Wednesday, May 13, 2009

Drugs, the Veterans, and some confusion

Sunday afternoon I drove north and crossed the border at San Ysidro and drove on to the Veteran’s Hospital in La Jolla for a date with my oncologist. For three days I had been having severe back and leg pains, I had hardly slept the night before, and was uncertain if I could make it. I made it okay.

I logged in with lodging, then went up to find my bed. The pain of walking was excruciating. There were five beds in the room, and I lay down on the one assigned to me. The pain was so bad I knew I would not be able to sleep. I went to a nearby nurse’s station and asked for some ibuprofen or anything. She could not give it to me. I would have to go back down to emergency and get it from the doctor on duty. The nurse found me a wheelchair and offered to push me down to Emergency. I told her it wasn’t necessary.

I wheeled myself to the elevators, and when I was down on the first floor wheeled myself to Emergency. It took more of an effort than I had expected, but it was not big deal. In about 45 minutes a young doctor came out, called my name, and after a cursory examination said he did not believe I had a spinal column issue, but a strained muscle. He ordered me some muscle relaxant pills. Pharmacy brought them to me quickly and I took one and wheeled myself back up to my bed.

After an hour or so the pain was so bad that I went back down to emergency to ask for something else. I waited three hours. The pain and the exhaustion became so great that I decided it was not worth it. I was so tired that I figured I could sleep on through the pain. Back in my bed for maybe fifteen minutes and I knew it wasn’t going to work and I wheeled myself back down to emergency. There was another wait for about an hour; I couldn’t remember ever experiencing a similar combination of pain and exhaustion. After another 45 minutes my name was called by a lady doctor who gave me a cursory examination and told me that in all likelihood the muscle relaxant was not going to help in the near term, that I was probably having a bout with the spastic nerve. She prescribed an anti-inflammatory drug and one for pain. I was pretty much under the water by this time and could only promise to follow direction when I took them.

I took three of the new pills there at the drinking fountain in the Emergency waiting room, rested for a bit, the wheeled back up to the lodging on the third floor. This time I tried to relax, drew my knees up to my chest and hoped for the best. It was four AM. My wake-up call was for 7.30. The pain was about the same, and I felt pretty dopey (not a straight-line). So long as I didn’t have to stand up for more than a moment at a time, I was okay in the wheelchair.

My first business was to go down to the first floor to get some labs, some blood drawn. I was there about 8.15. At 9 am I was on the 3rd. floor having the port in my chest irrigated. At 9.30 I was back down on the 1st floor in radiology to have the knees x-rayed. At the same time, I worked it out with scheduling to have the lower back x-rayed as well. They were very cooperative. The lady who did the work was very careful with me, lifting and moving me around on the gurney, but it was very painful when I had to be on my back.

Then it was time for my check up with Dr. Go, my oncologist. He already had the labs in his computer and was checking them. They looked fine, except for the fact that my white blood count is low. That was a matter of concern for him, but he had no advice for me. He made two observations. One, that low white blood counts are worrisome in that it could predict in some cases that the cancer might come back as leukemia, if I understood him right. I was so tired after the last two nights that all I could do was listen.

He also said that he had taken a “gamble” with me, in that he had given me very strong doses of chemotherapy, in the upper range of what is given, and he had been impressed by the willingness of my body to absorb the hits. Causes me to recall an earlier check-up while I was still doing the chemo, after I had asked some question, who knows what now, he had mentioned that he was “slamming” me with chemotherapy. This time, when he spoke about taking a “gamble” with me he laughed thinking about it.

If it worked. . . .

Now I had to go back down to the first floor and back to radiology to schedule an appointment for a cat-scan of the neck, where the first tumor was discovered. Then it was up to the 4th floor to Nuclear Medicine to schedule a pet-scan, a full-body scan. As I sat there in the wheel chair trying preparing to turn around to head for the elevators, the scheduling nurse, a man in his 50s maybe, offered to wheel me up. I told him I was okay, but thanks. I must not have moved because the next thing I knew the man had come out of his office and took hold of the chair. “I’ll take you,” he said.

In Nuclear Medicine I waited by the office window while the forms were being filled out. Once I fell asleep and only head falling down woke me up in time. I sat up as straight as I could in the chair then so that would not happen again.

Once the pet-scan was scheduled I rather woke up and wheeled myself to the elevators and back down to the first floor laboratory. I had to rest a couple, three times. There I explained that I needed to do more labs, as I had carelessly eaten a candy bar at midnight the night before while I was waiting in Emergency. My primary care doctor had wanted what they call “fasting labs,” blood drawn after at least ten hours of not eating anything. The lab nurse agreed, did the computer work, drew the blood, and I was finished with the VA Hospital in La Jolla. For the time being.

I wheeled to the main entrance, left the chair and walked outside. It wasn’t easy, and it was very painful. I stopped to sit on a stone bench for a few minutes. Anything to get off the right leg, where most of the pain was. Then I walked across the two-lane entrance street to the parking lot, to the valet stand. I couldn’t make it to my car without resting again. I young Black guy asked if he could help me. I gave him the keys to my car and he brought it over to me. Thank you very much. You’re reward will be in heaven.

Once in the front seat of the Jeep I was more comfortable. I started the drive down South. After a few minutes I noticed that I was weaving back and forth in my lane. I recalled that when I was given the muscle relaxant the night before, the young Chinese pharmacist had told me expressly that I should not drive the car. I had nodded okay to her. It’s been my experience that these precautions are always, usually, over-stated.

I soon found that I was driving so poorly that I had to get off the freeway. I had not yet covered the ten miles or so to down to San Diego. I pulled up into a residential street, put the car seat back and down, stretched out my legs and closed my eyes. I was so exhausted I could no lie quietly. The legs were restless. I got back on the freeway and started slapping myself first on one side of the face then the other until I reached Chula Vista, another fifteen miles maybe. I surprised myself to note how hard I was willing to do the slapping.

I drove to the Starbucks near Wal-Mart, parked, and went in. I could just barely walk for the pain, and I was so confused with the tiredness and I suppose the drugs for the pain that I had a difficult time ordering the coffee—a regular with three shots of espresso, I had to ask where the milk and stirring sticks were because I couldn’t find them, and then I had to get back to the Jeep. There I rolled down the windows and drank as much of the coffee as I could. Walking was very painful, but back in the seat of the Jeep it wasn’t too bad.

I started south again toward the border. I rather woke up. I had not eaten anything yet and the espresso must have it me with a little real lightening. I made it across the frontier and down to where we live in less than an hour. Outside the house the pain was very bad but I was still at least half awake. I went in the house to our bedroom and Irene came in and I told her about what had gone down. I lay around for a couple hours, then checked my email. I couldn’t get the brain to focus. I was taking the pain pills just as they were prescribed for me. Nothing with the pain was changing. The one thing that had changed was that I could lie down, and I didn’t have to do anything. So long as I didn’t have to take more than three or four steps, I was okay.

At 11.30 I went to bed for good. By 3.30 I think I was asleep. I woke at 8.30 this morning to the alarm and got up. I had a lot of work to catch up on. After a few steps to the bathroom and back, getting my pants on and so on, the pain was back where it had been the night before. And then we discovered, and I say we because I did not really understand what was happening until my wife appeared to be concerned and our daughter was burlesquing my behavior. I could not carry on a conversation, I was mumbling, it was difficult to walk, the pain was very bad, and my daughter was making fun of my slurred speech.

I was to get a massage at 2pm. Now that it was in my mind that the pain might be from a pinched sciatic nerve, I had reservations about a massage. I was dizzy, couldn’t walk more than a few steps, and was in severe pain. I decided to go around the corner to our family doctor. I called the massage guy and cancelled my reservation. It was decided that I would not drive the Jeep myself, but that Pretty would take me. Then I discovered that I could not find the car keys. Pretty got the keys from Irene and I got in the car.

At 2.30 I was with Doctor Olivia. I outlined the problem for her and told her what drugs I had been given for the pain. I was pretty non compass mentis, if that’s how you say it. I had to stop in the middle of a sentence to figure out what I was going to say. I recognized myself that I was slurring my words. I was exhausted. I got so many things mixed up that it became funny for both of us. Before we left the house I had just enough sense to take with me the bottles of pills I was taking.

10 mgs of Cyclobenzaprine HCL every 8 hours as a muscle relaxant.
500 / 1,000 mgs of Hdrocodone every four hours for pain.
800 mgs Ibuprofen each eight hours for pain

Doctor Olivia told me to get off the Cyclobenzaprine immediately. That was the one that was making me dopey, particularly in combination with the other two.

She gave me two substantial injections in la nalga (the butt), one some kind of B-vitamin concoction, and another that I can’t remember. Maybe for pain.

Pretty drove me back to the house and I went to bed. Slept for close to four hours. When I woke the pain was somewhat reduced. I couldn’t walk without the pain, but I could be there in the bed without pain, and when I did walk a few steps and sit down I was rather okay.

I understand. This is more than you could possibly want to know about anybody’s bad day. Still, I am pleased to be able to write even this, pleased to find myself sitting in a chair without feeling a need to whine about the pain, pleased that I am not exhausted, and that my head is relatively clear. And pleased to be able to report that tomorrow or the day I expect to be back to work.

For the present, however, I am not inclined to reflect on the peccadilloes of our Holocaust-fraud denier friends. As I say, maybe tomorrow. Maybe the next day.

1 comment:

Anonymous said...

You're excused, Bradley. Take your time.