Posts Tagged ‘stigma against opioids’

In Praise of Opioids, Part 2





Long-time readers of my blog will recall that I broke my leg – tibia and fibula – around six years ago. The point of the post was mainly to get to talk about my medical ailments, which I love, and that opioids, when used correctly, can be a huge blessing. I described how EMS personnel, on the way to the hospital, gave me a dose of fentanyl. The relief of intense pain was so miraculous.

Well, now I get to talk about my latest medical adventure.

I had a tibial intramedullary rod placed when I broke my leg. It worked beautifully and allowed my broken leg to heal much more quickly. I was ultimately able to get back to my usual activities after what could have been a devastating accident, had good medical treatment not been available.

But starting a few years ago, I had some swelling right at the middle of the tibia, with some pain. I went back to see the orthopedic surgeon, who X-rayed it, and said there was a bone callous forming there due to irritation from the tibial rod. He said he could remove the rod, and that would take care of the problem.

I asked him how big of a deal it was to remove the rod, or “nail” as it’s sometimes called, and he said, “Oh, about as much as putting it in.” That was enough for me to decide against surgery. Well, I also made the mistake of watching YouTube videos of removal of tibial intramedullary nails. Yikes. Let me just pause to tell readers that if you have an upcoming surgery, DO NOT Google or YouTube your procedure. It’s a bell you can’t un-ring.

Over the last few years, after moving to the country, I’ve been much more active, and pain at this area of my leg has bothered me more and kept me from being as active as I’d like. So, this summer I got fed up, went back to the orthopedist, got my surgery scheduled and had it done yesterday.

I was confident I could handle any pain after the surgery, since it certainly couldn’t be as bad a breaking a leg, right? Only as soon as I woke up in the Recovery Room, I had intense pain from my knee down, and started groaning and mumbling. The nurses were attentive and asked if I needed something for pain. I said yes. I’m no martyr. I had one injection of hydromorphone (Dilaudid) and it relieved all pain. I think I had one more injection of the same about a half hour later and didn’t need any more. By that time, I was awake and eager to get out of there.

Thankfully the surgeon injected the incision areas with Marcaine, a long-acting medication similar to Novocain that we get at the dentist. My leg felt numb, but that was good.

I really haven’t had much pain since leaving the surgical center. Of course, my leg is sore at the places where the screws were removed, and my knee is sore, where they withdrew the rod.

My biggest problem has been bleeding. I didn’t notice anything on the ride home, since I was drowsing in the back seat with my leg elevated on two pillows. Then when I got home, I noticed blood soaked my sock, through the wrap they’d placed.

I went to my recliner, got the two pillows, and slept, with my leg extremely elevate. I still felt a little goofy from either anesthesia or the Dilaudid, or both. I slept for a few hours, then woke to find the pillows covered with blood. In fact, the whole lower dressing was soaked, and I had to remove it, despite directions that say to leave dressing in place for 48 hours.

There was a stream of blood coming from the lower leg incision, where screws had been removed. I got some gauze and held pressure on the area with a bag of frozen corn, and the bleeding slowed to an ooze, then eventually to drops. It took nine hours to get this bleeding to stop.

As a physician, I do understand that a little bit of blood looks like a lot of blood, when it’s your blood. I put off calling the 24-hour number, thinking I was overreacting, and that the person I talked to would tell me to hold pressure, keep it elevated, and put ice on it. Still, by 10pm, I was worried enough to call, estimating I’d lost about a unit of blood.

A very nice physicians assistant returned my call, listened to my detailed report, and said if it was still bleeding in the morning, come to the Urgent Care. He also suggested elevation, pressure, and ice.

Eventually, I was so tired and sleepy that I put loads of gauze around it, replaced the pressure bandage and hoped for the best. I went to bed.

So far today, all is well. If there’s bleeding under there, I’m blissfully ignorant of it, and at least it’s not as bad as yesterday, when it soaked through the dressing.

I was given a prescription for hydrocodone, but I don’t think I’ll need it. I just took a few Tylenol and all the soreness is gone. I will keep my leg elevated, which I believe does more than anything to assist in healing, and gradually get back to normal.

Again, I think how grateful I am to have health insurance, and to have access to a great orthopedic surgeon. I feel blessed to have had good anesthesia throughout the procedure and in the recovery room, when my moderate pain was immediately addressed. I’m grateful I was given the option of taking post-operative opioids, even though I don’t plan to fill the prescription.

Yesterday I started to wonder if one of my patients, having the same procedure I had, would have been treated any differently. I hope not. Quite often, I must advocate for my patients on medication for opioid use disorder and tell their surgeons or providers that even though patients are taking a maintenance opioid, they still need short-acting opioids for acute pain situations. I hear – all too often – that patients prescribed buprenorphine or methadone are treated with judgmental attitudes, and this sort of bias has no place in modern medicine. I hope all my patients will be treated as well as I was treated yesterday, when they have medical events.

Opioids are a godsend, when we use them in the right way. The key is to use good judgment, and not to prescribe too long of a course (something that the NC STOP Act addressed) and get dependable family or friends to help a patient with opioid use disorder manage an opioid prescription for acute pain.

I’ll keep you updated with my progress. You know I will, since I love talking about my medical ailments, which are thankfully very few at this time.