Vicodin in the news

Vicodin, Vicodin everywhere but not a drop to drink...

If I have seen it once in the news, I've seen it 50 times in the past week or two. Of course, there is the horrid case of Sean Payton and the Saints. We've been reminded about Brett Favre's Vicodin thing. Then there was Kevin Ellison. Then there was the former Miss Russia Anna Malova. NFL bust Ryan Leaf got hammered for Vicodin possession recently. Then we were all reminded that Dr. House M.D. loves Vicodin. I just saw Bad Lieutenant, Port of Call New Orleans. For the Bad Lieutenant, it all began with a back injury and a prescription for Vicodin.

Then they dropped the bomb-shell: the mixture of 5mg hydrocodone and 500mg of acetaminophen (Vicodin) is the most prescribed drug in the United States of America. Surprised the hell out of me. Then again, I was not surprised.

I heard a lot of people were using this shit. For the life of me, I can't understand why. This always goes back to the narcotic resistant thing. I have a nice red laminated 8x5 inch card in my medical file at Dr. Bachner's office. On that card, you can read the words printed in large bold black letters "Narcotic Resistant Patient".

Resistance does not equal tolerance. Tolerance develops over a long period of abuse. Resistance is genetic, and it means you flat-cold don't respond to narcotics the way others do, and you never will. I have a different Mu receptor than you do. My DNA encodes a different amino acid sequence there. That is all there is to it.

Vicodin didn't work well for me at all. I was in a hell of a lot of pain after my first surgery. It struck immediately as I came out of the Propofol. On the surgical table I could feel the burning, itching, throbbing, swollen, cut pain in my right knee. My anesthesiologist was stunned. He though the Demerol he had given me would be sufficient. It didn't work.

He ordered another dose of Demerol. As the nurse injected me, she asked me if I could feel it. That seemed like a strange question. "Nope" I answered. She was shocked. She expected to see my eyes roll up in the back of my head and hear me let out a grunt of ecstatic pleasure like "Ahhhhhhh..." This is how most people respond to narcotics injected into their blood stream. Not me.

She asked me a moment later if the pains was gone. "Nope, I can still feel it throbbing and burning. It hurts a lot." Unbeknownst to me, that was my second shot of Demerol. She was amazed. I withstood a second shot of Demerol with little or no effect shown. Eventually, about 15 minutes later, the pain began to die down.

That is perfect example narcotic resistance for you. No head rush. No euphoria. No immediate relief. Delayed onset of the analgesic effect. Shorter duration of that effect. The doctors cannot control post-surgical pain using the weakest narcotics, which is the normal convention. Demerol and Vicodin weren't worth poop-squat to me.

Vicodin didn't do much for me after the surgery. I was in a lot of pain a few hours after than Demerol shot. I slept like crazy, partially to get away from the pain. It was a troubled sleep. It was not a restful sleep. I would be awakened many times by eruptions of 'break through' pain. I would take the Vicodin. It didn't do much for me. It made it a little better. I still felt plenty of pain.

For me Vicodin = weak and infective.

The second time around was entirely different. The Doc knew what he was up against. When I came out of the surgery the second time, Dr. Bachner ordered a double-dose of Dilaudid (dihydromorphinone). Dilaudid is 10 times more powerful than morphine. Demerol has only about 20% of the strength of morphine. Dilaudid is 50 times stronger than Demerol. He rolled out the big guns. He wasn't fucking around.

Dilaudid worked. I was comfortable after the second surgery. I didn't feel much or any pain. I still didn't feel "high". I had no delusions of godhood. I didn't feel sheer bliss. I was happy that I wasn't in pain, but that is not the same thing as euphoria and sheer bliss.

The surgical nurse monitored my pulse and breathing very closely after shooting me with two doses of Dilaudid. She had to make sure my respiration and heart rate weren't suppressed. There was no problem. My heart rate was between 65-68. My O2 saturation was at 97%. I was breathing fine.

This is another example of narcotic resistance for you. A resistant patient can take a double shot of Dilaudid, not get high, and not experience suppressed heart rate or respiration. If Marlin Perkins of The Wild Kingdom shot me with one of his famous narcotic tranquilizer darts, it might not work on me.

The Doc prescribed Norco for me the second time around. This is also hydrocodone and acetaminophen, however, the fuel mixture is different. Vicodin is 5mg hydrocodone and 500mg of acetaminophen. Norco is 10mg of hydrocodone and 325mg of acetaminophen. It did work better. I still experienced some pain, but not much. I was comfortable.

Incidentally, both times I stopped taking them cold-turkey. I didn't like feeling the pain again, but there were no flu-like symptoms. About two weeks after quitting the Norco, I caught a cold, but that was a fully-authentic cold. It was mostly about coughing and snot running out of my nose. This was not a case of withdrawal symptoms.

One of the advantages of being narcotic resistant is that I will probably never know the agony of withdrawal symptoms others suffer. My body doesn't like the stuff the way yours does. 97% of the people are like you. Only about 3% of the people are like me. I am a member of tiny minority.

With all that in the rear-view mirror, you can understand why Vicodin addiction is a mystery to me. I don't like the shit at all. Acetaminophen is worthless crap that hurts my liver. I don't want 500mg of that. 5mg of Hydrocodone doesn't come close to getting the job done. If a doctor were going to write me a prescription for Vicodin to control the pain of my arthritis, I might just say "thanks but no thanks, can you prescribe something else for me?"

Ask for Vicoprofen by name. 7.5mg of hydrocodone and 200mg of ibuprofen. I think 2 of those will produce the perfect analgesic effect.

With that said, I would like to say a word or two again those who recommend an FDA ban on Vicodin. The dirty little secret that the medical profession keeps in the closet is that there is only one way to control pain: block the Mu receptors on your nerves.

Despite billions of dollars in research thrown at the problem, we still have one and exactly one class of drugs that block Mu receptors. That is the opiates, or narcotics. Both terms refer to the same thing. These are chemicals that come from poppies, although a couple of patents have been granted to firms that can synthesize these agents from raw crude oil. (!!!)

This is where I have bitch-slap Mr. Matthew Herper of Forbes magazine. He recently suggested that Bextra (a chemical cousin of Vioxx) should be the FDA recommended replacement for Vicodin.

Bah! What drivel! What ignorance! He's obviousness never had arthritis.

Bextra is an NSAID. It is a Non-Steroidal Anti-Inflammatory Drug. There are many NSAIDS. Aspirin, acetaminophen, ibuprofen, naproxen sodium, and other drugs are members of the NSAID class. NSAIDs work by blocking two enzymes COX-1 and COX-2 which form prostaglandins. Prostaglandins are hormonal chemical messengers often responsible for fever and swelling.

Bextra is a so-called COX-2 inhibitor. This means it works by blocking COX-2, but not COX-1. In stark contrast, you plain old aspirin and acetaminophen block both of them. Is there any advantage in blocking COX-2 but leaving COX-1 alone?

Once upon a time, the theory said there would be. However, life is a beautiful theory ruined by an ugly fact. Years of use say there is no advantage. There may be serious disadvantages, like greatly increased risk of heart attack and stroke. Dr. Bachner will not prescribe these drugs. He doesn't believe in them. He thinks ibuprofen works best. So do I.

It is better to block COX-1 and COX-2. We should remember that common aspirin reduces the risk of heart attack and stroke. It's good for you.

EVEN IF COX-2 inhibitors like Bextra worked better than aspirin, which is not true, Bextra still does nothing to replace the Mu-blocking power of Hydrocodone. COX-2 inhibitors don't block the Mu receptors as narcotics do. If you don't block the Mu receptors, you don't kill pain. Ergo sum, Bextra can never replace the role Hydrocodone plays.

You might put hydrocodone together with Bextra, but I would rather not. Give me Vicoprofen instead, if I have to have something.

First blog entry after knee surgery

So, this is my first blog entry after having had knee surgery on the 8th of January. The surgery seems to have gone pretty well. Despite the fact that the surgeon made three incisions in my left knee (as opposed to two in my right) this has been a far less painful process than my last surgery.

I really could put weight on the left knee almost immediately after surgery. It was a bit tender on day two, but it was solid afterward. I could straighten it and bend it a bit immediatly without pain. None of this was the case with the right knee. I still have some ugly inflamation above the left knee, and I did bleed a bit (in the shower) from my stiches there last night. However, all things considered, this left knee surgery has been much easier than the right.

I was pretty grogged coming out of the surgery this time. Dr. Bachner came over to me and said "The surgery was successful. We found a lot and lots of things that could make you hurt." It sounded like he did a lot of work. I thanked him for his efforts. That is all I remember.

I do remember that it was approximately 11:30am when they wheeled me into the surgery room. There were atomic clocks posted on the wall all over the joint. It was 1:30 PM when they wheeled me into the recovery room. That means I was in surgery for almost 2 hours. Last time it was just 1 hour. Once again, it sounds like a lot more work was done.

The greater grog and the easier ride may have to do with the pain killers they gave me. I felt very little pain coming out out of the Propofol. Last time the right knee burned and throbbed and ached immediately. The abscense of pain this time may have had something to do with the local painkiller they shot into my left knee. It also had something to do with the double shot of Dolantin the surgical nurse shot into my IV bag. {By that two distinct injections into the bag.} It may have been related to the injection of Torodol they gave me. It could also have something to do with the Vocodine chaser she gave me. It may also have something to with the Norco + Torodol pills the doc prescribed for me to take later on.

Norco is literally twice as powerful as Vicodin. 10mg of Hydrocodone vs 5mg. Torodol is a hyper-strength NSAID that has to be taken with a meal because it can really upset the tummy. It is the very best thing for killing inflamation, but you cannot take it for longer than 5 days.

They obviously weren't taking any chances on me writhing in agony after the surgery. Once again, it sounds like the Doc did a lot of work on my left knee. I greatly appreciate the fact that I was able to sleep well all week. This has helped me to recover faster.

The post-surgery rehab experience

So rehab is now underway. I went to my first rehab session on Thursday. The night before, I found the courage to get up on the ROM machine and do the lower body workout. Much to my shock and joy, I performed extremely well. The knee felt as good or better than it did before the surgery. My performance was strong. I didn't try to push it hard, but the results were good. I did 1 minute, 2 minutes and 1 minute. The resistance was my normal 220 pounds.

Words cannot express how relieved I was when the workout was over, and the knee didn't turn into a radio active H-bomb of pain. I was so stoked up that I got up on the Elliptical and did 5 minutes. I found myself pressing much harder with the right, even leading with my right leg. This is something I have never done before... at least not since the day I bought the machine some 15 months ago. This suggests that the knee is coming back, and it will be much better than it was before my last injury. That is exciting.

Not surprisingly, I went to my first rehab session with a little inflammation. This may have had something to do with the fact that I had taken no pain killers or anti-inflammatories all day. My first rehab session yielded good results. The PT was surprised that I showed 105 degrees of flexibility in my right knee. He was expecting 90. My left only shows 117. I am within 12 degrees of my other 'normal' knee. That left knee has seen plenty of damage also. It may be the next contestant for Arthroscopic surgery.

The exercises I did were a doodle. I doubt they helped. However, the PTs performed Ultra Sound and Electro-stim work on me. This was very good. I believe this was the primary factor that led to my good results. This morning I was walking almost completely normally. I was able to stand up a bit quicker than before, and move down a flight of stairs more rapidly that any time after the surgery. Standing up from a seated position seems to be the most persistent source of pain. I look forward to the days when that will end.

Speaking of pain, I have become something of an authority on painkillers since my surgery. I wanted to know and understand every agent they gave me, from liquid injectable Demerol &Toradol, to Ketorolac, to Hydrocodone + Acetaminophen.

What can I tell you about these things?

1. Demerol works like hell. Kills pain dead
2. Toradol works when injected, but only to reduce inflammation. I don't think it kills pain well at all.
3. Ketorolac sucks shit. It did nothing but upset my stomach. I have most of the prescription left. I won't use it. It is good for nothing.
4. Acetaminophen by itself is for the birds. It is better than Toradol insofar as it has fewer side effects, but it still sucks. I get very little relief from Acetaminophen.
5. When combined with Hydrocode, Acetaminophen works fairly well. However, I did not find this combo to be particularly powerful. It took the pain down about 50%, but that still left me with 50% of the pain. I still suffered a lot of pain, despite this stuff. I gutted it out because I have balls. Call me Emmit jr.

If the Doc does my left knee, I am going to ask him to prescribe Combunox for me. I have spoken at length with several people who have had these surgeries, including one dude at rehab. To the last man, they all say Combunox rocks. It is the best painkiller money can buy.

So what is Combunox? It is the dreaded oxycodone + Ibuprofen. The difference between oxycodone and hydrocodone is obviously hydrogen vs oxygen. Oxygen works better. I don't know what you think, but I think Ibuprofen absolutely kills acetaminaphen in all phases of the game. For these reasons I suspect Combunox is the way to go next time.