For those who live with pain

I take the following for pain: Neurontin, Ambien, oxycodone, marijuana, and Cymbalta (an SNRI—selective serotonin and norepinephrine reuptake inhibitor). These drugs are what’s left of the 25 or 30 I’ve used, a list that includes every legal narcotic I know of, a half dozen sleeping pills, various anti-inflammatories, and, for good measure, Elavil. Cymbalta (see photo) has helped most, but, due to insurance changes, my cost for my next prescription will be $607 for a 90-day supply. While looking online for substitutes, I learned that Effexor (another SNRI) is equally good for pain and, because it has been around since 1994, comes in a generic form for $12.32. 

The high cost of Cymbalta is why, if you live in America, you are barraged with Cymbalta commercials, whereas you never see Effexor advertised. Along with price, other disadvantages to the latest “miracle drugs” is that their long-term downsides are unknown and they are rarely more efficacious than older drugs. So, why did my doctor prescribe an expensive medication before trying me on a dirt-cheap drug that is likely to be just as effective? Hell if I know, although I’ve noticed that doctors don’t usually know how much drugs cost. They also used to get kickbacks from pharmaceutical companies, although my understanding is that the government put an end to this.

It’s good to remember that you’re probably in a better position than your doctor to know which drugs might help you. For instance, if you suffer from ongoing pain, your medication options are limited, and with a little effort, you can learn what they are and stay abreast of the latest research. Of the drugs I’ve tried for chronic pain, I would say that narcotics are both the most heralded and one of the least effective. I mention this because some of you have trouble getting narcotics, and, as a consequence, appear to hold them in higher regard than they deserve. The reason for their relative ineffectiveness is that you quickly build up a tolerance, so if your starting dose is 5-10 mgs, you might be taking six times that amount (and incurring six times the risks) after a few weeks and still not get as good a result as you had with your initial dose. It is for this reason that I try to limit my narcotic intake to twice a week, but even then the tolerance problem remains. 

No doctor ever told me to take more than 20 mgs of oxycodone or Dilaudid at a time. This used to leave me in the troubling situation of thinking that, my god, I’m taking this strong narcotic that people rob pharmacies at gunpoint for, and I’m still in terrible pain—my condition must be hopeless. When I increasingly turned to the Internet for drug information, I learned about narcotic tolerance, and realized that my doctors simply weren’t taking tolerance into account, so I started increasing my own dosage, but no matter how much I took, I soon needed more. (If you should ever consider increasing drug dosage without your doctor’s consent, bear in mind the following statement from the American Centers for Disease Control and Prevention: “In 2008, more than 36,000 people died from drug overdoses, and most of these deaths were caused by prescription drugs.”)

Rather than the prescribed strength being too weak, I’ve also seen it go the other way. For instance, if I had used that 100-microgram Fentanyl patch that one doctor gave me, I’m pretty sure I would be dead. After another doctor started me on a triple dose of Demerol, I could hardly get out my chair for three days. Such overkill (ha) is another reason that you should do you own research.

Because of my positive experience with Cymbalta, I’ve become very interested in anti-depressants for pain relief. Some of you might know that the old tricyclic antidepressants (Norpramin, Tofranil, and Elavil, to name a few) have long been given for pain. Then came the SSRIs (Prozac, Lexapro, and Zoloft are three that I’ve taken), which weren’t good for pain by themselves but were good in combination with a tricyclic. The next advance was the SNRIs (Cymbalta, Effexor, Pristiq), which are effective for the pain of arthritis, fibromyalgia, and neuropathy, along with depression, panic disorder, social phobia, and obsessive-compulsive disorder.

As you can imagine, any drug that can do all that can also kick your ass, as I discovered when I stopped taking Cymbalta cold turkey last November and felt utterly exhausted, experienced excessive scalp sweating, had symptoms approximating the early stages of a horrendous cold, and wanted to rage one minute and cry the next, symptoms that continued for nearly two months. Since I had stopped taking narcotics at the same time, I assumed I was suffering from narcotic withdrawal and so did my doctor. When I finally went online, it didn’t take me any time to become convinced that it wasn’t the narcotics, it was the Cymbalta. Why didn’t my doctor know this? Maybe he didn’t sleep well the night before, or maybe he was thinking about his last patient or the fight he had with his wife that morning. I have no idea, but I do know that one should never go to any doctor with the assumption that everything that can be done will be done, and that it will be done right. I’ve experienced situations in which so many mistakes were made by so many people in so short a time that I imagined myself trapped in a Monty Python skit.

I’ve gone into some detail about anti-depressants for pain control because Cymbalta has worked fairly well for me without severe side-effects or a tolerance problem. It’s important to remember that chronic pain causes anxiety and depression, problems that worsen the pain, and that anti-depressants have the advantage of treating these along with pain. The worse downside to Cymbalta—so far, anyway—is that, having been through drug withdrawal a few times by now, I worry more about drugs that cause withdrawal than I do about drugs that I can easily stop. Whenever I start to focus on such concerns, I remind myself that living with pain and depression pose their own serious health risks. For example, chronic pain makes a person more prone to accidents; depression impedes his immune system; and the two of them together make it impossible to get adequate sleep. I, like so many of you, can no longer imagine a drug-free life despite the fact that I anticipate dying earlier because of it.

I have found living with pain—and the resultant disability—to be a major challenge to my desire to live at all. Many people experience this, and because of it, I have a great deal of sympathy for other sufferers. We share a problem that can be very hard to treat and that many people don’t understand (especially if you “look normal”) and often seem bored by. I do understand what pain sufferers are going through, at least somewhat, and I am far from bored by it. Just as some of you worry about me, so do I worry about you. I am hardly the worst-off of those in my blogging community, and I can thank many of you for helping me keep my head above water.

It was a Hitler kind of week

I unintentionally lost seven pounds in six days last week, my only other symptom of illness being fatigue so severe that it kept me in bed for much of the time. Because I regularly take pills for nerve pain, pills for arthritic pain, and pills for sleep, along with marijuana and strong narcotics, my first thought was liver or kidney failure, so I stopped taking everything. I knew I would be in more pain, but I had no idea how bad it would get. My shoulders, my back, my hips, the hand that I broke last summer, and my upper legs and knees, were all screaming at me, and I could do nothing for them. When I couldn’t sleep in bed, I moved to the recliner that served as my bed for eight months out of the twenty-four that I was having surgeries, but I couldn’t sleep there either.

I didn’t want to go to the doctor because there are a lot of bad colds going around, but when four days passed, and I was little improved, I decided that I had to go because I wasn't holding up well under the pain, and because I thought I might be so ill that my life would be jeopardized if I waited. He took some blood tests, and I went home to await the results, practice having made me fairly stoic about such things. Peggy came down with a cold that night. The tests came back yesterday, and to my very great surprise, they were normal. The doctor speculated that, whatever the initial problem had been, my later fatigue and weight loss had been due to narcotic withdrawal, so I’m back to taking pills and eating marijuana cookies (but no narcotics). If not for the pain and fatigue, I would have enjoyed seeing the universe without a haze around it. I hadn’t realized how absent from the external world I had become, even though it had been a welcome absence for the most part. I mean, between hurting bad and being loaded, which would you choose? Duh. 

When people talk about the redemptive power of suffering, I think they’re full of shit. They’re invariably people who have no firsthand experience of what they’re talking about, at least when it comes to bad chronic physical pain. Imagine that you have the worst toothache you’ve ever felt, that it’s untreatable, and that the only thing that will even reduce the pain by half might cause you to sicken and die. Is there anyone on earth who imagines that he would gain from that? If there is, bring him over, so I can slap some sense into him. My life is a war of attrition, and every year I lose more hope, feel more pain, and become more disabled, and I’ve yet to meet anyone in my situation who is doing any victory dances. 

I can’t say that pain hasn’t given me insights, but they’ve been insights about how really bad life can hurt, how little can be done about that, how little support anyone can give, and how utterly tedious it all becomes, both to the sufferer and to everyone he looks to for support. I never dreamed that my life would turn out like this. Quite the opposite. I thought I would be strong and capable almost until I died, and now I’m wondering how much longer I will able to clean house. It took me three days last time, and it’s not even a big house. 

I think it likely that the only thing that keeps me alive is Peggy (I’m grateful for this), but she is also the person who suffers the most because of me, and that alone is enough to bear. I can only justify my life by bringing good into hers, and I rarely feel that I do particularly well. I have observed little difference in whether pain is physically or emotionally based because either way, the struggle to overcome (or to at least adjust) is likely to be longterm, intense, and a pain in the ass of ones partner. I guess I can give myself credit for doing the best I can, but how would I really know?

P.S. Yes, I understand. I could be worse off, much worse off. I probably know that better than those few who try to remind me of it because living with pain has improved my ability to sense pain in others. It’s like if you bought a red Toyota Camry, and all of a sudden you notice how many red Toyota Camrys are on the road. But, more than that, you have become deeply interested in red Toyota Camrys. Rather than bore me, people who tell me about their pain fascinate and encourage me.

You who read this blog regularly will remember that I had a period last summer when my pain level dropped by 90%. It lasted for about three months, and since then, the pain has kept getting worse. Those three months were the first time in a few years that I had seriously dared to hope, and when the pain came back, they just made it the harder to bear.

Drugs and addiction

It’s a rare night that I can sleep without drugs. For pain, I take Cymbalta, Dilaudid, oxycodone, and Neurontin. For sleep, I have Ambien, Dalmane, Restoril, and marijuana. All of these drugs have overlapping benefits and they work best in combination, but with the exception of marijuana I seldom mix them because of the increased risk of side effects. Also, except for marijuana, I never take any of them during the daytime. The one exception was when I took oxycodone two weeks ago for that anxiety attack caused by the Cipro.

My most effective painkiller/sleep aide, is Neurontin. Oddly enough, considering how strong it is, Neurontin doesn’t make me high unless missing doorways and bouncing off walls counts as being high. To avoid tolerance problems, I save it for when I’m desperate. For example, I hardly slept three nights ago, and when that happens, I go for broke the next night, so I took three doses (900 mgs) of Neurontin at once and spent the next several hours flat on my back. One of the ways I minimize pain is by turning over a lot, so when the pain finally awakened me, I was hurting pretty bad, but the drug still had enough kick (about 16 hours worth altogether) that I was eventually able to get back to sleep. 

Last night, I was so tired that I did my best to sleep without drugs, but that only lasted for five hours before I took a 10 mg Ambien, which is my short-acting favorite. Taking so many drugs means that I'm pretty much permanently snookered. I'll give some examples of the annoyances this causes. One. When I got up this morning, I couldn’t find my sunglasses, so I finally left the house without them. When I got home, there they were, right where they were supposed to be, which was the one place I didn’t look. Two. I’ve already looked once today, and I still can't remember if this is 2011 or 2012.

I’m going to address addiction since some of you expressed concern about it following my last post. I was surprised that one person was especially worried about marijuana because I consider marijuana to be the least harmful drug I take in terms of tolerance, dependency, side-effects, or—in the case of narcotics—addictiveness. It strikes me as exceedingly odd that the least scary drug I use is the only one that's illegal. Marijuana can be habituating, of course, but then so can jogging or eating ice cream. Narcotics are a whole other animal because they bring about permanent changes in the brain and hellacious withdrawal symptoms. As I write, I haven’t used marijuana for five days (I sometimes get tired of being high) without the least problem. If I used narcotics as often as I normally use marijuana, I would be under medical care for withdrawal.

To further compare narcotics and marijuana; I prefer marijuana because it causes me to think about the world in deeper and more interesting ways, ways that are so profoundly true for me that they seem to be coming from the core of my being. The drug rarely leads me to euphoria while it not uncommonly makes me anxious, dysphoric, and sometimes downright miserable. I often go for months during which I start most days with marijuana and coffee and then continue to use marijuana until bedtime. I do this because I like the mental stimulation but also because pot works far better as a sleep aide if I use it all day. Sleep is my major challenge not just because of the pain but because I have four separate sleep disorders—insomnia, sleep apnea, nocturnal myoclonus, and nocturnal bruxism.

Narcotics differ from marijuana in that they do induce euphoria, although I find them boring in terms of thought stimulation (who needs to think when he’s euphoric?). I’ll use an analogy to describe how I envision narcotic addiction. Imagine that you’re rafting down a slow and muddy river. The hot air is stifling and the scenery boring. You too are stifled and bored, and you wish with all your heart that you could feel like you were getting somewhere, but your entire life has come to seem like a failure no matter what you do. Then you come to a whirlpool (narcotics), but you don’t realize it's a whirlpool because it's so wide. You’re just pleased to find that you’re moving, although you can’t really remember why you ever wanted to be someplace else. The breeze in your face is cooling, and the same scenery that bored you a few minutes ago is now fascinatingly beautiful. Happiness seems so simple and natural, and sadness so twisted and complex that it's hard to imagine that you were ever unhappy. By the time you see Death at your side, you might be too far gone to turn back. I’m not talking about me, but neither do I remain cocksure that addiction only happens to other people, people inferior to myself. When you're desperate for a way out, even a bad option can look better than no option.

My narcotic mainstay is oxycodone (when it comes combined with acetaminophen, it’s called Percocet) because I’ve been approved for a years’ worth without even having to go back to my internist. I limit myself to 30 mgs at a time (the starting dose is 5-10) three or four times a week. Unfortunately, I feel less euphoric and get less pain relief from thirty than I once got from ten, but I'm afraid that if I take a higher dosage even once, I’ll be tempted to do it again. Why did I set 30 as my limit when my prescription calls for 10-20? Because I was taking 30 when I got scared, and since I was handling that okay—except for the hellacious constipation—I stayed with it. Narcotics are so insidious that even though 30 no longer gets me high for more than a half hour, I crave it on my narcotic-free nights. On the nights I do take it, I have trouble waiting until bedtime to do so because the rush initially makes me too happy to fall asleep, so I want to be up doing fun things. There's nothing like high on narcotics and marijuana and then baking crackers while watching a movie. Yep, that's right, I can carry on real well even while real high, so well in fact that even Peggy can't even tell if I've had anything.

I sometimes imagine that narcotics are talking to me. They say they’re my friends, and that there’s really no reason for me to be in pain when all I have to do to feel better is to take a few milligrams extra. They assure me that, just as most people can safely relax in the evening with a few drinks, so can I relax with a few narcotics. Besides, don’t I deserve a little euphoria? Hell, I’m in pain; my brain—the one I once took pride in—is a turnip; I can’t do many of the things that I used to find meaning in; I look like shit, having gone from 180 pounds of muscle to 160 pounds of skin, bones, and a little round belly; and, worse yet, I have no hope of ever escaping the pain or ever regaining my strength and intelligence. As a matter of fact, the whole goddamn rest of my goddamn life looks pretty fucking bleak, and even after years of pain, I still don’t have a clue how to handle that. Narcotics tell me that they’ll handle it for me and make me deliriously happy.

The words that I say to myself are a bit different… "Why can’t I handle this better? I know people who are worse off but appear to be doing fine. Why can’t I be like them and cut through adversity like a knife through warm butter? And why, when I spent years trying to stay healthy and more years trying to regain my health, am I like this while people who are older than I and never gave a thought to diet and exercise are doing fine?"

So far, I haven’t been tempted to take a higher dose of narcotics or to take them during the daytime (except for two weeks ago when Cipro took me to the doorstep of panic). I’m helped in this by reminding myself of what George Peppard (see photo) said about drinking: “You have problems, you think drink helps, then you have two problems.” I never knew him, and he has been in his grave for years, but I sometimes imagine him beside me, looking the way he looked toward the end of his life when his arrogance was gone. I don't only want to be strong for myself and for Peggy; I also want to be strong to honor his memory because every little bit of inspiration helps, and George Peppard's tortured existence and eventual triumph has certainly inspired me.

The bareass truth is that I need drugs to sleep, mostly because I’m in too much pain to sleep without them, but also because I’ve taken them for so many years that normal sleep is all but impossible. Yet, drugs are robbing me of myself almost as much as the pain is, not because I’m addicted but because when you take mind-altering drugs everyday, you start to lose sight of who you are. I’m desperate to give up drugs as a way of life, but I’m desperate for sleep too, and I can’t have it both ways. You might look at my situation and think you could do better, and I hope you could because you might have to someday, but where I am is where I am despite the years I’ve put into trying to either get well or get strong. 

I just came off a five-month break from even trying to help myself—well, except for diet, drugs, writing, physical therapy exercises, and buying potted plants. When I started getting scared about how much I was looking forward to narcotics, which wasn't too long ago, I signed up for a Qigong class. My classmates are mostly old ladies, and I'm having trouble keeping up with them. I would have already quit the class, but where do you go after Qigong? It would be like dropping out of kindergarten. 

As the saying goes, “You either get tough or die.” I’m not all that tough, but then I’m not dead or on a psych ward either... I grieve my life. Although, for years now, my experience of it has hardly been in the league of a walking death, it seriously sucks. My chief support has come from Peggy, my doctors, and you. Two bloggers who were dying (Renee and Nollyposh) gave me a generous portion of their time and compassion, and that still helps even though they're gone. I wouldn't be surprised but what many a life has been saved by a single act of kindness on the part of someone who had no idea of the significance of what they were doing.

Bamboo shadows on a rice paper floor

Today is the first warm sunny day since last fall, and every square yard of earth is covered with shoots, buds, tendrils, flowers, and new leaves. By afternoon, I was drowning in…what? Fecundity? No. Reality. I became confounded by the thought that being alive is so intense that I can't imagine how I've pulled it off all these years--or how I can possibly continue to pull it off. It's usually a bad idea to smoke pot when I'm anxious, so I contented myself with 30 mgs of oxycodone. Thirty is a wee small dose for me, but it's frightfully high by most standards, and I've vowed to never exceed it. Odds are that 50 would make me feel really good, but after a week on 50, I would need 60 to feel really good, and then the day would come that I would lie down to enjoy my opiate euphoria, and I wouldn't get up again.

At bedtime, I added 600 of Neurontin (another painkiller) to the oxycodone and, curiosity getting the better of me, smoked some pot. As soon as I turned out my light, the hallucinations started. A long procession of indistinct gray images appeared one after another after another until they exploded in a blinding barrage of light, color, and movement. Afterwards, the darkness pullulated with images that passed before me like so many room-size flash cards. Some were still lifes. Others were in motion. The one that touched me deepest was that of my dead neighbor, Belle, and her dead poodle, Lily. I liked Belle, but I loved Lily. (How I wish I could draw close to humans the way I draw close to dogs and, now that I have Brewsky, cats.) I fought to stay awake, but the Neurontin eventually won.

It’s now 2:50 in the afternoon on the following day. I feel hyper and am so near the edge of reality that I could easily start hallucinating again. 

Oh, NOOOOO!!ll! Leg cramps! WHOA! I had to to throw myself to the floor to massage them, only I would scarcely start on one before another one stabbed me. Paul Butterfield (http://www.youtube.com/watch?v=YaV-S5ivX3E) is starting into "East West" again. I've listened to all 13 minutes and 14 seconds of it scores of times since yesterday because I want to go deeper into whatever trip this is, and psychedelic music sure helps. 

The room is now pulsing ever so slightly, and I am very close to being dizzy. Everything around me—my monitor, the pictures on the wall, the chair in which Brewsky lies sleeping—appears to be slowly moving further to my right. Objects are also expanding and contracting as if breathing, yet I'm less surprised by all this motion on the part of inanimate objects than I am that I never noticed it before. In other words, I don't feel like I'm hallucinating; I feel like I'm seeing reality more clearly than ever, yet my rational brain keeps suggesting that it's pretty damn unlikely. I'm also jerking and trembling, almost too much to write, and I don’t even know why I'm having this wild trip. My best guess is that I’m high on some medication that I’m not supposed to get high on, although the only new drug I'm taking is the antibiotic Cipro (to hopefully rule out prostate cancer), and the only problem I've ever had with antibiotics was the runs. I definitely like this better. But what if it's not a drug behind the weirdness? Would I be okay with that? Probably. This will surely sound strange in the kinds of experiences I'm having, but I feel secure enough in my sanity to allow myself to be insane.

...I did it. I looked up Cipro, and sure enough, running amuck in a blind panic while having outrageous hallucinations are two of the 150 or so side-effects, and they actually looked pretty good compared to some of the others--liver failure, tendon rupture, cartilage destruction in weight-bearing joints, death! The website advised that I contact my doctor immediately about the hallucinations. Yeah, right. The odds that I’m going ask a doctor to fuck-up a really good drug trip are WHAT exactly?! Years ago, some other drug had euphoria listed as a side-effect that I was supposed to call the doctor about. I thought it would be pretty funny to get my internist out of bed at 3:00 a.m. to complain that his pills were making me exceedingly happy.

...Now I'm lost in the spaces between things. What is this nothingness that exists between us? Neither matter nor energy distinguishes it, yet we all agree it's there, and that entities which do consist of matter and energy couldn't exist without it. What, then, IS it? Is it a void—whatever that means? Might it swallow me up? Has it already swallowed me (all of us) up? Is that the problem, and does it go all the way back to the Big Bang? I often feel desperate for answers to questions that don't even make sense to a lot of people. Unfortunately, the questions that plague me most don’t necessarily have answers. They’re the SCARY questions, the ones that make existence too ironic to be believable, and so it is that I tremble.

Trembling is actually a big part of my life when I’m alone (I try to avoid experiencing life deeply when I'm not alone because people commonly interpret my intensity as something to be fixed or pitied, and this makes them a complete drag to have around). Drugs like pot — and Cipro, it would appear—that have the power to cause hallucinations, crank up my intensity many times over, which is why I’m drinking coffee and smoking marijuana right now. Life would be easier if I gave them up while I was on the Cipro, but it would also be less rewarding.... I just restarted "East West" for about the 100the time.

It's now another day—I don't know which one—and I'm still lost in a world that looks surprisingly different than any world I've ever seen. I went early to my second ever Qi Gong class today so I could stand directly in front of the teacher, Matsuko. I was very much enjoying the music she was playing because I imagined myself on a rice paper floor that was being slowly encircled by bamboo shadows cast from plants that were swaying in a soft breeze. This pleasant fantasy soon turned into a compelling hallucination in which I lost all awareness that I do now or ever did exist as anything other than Matsuko’s hypnotically undulating arms. I had been mirroring her body--but especially her arms--for nearly an hour with complete concentration from no more than eight feet away, and that, combined with my Cipro-altered state, bewitched me so profoundly that I ceased to exist in my own mind. All too soon, an internal (and maybe infernal) spring snapped me back into myself, and, remembering where I had gone, my eyes moistened with affection for this person whose arms I had experienced as if from the inside. I was so moved that I was contemplating leaving the room so I wouldn't make a spectacle of myself, but then my eyes looked of their own accord into Matsuko’s eyes for almost the first time since the lesson started. She was back at me as if in accepting acknowledgement that whatever I had just experienced, it must have been a doozy. After class, I very much wanted to tell her all about it, but I'm seriously considering becoming her student for the long haul, so I didn't dare risk it. 

By Jove, I feel inspired to write a proverb. Here it goes: "You should neither assume that your experiences during a drug trip have anything at all to do with the people about whom you have them, nor should you imagine that those people would be pleased to hear about them!" 

It is now yet another tomorrow—at least I think it is; I’ve edited this so much that I’m about to fall over—and I just took my last Cipro. I've been in a significantly altered state of consciousness for five days and have even gone out of my way to intensify an effect that the drug's manufacturer considers a grave problem; I'm tired. Really though, if they want you to call your doctor, shouldn't they give you a better reason than that you just embarked upon a five-day, all expenses paid, psychedelic vacation to the mountaintop of the holy mystics?

I finally put aside "East West," and have since been listening to various artists (Yanni is currently doing a great job with "In the Bleak Mid-Winter”). I want to share one of those artists with you. Please do me the favor of listening to Suzanne Ciani's "Silver Ship" for ten seconds. If you're not hooked by then...well, I would be astounded. In the presence of such perfection, I'm ever struck by the thought that it only takes a few minutes of absolute beauty to erase an entire lifetime of mistakes. Unfortunately, this speaks to the rarity of absolute beauty.

My experience with marijuana versus narcotics for chronic pain

Oxycodone is at least a little useful for relieving my pain, plus it makes me very, very happy. Some people say that narcotic happiness isn’t real happiness, but the only difference I can see in how drug happiness feels versus how natural happiness feels is that drug happiness is usually deeper, mellower, and disconnected from the events of one’s life. The problem with oxycodone—and all narcotics—is that if five milligrams will take you to heaven today, you’ll need 25 the day after tomorrow if you keep taking it. I think of the drug as like a Siren that—thanks to my genetics—has been unable to pull me beneath the waves. As an example of people who weren’t so blessed, I’ll mention two addicts who held up local pharmacies at gunpoint but didn’t take money, just oxycodone, Percocet and Oxycontin (the last two being products that contain oxycodone).

Marijuana interests me more than narcotics and works as well for pain, but I never become accustomed to losing what little control I have over my thoughts as they are cycled rapidly from happy absorption in almost anything, to befuddlement, to extreme anxiety, and back again. Despite such feelings—if not because of them—I enjoy the drug (god help you if you're ever in chronic pain and sincerely despise psychoactive drugs), and I’ve enjoyed learning to carry on a normal life while using it. I do handyman projects; go to doctors’ appointments; conduct business on the phone and the Internet; cook, shop, do housework, and take care of the yard. If marijuana took away my considerable desire to be active, I wouldn’t like it nearly so well. Oxycodone does make it all but impossible to carry on a normal life plus it leaves me feeling groggy, which is why I only take it at night, and never more than twice a week. The rest of the time, I either take marijuana alone or I mix it with Neurontin, Dalmane, Ambien, Requip, or sometimes Dilaudid, which is a bit stronger than oxycodone. Ironically, I’m able to live more like a normal person when I’m drugged than when I’m straight because drugs are less distracting than pain and sleeplessness.

Many users believe that marijuana has made them better people. I’ve thought about this a lot, and I doubt that there’s anything to it. I get along more harmoniously with others—including Peggy—when I’m high because I’m more patient, tolerant, and sociable, but I have no confidence that this would continue if I stopped the marijuana. On the downside, the longer I use marijuana, the harder it becomes to express myself through my writing. I discard post after post, and when I do put something online after days of editing, I continue the editing even after most of the responses have come in. Other downsides are temporary memory loss, a feeling of floating out of reality, and the impossibility of accurately judging time and speed. As with many useful drugs, medical marijuana is a case of damned if you do and damned if you don’t.

During my adult years in Mississippi—in the seventies and eighties—I only had two friends who weren’t pot smokers, them being alcoholics only, but I never saw anyone too stoned to stand. Now, it happens to a lot of people, not because they want it but because sophisticated growers have succeeded in making marijuana so strong (just ¼ of one of my little marijuana cookies packs quite a punch) that you can get in over your head before you know it, especially if you’ve been away from the drug for years. Marijuana’s strength combined with its inability to kill me (well over 100,000 Americans die from legal narcotics each year) are two of its most attractive attributes. I have every confidence that, however bad marijuana’s long-term effects might prove to be, I won’t die from it, and when you take as many drugs as I do, that’s a significant recommendation. With this as with many things, our national policy is the opposite of what makes sense to anyone who is looking at the issue from the inside.

...I hate smoking anything, so I cook my marijuana. First, I run the dried leaves though a blender until they look like green flour. I put two ounces of this flour (twice the suggested amount) into a crock-pot with a pound of butter, and cook it on low for about eight hours. I then double the amount of butter in a Betty Crocker sugar cookie recipe, being careful to weigh the dough so that each unbaked cookie contains exactly one ounce. The main challenge to eating marijuana is simply getting the amount right, which is why I only use the one recipe. I wrote about the results of eating too much in my entry of August 8, 2011.

As for cost, I get my marijuana free from a generous and idealistic grower, but if I had to pay for it, it would run $5 to $8 a gram on the legal market (to be legal, you have to register with the state, and you can’t make a profit). One ounce contains 28 grams, so this comes to $140 to $224 per ounce. Again, this is on the legal market, so it should be relatively cheap. I have no idea what the black market would charge. Critics of the Oregon law argue that every Oregon drug addict and his cat are trying to get a medical marijuana card just so they can buy pot cheap—or grow it themselves—and not worry about getting busted. In this scenario, a druggie would learn what he needed to say to a marijuana doctor (a doctor who spends her days recommending patients to the state of Oregon for billfold-size marijuana permits) to qualify for a card, pay the doctor a few hundred dollars for the consultation, mail another $100 to the state of Oregon, and, voilà, get a permit. I’m sure this happens, but it doesn't justify scrapping a program that is vital to the welfare of thousands of people. When you hear the government claim that marijuana is a dangerous drug with no medical uses that can’t be better served by a prescription drug, you can rest assured that it's lying.

What I've been feeling and doing, and why I'm not visiting blogs

I saw my new pain doctor today, and he loaded me down with Lidoderm, Cymbalta, and Butrans (I already had Dalmane, Ambien, Restoril, Neurontin, Dilaudid, oxycodone, Vicodin, Demerol, Fentanyl, Requip, and probably a few more that slip my mind at the moment). He also referred me for acupuncture, hypnotherapy, physical therapy, biofeedback, and a half dozen other therapies, and finished off by telling me to consider a TENS unit and a lidocaine infusion (I obviously looked wealthy). All this plus a new diagnosis. No, it’s not CRPD like my internist said, and it’s not even syringomyelia like my last pain specialist said, and it’s hardly a complete mystery like my surgical neurologist said. Oh, no, it’s CPS (central pain syndrome, whatever that means—I rarely even Google diagnoses anymore). I damn near fell on the floor laughing when he said that. God, I could diagnosis myself by closing my eyes, opening a medical encyclopedia, and pointing at a disease, so what the hell do I need these overpaid morons for? Oh, drugs. That’s it. I need them for drugs, man.

I’m going to rant—or should I say “continue ranting”? The son of bitch had me piss in a goddamn cup so he could fucking test me for drugs (“I told you what I’m taking,” I said. “Don’t take it personally,” he said). He even insisted that I bring all my medications so he could look at the bottles, but he wasn’t content with just looking at them; he counted the pills—or rather his nurse did. I knew that a drug test awaited me before I went in, so I hated him from the start, and tortured myself about whether to go at all since I didn’t really expect any good to come of it anyway (you lose faith after your 30th doctor). I agonized right up until the last minute, at which time I concluded that I would put up with his drug test shit until the first of the year when my insurance cycle starts over, and I have to start paying through the nose again. The whole time I was there, I kept wanting to slap him silly. If I were a hair’s breadth less stable, I would have too. Although I’m not entirely unsympathetic to a doctor's need to protect himself in the event of a lawsuit, I doubt that it sets well with many people to be forced to prove they’re not lying.

After I left his office, I went to another doctor’s office for an Orthovisc shot in the knee. He missed the joint three times, and kept having to jab that long old needle around. (Why, yes, thank you, it did hurt about as bad as it sounds like it would). I’m glad that I’m able to handle pain as well as I am. I’ve been so near absolute panic and/or despair so many times that I’ve lost count, yet I persist in believing that I handle pain better than most people. I’m probably a fool for thinking this, but it somehow helps me to maintain that illusion, if it be an illusion.

I’ve all but stopped smoking the medical marijuana (I’m still eating it in small amounts). After I poisoned myself (see August 8), it just never felt the same. When I smoke it now, the first thing that happens is that everything that makes me anxious or unhappy hits me at once and is multiplied by a factor of ten; and the second thing that happens is that I become a complete idiot. I can still write—I’m ripped right now in childish rebellion against the fact that the pain specialist told me not to mix pot with one of my new drugs—and it even makes me write when I wouldn’t otherwise want to, and about things I wouldn’t otherwise write about. Like now. Peggy’s off to New England for two weeks, and I had just as soon be working at a job that I started three days ago after postponing it for years for fear the pain would become unbearable. That job is painting the laundry room and building a new shelf unit for it. The work entails filling holes, moving heavy things, scrubbing the walls and ceiling with trisodium phosphate, cleaning up the mess, and then applying three coats of paint. Six years ago, it would have been a small job, but now it’s killing me. It’s also making me very happy because I do love manual labor.

With Peggy gone, I let Bonnie the dog and Brewsky the cat sleep wherever they please instead of locking them away like we usually do. Surprisingly, Brewsky has taken to sleeping with me in my twin bed. Two dudes together, you might say. I feel badly that Bonnie can’t join us, but it would be a bit much for me even if it wouldn’t invite trouble between her and Brewsky—it would also mean a move to Peggy’s double bed.

So, there you have it; I’m busy, so I’m not visiting blogs, and I wouldn’t be writing in one now if I hadn’t smoked that pot, because I really want to get this job done as a surprise for Peggy who after forty years still hasn’t learned that I’m dumb enough to do such a thing.

Things just keep getting stranger and stranger

Russell—my habitually jobless brother-in-law—lived by the motto: “Dope will get you through times of no money better than money will get you through times of no dope.” If Russell was out of marijuana, he would drive as far as it took and spend as much as necessary to get some, and he would smoke it all day everyday until he ran out. Then he divorced my sister, married a woman with three children who vehemently opposed drugs, and took a sixty-hour job at an egg factory (picture a filthy, smelly, ear-shattering, disease ridden, standing-room-only hell for a million defenseless creatures, and that’s an egg factory). Go figure.

I never wanted to smoke dope all day long, but I’ve been high to some extent for weeks now, and I can’t say that I oppose staying that way. Pot lessens my pain, lightens my mood, helps me sleep, decreases my stress, renews my sense of wonder, heightens my appreciation of music, helps me get along better with Peggy, makes me tolerant of—and interested in—other people, and enables me to be more honest yet more tactful. On the downside, it shreds my memory, makes me accident-prone, messes with my coordination, decreases my ability to judge time and speed, and probably has long-term consequences that I don’t even know about. This leads me to ask which are more important to me, the good things that pot gives or the good things that pot takes away. Right now, my vote is with number one. Sometimes, you don’t know how bad things have been until they get a little better, and pot has made things a great deal better. Fuck having brains; I just want to feel good.

As I see it, pot is different from narcotics, anti-depressants, and sleeping pills (all of which I’ve relied on heavily at one time or another) primarily in that it does a better job with less risk. I’ve taken a lot of powerful drugs, but they all scared me so much that I never had the balls to take as many as I actually needed, and my fear increased dramatically as I built up a tolerance to every one of them. One virtue of pot is that you’re not going to wake up with yellow eyes or failed kidneys, and I would sacrifice quite a few brains cells to avoid either of those. Brains are good, obviously, but you have to ask yourself after a certain point how many are strictly necessary. Of course, I’m assuming here that marijuana-related memory loss is long-term, and I don’t know that to be true… Now what was I saying?

The photo is of a psychedelic frogfish and was made by David Hall at seaphotos.com

Update

I am now living a life in which I am desperate for sleep. I don’t know why I’m in such pain, but since I felt similarly after my previous surgeries, only to eventually reach the point where I could sleep for up to four hours at a time, I can but hope that this time will be that way also. After all, I only had my third surgery nine weeks ago today.

Before my final awakening this morning, I dreamed that I flew bodily to the home of my friends—long since dead—Jim and Doris Bateman. I was so happy to have surrogate grandparents whom I could drop in on at any time that I cried, partly out of gratitude and partly because I couldn’t allow myself to believe that I was really welcome. When I awoke, I was desperate (it seems that I’m desperate about everything anymore) to have such people in my life again. I then realized that I do, really. I have Bella, and I also have a couple of elderly neighors who would love to have me visit. It’s not the same though now that I’m 62. Sadly, the time for grandparents is past.

I’m taking fewer narcotics because they don’t work well enough (outside of elevating my mood) to risk liver damage. Double doses of sleeping pills still deaden the pain enough for me to at least rest a little, although I worry far more about becoming dependent upon them than I ever worried about Demerol or Dilaudid. I’m still pursuing marijuana, and, because of my desperation, I have placed what is surely an inordinate amount of hope in it. Meanwhile, Obama just reversed his promise to not bust medical marijuana users, doctors, growers, and everyone else affiliated with the drug. Because Peggy is a nurse, I worry that she might lose her license simply by being married to me—sort of a collateral damage scenario. The waste, bigotry, and short-sightedness that is America leaves me aghast. I violate my conscience everytime I pay taxes. I mustn’t dwell on that though…. I see that the mailman just delivered my seventh medical bill of the week.

When I go to a doctor, I take along a summary of my problems so that I can express myself succinctly and not forget anything. The rest of this post consists of my summary from last week.

Treatments that have been of little or no benefit in relieving my bilateral shoulder pain:

Three shoulder surgeries in two years
Numerous steroid shots
Several courses of physical therapy
Dalmane, Restoril, Ambien, Lunesta, Hydrocodone, Oxycodone, Ultram, Demerol, Dilaudid, Naproxen, Piroxicam, Celebrex, Neurontin, Elavil, Tofranil, DMSO, Ginger, Turmeric, SAM-e, Habanero Peppers, Topical Anesthetics
Ice packs
Massage, Yoga, Acupuncture
Sleeping in a recliner

It is a good night when I am able to sleep two hours in a row before the pain awakens me, at which time I have to take more pills, get a fresh ice pack, or stay up for awhile. The pain makes it necessary for me to sleep entirely on my back, but my middle back hurts so much in that position that it combines with the shoulder pain to keep me awake.

Before the onset of shoulder pain, I enjoyed yardwork and handyman projects; but I have to be very cautious about such things lest the nighttime pain becomes so bad that I am challenged to sleep at all. I also enjoyed camping, but the pain now prevents me from doing that as well. Life as I had lived it for decades ended in 2006.

I’ve spent 4 ½ months out of the past two years in a sling, and 4 ½ additional months during which I couldn’t lift anything heavier than a cup of coffee. Now, I’m facing at least one more surgery. As with other treatments, I will submit to it simply because I am desperate for relief and don’t know what else to do.

Other complaints:

Burning pains in both shins was diagnosed by one doctor as complex regional pain syndrome and by another as syringomyelia. A third doctor disagreed with both diagnoses but didn’t have one of her own.

Raynaud’s Disease in both hands.

Advanced osteoarthritis in my left knee accompanied by a Baker’s Cyst and chondromalacia (a 2006 knee debridement failed to help).

An osteonecrotic C-5 vertebra that was initially thought to contribute to my shoulder pain, although a vertebral biopsy and a series of steroid shots to my neck failed to reduce the pain.

Sleep apnea for which I use a CPAP.

*Photo by O'Dea