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Sunday, October 12, 2014

A few days on opioids and gearing up for Ketamine day #1

Well, it's been a rough few days for days, and really weeks, for me. Up until mid-week, I had continued experimenting with different dosages and strains of my medical marijuana but still hadn't been able to recreate my magical Sunday (two weeks ago now).

Wednesday evening, Craig and I met with Dr. Dodick at Mayo to discuss his opinion on the ketamine infusion and see if there is anything else he thinks I should be trying. We both really love Dr. Dodick and appreciate not only his perspective and expertise, but his empathetic and respectful way of engaging in conversation with us. He gets it. So even though he was honest in sharing his general apprehension towards ketamine therapy based on his own experience (which included risk of toxicity and questionable efficacy in treating pain, specifically headaches), he agreed that for me...anything is worth a shot.

I've explained this many times before, but Dr. Dodick is confident that the reason for my initial pain (whatever it was..inflammation, ligament instability, etc), is no longer causing my headache. He believes (and I agree with him) that my headache has become centralized, meaning that it's likely no longer a matter of peripheral input. Chronic pain can change your brain chemistry and even the wiring of your central nervous system. It also creates muscular tension (for me, in my neck, traps, upper back), that can then feed back into the cycle of pain. The musculoskeletal dysfunction then can become a secondary contributor to pain, but not necessarily respond to soft-tissue treatment simply because it's actually more of a symptom of the pain than an underlying cause. That's why even though I'll continue exploring all approaches to treatment, the focus of reducing and eliminating my pain has shifted somewhat.

Wrapping my head around the mechanism of central pain hasn't been easy. When you sustain an injury that causes pain, you want everything about it to be tangible...the diagnosis, the pathology of pain, the prognosis of treatment and timeline to recovery. But there's really nothing about this that is straightforward...which can make the process of seeking treatment feel like a series of fingers-crossed shots in the dark....each failed attempt taking a serious toll on my dwindling hope. Lucky for me, Craig still tells me (on an almost daily basis) that if I can't find it in myself to believe that my headache will someday (hopefully some day soon) be gone and my life will be whatever I want it to be, I just need to believe that he believes. And somehow, that is easier for me to do.

Back to the appointment. After rehashing the list of medications I've been on to date, we realized that I've never actually been prescribed a pain medication. The list of drugs I have been on, though targeted at my pain, has included anti-seizure meds, anti-depressants, anti-inflammatories, etc., but never opioids (i.e. narcotics). Opioids are used to treat pain by binding to opioid receptors in the brain, spinal cord, and other parts of the body and then reduce the sending of pain messages to the brain.

Dr. Dodick proposed a trial of an opioid, Hydromorphone (i.e. Palladone or Dilaudid), for just a few days before deciding whether to move forward with the ketamine. The plan was to start a low dose of Hydromorphone Thursday morning, take it every 6 hours, up the dose Friday morning and then by Friday afternoon, IF i was feeling any better, I'd continue taking it for a few more weeks and stick the Ketamine plan on the back burner. If my pain wasn't down, I'd stop taking it and start the Ketamine this Monday per our original plan.

To be clear...I hate the idea of being on medication of any kind, as many people do. The only thing I hate more, though, is having a headache every waking second of my life. So I was on board and started with Hydromorphone Thursday morning, prepared for the expected drowsiness but going into it as optimistically as I could. Craig knows how hard it is mentally for me to pop pills, so to help get my mind right, he's constantly reminding me of how strong and resilient my body is...how well I nourish it with the most nutrient-dense foods possible and how well it will respond and bounce back from pouring any amount of pharmaceuticals into it.

Unfortunately, though, the Hydromorphone provided no pain relief and I ended up feeling like absolute shit on Thursday and Friday, Saturday, and still a bit today as it works its way out of my system. Groggy, dizzy, nauseous, the whole sha-bang. So, the plan now is to start the Ketamine infusion at Freedom Pain Hospital tomorrow morning. I'm scheduled for 5 days of treatment but we should know after tomorrow's session whether there's value in continuing the rest of the week. I'll try updating tomorrow afternoon depending on how I'm feeling.

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