Construction Nightmares

So, Monday the floor installers were here to put in new hardwoods due to our “little flood.” Two men showed up around 9:30 am. Very friendly and professional. Mom and I had spent the previous week boxing and/or bagging what we could to help. We emptied out China closets and hutches, gave away a ton of items to Salvation Army, and moved what we could. I was already in 9+ pain from the additional exertion. My back was in spasms, my hip was on fire, and my poor head was begging me for some relief. I took my usual meds and threw in some Advil for an additional boost. I was welcoming, good-natured, and smiling at the workmen. Then, it began. Hammering, sawing, nail guns, compressors, doors slamming, loud voices, etc. Even my noise-cancelling headphones didn’t help. These nice people, who were only doing their job were on my shit list. They invaded my safe place, my bubble, my sanctuary. I had no where to go. I had to wait it out. 3  days. Seems like nothing. It was hell on earth for me. I took extra pain meds. I tried relaxation techniques. The noise was piercing my brain. Finally, I cried. It hurt so badly. Daytime nightmare. I know it sounds like I’m exaggerating, but I’m not. If you are a fellow migraine sufferer, you understand how noise, light, smells are amplified 1000%. They were finally done and everything looks beautiful. But as they packed up for the last time, I admit I was beyond thrilled to get back to my reality. Where I’m in control of my surroundings. I let out a huge sigh of relief. Until Mom said, “What do you think about redoing the kitchen?” Arrrggghhhh! Carrying on. Always keep fighting!

Don’t you cry no more!

Musings At Dawn

So, I seem to be discovering new symptoms almost daily. WTH?! The bottoms of my feet hurt and are cracked. My ankles hurt. My legs are weak and I feel like they may not hold me up. My elbows are painful to certain motions. My fingers feel tight and swollen (don’t look it) and hurt like hell. My vision is blurred and I have to strain to see. (This may be a med side effect.) My night vision is even worse that it used to be. I’m sure there are others, but it’s 3 am and I’m not at full capacity. Although I never am anymore. What is happening to me?! Why is this happening to me?! What can I do to make it stop?! Trying my damnedest to carry on and keep fighting! wpid-wp-1423238659414.jpeg

In The Dark

I always loved the sunshine. I adored the beach on a sunny day. I’d sit on the patio and stare up at the sky. My body seemed to crave the sunlight. It made me strong and positive. I left the lights in the house on. I felt safer in the light. I noticed I’d get depressed if I didn’t have enough light. I was more prone to bouts of sadness in the winter. Rainy days were days for me to reflect, think too much, and cry. It’s funny what a difference almost five years of chronic migraine and Fibromyalgia can make. Not funny like ha ha. Ironic funny.

Now, I find comfort in the dark. I never used to. I feel safe here. I’m awake for most of the night. I record my thoughts. I read stories when the migraines allow. I just sit in the dark, curled up in my favorite chair. Usually with a lapful of purring tuxedo cat. Samantha lulls me into a comfortable state of mind. I don’t cry much at night. I’m almost content. The pain fades into the background. Maybe knowing I don’t have to do anything or go anywhere. There’s no stress. I can almost pretend that my life is normal.

Then morning comes. I’m rudely shaken from my safe place. It gets lighter outside. The birds and squirrels grab Sam’s attention. She’s off to the window. I think about what I need to get done. I wonder if I’ll get to do any of it. The pain comes back to the forefront. I’m stripped of my security bubble. I have to try to function. Act like a “normal” person. Deal with reality. Be responsible. In the light of day, it’s hard to hide. I don’t want to be seen. I’m not who I was before. It’s not as obvious at night. I can pretend things are okay.

I’ll struggle through this day because I have to. I’ll do what I can and try not to feel guilty about what I can’t. I’ll smile and, if asked, say I’m doing pretty well. The entire time just waiting for nighttime to return. To get back inside my cloak of darkness. My safe place. My world. wpid-img_20150323_064829.jpg

Midnight Ramblings

So I’ve been sitting here, alone, in the dark, just me and my thoughts. Never a good combination. I’ve been awake for hours. Got a few hours of tossing and turning in. Trying to get comfortable. Not able to find a good position. So much worse since I fell last week. Everything is bruised and/or scraped. I can’t tell which pains are from the fall and which are from the usual suspects (Fibro, migraine). It’s a strange feeling knowing that when most people injure themselves, once they heal the pain is gone. My bruises will fade. My cuts will heal. But my pain will remain. Not even a short respite. Doesn’t seem fair. But who said life was fair?! Like I said, me, alone with my thoughts, 2 iffy hours of sleep, not a good combo. Oh well, carry on fellow pain warriors. Do what you can and don’t push too hard. Better days ahead. I hope. wpid-wp-1432820304823.jpeg

Now This: Perimenopause May Make Migraines Worse Editor’s PickFebruary 3, 201

Attributing article from @MigraineAgain:

Understanding the uproar over Zohydro ER JAMES PATRICK MURPHY, MD | MEDS | MARCH 30, 2014

wpid-fb_img_1424364439689.jpgIn March 2014, Zohydro ER (hydrocodone extended-release) was introduced to the market. Never in my medical lifetime do I recall a medication stirring such angst. Worries of mass overdoses, backdoor FDA conspiracies, and blatant disregard for the public well-being abound. Is there method to this madness?

Zohydro ER is a pain pill that, when taken by mouth, is released slowly over twelve hours. The active ingredient, hydrocodone, is an opioid (i.e. narcotic) that’s been around for decades in a short-acting pill form (e.g. Lortab, Vicodin, Norco) and has historically been combined with APAP (a.k.a. acetaminophen, Tylenol). The FDA considers hydrocodone-APAP combination pills to be relatively less addictive and designates them as a schedule 3 drug. Physicians can prescribe schedule 3 drugs over the phone, with up to six refills. By contrast, schedule 2 drugs (e.g. morphine, oxycodone, oxymorphone), even when combined with APAP, are considered more addictive, can’t be called in, and can’t be refilled without a new hard copy prescription.

Because it is effective for pain, relatively well tolerated, and convenient to prescribe, hydrocodone-APAP pills have become the most commonly prescribed opioid in the United States. It’s therefore not surprising that, since there’s so much in circulation, hydrocodone-APAP pills are frequently the most available opioid for abusers to abuse. Add to this the legitimate worry about acetaminophen (APAP) overuse causing liver failure, and you can understand our leaders’ concerns surrounding this pain medication.

Enter Zohydro ER, the first extended-release hydrocodone pill without APAP. It’s easy on the liver and lasts twelve hours; so people with around-the-clock pain may need fewer pills per day. Additionally, it’s a schedule 2 drug. In summary, Zohydro ER is a long-lasting version of a widely used and effective opioid, which until now had only been available in combination with acetaminophen. So why the controversy?

Zohydro ER does not have any of the new and popular tamper-resistant technologies; e.g. a matrix that won’t dissolve easily, or a coating that is difficult to crush. Instead, the makers took advantage of a delivery system (SODAS) already used successfully in a number other of extended-release drugs such as: Ritalin LA, Focalin XR, Luvox CR, and Avinza.
Oxycontin and Opana ER are two examples of opioids that manufacturers took off the market briefly for reformulation as tamper-resistant. However, while the changes have made them more difficult to snort or inject, many addicts still find ways to abuse these drugs or have just moved on to heroin. Tamper-resistant does not mean tamper-proof.

By the way, the generic form of Opana ER (oxymorphone extended-release) was not reformulated and is still available without tamper-resistant technology. Also, consider that Avinza (morphine extended-release), which employs the same sustained-release system (SODAS) as Zohydro ER, has neither been recalled nor been required to undergo reformulation. In reality, probably 90% of the opioids in circulation do not have tamper-resistant formulations.

That’s why I have difficulty understanding the uproar over Zohydro ER. As a pain specialist, I welcome another effective treatment to offer chronic pain sufferers. Sure, I’d be happier if it had a hard coating or some other “deterrent” to abuse. But in reality, Zohydro ER is, for all practical purposes, neither safer nor more dangerous than many of the drugs I already prescribe with success. So far, tamper-resistant innovations have not been proven to be effective in the big scheme of things. All opioids, regardless of the formulation, must be prescribed with caution and careful monitoring.
According to the American Society of Addiction Medicine, there are four main factors that contribute to a drug being addictive:

How much will it cost me? All things considered equal, people will choose a drug that is cheaper.
How fast does it get to my brain? Hydrocodone is water-soluble and actually diffuses into the brain slower than many other opioids.
What kind of a buzz will I get? Opioids stimulate the brain’s “reward circuit.” There is no proof that hydrocodone is any worse in this regard than other opioids.
How much of it can I get my hands on? People will abuse what is available to them. Since hydrocodone is the most prescribed opioid, expect it to be one of the most abused. It follows that if Zohydro ER floods the market it will be abused.
Therefore, my recommendations to physicians are:

Prescribe Zohydro ER in the lowest dose possible, for the shortest duration of time, and only if the benefits outweigh the risks.
Monitor regularly for effectiveness, side effects, and patient compliance.
Educate yourself and your patient.
Follow guidelines and regulations faithfully.
By the way, that’s my advice to physicians regardless of which opioid they prescribe.

Zohydro ER may not be tamper-resistant, but tamper-resistant drugs are not super heroes. Do not expect them to save us from the real villain.

The real villain is not the FDA, not the drug company, not the drug, and not the patient.

The villain is the disease of addiction.

Focus on the disease. Prevent the disease. Treat the disease.

This Zohydro hullabaloo is a prime opportunity to shine light on the problems surrounding prescription drug abuse and addiction. Let’s take advantage of it.

And stop the madness.

James Patrick Murphy is a physician who blogs at The Painful Truth. He can be reached on Twitter @jamespmurphymd.