Life as an Extreme Sport

Author: Kelly

AHA tells docs: don’t treat chronic pain with drugs

...and everything else, Bioethics

To be honest, this has me sort of speechless. I will be the first to admit that I can be a bit irrationally biased when it comes to the topic of pain management, but that’s in large part because nights like tonight, while not common, are also not very rare: I’m laying on a heating pad, have targeted heat strips on several key pain sites, and am both counting down when I can take my next short acting pain control medication, and contemplating doubling the dose of my longer acting pain medicine.

In short, I’m hurting. And I get very cranky when I see people making recommendations that, were they followed when I was first diagnosed with a chronic pain issue, would have kept me in pain for months while we ran through all of the American Heart Association guidelines.

According to this release,

Patients should be treated first with nonmedicinal measures such as physical therapy, hot or cold packs, exercise, weight loss, and orthotics before doctors even consider medication, said the AHA scientific statement published in the journal Circulation.

Patients who get no relief after those measures have been exhausted can be considered for drug therapy, but doctors should try drugs only in a certain order, the statement said:

“In general, the least risky medication should be tried first, with escalation only if the first medication is ineffective. In practice, this usually means starting with acetaminophen or aspirin at the lowest efficacious dose, especially for short-term needs.”

While most patients are likely to be helped by those drugs, a smaller number may need to try a drug such as naproxen. Patients who require additional help should be given other nonprescription painkillers such as ibuprofen, and only after that option has been exhausted should physicians consider Cox-2 inhibitors.

Oh, where to begin? By the time I finally saw my doc for the pain I was experiencing in my arm, I was in significant discomfort. I was taking 2400-3600mg of ibuprofin a day, barely sleeping, cranky, and had already damaged my posture because I was “sheltering” my injured area. Touching my arm often resulted in me screaming involuntarily. The gust of the fan across my skin brought tears, and I would occasionally run from wherever I was to the shower to let hot water run over my arm and shoulder – the only thing that would bring even a bit of relief.

To even be able to tolerate physical therapy, I had to be drugged to almost unconsciousness. A single woman, I needed to arrange for people to be able to escort me to and from therapy, or have a taxi waiting.

As is, it took my fabulously responsive doctor four months to diagnose me to the point I could be shipped off to a pain management doctor. If, during that time, she hadn’t liberally prescribed a variety of pain medications – including Cox-2 inhibitors – until we hit on a combination that worked for me, I honestly don’t know what I would have done. There were times – there are still times – where the pain gets so intense, so bad, that I become almost consumed by the idea of cutting the arm off, of permanently relieving the pain. I might have broken a limb – left hand, arm, or foot, just to get temporary relief from the fiery pain burning up my right arm. I might have harmed myself worse than that.

And speaking of pain management docs – did AHA even consider consulting any before making these declarations that affect the profession?

I realize I’m rambling a bit – like I said, I’m actually in significant pain tonight, and I’ve had very little sleep the last few days. But I am just aghast that this statement by the AHA presumes to tell another specialty what and how to treat, as well as presumes that there are either NSAIDs or Cox-2 and nothing else.

There are many ways to treat chronic pain problems, and how the treatment happens should depend on the individual scenario. While it would have been perfectly fine for the AHA to come out and say “look, there are some serious risks associated with both the Cox-2 and NSAIDs, and here they are, and this is how we’d recommend using them” – well, okay, that’s one thing. But that’s a far cry from recommending not how to use medication but to treat patients, and from declaring that no chronic pain patient should receive painkillers until after they’ve jumped through a long and potentially detrimental (without relief) series of hoops.

CIRM Check

Bioethics

Apparently the Oscars were a good nod for CIRM, too – the 1st District Court of Appeals has upheld a lower court decision that ruled in favour of the creation of the institute. The legal challenges came from abortion opponents and anti-tax activists, who worked together to challenge the legality of the of the program, questioning whether it violated a host of laws concerning state spending, oversight, conflicts of interest, and the very structure of ballot initiatives.

The immediate result of the litigation was that CIRM has been unable to issue any of the earmarked $3 billion in bonds, although the program was able to award its first research grants (nearly $45 million worth) thanks to a combination of loans from the government and philanthropists.

While opponents will probably appeal to the California Supreme Court, everyone on the CIRM side of things seems to believe that even if the state Supreme Court opted to hear the case (and some are saying that the ruling is so strong, there’s no way the court would even hear an appeal), it would be ruled on before the end of the year, and that CIRM will be able to begin allocating their $3 billion very soon.

Here’s to some crossed fingers and positive vibes to the state currently south of me. A lot of other states are watching CIRM intently, hoping for a role model – it’d be nice if it could be a positive role model.

fractures

Duct Tape and Prayers

Everyone says you have to be strong in the face of cancer. Brave and optimistic, you put up this facade in front of everyone; patient, family, friends. And everyone in the house is doing it, straining the mask of proper behaviour to fractures. Because no one wants to burden anyone else, no one wants to be seen as weak, no one wants to have done something wrong.

Mom breaks, sometimes. She’ll see something on TV, or read something, or spend just a little too long along with her thoughts, and then the tears and frustration and despair and fear come pouring out, laced with apology for showing it in the first place. But the rest of us soldier on in our small rooms, alone save whatever furry beasts call us their own.

The stress is taking its toll. My parents have been bickering since I’ve been back, to the point that within 24 hours, over the weekend, I yelled at them both. Dad, for just not listening, and Mom for not letting Dad do anything to help, and faulting him for anything he did (whether it was good or bad). But the stress spreads – I find my temper getting shorter with everyone, friends and colleagues, and being online is a questionable idea. (And oh, my poor boss, who’s received a good chunk of temper, whether he realizes it or not. And lucky, lucky me for having such a dream boss in my life!)

I set up a meditation area in my bedroom last week, thinking that I needed the reminder to sit, to breathe, to center myself. Unfortunately, I’ve managed to get myself so wound up in the short time I’ve been back, with so many different stresses pulling at me at once, that physically staying still long enough to meditate makes me more tense and antsy than any good can cover.

I’m hoping that my 36 hour escape to Seattle later this week will give me the chance to take a deep breath and let the fractures settle back around me. That I’ll be able to unwind, laugh, relax in the company of people I’ve known for years. Where there are injokes that I’m a part of, and the last thing I need to worry about is, well, anything.

Of course, since I’ve already managed to tie myself in such a tight knot, I am worrying that returning to Seattle for the first time since moving in June will be the very wrong thing to do. That I will either be homesick, or…maybe worse…discover I don’t miss anything about it at all.

The sound of the TV is drifting down the stairs into my room, the low strains of my iPod and purring cats drowned by vague baritones and canned laughter. I keep drifting off to sleep with the rhythm of my breathing, only to have a particularly high-pitched noise snap me back awake. It’s a state I’ll drift in until my parents go to bed; too tired to do anything but lay here until sleep sticks and 5am comes. Lay here in my fractured pieces, knowing everyone is suffering from the stress, and no one is talking.

CIRM Meets Oscar

Bioethics


If you blinked, you might have missed it, but Tom Cruise just mentioned stem cell research and CIRM at the Oscars (during a humanitarian award presentation), and the CIRM logo was up on the screen just long enough for both of my parents to go “huh, do you know anything about that?”

there are times when it’s not a good idea to be awake

Academics, Bioethics, Duct Tape and Prayers

It’s 3:00pm, approximately, on a Sunday afternoon. I have been awake close to 11 hours at this point. Perhaps it is no surprise that I am, in a word, cranky.

My arm is killing me. Another not big surprise, since I’ve probably done more sustained writing, reading and typing in the last two weeks than I have in the last year. Normally, I’m at least semi-sane at pacing myself. But I really outdid myself with stupid, especially the last couple of days. This does not make the cranky any better. In fact, it makes it worse.

I would make a crack about being driven to drink – Blogger alone has given me a massive headache – except that the reality is, I’m going to have to drive myself to the store to get alcohol, and the only option in Oregon on a Sunday is beer or wine. (I’d really like to find a nice bottle of vodka, and some tasty flavoured liquor to spike it with. But no, Oregon has to have the most asinine liquor laws in the nation.)

So instead I’m going to do what any sane person in my position would do. Remove the cat from laying across said fubar’d arm, dose myself with the various painkillers I have on hand, turn off email, crawl under a blanket, and forget the world outside my room exists.