14 Minutes

image courtesy of addiction search

I'm having great dreams.  My last flirtation with sleep had me at the White House in tennis togs, running up and down a lovely, wide, red-carpeted staircase, happy as a clam.  The President and First Lady were scheduled to renew their wedding vows, and I was serving, of course, as a bridesmaid (a word and concept that makes me cringe).  People were reputed to be lined up outside, dressed to the nines, and upset that the wedding party had spent the afternoon on the courts instead of primping -- we had delayed the festivities when our mixed doubles required a third set.  So President Obama made a charming statement, promising that we'd all be downstairs and completely suitable within 14 minutes.  He repeats the 14 minute reference several times and it seems to be an inside joke, as the press and all the gathered beautiful people are snickering.

What can I say?  It was a dream.  14 minutes.  *These* are the dream details, Dear Sigmund, that I'd love to understand!

Clearly, there is nothing profound going on between the ears.  My brain is simply a little less inebriated than usual:  About ten days ago, I decided to try and be off of methadone and Percocet before the next Ketamine treatments.  If we are going to try and approximate the protocol used by Dr. Schwartzman, and if that's part of what he recommends, well, that's that. 

From a beginning dosage of 40 mg a day, I am down to 15 mg of methadone.  From a usual four pills a day of Percocet, I am down to three. 

I may need to pause here for a few more days, though, and I'm thinking it looks "iffy" that I will make the deadline of "no opiates" by June 13.  Why?  Well, most of all, methadone has a long half life and it surely won't be completely out of my system. 

And as for Percocet -- it helps too much for me to imagine not having to take it.  Judicious use of Percocet and ibuprofen has saved many a day.

I will do what I can do.  Any reduction is good.

In an effort to make it easier, and to control symptoms while attempting this crazy thang, I'm relying more than usual on non-addictive adjunct meds -- amitriptyline, baclofen, Cymbalta. Mostly, though, I am just trying to see the "absolute value" of taking as little narcotics as possible.  A clearer head, a happier gut, and maybe, given the infamous rebound potential of these drugs, less of a certain type of pain.

I can report that I'm not having as much of the burning so much a defining element of neuropathic pain -- but that might be due to the higher dose of amitriptyline (I hate amitriptyline and won't maintain this higher dose much longer).  The rest of my pain is unchanged and if you forced me to pick a number on the Pain Scale, it would be an eight, which is about as high as I ever will claim. 

Let's put it this way:  At my current level of pain, it sometimes takes me up to 10 or 15 minutes to just get out of the wheelchair, and I am likely to be crying by the time I am on my feet.  This morning I had to go without coffee because my shoulders, arms, and hands couldn't tolerate the weight of water.  I'm not suffering any delusions about having a pain free life.

There are whole communities on the internet of people trying to stop taking methadone, and after perusing the goings-on within them, I got really scared.  Weeks and months, even, of withdrawal?  Going through a literal hell? (Also, shouldn't I be referencing "percs" and "dones" so as to better perfect my Addict Persona?)

Among these conversants, though, there are very few who are taking methadone to treat pain.  Most are part of a methadone maintenance therapy that enables them to resist the cravings for other drugs, usually heroin.  It really is awful to contemplate -- to be hooked on heroin, then to be put on another drug to which one invariably becomes dependant?  I get the argument -- it's cheap, it's controlled, it doesn't require a life of crime or victimhood to sustain... Still.  How awful.  

The constant theme is withdrawal, and at what point to consider "jumping off" and going cold turkey.  It is generally agreed that it's nuts to do it above 30 milligrams.  Obviously, the lower the dose at which one jumps off, the better. (And then there is the constant motif of suboxone!) If I had more time, I'd do it all by taper, but I will have to choose a jump-off dose as well, with the expectation of about a week of withdrawal symptoms, probably beginning on the fourth or fifth day.

In other words -- any day now.  I have June 1 in mind. It would be lovely to be at a comfortable 10 mg a day in the next week.  We'll see.  Again, if I cannot do it, I won't see that as a failure, but it will mean going into the upcoming Ketamine treatments under less than ideal circumstances.

For me, this is a fairly straightforward case of diminishing returns.  Higher doses of pain medications that are not terribly effective anyway make no sense.  Finding the lowest, most effective dose seems logical, and along with that, testing the validity of that dose from time to time (I believe in drug holidays).

My poor brain is trying hard to keep up.

The increased sleep is helping.  Who would not enjoy mixed doubles with Michelle and Barack Obama?  Finally, too, I get to wear a bridesmaid dress that is not a gauzy, goopy pastel but instead is a copper-colored raw silk with a clean, clean line.

And I'll figure that 14 minutes reference out one day...