The Second Kick of the Mule

F20-13at_pancreas_c Some may recall a post I wrote several years ago detailing an encounter with pancreatitis that required a short stay in the hospital. A painful experience, for sure, and not anything I wanted to ever experience again. So strong is that conviction that I have not, since that day, consumed an alcoholic beverage…per the doctor’s strong suggestion.

 

Much has changed in my life since then, mostly for the good. But, given the human condition, the passage of time, and the stress of a major change in my life, it was inevitable that some aspect of the prevention model would slip.

The first sign was a series of small "episodes" that began in early fall. The pain would begin, I would stop eating and drinking, while medicating with a carefully stored cache of pain pills. I knew something was going wrong, but, after a day or two, the pain would abate and I could continue with my studies.

Twice I had to miss important obligations.

Then, right before Christmas, a serious episode struck. Much more pain, a lot more pain medicine, and 4 days of writhing on the bed while wondering if I should call the doctor, knowing that the call would send me right into a hospital bed. Finally, the pain eased, and we were able to make our biennial Christmas drive to the frozen Mid-West.

Even after returning home I did not feel "right". Lacking energy, unable to muster the will to do simple things, my body was telling me that I had a problem. Still I did not call my doctor….I really did not want to look at the bill for a multi-day visit to the hospital.

The decision was made for me Sunday morning.Shortly after a delicious breakfast (eggbeater omelet and wheat toast), I was overcome by nausea and began vomiting. And vomiting, and, finally, retching. At the same time, a sharp pain pierced my stomach, increasing in intensity in waves of pain that doubled me over. Dripping in sweat, retching, and barely able to talk, concerned wife doing what she could to help, I finally uttered the necessary words:  "Call S*^@%".

We were in the emergency room in 10 minutes. In another 5 minutes, the IV was running and the doctor asked the familiar question: "On a scale from 1 to 10, with 1 being no pain, rate your pain". I remembered the question from Bozeman, and the medical responseto my answer was the same. In just a moment, the dilaudid began to flow into my arm.

Now, dilaudid is a bit different from the morphine of my earlier experience…

…hydromorphone is somewhat faster-acting and about eight times stronger than morphine and about three times stronger than heroin on a milligram basis. The effective morphine to hydromorphone conversion ratio can vary from patient to patient by a significant amount with relative levels of some liver enzymes being the main cause; the normal human range appears to be from 8:1 to a little under 4:1. It is not uncommon, for example, for the 8-mg tablet to have an effect similar to 30 mg of morphine sulphate or a similar morphine preparation.

It was soon clear that I was dealing with a different kind of pain reliever. And yet the agony persisted, alternating sharp jabs with throbbing aches that forced me to groan in an almost helpless way.

Friends, it was a very tough 24 hours. By Monday afternoon, the pain had subsided greatly, but various fluids were still pouring into my arm. Sleep was, as I remembered, hard to come by, as some nurse or tech needed some fluid withdrawn every 2 hours. By Tuesday, I was finally allowed a glass of water, and then, later, a small bowl of soup. Tuesday night found me in my home, showered and ready for sleep in my own bed.

I can already tell that this recovery will be tougher. I still haven’t left the house, there are hints of pain from time to time, and I am eating with an acute awareness of the need to process whatever I take in. In the near future are another CT scan (to check on the cysts that may now inhabit my pancreas), weekly lipid panels to monitor my triglycerides (you would not believe how high they were when measured in the hospital…), and a very close watch on my glucose levels.

Could this latest episode have been avoided or prevented? Most likely. All I had to do was get a lipid panel every 3 months and my doctor and I could have caught this long before things blew up.

Friends, there is no lesson in the second kick of the mule…….listen to your body.

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