The Other Side of the Opioid Epidemic

Just about a year ago today, I had my hip replaced. I was born with hip dysplasia, and as I got older, my hip began to give me greater and greater grief. I finally, at almost fifty-one broke down and agreed to the operation. My doctor, Dr. Craig Tingy is apparently one of the best orthopedic surgeons in Las Vegas; he briefly went over the recovery and ramifications of having total hip arthroplasty. I should be fully recovered after about six weeks. Awesome! I have a beautiful 120 pound lab and live in a condo, so a lengthy down time was not an option. Dr. Tingy failed to tell me, however that eighteen out of every one hundred hip replacements need to be revised, according to a recent study. There are many factors involved, however, my surgical experience and subsequent revision and horror story is a result of good old fashioned human error. Dr. Tingy hammered the prosthetic into my femur and fractured it, requiring a second surgery. The pain ancillary to a fractured femur is something I can hardly describe. The femur is the strongest and most utilized bone in the body; putting pressure on a fractured one is literally impossible. After the second surgery, which followed the first one by seventeen days, I was sent home on a walker. This was a bad decision, as my leg gave out, causing a fall, resulting in a dislocation of the hip and a broken trochanter. A third surgery was obviously necessary. During the third surgery, I contracted a staph infection, resulting in a pic line to administer IV antibiotics for six weeks. Needless to say, the recovery was arduous!

I was prescribed a plethora of opioid pain medication, and I mean a plethora. I'm gonna guess that I took a thousand pills from November 1, 2016 to April 1, 2017, all of which is included in a DEA file on me. Let me just just interject, the amount of pills is clearly available to the eyes of pharmacists, doctors, law enforcement and the United States Government, however, what the doctors and the hospital did to me that required me to consume such a mass quantity of narcotics is not; under HIPPA, THAT information is private, and while I will gladly release it, no one really cares to see it, as it is antithetically concise to the medication record, which simply lists the narcotic pain medication a patient has received. During March and April, I worked with my doctors to decrease the amount of pain medication I was taking; this was by my choice. It was never suggested to me by my orthopedic, primary or pain management doctors, nor was it advised by my pharmacy. By May of this year, I was narcotic-free and walking my dog further and further. Over the summer, I swam for strength training, participated in physical therapy and began my new life with my new hip.

And then...

In September, I began to experience pain in my femur, so I saw my primary doctor who thought perhaps I might be overdoing it a bit, and I had been pushing myself, walking a mile or two, here and there, so she prescribed me a low dose of pain medication called Tylenol 4. My pain continued to get worse. We increased  the medication to Vicodin, however, the pain increased, radiating down the back of my leg. At this point, my doctor ordered an X-ray, which indicated a CT was necessary. While waiting for my imaging appointment, the pain exponentialized to the point that I was hardly able to walk my dog this weekend. This morning, I went to the ER, which is located right next door to my doctor's office. I was hoping to get the CT done there and be treated for the pain that was now burning all through my my hip. The ER doctor attempted to give me a drug called Toradol. I am allergic. I told the nurse and she confirmed that this was in fact in my chart. I confronted the doctor. He proceeded to give me a history lesson in the adverse effects of opioid medication; I will paraphrase.

"Mrs. Arzola, the pain medicine your doctor gave you is making your pain worse. It only takes one dose to completely change your brain chemistry. Narcotic painkillers kill more people than they help". I asked him directly, "Do you think I'm here seeking drugs?" "Yes, I do", he replied. I promptly removed my IV and thew it in his face and if I do say so myself, it was one of my finest moments. I then left the hospital and went next door to let my doctor's office know what just happened and went home. My leg is on fire as I sit here writing this article and I have absolutely no control over what has happened to me regarding my hip replacement and the subsequent nightmare that has followed. I don't really know what my next move is other than to see my primary doctor, again.

I do want to talk a little about what the ER doctor said regarding narcotic medication and brain chemistry. First, let me say that extrapolation is one of my biggest pet peeves. It begets racism, sexism, all kinds of isms. Everyone is different. However, here is a little medical information on morphine and the brain: many a study has been done on long term effects of morphine, the opiate from which all pain medications are derived, on the brain. First time use, and short term use studies are few and far between, however, a study by the National Institute of Health conducted in 2011, using subjects that were given increased doses of morphine over thirty days and subjects that were given a placebo did note marked changes in the amygdala part of the brains of the morphine subjects, however, these changes seem to resolve within days to weeks of cessation. The study found that environment and a genetic predisposition played a role in the addiction process. In the absence of significant pain, the opiate receptors in the brain feel rewarded, like sex. The thing about morphine, however, is it seems the brain does not forget just how rewarding morphine feels, making it easier to fall victim to addiction and also suggests repeated use begets tolerance, requiring more morphine to feel the same reward. This is an obvious drawback ancillary to the use of morphine. But do the cons outweigh the pros? And does everyone become addicted? And should everyone in America be punished for the misuse of a few folks who, through no fault of their own have fallen victim to the negative effects of morphine? 

For millions of people across the globe, morphine is a godsend. Can you imagine waking from surgery with no pain medication, or how about suffering a broken limb, no morphine...In the age of Oxycontin, people are dying in unbelievable numbers, and this is the great American tragedy, but that tragedy begins with the lies of greedy, capitalist pharmaceutical companies and doctors, who knowingly over-prescribed an end-of-life narcotic pain medication to people with back pain. Oxycontin is highly addictive and should never have been prescribed so freely across the board. The only people to suffer are the patients. Purdue Pharma, who was fined $600 million by the federal government in 2010 for misleading EVERYONE about the effects of Oxycontin got rich. Doctors went on golf vacations, patients, who were subsequently treated like pariahs, turned to heroin, which is now being "cut" with Chinese fentanyl and that is why they are dying. 

But what about patients who truly are in pain and need to take pain medication, either short or long term. As established by the aforementioned study, the brain in pain reacts differently to the brain that is not when it receives morphine. Doctors, like the one I had the displeasure of dealing with today need to stop extrapolating the entire population. Every case is different and the government is doing a fine job of keeping tabs of every single pill given to every single patient. Urinalyses are required, pain contracts between doctors and patients are the new normal, current state identification is required to receive medication from the pharmacy. These rules are relatively new and it will take years to repair the damage done by big pharma, like Purdue and the complicit doctors who took kickbacks from them to peddle their poison to the masses, but the rules are in place and they're working. An emergency room doctor, who practices crisis management is in the wrong department if he is to sit in judgement of the patient who is in pain. If he is a doctor who chooses to extrapolate and refuses to prescribe pain medicine in an emergent environment should find another area of medicine, one in which he never has to prescribe pain pill one, again.

I needed help, today. I did not get it. I blame him, not the junkies of the world who are dropping like flies at the end of a needle; they are victims, too. We, as patients will always need morphine, regardless of the changes to the brain said morphine causes. According to the study, my brain should have gone back to a relatively normal state after discontinuing the use of my post-surgical narcotic medication. I'm just a normal, everyday fifty something year old woman with a family and a dog and friends a fledgling writing career who was physically damaged by a doctor who apologized to me for being distracted during my care due to his father's illness. It appears my prosthetic hip may need to be replaced, again. The pain is almost unbearable. I walked into an ER seeking relief, not a high. I was treated like a junkie, a word I hate, and don't mean to use in a derogatory manner, however, in his eyes, that's exactly what I was.

Doctors need to figure out how to handle this opiate crisis in a far different manner. It is not my job to do that. I am the patient.

Deannalynn Arzola