When we last visited this fun topic, it seemed that there was only the mere possibility of getting to test how opioids affect mental issues. Since this is 2020, the chance came sooner than expected. At the hospital, 42 hydrocodone pills were prescribed. After surgery, I picked up another 42 pills. That is 4 a day, so a 28 day supply prescribed inside a week. If this was at the VA, they would have just said to take ibuprofen to deal with a shattered collarbone and 5 broken ribs. They have become very sadistic at the VA. So today, exactly two months since the surgery, there are 33.5 pills left.
Most of the time, they were cut in half, and no more than 3 halves were taken a day. I don’t really take them anymore, maybe ½ a pill a week since the incision gets extremely painful once in a while. Every so often, rolling on my left side occurs, and something sharp rips into the tissue. That hurts for a day or two. The weirdest things are numbness in the entire shoulder area and half of the upper arm, and the collarbone feels like a metal rod with a pointy end.
The x-ray looks like the collarbone was replaced by a chain. It really does look like a chain from end to end.
When recovering from my surgery two summers ago, I only needed to take opioids for a few days. It had a severe and shocking effect on my mental state. Other issues were not helping. Honestly, they affect me to this day and probably always will however that is usually manageable.
This time the accident itself made my depression worse. Getting into good shape and being able to exercise for hours and losing that, even temporarily was hard to deal with. That made this fall another bad one, three in a row, and that is before introducing more pain pills this year.
If I am being honest, sometimes those pills did nothing at all. There were no fuzzy feeling side-effects and no pain relief. In the past few years, I have noticed that I react differently to things like this. It seems that my brain has changed and now can reject them, or at least lessen the expected effects. Sometimes, it did not. It is strange, a few days after my birthday last year, I was doing horribly and took 4 Klonopin in about 3 hours. That is equivalent to at least 40mg of valium. That is A LOT! That is probably the first time in my life I had purposefully taken more than I am supposed to and have not taken them since. Benzodiazepines are in a totally different class than opioids. Still, it made me wonder because that many pills should have put me out for a week, it did not. I maybe slept for 2 hours. The funny thing is that my sisters didn’t seem to notice how awful I was doing. Even when I am ripping myself apart inside, I am the same calm, extremely boring person that I always am. I guess that is good?
Anyway, the current incident started with some minor experiments at the hospital. As I mentioned in the essay I wrote in September and already linked to twice here, they gave me morphine mostly. They wanted to give Dilaudid, which is stronger than morphine, in the ER. I mentioned how I overdosed during my sinus surgery from whatever they gave me and that I was having a bad enough day without overdosing again. By the time I got home, I was already two days deep into opioids and started for two days with full pills and just mostly cut them after that. I had to take a day or two off completely at least once a week; because the side-effects, especially dizziness was overwhelming. On days I had to drive to shop or go to the doctor or PT, I would not take one at all until I got back.
Besides, the dizziness - which got the room spinning - it caused severe headaches. That seemed odd. My head hadn’t hurt so badly in decades. The worst was depression got bad again. Not as bad as a year ago, but enough for me to notice. I am constantly depressed, so if I notice it, it is bad. It has become like headaches. They are a part of me now, and only notice when they are severe.
I would try to take walks and get dizzy. I fell a few times and started walking with a cane. It probably looked like a 90-year-old man shuffling down the street.
Grocery shopping was a total pain and slow. Not just because of being one-armed. That part was difficult getting things off of shelves and even at self-checkout. Of course, no one ever offered to help - good to know invisibility is still a thing. It also went so slow, the drive to the store is less than 10 minutes and one day left around 3 in the afternoon and got home near 5:30! I had 4 bags of groceries and have no idea what happened at that time. That is usually a 30 minute round trip, so what happened? Don’t know. Like always, had not taken anything that day but have lost time.
In the past two months, there were lots of lost time. Actually, in the past 15 months, if this is full disclosure. Not like the last two months. Days lost in one go. Wake up thinking it is Monday, but it is Thursday. Literally can’t remember Tuesday or Wednesday. Didn’t sleep three days straight but still lost. Very odd, but it doesn’t happen so much and so badly anymore. I think just Thursday was lost this week, so that is closer to normalcy.
The best part was one day at the PT office. It started out bad, showed up with a severe headache, and didn’t feel right. The physical therapist told me to get on the table for the massage. I stood up and dropped to my knees because of the dizziness. The PT freaked out and thought I was going to have a stroke. I informed him that this is pretty normal for me and get this way a few times a year. That wasn’t a lie. I really do, even without opioids. They just make it happen more often, a few times a week. The nurse and the PT both told me that I look awful and very pale. I responded that I always look like crap. Being very pale isn’t unheard of; my daughters notice it often.
He didn’t listen to me at all. They just let me lie down and got a neck and head massage. They took my blood pressure and pulse every two minutes. My pulse was super high: in the mid-‘90s, normal is 65-ish. Blood pressure was a bit high but not so high that anyone would remark about it. It was about 120/85 when the normal for me is 110/70. They asked questions to test alertness and had no problem. I kept insisting that I was fine and could do my exercises. They didn’t listen which is okay, it was the first real concern shown since my accident from someone other than family. It seems strange that someone would actually care. Maybe they just didn’t want the hassle of this dork dying in their office. Even if they were insincere, it is still nice, but I think it was sincere.
PT is going somewhat slowly but improving every week. About a week ago, my shoulder made a giant leap after a wonderful session in physical therapy. Apparently, my muscles are exceptionally tight and not just in the shoulder area. They are focusing on the left side of my back, shoulder, and chest. It gives confidence starting yoga to loosen everything up is a good idea.
Tightness is about 60% of the reason my knees hurt, 20% is lack of strength around it, and the rest is that they are a dumpster fire. I wonder why I am so tight? Premature rigor mortis? Ha! Perhaps all of those years programming? Glad I have curtailed that to reasonable levels now that I have no deadlines and can do whatever I want and can work lots of time in for exercise and stretching.
The range of motion in my shoulder is about 85% of the way there in most directions. There is still some pain in the 70%-85% range. Putting my arm straight up is almost 100% but can not yet straighten my elbow when it is in that position, but progress is good.
Effect on the mind and mood
Besides sending my depression into a tailspin, I had other issues. It is not clear if the extra depression caused it or the opioids directly caused it. Nor is it clear if that distinction is an important one.
The first issue was anxiety. It was not good for the first month. A part of that is just that my lifestyle changed quickly and drastically, and it was not yet clear what I could do going forward.
Solitude is a driver of anxiety but does not cause it since I go a long time without seeing or talking to anyone. With PT, at least have interactions twice a week, now it is only once a week. One time, during a good week, I see my daughter and granddaughter. It is not as quiet as it was last spring, where I went about 3 weeks without speaking to anyone. About a week after surgery, one of my sisters came to help for a few days. That was really nice. A neighbor, who has never spoken to me in the 2.5 years I have lived here, brought over a nice dinner for me. That was so kind. She even waves and says hi to me now. They are a very lovely family.
One big issue in the past three to four weeks is seeing and hearing things, especially at night. Footsteps and voices upstairs, rattling around in the kitchen and whispers and footsteps in the hallway outside my bedroom and upstairs. Strange noises in the basement that has no description. I hear strange things in the garage, it is a large 4ish car garage, so if the wind rattles the doors, it echoes around. That is what I tell myself, at least. It is nice to have a plausible explanation for at least one of the sounds.
This house is too large for just me. They all happen mostly, but not exclusively in the evening and into the night. At least it is not ever constant.
The absolute worse is what I see. I see images of a person walking into my room and things like that. It feels real, but I never think it is. Sometimes, the person is recognizable but mostly not. That is not really a bad thing, once in a while it makes me smile. I suppose it could be a bad thing if I ever think it is real.
What is terrible is that giant spiders are running up my walls. Like South American tarantulas large. Always out of the corner of my eye. I know they are not real, so don’t freak me out like the sounds, but it is awful seeing things that aren’t real. Makes me feel even more worthless and unlovable.
It is all very isolating.
If all of this happened a year ago, I would not be here. I am not sure if that is a good thing or not. I just have not felt suicidal. It doesn’t matter how depressed I get; if I don’t feel suicidal, it simply won’t happen. It must sound strange, but depression, suicidal ideation, and suicidal intent are three separate and unrelated things. At least in me. It is difficult to explain, and even writing about it makes it seem nonsensical, but it is not. Suicidal intent can happen when depression is low or high and when nothing all that negative is happening. Suicidal ideation is common in me, especially when I first wake up and realize that I woke up. It is just idle thoughts that lead to neither depression nor intent.
Maybe I am kidding myself thinking that they are independent of each other. As I write this, it seems too ludicrous, but it is true. As I have learned studying science and mathematics, many things that simply aren’t intuitive and even seem wrong are, in fact, right. It is one of the difficult aspects of learning about math and science. To learn to not always trust one’s intuition is not natural.
Hearing things have not subsided as I have gotten further away from needing pain medication. The visual hallucinations have lessened, regretfully. No regret for fewer spiders, of course. I do not have arachnophobia, but they creep me out. Even watching the movie Arachnophobia is tough for me without feeling creepy crawlies on my legs.
I continue to feel so lucky that addiction does not seem to be an issue. In the ‘90s, I was on Darvocet for about 5 years. Three pills a day almost every day and quit without any problems and without having to taper down. It seems that a taper was needed this fall. The reason seems to go back to how it appears that my brain has changed. Maybe all those years of psych meds did something? I am always calm, at least it seems so from the viewpoint of others. Whether my brain has changed or not, the net result is not a bad one.
The withdrawal effects, or at least what seems to be withdrawal effects were concerning. The withdrawal felt similar to that of psych meds, which is not good because it can be painful. However, it is not so bad because the effects do not come with wanting to take more to get rid of them.
I rarely feel like I have any luck at all. Other than the fact that substance abuse has never been an issue or concern, despite taking a lot of addictive medications over the years. It is a great blessing. I have enough problems!
Anything of value learned?
I think, at least in my case, it is safe to say that opioids definitely have a deleterious effect on my mind. It is just an anecdote, a data point.
I hate how it made me feel: old and helpless. I did mow my lawn with one arm and did some light work in my yard. That made my daughters screech at me. I live alone and have to do things regardless of my condition. It took about 3 times as long, but I did it dagnabbit!
I am grateful there is not much anxiety this time. I was so anxious a year ago, and if all this happened, then it would have been difficult to survive. Sleep is improving, maybe too much. Sleep got so bad I was taking 10mg of melatonin and 25 mg of doxylamine, and that is a lot. Way too much, but it would allow me to sleep within 3 or 4 hours of laying down and would sleep maybe 4 hours, and that is okay for me, even when very active. I really can do yard work and then ride my bike for 40 miles with less than 4 hours of sleep and still not sleep that night and do it again the next day. My sister told me about something she takes to help anxiety. It is some lavender concoction. I take that with 25mg of doxylamine - which is the recommended dosage on the label - and sleep within 30 minutes and sleep 7-9 hours without waking.
The not-so-funny thing is that I do not feel any different than if I sleep 9 hours or 4.
I kind of wish that I knew about this before my accident so I could remove lack of sleep as a variable in my not-at-all scientific study. I am sure poor sleep made everything worse.
I am coming out of the haze but what such low dosages did to me was not nice, nor was it fun. Taking less than 50% of what I was supposed to, did terrible things to me. I did take it longer than 28 days, and perhaps that has an effect. After 28 days, there was still much pain, and if I got a refill because I was out because I was taking it as prescribed; I am sure things would have been much, much worse.
My shoulder needs more work sometime soonish and possibly my knees as well, although that is not a given. There may be more opportunities coming soon to test further and to be able to remove a lack of sleep as a factor. That way there is one less thing messing up my totally unscientific data. I don’t want to anger the universe further, so I will not even expect to have solved my sleep issues. My focus is switching to winter projects, programming, and getting back into shape on my indoor bike while continuing to improve strength and flexibility everywhere.
If anything good came of this, it will hopefully be that I am cautious in my actions, so I do not hurt myself and have to go through this again. Either that or make sure that the next incident to happen is not survivable.