Post-Surgery Withdrawals/Recovery

On Monday, I underwent spinal surgery. Two small pieces of spinal disc were somehow chipped off of one of my discs and stuck in the nerve canal of one of my vertebrae. The surgery was a success and requires two to three weeks of recovery.

During my pre-surgery meeting, my surgeon told me he would use Dilaudid, which is an opioid and a derivative of morphine, for my pain relief and then prescribe morphine for the pain. I immediately let him know I had previously been on medically prescribed morphine for a year and was not interested in having to manage withdrawals and would prefer something else. He said he would accommodate my request regarding the post-surgery pain management and use Tylenol with Codeine along with muscle relaxants.

Well, I stopped taking the Tylenol w/ Codeine and the muscle relaxants on Thursday morning and have since been experiencing what I can only describe as withdrawal symptoms. I have no concerns about addiction issues. I'm just disappointed that I'm going through withdrawals after being on narcotics for only 48 hours. And perhaps that's what I can expect as a result of a being on morphine for a year. Hopefully the withdrawal symptoms will subside in a day or two and not drag on for 10 days like the morphine withdrawals did.

On a good note, Extra-Strength Tylenol seems to be enough to manage the post-surgery pain. If all goes well, my medical leave from work will only last two weeks at the most.

Where's My Morphine???

Wow! I am amazed at the degree to which the morphine had masked the pain and discomfort that results from the Neulasta shot I receive on the day that follows my bi-weekly chemotherapy treatments. The shot stimulates the production of white blood cells because it is white blood cells that are inadvertently destroyed by chemotherapy. And as a result, there is pain that shows up in the body's largest bones since that is where the greatest number of white blood cells are produced at this faster than normal rate. A little Extra Strength Tylenol seemed to help reduce the pain a little bit.

Had I known, I would have waited to kick the morphine until after my full regimen of chemotherapy was completed in the Spring of '09 and as a result, had a far less painful experience. Oh well. Too late for that!

...and reeling...

The pain I am experiencing from this withdrawal and detox is fascinating. The pain is throughout my body from my toes to my eyeballs along with hot and cold flashes that come and go. The greatest aches are from my elbows and forearms into my wrists and hands as well as from my hips through my knees and into my calves and ankles. I also have pain in my eyes - directly under my eyelids. And the inside of my mouth hurts as well, specifically the roof of my mouth.

Throughout the day I have also had back pain in the thoracic vertebrae. Daniela has kindly rubbed my muscles when the pain has gotten intense. At the moment, my hands are killing me, but for some reason it's not making typing difficult. And my ears ache as well. Ya know, I guess it's safe to say that I am in pain just about everywhere in my body - from my toes to my eyeballs [I feel like I've heard that somewhere].

So that's the update and I hope I can tough it through without taking anymore Roxanol. I want to get this over with as soon as possible.

My Latest Adventure

My latest adventure, with the help of Dr. Allerton, is to get off of morphine for good. I was on a 25 microgram patch for...quite a while...many months. A month or so ago, Dr. Allerton put me on a 12 microgram patch for which I noticed no withdrawal symptoms.

On Friday November 7th, my patch was due to be replaced (they must be replaced every three days). On Wednesday November 5th, during my chemotherapy treatment, Dr. Allerton recommended I not replace the patch on Friday and instead simply take a 5 mg dose of Roxanol (liquid morphine) when ever the withdrawal symptoms become too much to deal with. The idea is that I will eventually no longer require the Roxanol and be able to push through the detox symptoms (commonly know as DTs) without the use of it.

I'm looking forward to no longer being on the stuff. As I have posted in the past, I have woken up in the middle of the night going through a detox because I forgot to replace my patch a few different times and it's quite an unpleasant experience. I definitely look forward to being without it. The only part I left out is asking Dr. Allerton how long this process is expected to take. I'll have to send him an email and find out.

In Need of My Patch

On Tuesday night I went to bed around 1:30 AM or so. I was quite tired and looking forward to some deep sleep. After almost falling asleep a couple of times, I found myself wide awake but I also felt a strange sensation in my arm - a tension like sensation. I shook my arm a few times just to get the feeling out. Then I had the same experience in my leg. Eventually I went back downstairs and laid down on the couch. If this was what falling asleep was going to be like, I would at least do it downstairs where I wouldn't wake Daniela and Beau.

I read for a while until I could no longer bare to do so any longer. I found myself filled with tension and an inability to concentrate. All of a sudden it hit me and my eyes were as wide as saucers - I never put on a new Fentanyl patch aka morphine patch. My morphine patches must be replaced every three days and last night at 3 AM, I was about 5 1/2 days past due.

Yup. I was in the early stage of morphine withdrawal. I immediately adhered a new patch to my leg and then took 2.5 mg of Roxonal (aka liquid morphine) - what I consider a half dose - since it would be a while before the patch made its way into my system.

If you have a concern about how much morphine I took between the patch and the liquid, you need not worry. My tolerance is quite high compared to someone who does not take morphine. If I gave you 10 mg of liquid morphine, you would probably throw up and then sleep for three days. I on the other hand, would take 10 mg of Roxonal on top of what I get through the patch each day and I would relax on the couch to a good movie or read a book. It's not the intention, just the result of 10 months of daily morphine usage.

So anyway, I figured I'd fall right asleep. Oh no. It was about 3:30 AM when I began to feel some relief. And at 4 AM - I couldn't believe it - I was wide awake and not about to fall asleep. By 5:30 AM I began to wonder when exactly I would fall asleep. At 6:30 AM I woke up and fell back asleep. Aaaahhhhhh. How peaceful.

Daniela & Beau came downstairs at 8:36 AM. I thought I would head upstairs and get in a few more hours of sleep. Well I never made it upstairs and I've been awake ever since - right now it's 10:15 PM.

What an odd experience to go through all of that last night and then to be wide awake all day today. On a good note, I went through two days without a new patch without any serious pain. Granted it takes a bit for the morphine to exit the human body when you've been on it as long as I have. But it's a good sign. I should be able to start weaning myself off of the stuff which I very much look forward to. Because not being able to sleep at night because "I didn't get my fix" ain't exactly something I want to continue any longer than I have to. And you can be darn sure I will adhere a new Fentanyl patch every three days as long as it's a part of my pain regimen.

Incredibly Lucky

In case you don't remember, to stand in place has been very difficult for me. I have only been able to stand still for a minute at the most. After that, the aching pain of the tumor becomes too much. Also, sitting can be painful, especially if it's on a wooden chair. And walking...well, it doesn't hurt, but if I walk a significant distance, I will be in serious need of a bathroom and consider myself lucky if I get there in time.

Well on Saturday, I went to a friends house to listen to the final mix of my upcoming record. After the listening session, we hung out in the kitchen for about 45 minutes. What amazed me is that I sat on a cushioned stool with my Tempur-Pedic cushion for almost the entire 45 minutes with no pain. THAT is a first. Later we dropped off the CD for duplication and then went to dinner. Fortunately we were able to park across the street from the restaurant so the walking was minimal. But then we sat and had our meal for almost an hour and again I had no pain.

On Saturday I stood for three to four minutes at a time with no pain and even carried Beau in from the car again with absolutely no pain. I brought Beau in from the car again this evening and then walked him him upstairs to bed upon his request. [By the way, it was SO incredibly cute. I held both his hands as we climbed the steps and I watched as he stepped on the next step ahead of him only to then stretch his little leg over not just one, but two steps and then he continued this random pattern until we reached the landing. He didn't miss a beat. It was adorable.] So, my point is that although I am still on morphine, my pain level has gone way down. And since Dr. Cagir has noted major tumor shrinkage, I'm hoping this decrease in pain is related to the decrease in tumor size.

Believe it or not, the radiation is still attacking the tumor even this far along after the treatment has ended. So, wouldn't it be sweet if there was continued shrinkage and the tumor had zero contact with the pelvic bone? As you can imagine, that's what I'm shooting for.

And on the topic of the tumor, folks have been asking me how I'm doing considering that the surgery is only days away. Well, Daniela acknowledged that a week or so ago I was going on tirades about anyone and everyone - but of course not you. I was definitely uptight. On Friday I was still amped up. If it was 10 years ago and I was still drinking alcohol, I'm sure I would have put on quite a performance. I was clearly emoting quite well on Friday.

Now that that's out of me, I feel fine. I'm three days out from surgery and I'm definitely not stressed. I have no desire to be cut open and reconfigured - I hope that's a given - but at the moment I'm looking forward to opening my eyes on Wednesday following the surgery and being told everything went well. And other than that, the only other concerns I have is if the hospital will have enough channels so I can catch the Red Sox on Saturday and if the Sox will maintain their lead in the American League East. There's also my hope that the American League wins the All-Star Game so they have home field advantage in the Series, but let's not even open that can of worms.

There are other concerns as far as the outcome of the surgery and future oncological treatments, but no matter how much I worry or how scared I become, all the worry and fear in the world won't make the outcome of the surgery any better. Or the treatments that follow for that matter. At best it would just stress me out and make me miserable. And since that isn't particularly appealing and there isn't anything I can do but wait, I'm just going to wait. And we'll see. And to tell you the truth, all the inspirational perspectives in the world don't do a damn bit of good just because I can recite one after another, but for some reason right now, the one I shared about worry and fear is simple & true for me and exactly where I am. And for that little gift of perspective [and an absolutely extraordinary wife], I consider myself incredibly lucky.