Saturday, June 13, 2015

Coping With Post Surgical Pain

                         
This is a chapter from  my soon to be released book on penile implants.


I've learned how easy it is to lie to ourselves and then to our partner. If I were not in the process of writing an account of my journey with implant surgery I doubt I would have uncovered the truth about the reasons why something awful happened during my post surgical recovery.

The fateful day began with two wonderful events. I was toward the end of my third week post surgery. One morning I woke up to discover my second round of antibiotics was successful wiping out my infection. I breathed a huge sigh of relief.  This meant I wouldn’t need two additional surgeries. The first to remove the implant and a second to put in another implant a few weeks later. This turn of events led me to be in a celebratory mood.  The next amazing event combined with the first, made this day fantastic. When I examined my scrotum I discovered in a single night the swelling was completely gone. My scrotum was back to normal size. Best of all, I was completely pain free.  I was joyful.  Since I was pain free, I abruptly stopped taking my pain medication.

I was so delighted with this turn of events the very first thing I did was to call my Surgeon’s office to see whether I could get an appointment for my six week post surgery implant activation appointment. When I received an activation appointment date, I thought this day was one of the best days of my life.  From that point on Brenda and I expected the rest of my post surgery recovery would be uneventful.  We were both looking forward to the day I could use my implant.

Our celebration was short lived. Within a few hours, I felt as though I were coming down with the flu. I experienced a severe case of the chills so I put on a winter coat while everyone else in the house was wearing spring clothing. It didn't take long for chills to stop, then I begin to sweat. At that point I needed to remove my winter coat and wear light clothing.  During the next few hours I’d alternate between feeling very cold and very hot.

At bedtime I was too agitated to stay in bed. I began pacing around the house. I tried to sit in one place, but I couldn’t.  As I paced around the house through the night, somewhere between 4-5am it occurred to me I wasn’t dealing with a sudden case of the flu. Something else was going on. I went on line and googled “symptoms of oxycodone withdrawal”  As I looked at the list of symptoms I found I experiencing enough of the withdrawal symptoms that I ruled out the possibility I had the flu and began to wonder whether I was going through oxycodone withdrawal. As I stared down the list of twenty symptoms, I had seven. They were:
 *anxiety
*diarrhea
*difficulty falling asleep or staying asleep
*irritability
*restlessness
 *sweating
 *chills

I found it difficult to believe I was going through withdrawal symptoms. I kept saying to myself, this can't be happening. When morning came, I’d been awake most of the night. Day two was no different from day one.  On night two in the middle of the night as I paced around the house, I realized I’d reached to end of my capacity to cope with withdrawal from oxycodone by myself. I wasn't sure what to do, but I one thing was certain, I vowed I would not spend a third night going through oxycodone withdrawal. I decided I’d take as much oxycodone as necessary to end my symptoms of withdrawal. I’d made the decision if it were necessary on night three to go back on oxycodone, I was going to call a rehab center the next morning and ask to be admitted for oxycodone withdrawal.  If you have asked me that night if it was worth the pain and suffering to have penile implant surgery, I would have answered you back by saying: “Absolutely not, avoid this surgery like the plague.” 

I can’t put in to words the relief I felt when I went to bed on night three and fell asleep. I’d completed the process of oxycodone withdrawal cold turkey. This crisis was over. There is a difference between addiction, which involves a compulsion to use a drug vs being dependent on a drug. Thankfully, I was not addicted. As soon as the pain went away it was an easy decision to stop using oxycodone. I had no desire to use any pain medication once the pain was gone. What neither of us understood at the time is how or why this happened to me. It would take me four months to uncover the truth.

I asked a physician who was a friend of my mine how was it possible to become dependent on oxycodone in such a short time. He told me that most people following surgery experience gradual pain relief and taper off their medication slowly and gradually. In my situation the pain stopped abruptly, so I didn’t taper off pain medication gradually, which caused me to go through withdrawal. His answer explained what occurred in a way we both understood. We both believed the mistake I made was to suddenly stop taking oxycodone. The truth remained buried for a few months longer until I began to write this chapter for the book.

I reached the point in this chapter where I wanted to put together a list of the medications I would have taken to a drug detox center had it been necessary for me to go there. When I went to the medicine cabinet to pull out everything I’d been taking for pain, I was in for a rude awakening. The first bottle I found was my oxycodone. I remember when I decided that taking this every four hours was doing nothing for my pain, so I moved it up to every three hours. This meant I was taking oxycodone six to seven times a day.

As I was doing some research about the maximum daily recommended dose for oxycodone I discovered that a total daily doses greater than 80 mg, may cause fatal respiratory depression when administered to patients who are not tolerant to the respiratory depressant effects of opioids. I was at higher risk for this since I have moderately severe sleep apnea. Oxycodone can become habit-forming, even at regular doses. The higher the dose the higher the likelihood you’ll end up addicted or drug dependent.  An acetaminophen overdose can damage your liver or cause death.

I can’t be certain, but I do believe knowing these dangers might have prevented me from moving my dose from every four to every three hours. If that’s all I did, I put myself in life threatening danger, but that wasn’t all I did.  Since oxycodone did not relieve my pain, I went into my supply of medications at home to see what else I could take to get bring down the pain to tolerable levels. I found some powerful medications to mix with oxycodone.

The second medication I took was liquid hydrocodone.  The maximum daily dose for this drug was six tablespoonfuls daily. I have no way of knowing exactly how much of this drug I was using because I didn’t use a tablespoon to measure my dose, I’d take what a call a swig. I lifted the bottle to my mouth and drank what I thought might be two tablespoons. I did this at least three times a day.

That wasn’t all. I found a bottle of tramadol.  I found this warning about tramadol on-line: You should not take tramadol if you have used narcotic medications within the past few hours and this, MISUSE OF NARCOTIC PAIN MEDICATION CAN CAUSE ADDICTION, OVERDOSE, OR DEATH,
Tramadol is another drug that can slow or stop your breathing.

Since bedtime was the most painful part of my day here’s what I did on most nights. I’d take an oxycodone and, wash it down with a swig of liquid hydrocodone.  If I were in severe a third pain reliever called tramadol. After the tramadol, I took restoril every night to help me get to sleep. It’s reasonable to wonder how on earth I managed to accumulate so many different pain medications. I hoard my medications. Usually I try to stop taking them as quickly as possible so I can save them for another episode or bout with chronic pain. This was the first time in my life that I’d ever combined pain medication in this way. If I want to live to a ripe old age, this also was the last time I’ll make this mistake.

Frankly, as I looked up each of the medications I was taking daily, I’m amazed that I survived the combination of powerful pain relieving prescription drugs I was using daily. If it were necessary for me to go to a Drug Detox Center, I have no doubt they would have classified me as a serious abuser of pain medications who developed a life threatening habit.

What I learned about myself isn’t pretty.  I suspect this applies to tens of thousands of people who experience unrelenting and/or chronic pain.  In order to experience pain relief I was willing to lie to myself and to my wife. I was willing to risk the possibility of addiction, drug dependence, an overdose, or death. I was single minded.  I needed pain relief and I was willing to do anything to bring my pain down to manageable levels. I never expected of one of the take always from my experience with implant surgery was an up close and personal understanding of how people end up addicted, accidentally overdosed or die as a result of mixing a variety of prescription drugs.

Once I gained these insights, I knew I needed to tell my wife the truth.  I’d been combining a variety of prescription drugs without telling her what I was doing. Since the danger past and I’d survived, I seriously underestimated the devastation Brenda experienced when I told her exactly what I did. I assumed that Brenda would be as grateful as I was that I’d survived. Brenda wasn’t grateful, she was rightfully ticked off. I’d lied to her.  I’d taken dangerous and potentially fatal amounts of prescription drugs. I’d become drug dependent. We went through three days of withdrawal together without Brenda knowing that I combined and abused multiple pain medications.  By far, the worst consequence of confessing to Brenda how I abused multiple pain medication was the loss of her trust in my judgement. Brenda’s greatest fear is that I’ll repeat this behavior of lying and combining pain medications the next time I face chronic pain. It’s important to me and it’s important to Brenda I don’t make this mistake a second time.

For the record, if you were to ask me today, four months post surgery whether I recommend implant surgery, without any hesitation I'd say a resounding Yes it is, but  read my soon to be released book to avoid a lot of unnecessary suffering.

Comments and feedback are appreciated.

Rick Redner and his wife Brenda are the authors of an awarding winning book written to help men and couples cope with life without a prostate. I Left My Prostate in San Francisco-Where’s Yours? Coping With The Emotional, Relational, Spiritual & Sexual Aspects of Prostate Cancer
 can  be previewed and purchased at 
Amazon.com