Spring, the Season of Misery, Drugs, Infusions, and Pain Specialist Visits

With physical activity comes pain, and this being my most active time of year, I live with exhaustion, irritability, despondency, a shoddy memory, attention problems, and near hysteria. Because it's damnably hard to say no to the one thing that gives me appreciable relief, I ran out of narcotics early last month, and the withdrawal symptoms were like a rocket booster to my misery. (Actually, I go into withdrawal everyday of my life because I take my day's supply all at once.)

Today, I saw two pain specialists, the first (Tom) was the doctor I went to for a Ketamine infusion three weeks ago and then went back to for two Lidocaine infusions. Since these things didn't help, I don't anticipate seeing him again. The second one (Frank), I've been seeing for many years, but like nearly all doctors anymore, he works for a mammoth medical group, and one of the limitations he has to live with is that he isn't allowed to administer drugs by infusion, which is why I went to Tom. When I saw Frank today, we discussed Tom's proposal to switch me to another (even stronger) narcotic and the fact that I had turned him down because it would have overridden Frank's order.

Frank agreed that the drug proposed by Tom would help stabilize my moods (I go from heaven when I take my daily narcotic dose to hell when it wears off). He then offered to prescribe it for me, but he said I needed to know that, since the drug has historically been given to addicts to wean them off heroin, it carries an unfortunate association that might haunt me down the road. Because I'm adamantly opposed to anything that might make a future doctor hesitant to prescribe narcotics, I told Frank that I would stay with what I'm on.

I then asked Frank to put me back on Ativan, which I've taken in the past in conjunction with narcotics. The benefits of Ativan are that it evens out the narcotic-induced mood swings, and that it helps keeps me from going to pieces when the pain is especially bad. Frank said that, unfortunately, a "black box warning" was recently issued in regard to prescribing downers and narcotics for the same patient, and that he would lose his license if he ignored the warning, and I ran into difficulty. Moreso than most doctors, Frank chafes at being forced to play games with the government and insurance companies, and on this occasion, he made his distress known with mild profanity. Doctors so seldom curse in my presence (I can only think of two that have done it) that I'm flattered when they do, the implication being that they trust me to not make trouble for them.

Yet again, I raised the issue of CBD, as I have done a few times in the past year. CBD is made from hemp and/or marijuana, and some people swear by it for chronic pain, but it too comes with a problem. Specifically, the consumer has to trust the manufacturer to truthfully state the product's THC content, and manufacturers have proven unreliable. What this means is that if I'm called in for a drug screen (which rarely happens but is always possible), and I test positive for THC, my narcotic prescription could be in jeopardy. Frank gave me his word that, unless my THC level repeatedly came back outrageously elevated (which shouldn't occur with any brand of CBD), he wouldn't pull the plug on me, but here again, I worry that something might end up in my chart that could cause me a problem down the road.

As my visit drew to an end, I again raised the possibility of trigger point injections. This is where a doctor takes a big needle (with a drug in it) and jabs it repeatedly into various parts of a muscle to relieve the horrible tightness that I live with and that never goes away. I've been there/done that with Frank, and although it didn't help, I'm desperate enough to try it again. He then told me something else that I didn't know. Specifically, he said that every doctor has a different technique, so it could be that I would have better luck being poked by someone else. 

Because I am not eager to see yet another doctor, I asked Frank if he really thought it might make a difference. He said no, and gave me two reasons. One was that I'm sufficiently thin that it's easy to find the appropriate places to poke. The second was that he's more aggressive than most doctors, so unless his previous attempts have caused me so much pain that I simply want a gentler doctor who pokes fewer holes, I would do well to stay with him. I had no idea that doctors' needle-poking aggressiveness varied (having never had anyone but Frank do it), and I told him that I would prefer that he be even more aggressive because I really need relief, the flipside being that I don't want to be poked by some doctor who's trying to avoid hurting me. I had wanted him to stick me then and there, but because I could tell that he was slammed for time, I suggested that he do it later. Maybe he would have suggested as much himself, but when I like a doctor, I do everything I can to present myself as an easy patient.