’t need coffee

Surgeons rarely kill people. They might screw them up, but they don’t normally leave them dead as a doornail on the operating table. Anesthesiologists are more likely to do that. How weird is it then that people choose their surgeons but take whichever anesthesiologist walks through the door? I made a big deal today of requesting the same anesthesiologist I had in March. I liked how he dealt with my sleep apnea, and he and Mark (my surgeon) obviously liked one another.

This brings me to another thing to ponder when you’re having surgery. You want to do what little you can to insure that your surgical team works well together because a successful surgery is never a one man affair. This is why I didn’t ask Mark to operate at my usual hospital—the big one where Peggy works—even though Peggy wanted me to. Better for me to be in a strange environment than for him to be in a strange environment.

I went both to the hospital and to Mark’s office for my pre-op today. The lady at the hospital smiled when she said I wouldn’t “have to be stuck” for blood tests. I said I wanted to be stuck, so she stuck me. The negative results were welcome after all these months of heavy medications.

The lady at Mark’s office said he would be in shortly to talk to me about my upcoming shoulder replacement. “I’m not having a shoulder replacement,” I said. “I’m having arthroscopic surgery on my left rotator cuff, which is to include an acromioplasty, a bursectomy, a supraspinatus repair, a glenohumeral joint debridement, articular cartilage restoration, and a few other odds and ends, but no shoulder replacement.” “Since the surgery on your right shoulder went so badly, he wants to go ahead and replace your left one at the outset,” she said. Peggy and I looked at one another. When Mark came in, he said there had been a mix-up.

If I didn’t trust him, I would have needed an explanation, but a good patient needs a good doctor more than a good doctor needs a good patient so I don’t rock the boat unless it matters. Besides, we had a lot to talk about. Like the following, which I wrote for him and will condense for you. It might not look like much, but it contains considerable learning, some of which might be of benefit to you someday.


“Prescription-related challenges and requests”

“Sleeping in a chair while in pain was a major problem last time (I was in that chair for four months), and I fear it will be this time too.

“I’ve learned that a good sleeping pill is often preferable to a narcotic because it: (1) enables me to get to sleep sitting in a chair, (2) enables me to stay asleep through a surprising amount of pain, (3) lasts twice as long, and (4) doesn’t make me itch. I would therefore like to rely on sleeping pills more and narcotics less. The Restoril you prescribed works well, but one can develop a tolerance in ten days, so I did some research and came up with Dalmane as a reasonable companion.

“Ron at Peace Health Pharmacy agreed that Dalmane is my “best bet” as a companion to the Restoril, and added that it has the advantage of being stronger and longer acting. I also have some Ambien on hand, but he confirmed my observation that it isn’t all that strong and wears off quickly. My insurance requires prior authorization for Ambien CR, but I have a coupon for a four-night sample if you see fit to authorize it. I also have a coupon for a week’s worth of Lunesta—which is also a wuss drug compared to Restoril and Dalmane.

“The reason I am so enamored of sleeping pills is that I’ve never had a really great experience with a narcotic whereas (aside from a little day-after grogginess) I’ve never had a bad experience with a sleeping pill. Of course, I’ll never complain that you’re ordering too many blood tests to verify that I’m not inadvertently poisoning myself.

“So, here is what I would request.

A painkiller. Maybe more Demerol, since it’s the only narcotic that doesn’t make me itch.

Dalmane (flurazepam hydrochloride). 30 mg is the usual dose. If you specify tablets rather than capsules, I can start with half a dose (I always prefer tablets for this reason). As with everything else, I can get three months’ worth for the price of two, so if you prescribe 90, I won’t need a second prescription.

“I’m set for Restoril and I don't need a prescription to buy all the stool softener that a person could ever want to own.”


Mark gave me what I wanted but not as much as I wanted. Sometimes, he will give me a lot of something, and other times he won’t. I can see no rhyme or reason in this, so I suspect it’s simply a matter of mood or attentiveness, but I never ask about it. These drugs are addictive, and that alone makes it impolitic to ask for bigger bottles. Just asking for a particular mood-altering drug can put a doctor on guard, yet I do it all the time because I’ve learned that I have to be my own authority to an extent. No doctor can know what works for me, and no doctor will spend one one-thousandth as much time as I will focused on what I need. In my experience, most doctors aren’t even that good at pain control. They basically have one or two favorite drugs that they give to everyone who walks through the door. Some doctors even view a patient's request for pain control as a sign of weakness or addiction. They are unworthy of their profession. People in pain need to feel empowered.

I spend so much time thinking about and reading about drugs that I even give them personalities. Vicodin? A skinny little nymph for those days when you need just a whiff of a narcotic. Norco? Vicodin’s big sister (her parents didn’t want a baby back then, and that’s why they gave her that crappy name.) Percocet? Full-figured and cuddly. Demerol? The thinking man’s drug because it makes a man sit and think—even when he would prefer to get up and do something. Ambien? When it’s 3:00 a.m., and I’m not in a lot of pain but I can’t get back to sleep either, Ambien comes like a sleepy-time angel with long white wings and a long white gown. Restoril? A fatherly hand that covers my eyes and drowns my pain in the waters of oblivion.

As I approach this latest surgery, my main comfort is that the things I’ve learned should give me a better shot at sleep and pain control even if this recovery is as bad as the one I started in March—for which I still sleep with ice packs. And, who knows—maybe it won’t be as bad. After a little vodka, I can even think of it as a grand adventure—sort of like a trip to an exotic land, only with a lot of pain and disability thrown-in at no extra charge.

But even if it is as bad, things could still be A LOT worse. Parkinson’s, Alzheimer's, kidney failure, liver cancer, complex regional pain syndrome, amyotrophic lateral sclerosis… Yes, things could be worse. I have no real complaint, but sometimes I get carried away by fear as if fear were itself a drug. I picture it as a big horse with frantic eyes and frothing lips. It keeps running faster and faster, and I struggle mightily just to stay in the saddle because to fall would be unthinkable.

29 comments:

Marion said...

A wise and very informative post, Snow, and I wish you great success with your surgery. (By the way, we had SNOW last night and today here in the tropical South. It was beautiful, but is fast melting!!)

I had a surgeon who not only crippled me for life and denies he did it, but also is a son of a bitch when it comes to giving me my wussy pain pills. His staff is rude and lie to me routinely and do not return calls. They'll only give me 2 weeks worth of my wussy pain medication at a time and I've been trying since May of this year to get them to fax my records to a pain management doctor who will address my needs with more care. I researched him and he's a great, caring doctor. But the bastard surgeon's office staff is slow and incompetent. I've sent them two letters and have made at least a dozen phone calls to no avail. I'm also a victim of a crooked, uncaring, evil Workman's Comp system in Louisiana. They are 100% against the employee. It's sad.

I'm happy that you have such good healthcare. I'll be praying for you to have a successful outcome in your shoulder surgery. Blessings, friend!!

RNSANE said...

This was an excellent article. As a nurse who has been an operative patient, I believe in communication with doctors. In 1985, while an operating room nurse, I slipped IN THE OR, on hydraulic fluid that leaked from a defective table. It began a nightmare! I was running to get blood and went flying, landing on the floor. Three months later, after a second opinion, Joe Montana's ( the famous 49er quarterback )surgeon, an orthopedist in our OR, did extensive back surgery on me. When I met with him, I asked for several things: I wanted to be operated on early in the week, perferably Monday ( there are fewer nursing staff on the weekends ). I wanted to be the first case of the day ( otherwise, you follow another case that can have gone on forever and the docs are tired! - also, you are fasting from midnight and it's awful hanging around all day,
starving! ). I chose my anethesiologist ( having worked in the OR, I knew the good, the bad, and the ugly! ). I picked my scrub nurse, my circulating nurse and even my recovery room nurse ).
I think it is very important to discuss pain management! I went to a class once and there was discussion that patients are not given medication often enough to allay pain, that it is withheld until they are in so much pain, the dose isn't adequate to alleviate their suffering!

Good info!

geek said...

You live! (It's a term used in my country when you suddenly see a person you haven't seen for a long time). Well glad to know you're okay. I haven't been in a surgery before so I wouldn't know how you feel. But I do hope that everything goes well.

And it's good that you're keeping track with your operation and the medicine you take. 'Cause some people would just be like "Hey! If the doc prescribed it, then it's fine". I think it's good to research on things that could affect your body.

I've also taken up researching the medicine prescribed to me just recently. Especially when one of them knocked me out for two days.

I like how you described fear. Well fear can be helpful at an extent but never let it overcome you, of course.

Big hugs from across the globe.

Winifred said...

I hope this surgery goes well for you. You've had a bummer of a time.

You're right about the drugs, only you know how they affect you and what works for you. I bet you know more about them than surgeons do. Love your drug images!

Too true that there's nothing as frightening as fear itself. God bless!

lakeviewer said...

Snow, you are a walking pharmaceutical encyclopedia. Good for you and your pro-active stance. Good luck on your surgery. May you sleep soundly and wake up restored. My best wishes.

Snowbrush said...

Marion, I wonder if the threat of a complaint to the local medical board would help--or at least the doctor's practice manager (not office manager, practice manager). How about sitting in the office and refusing to leave until you get xeroxes of your records, or else calling and dropping by several times a week to see if they're ready. Maybe you could get the doctor's home phone number off the Net and call him there a few evenings in a row. Another idea would be to explain the problem to your new doc-to-be, and ask him or her to call your old doc personally. Don't you have a primary care doc who could do better by you on the pain care end--and maybe talk to your surgeon on your behalf? My last surgeon wouldn't give me anything but Elavil for pain. That was the last straw for me remaining his patient. If I were you, I would make it my career to do everything I had to do to get those goddamn records. I would literally call his office a dozen times a day if that's what it took. I would not let up. You would not believe how intensely I would become. You have right to your records, and your doctor is not complying with the law or with medical ethics by withholding them.

RNSane, if I knew who the good nurses were, I would ask for them by name. My doc only does end-of-the-week surgeries, so that eliminates some problems, and mine was first-up last time, and will probably be first this time because he takes the more complicated cases early.

Geek, have you gotten on line and checked the proper dosage of the drug that knocked you out for two days? Not to one-up you, but Demerol made me feel so bad for three days that I felt as if the life were draining from me. Guess what? The prescription was written for 200 mgs when 150 mgs was the very most I should have taken. Never assume that anyone gets anything right when it is your life that is at stake. I've had five surgeries in 20 months, and you would not believe the screw-ups that I and everyone else who is in the system long enough has witnessed.

Winifred and Lakeviewer, great hearing from you. I feel bad that I haven't been around for awhile. After surgery, I'll have a lot more time to sit.

swan said...

Snow,

Please LIVE and LIVE all the way... I say this for purely selfish reasons, I want you to live so that I have somthing to read... :) I want you to live so that I can read your writing! YES LIVE and WRITE! You are beautiful!
swan

khelsaoe said...

Great to see you in my dashboard today! I love to see people taking care of their own health control. I have a feeling that this surgery is going to go great. Just think....all of this prep, and maybe it'll all be for nothing because you'll heal up in no time! Good luck, friend.

Snowbrush said...

Thank you, Klelsaoe. Thank you, Swan.

Marion, another thought. Try paging your surgeon at his country club. Show up at his church and talk to him with other people around. Ask his pastor to intervene. Yes, I WOULD personally do everything I've advised. You've go to stop worrying about making people hate you. I know it's way, way, way harder when you're wounded and in pain and dealing with someone who has more money and social status, but you've got to. Also, get your husband to help (why isn't he doing it already?). Nurse Peggy always takes me to the doctor with her because she says she'll be treated better if a man is there, even if her doctor is a woman (actually, she says that women doctors treat nurses worse than men doctors do).

geek said...

Yes, I checked the proper dosage for the medicine I'm taking. The dosage was okay but it has sedative and analgesic components -- which my body isn't used to.

Get well soon, Snow!

Snowbrush said...

Geek, glad you're looking out for yourself.

Marion, the first two paragraphs of the following are from page eight of a document entitled "Your Medical Record Rights in Louisiana." The last paragraph is from page one.

"You have the right to see your medical record. You also have the right to get a copy of your medical record. These rights are often called the right to access your medical record.

"Usually, your health care provider must respond to your request for your record no later than 15 days after receiving your request.

"You have the right to file a complaint with the Office for Civil Rights, U.S. Department of Health and Human Services if you believe your health care provider has violated your right to see, get a copy of, or amend your medical record. You can also file a complaint with the state agency that regulates your health care provider."

You can find the document at: http://medicalrecordrights.georgetown.edu/stateguides/la/la.pdf

kylie said...

wow! you know your stuff and good for you. too many people just do what they are told by the great medical gods.
it has to go better this time.

all the best and i look forward to your full on return to blogging

k

Just_because_today said...

It amazes me and I admire how much you know about your condition. I'm sure you baffled the lady at Mark's office.
Fear can sometimes take over our reason but as long as you stay on the saddle the horse will eventually stop.

CreekHiker said...

Snow, I LOVE your descriptions of the pills...I've never taken narcotics well at all. I stay wide awake and very jumpy! You sound very wise and in tune with your own body.

I wish you well. I pray this recovery goes much better!!

Natalie said...

Sending you love and prayers for a successful operation, and a very speedy recovery.xx♥

Gaston Studio said...

Snow, am also sending you love, gentle hugs and prayers for your upcoming surgery.

I so agree with you that only you know what will work for your body and mind. Love your descriptions of the pills!

I know it won't be painless recovery but hopefully, you'll have the right "stash" to keep you comfortable until the worse pain is over.

xoxo
Jane

rhymeswithplague said...

Snow, my thoughts and prayers are with you. I'm really impressed with the info you gave Marion. Most of us are content to sit back and complain and whine. You take the bull by the horns (a metaphor best not explored too deeply here)....

Get well. Stay well. BE well. One day all this will be behind you.

JOE TODD said...

All your preparation sounds pretty astute. Wish you the best.

nollyposh said...

i so get you about the ~fear~ thing... Too easy to buy into sometimes especially when it is the wee hours of the morning & one can't sleep for pain... That's when fear whispers in my ear, but i see 'her' more as sneaky back stabbing unsupporting 'friend'(Than a frothy mouthed stallion)... You know the kind of 'friend' (you may have had as a teen) who had a penchant for getting you both into trouble! ...i also think it is great Snow that you are organized with your surgeon etc... My surgeon has always said just that to me, that only i truly know my own body & he needs to be guided by that knowledge too... GoodLuck x

Marion said...

Snow, I love you! My husband (a retired nurse) has been helping me and has himself sat in the doctor's office for me many times just to demand my medications.

I am going to take all of your advice. I have a head start because my hairdresser knows the scum sucking surgeon and goes to church with him, so I'll have no trouble getting his address AND phone number. I'm going kamikaze on his ass this week. Will keep you posted, dear friend. Wishing you health, wealth and peace of mind. Get well soon!!! I so appreciate your help!!!!!BLESSING!!!

kj said...

snow, god you look like my good friend walter in minneapolis. if you saw one another on the street, you would both laugh out loud.

i happen to think your surgery is going to go much better than last time around. how about we bet $10? i will trust you to tell the truth but i won't tempt you by betting $ 100.

your personifications of drugs is hysterical. i work in a mental health clinic and i just may pass your apt descriptions on to the shrinks-that-be.

i'm rooting for you, snow. please keep in touch.

xo
kj

Pamela Terry and Edward said...

So sorry to hear you are having to endure all this! I'm a fairly disgusting healthy creature, but I have had migraines for years and know about pain. Unfortunately, pain medication is equal to sweet tarts when it comes to migraine. But fortunately, I don't have them anymore.

My doctor did gives Ambien when I take an overseas flight at night. I was convinced they wouldn't work, said so, and two minutes later woke up in London. They work.

Sorry I haven't visited lately. For some reason, I had neglected to sign up to follow your blog. Problem rectified!!

Bernie said...

Sending you prayers for a speedy recovery.....:-) Hugs

Renee said...

Fear is the mind-killer so stay clear of it.

You are so amazing Snow and such a good advocate for yourself.

I know it is so hard sometimes to even ask for what we want when we are in so much pain or sick, so good for you for being so clear headed.

I'm thinking positive thoughts dear friend.

Love Renee xoxoxo

Snowbrush said...

Had my surgery, and made it home. Am tired, drugged, and typing with one hand until I get a different (and much bigger) chair in here (so that I can type without lifting my arm in its sling), so I'll keep this short). I'm mindful that some of the responses require a response from me, and I hope to get to them soon.

The doc said that this arm looked better than the one he did in March, so I'm hoping for a better recovery as well.

Sinthalunda said...

This last post is an emotional piece of writing from the heart. Thanks.

Crazed Mom said...

At Last! Someone else who thinks vicodin is the weeniest pain killer ever! How do people get addicted to it? I agree on the sleep meds as well. Lunesta is completely useless. I have several friends with chronic pain and insomnia because the two go together. I get soooooooooooooooo angry because docs treat folks with chronic pain and/or migraines(me)as if we're junkies or we sell the stuff. Real working pain clinics needs to be mandatory with doctors who are pain experts. Include adjunct therapies, realize patients in true pain rarely get addicted.

I personally do not get euphoric from percocet. Demerol makes me hallucinate and hurl. Morphine makes me hurl. I don't want major opiates. I want pain relievers that work w/o turning people into zombies. Toredol can be effective for very short term but is very hard on kidneys.

Because pain cannot be measured by mathematics and differs from person to person, culture to culture, people in chronic pain tend to get screwed. I know there is better meds out there but the FDA farts around or gets overly cautious esp. after the oxycontin epidemic.

Now I'm ranting. I'm a huge advocate for effective pain relief for patients.

dana said...

During one of my more traumatic surgeries, I was telling the surgeon what was helpful for pain, NOT to use staples, and I told the anesthesiologist what I prefered as an anesthetic. The surgeon listened. He knew me. The anesthesiologist gruffly asked "Are you a DOCTOR? When you're gone to school for 8 years, you can tell me what to do"

I said "I'm not a DOCTOR OF MEDICINE, I'm a 40 year graduate of intensive study regarding crohns disease, medications for crohns disease, and ME."

Rob-bear said...

Snow, I'm fascinated by the "personalities" you assign to medications. Never thought of that approach.