The Disambiguation of Pain (produced the Pisan Cantos): A working theory

What follows is a live-action demonstration, from July 2009, of how to control pain using the art of distraction.

To employ this method at home, you will need internet access and some sort of writing platform (a blog, spare bits of tissue, rice paper with ink and paintbrush, etc.).  Also, if you have a legal and appropriate pharmaceutical at hand, you may take it, but take the lowest necessary dosage, decreased by half.

[Your first few times employing my proprietary blend of distraction, though, consider not using any medication at all. It may not be necessary to your relief.  Not while you have a brain!]

Tell yourself, aloud:  "I will feel better in 15 minutes. 20 minutes, tops." For a successful outcome, position yourself, your internet-accessed device, and any external writing paraphernalia (beware the literati cops!) within comfortable reach. Place everything with such care of thought that should you drift off in a cloud of painlessness, nothing will be harmed. That means, for instance:  no hot beverages!

There.  You are all set.  Breathe in, breathe out, slowly.  Engage your creativity and release your inhibitions and prohibitions.

You are about to disambiguate your pain.  Bon voyage!

***********   ***   ***********   ***   ***********   ***  ***********   *** 

Ezra Pound

I had a night full of crazy nearly-nightmarish dreams and woke to the indescribable pain caused by Uncle Kitty Big Balls licking my CRPS-stricken right big toe. [He's obsessed with toes... maybe because we had to have one of his chopped off to save his sorry hide.]

I don't plan to scrape UKBB:-:Pickle Head:-:Little Boy off the wall anytime soon. Yeah, go ahead. Report me! Turn me in! Drag me off to the slammer, the big house, get all touchy-feelly about mistreatment of cross-eyed, streetwise, stinky-pooping cats.

Lately, UKBB:-:Pickle Head:-:Little Boy has accumulated even more monikers, none of which have definitively stuck, alas. Bugsy. Gus. (I was watching, for the umpteenth time, Lonesome Dove. I have an enduring love for Robert Duvall, and had just announced that I really, really wanted a Gus of my very own, when UKBB promptly announced himself with that weird, raspy half-*ack*-*ack*, half-mee-row that also managed to denote a scruffy beard and teeny-tiny cowboy hat.)

Also: Aeolus -- Greek God of the Winds, for reasons that are air-borne and truly, truly unfortunate. Dirty Harry.

Ah, the serendipity of internet searches and plain old, errant, mindless keyboard clicks. As I began to write about UKBB and his assault, it occured to me that I did not know many synonyms for jail, prison.

What?

Is that not normal mental function? Don't you jump from allusion to allusion, gleefully following each verbal twist until your childlike wonder is definitively shown up as your unique form of mental retardation?

The first thing that popped up was "Yahoo! Answers," where someone had posed the same query -- wanting some slang for prison. Pen, pokey, cooler, lockup, clink.

Not terribly familiar with this Yahoo! feature, I decided to look into what pressing questions were on the mind of the world wide web citizenry:

What's wrong with my cat?
In Cats - Asked by Aida-Christine - 11 seconds ago

How is the average speed solved using the ticker tape?
In Physics - Asked by Dulce Amor - 11 seconds ago

What does human context mean in terms of the elements of drama?
In Words & Wordplay - Asked by LittleMiss - 15 seconds ago

HIS and STORY = HISTORY. should it be HER and STORY = HERSTORY?
In Gender & Women's Studies - Asked by Bored Observer - 16 seconds ago

Where can I buy thermal printers for embossed printing on invitation cards?
In Printers - Asked by Mitch - 16 seconds ago

I cant check my email. Some help please?
In Other - Yahoo! Mail - Asked by infantry_wife - 23 seconds ago

Do I need to be in the center of my surround sound?
In Home Theater - Asked by kc17170 - 24 seconds ago

Are muscly calves genetic?
In Diet & Fitness - Asked by єℓιzα©™ - 24 seconds ago

How do you Say this in Japanese?
In Languages - Asked by Areazel - 27 seconds ago

Whats a good acne medication or cream or something !?
In Other - Skin & Body - Asked by Selah - 29 seconds ago

Production of atp in prokaryotes?
In Botany - Asked by yashwanth - 33 seconds ago

What is the best FREE MUSIC MIXING softwware to download?
In Software - Asked by JasonC. - 37 seconds ago

After a tattoo is pretty much healed is it ok to use cocoa butter without fading?
In Tattoos - Asked by Angie - 37 seconds ago

A quetion about herbal essence shampoo?
In Hair - Asked by BoPeep - 43 seconds ago

How much are Alternators for a 1998 dodge 1500?
In Dodge - Asked by iaskquestions - 43 seconds ago

Is male pregnancy possible?
In Other - Pregnancy & Parenting - Asked by Phylisia Y - 43 seconds ago

What album tracks do you always skip when listening to your favourite bands?
In Rock and Pop - Asked by mark j - 45 seconds ago

What will the human race look like in 1,000,000 years time?
In Other - Social Science - Asked by x-jessicalouise-x - 47 seconds ago

Can you guys use the search feature?
In Yahoo! Search - Asked by Artanis186 - 47 seconds ago

Pls help me with my homework?
In Homework Help - Asked by oyoboy - 49 seconds ago

It's enough to put Darwinian theory in doubt.

So, I am almost in danger of losing the train of my thought, the choo! choo! choo! so dear to coherent conversation and logical composition. Ah, but my darling Reader-Friends, after years of living with an ADHD-driven sweetheart, a cartoon diva, and the neurotic feline Sam-I-Am -- not to mention the impact of inhabiting the Tête de Hergé? I got a mind like a steel trap.

Okay, Beloved Students, let's take a moment to assess things.  
Have you noted The Method in the madness of my various circumlocutions? 
Observe:

Feel pain; Immediately invoke the pain management technique of DISTRACTION.

Not quite there yet, FREE ASSOCIATE; Discover a strong stream of consciousness around the concepts of PRISONS, CATS, and ROBERT DUVALL.

Effective pain management requires a more narrow focus, for which I FISH, using the apparently contrarian method of SEEKING THE SYNONYMOUS.

In so doing, the hard-and-fast rule of "when in doubt, Google," returns the oddly appropriate suggestion of SEEKING THE SYNONYMOUS by visiting Yahoo! Answers.

Having achieved considerable pain relief by such perfect use of DISTRACTION, toss in some deep breathing exercises, maybe a coffee and cannoli.

EXTRAPOLATE WITHIN THE CONFINES OF THE SYNONYMOUS.

This almost brought me to the edge of disaster (located near the stream of consciousness), even unto the brink of the aforementioned Darwinism.

Ah! But as Ezra reminds me, daily:

When the mind swings by a grass-blade

an ant's forefoot shall save you

the clover leaf smells and tastes as its flower.

--from LXXXIII

And so it is that I arrive... at pain relief by DISTRACTION, and you, my darling Reader-Friends, once again scratch your heads and roll your eyes, wondering about drug abuse, mental stability, and why I can't just stave off CRPS' impact by sheer force of will.

That's okay, I understand.

But -- the process is not over. There is much more to this pain management technique of DISTRACTION.

My mind now calm, even if my body still occasionally gives in to the odd writhe, and the voice to disembodied moan, I complete things. I "choo" the "choo," as it were! (You are not successfully circumlocuting if the ends never meet.)

Usually? I don't trust you or like you enough to show you the ending, the meeting of the circle ends. You don't know of my love for Euclid, and my secret glee, inasmuch as I am a writer, of the writerly things I find everywhere:

A circle is a special ellipse in which the two foci are coincident. (Wikipedia)

Wikipedia frequently offers its efforts at disambiguation, in which I delight, for I will refuse all efforts at disambiguation of my own text, while hungrily acquiring the nit-and-grit of that dialogue of contrariness. To wit, I usually would not go on to share that an investigation of ellipse necessarily includes a parse of its use as a rhetorical figure:

a rhetorical suppression of words to give an expression more liveliness.

Now, really, friends, isn't that a pure HOOT?! Coming, as it does, from the figurative pen of Retired Prof, Profderien? A freaking SUPPRESSION of words! Mwa-ha-ha-ha!

Okay, to be honest, as this has been composed in actual time during an actual episode of severe pain, I took my breakthrough pain medication (15 mg Endocet) about 40 minutes ago.

DISTRACTION as an effective pain management technique? Maybe for those perfect souls who are into suffering as means of spiritual purification. Maybe for those stellar people whom I truly admire, whose minds' natural ability to focus does indeed allow for it, like Jeisea, down under at her blog crps/rsd: a better life -- though such sites tend to irritate me because of the pride of suffering (no, I won't unpack that -- you know what I mean -- don't be coy). Also, I am jealous.

I used to be one of both of those -- seeing an overarching good in learning to live with severe chronic pain and able to hone my mind's eye to the razor's edge of a laser beam, and so hope to escape that damned pain.

But no more, unless I have to. When did the "I-have-to" Era arrive? I think when the reality of my immunosuppression and the seriousness of this apparently untreatable osteomyelitis finally made me see that the Ketamine Cure (think Keystone Cops) was too dangerous for *me* to try, that I'd never be accepted in a trial, that the SCS and pain pump were no longer available to me as pie-in-the-sky options.

Now? I try to write through it, perform it. But I also take the medication prescribed me, as it is prescribed me. Well, hmmm, that's a lie. I take less pain medication than my doctor knows or suggests. I force myself through monthly "drug holidays." I try to explore adjunct pain medications, so as to narrow the focus and thereby treat the pain more *precisely*. Mostly, that has come to mean use of baclofen to ease spasm and tics, and ibuprofen to attack inflammation.

And so, let's see: through writing this weird blog and the work that goes into it, there is significant distraction from pain, even though it usually means blogging on that very topic. Writing has become a process undertaken while waiting for conventional pain medications to kick in and do their job, or it is a Hail Mary Pass when I have taken all that is allowed. Anger emotionally fuels and informs my pain, once it has started, and so writing, again, is a way to get through that -- a way to bring the circle's ends back in line, and my mind to a measure of quiescence.

Having literally said, and also performed, this real cycle of pain -- allow me to finish. This is usually the secret part.

When last we left our intrepid painkilling thread, we were citing one of the more predictable quotes from Pound, that crazy, dangerous fool. You know, the ant's forefoot, from the last of the Pisan Cantos.

Here is a brief map of Pound's route to Pisa and on to trial and twelve years at St. Elizabeth's:

Pound met the Fascistleader Benito Mussolini, and it was in this man that Pound saw the opportunity for economic and social reform. As a supporter of Fascism, Pound's statements broadcast over radio became infamous, such as his anti-Semitic statements against what he saw was a Jewish control of the economic systems of Europe:

"..if some man had a stroke of genius, and could start a progrom against
Jews... there might be something to say for it."

These World War II broadcasts, made in Rome, were openly Fascist (it was clear that he hated U.S. President Roosevelt and usury banking), so it came as no surprise when EzraPound was arrested in 1945 by U.S. forces on charges of treason - Pound was still a citizen of the United States of America. For twenty-five days, Pound was imprisoned within the 'gorilla cage', an open cage which was situated outdoors, and was moved into a tent at the end of this time for medical reasons. This incarceration at Pisa lasted for six months in total, and during his time here he continued to translate Confucius and work upon his most famous work, the Pisan Cantos, writing it on scraps of papers and typing up his poem in the medical tent, after-hours.

Leaving Pisa to stand trial for treason and broadcasting Fascist propoganda in the United States, Pound arrived, and was examined by a panel of four mental illness experts before the trial began. Their conclusion was as follows:

"He is abnormally grandiose, is expansive andexuberant in manner, exhibiting pressure of speech, discursiveness and distractibility... He is, in other words, insane." - The judgement made by the four examiners.

Following this 1946 judgement that he was "insane and too mentally ill to stand trial" (and consequent acquittal of the charges on thesegrounds), Pound was taken to St. Elizabeth's Hospital in Washington, D.C. where he remained for twelve years until the continual appeals made by his writer friends ensured his 1958 release.

The ten cantos comprising the Pisan Cantos were composed in the weeks immediately following Pound's several week stay in one of the camp's death-row wire cages, where he had been exposed to the elements, and where he was deprived of the comfort of the human voice, as he was considered too dangerous to be engaged in conversation. When it was finally decided that he was not a high risk prisoner, after all, his health -- physical and mental -- was already in decline. They moved him to one of the medical tents, and there he composed LXXIV-LXXXIII (84 was added later, as coda).

Indicted for treason, found incompetent for trial, Pound ended up, as most crossword-puzzlers and American Lit 101 (or some other introductory course on modernism) know, at St. Elizabeth's.

Just a few months back, a very sweet woman -- who turns out to be my aunt -- filled me in on some of the more fascinating tidbits of Our Family History. My great-uncle Otis spent the last third of his life as an inmate at St. E's, the unwitting victim of tertiary syphillis.

See? It's not all coincidence and serendipity. Nor is it self-indulgence. Well, nor is it entirely self-indulgence -- this defeat of pain by DISTRACTION.

And haven't you had a wonderful time?

Just That Elemental

I've increased some of my medications in an effort to stop the spasms.  These demonic twitches have been starting up three times a day, lasting anywhere from just thirty minutes to an interminable three hours.  Their three instances vary, but the last few days have seen a pretty early first onset, around 11 am, with the second visit in the late afternoon, and the unforgiving third beginning almost promptly at 8:30 pm.  What has prompted me to resort to grabbing more pills, though, instead of white-knuckling my way through, are the changes in frequency and in the sly adjustments my enemy has made in how it conducts its wily, ugly, piece-of-crap self.

I'd never given much thought to how much time was elapsing between spasms, but when my screams seemed to be piling up, one shriek right on top of the echo of the last yell?  I decided to be oh-so-crafty, too, and count off the intervals.  My first attempt at counting, I made sure to follow the tenets of "one one-thousand, two one-thousand," calm, steady, and every time, I got to "eighteen one-thousand" before I had to scream.  Even when I felt stubborn and resolved not to make a sound when I hit "eighteen one-thousand," I had no ability -- none -- to stop that disturbing vocalization.  The second go-round with counting off the time?  I couldn't even maintain the pattern, that comforting rhythm, because the short-circuiting area of my brain decided on irregular firing, on pulses of 18, then twenty-two, then 12.  My point?  That is a very short amount of time between onslaughts;  There is no time for recovery.  This is new.

This is horrible.  I understand the meaning now of "I wouldn't wish it on my worst enemy." Okay, well, that is something of a sad confession.  Until this, until now, I had little problem wishing stuff upon my enemies, and I admit it.

A doctor told me recently that he would kill himself if he had CRPS.  I assume he meant CRPS as I have it  -- bad and unbeatable.  What else could I assume, since I was the only "CRPS referent" in the vicinity of the conversation, a conversation being held aloft by just three human tongues?  What is sad is not his comment (it's more in the category of neutral, a rhetorical ecru) but my complete lack of shock, the absence of any surprise.  "What? My God!  Why ever would you say such a thing?" has faded away and left me with "What?  What?  Oh, that?"


I can't kill myself right now because Fred would be lost, financially.  I promised, at some point, to take care of him -- and what I cannot explain here, though I assure you it is true, is how Fred has given up more than you can imagine, and that he did it for me, and that I owe him, as is said, big time.  He has not been able to travel certain paths, plan for life as he would have.

I have to keep my promises.

Yeah, so.  I don't know how I got to talking about *that*.  Good grief.

The other change in the current Shift Toward Intolerable?  The center for these bits of seizure has shifted so that I would swear (and bet all of Fred's inheritance, no matter the odds) my hips were grinding themselves to bony bits.  Actually, I have a prosthesis for a right hip, and the left hip is pinned. The right one is okay, most of the time.  I can tell there is activity on the right by the degree of generalized soreness.  It's my best major joint, that right hip!  Yay, right hip!

But the left hip, despite still having its original parts, is the Devil's Spawn.

Oh, I give up.  There's no explaining it, and why should there be?

The amount of Baclofen required to just get through the day is not enough to stop the pain.  Somehow, my mind is supposed to keep that knowledge front and center, available to reason.  As in:  Don't take more just because the pain continues, the screaming continues, the smashing and grinding continue.  It won't help and it could kill.  It's the same with the other meds -- with any medication, any drug.  It's imperative that I remember that in the middle of all the awfulness.

I think, every day, several times every day, how understandable it would be were I to forget.

On the way to the orthopedic surgeon's office on Thursday, I had just escaped the first of the three spasm periods for the day and hadn't had an opportunity to really process the night -- I woke myself with my own screams.  He was driving.  I was riding.  I thought we were okay.  I began telling him about the night, about the pain. He stopped me, said I overwhelm him.

All I could do then was cry.

Because -- of course, I overwhelm him.  Who would not be overwhelmed?  Who would not feel trapped?  Who would not be sick of pain, talk of pain, the sound of pain, its look?

But what makes me angry, besides being told, basically, to shut up, is that he thinks he knows what I am dealing with -- and he does not.  He thinks that if I feel it, I blurt it out -- I blurt it out all over him, and rush to do so -- and feel better afterward.  As if it were a beneficial purge.  Except that I don't.  I don't tell him most things, and I surely don't share with him most pains.

And it has been many years since I have felt better for having shared with him.

He is controlling me, in many ways, and I resent each of them.  I resent him.

He passes himself off as a "caretaker."

He does not.  He does not take care.  I tell you -- he could not discern another person's needs if you paid him to -- and, ha!  I do!  And he doesn't.  And I don't deserve this.  I have to keep living because of him and his inability to care for himself, never mind anyone else.

All of this is true, but all of this is nothing but me, unabashed, unfiltered ego, the moi at the center of the universe -- it lacks the grace of the angels, it lacks the child that shines from Fred, it doesn't pray for what the congregants are pleading.

It just freaking overwhelms.

I'm going to be twitching for a while yet tonight, and then later again. I need to wash and change my clothes, do the dishes, write my mother a letter, my brother Grader Boob an email.  Wave at the moon that is the same moon shining over the Grand Canyon, and over my brilliant brother Tumbleweed (and friends).  We got a postcard from him today. I swear, the boy is having a good time!

I wish I could be among those pilgrims.

Fred is asleep right now, curled up on the sofa.  He looked cold so I covered him with a blanket.
We need things just that elemental.

Stasis

Well, it looks like I may keep blogging after all.  Your spontaneous cheers of approval warm the cockles of my heart.  Thank you so much (my best Brenda Leigh Johnson impression).

It was an afternoon of misadventures, my favorite kind of afternoon.  I do feel awful, though, for dragging others through these fun times, and by "others," I usually mean Fred.

I had not been to my pain management doctor's office since March -- at which time two things happened:  the PA I had been seeing there quit, and I began the Great Subanesthetic Ketamine Adventure over at the Hospital for Catastrophes.  Each one of these two things engendered other things until I was practically tripping over all that accumulated quiddity.

The PA leaving caused me to question the quality of care I'd been receiving.  It sounds odd, I am sure, but Allison the PA was light years ahead of the doctor of record, in terms of staying abreast of CRPS research and treatment opportunities.  He had begun to depress me.  I would show up every month with questions from what I'd been reading and about what others had told me.  I swear that I was not obnoxious about it, and never dominated his time.  Fred used to time him from the moment of entry to the second he grabbed the door knob in retreat -- and this doctor rarely stayed in the exam room longer than 3 minutes. 

At some point, Dr. PainDood decided that I did not understand my situation.  He began taking my gesticulating hands in his big old dry ones, looking me soulfully in the eye, and saying:  "Prof-de-Rien, there are no more treatments to try... There is nothing that is going to help... We can only manage the pain to the best of our ability."

He's a very handsome man, and he would pause, head held at a flattering angle, long arms and finely tapered fingers extended -- Dr. PainDood loves handshakes, handholding, all things hand.

[I suppose that is preferable to, say, the kisses I used to field from a certain rheumatologist, and it's definitely superior to the tears that always flow from the sweet, sensitive eyes of my neurologist, The Rock.]

I got the same speech, month after month, fighting it, hating it for the first several iterations... then caving, imploding, believing it.  And so it was that nothing ever changed, except for a worsening of CRPS, then the onset of infected prostheses and osteomyelitis, all accompanied by the collapsing joints of avascular necrosis.  Life may not have been anywhere near good, but there was a measure of orderliness to my degradation.  Woo-hoo!  I got worse but my pain management stayed the course;  I got the same medications, at the same strength, month after month, year after year, and it was consistently ineffective.  If I dared raise the specter of change, I got The Speech -- and the Handholding.

There came a visit, about 3 years ago, I think, when the last remnant of rebellion in me reared its faltering head.  What about x, what about y?  Couldn't we give z a go?  And then, poof, Dr. PainDood took back both his hand and his spiel, declared me to be on permanent pharmacological pain management, and turned me over to his Physician's Assistant, Allison.

I thought she was punking me, for sure, the first few times she began the appointment with news from a conference on neuropathic pain, with an update on the research into the inflammatory response, or with the suggestion that we give an old drug a new try at a radically different dose.  Sure, sometimes she pitched ideas that were clearly birthed in left field, but always, always, I knew that she believed that improvement was possible, that improvement was necessary.

Plus, she totally understood that my hands HURT, and so she left them the hell alone!  (You've no idea how much I dreaded Dr. PainDood's obsession with the shaking and holding of hands.  I figured it to be some sort of bizarre challenge to my integrity, a nonverbal inquiry into whether my continuing ed credits from the Emily Post Institute were up-to-date.)

She and I both thought that Ketamine might be my Big Chance, and it was Allison who discovered that there were treatment opportunities right here in Tête de Hergé.

You've probably heard about "contracts" between doctors and patients when it comes to the serious matter of narcotic pain management.  I probably signed one but I don't remember.  The guidelines make sense and I always followed them -- if I get my pain medications from this doctor, then I don't seek pain medication from any other doctor.  I take my meds as prescribed, and I don't sell them or give them to anyone else. 

The only deviant behavior I exhibit is a tendency to not take as much as I am told to take.  That's it.

Since my last appointment with Allison and my first appointment today with her replacement, Maria, I have tapered off of methadone and Percocet, and lived on ibuprofen.  I have been in more pain than I knew was possible.  I did it so that the ketamine infusions would have the best chance possible to work -- you gotta let that stuff antagonize the heck out of those NMDA glial cells, hoo-baby, uh-huh!

Of course, I've pretty much been bed-ridden from pain and sometimes I devolve into Pure Twitch.  Ibuprofen was dissolving my stomach lining, and beginning to mess with my kidneys. 

The only option offered after ketamine failed was to have an intrathecal pump "installed" so as to receive the very toxic, very potent, crazy-making drug Prialt, a synthetic model of a certain sea snail's venom.  Being too close to crazy already, and since my spine is riddled with thousands of micro-fractures already... I declined.

So the catastrophic hospital politely returned me to the care of Dr. PainDood, although they cordially invited me to check in every few months to see what might be blowing in the wind...

It's not like I've been hanging on the street corner these last few months, making drug deals -- at night, traipsing off to raves, clubbing -- life a sudden party.  Still, my welcome back into the bosom of narcotic pain management this afternoon was fraught with suspicion.

Between March and July, where had I been getting my medication?
Did the doctor at the catastrophic hospital prescribe me any pain killers?
Was I sure?
Did I understand the question?
Was I sure?
Did the doctor at the catastrophic hospital prescribe *anything*?
Was I sure?
Did I understand the question?

The idea that a patient would stop taking narcotics on their own just did not compute.  To cheer them up, I told them that I was filled with excitement at the thought of taking opiates again.  "I can hardly wait," I crowed.  "Please, please, return me to the stagnant status quo!"

Okay, so I may have left out that when we showed up this afternoon, they had no record of the appointment.  Did I fail to mention that the new PA, Maria, kindly worked me in, so that we didn't have to make another trip across the wilds of The Lone Alp?  She sorted through a complicated history in an organized way, applauded my reduction of methadone dosage from 40 mg to 10 mg, and...

suggested acupuncture.

Things are back to normal. 

Update on the Jump Off

i cannot tolerate the taste of coffee.
i keep forgetting to take the rest of my medications.
i drop things. incessantly. it's about to drive moi crazy.
i cannot keep up my end of conversations.
suddenly, two out of three felines are afflicted with the dread klingon dirty butt syndrome (dkdbs).
more cow bell!
oh, didn't i tell youse guys? i love christopher walken.
doesn't ANYONE (beyond her grandparents and uncle) remember caylee marie anthony?
i'm sorry but arpad don't-make-me-say-"corroborate" vass wasn't in the least bit "sympathetic" as a witness!
i lost my sympathy the first time i heard his simpering giggle.
and if they make the jury sniff "dead air"? uh-huh, it's all over. (the jury is gonna resent the heck out of that!)
how is it that i went roughly 7 hours almost withdrawal symptom free, then got hit with the godawful leg seizures in the eighth hour? whywhywhy?
buddy the kitten has been seeking reassurance of our love today --
he has been repeatedly shooed away when we are enjoying The Dobster
and apparently, he is shaken to his kitten core by that.
i am the very definition of "bloated."

that's about all that's fit to note.

oh, and my vision is permanently blurry.
also -- i mopped the entire manor this morning (and you know how big marlinspike hall is!) (i did it during the above-referenced 7 hours.)

and when i say "bloated," i mean BLOATED.

The Jump Off

Well, this methadone addict "jumped off" last night at precisely 6:30 PM. I'm not at the 24 hour mark yet, 2 more of those hours remain. You wanna hear something crazy? I've now started the "jump off" for Percocet -- retroactive to 5 AM today. I'm about at the 12 hour mark for that bit of lunacy.

The 30 hour mark for methadone is notorious for its difficulty, so tonight at just half past midnight is when the toughest times are anticipated to *begin*. Is that scaring me? Yes. Do I think I will emerge victorious in my battle against the Demon Opiates? Yes, indeed. Else I would not have "jumped off" to begin with. According to the written schedule I drew up over a week ago, I was so scared as to give each new level of methadone dosage FIVE days... Yet I decided last night to give the 10 mg level short shrift and only ONE day of experience.

My hands are twitching so much that I may actually have to run spellcheck.

We won't discuss my legs except to say that were my feet able to stand the feel of shoes, balletic toe shoes (size 15) might just slip right on. My toes seem to fusing...

And my knees are somehow imploding, bending backward.

And, yep, I am testing those knees every time the half-bath -- just 15 feet away -- calls.

And, yep, Fred is up to speed and greatly encouraging. I believe that my earlier read on The Fredster was Demon-Driven. Was I setting him and myself up as the excuse of my failure? I damned well think I was. But no more. Let's just say that I remembered, just in time, that Fred was raised on cowboy movies and cowboy philosophy, and that he cannot be envisioned in anything but a white hat.

Possibly the weirdest symptom of this withdrawal is how COLD I feel.

COLD in terms of temperature, You Numbnuts! I woke covered by heavy blankets, something that I just don't do. Always, I feel HOT, stifled by CRPS and its attendant pains. I even dialed down the temp for the air conditioner, again something that I just don't do.

The worst symptom is exactly the reason for which I began taking methadone to begin with, and that is PAIN. I feel every ache, every lancinating bit of neuropathic sadomasochism. It's the only thing reminding me of the despairing truth -- that I will have to find a new way to control pain if the new ketamine regime fails. The only thing I know for sure is that it will not be what the doctor there wants me on -- Prialt. I cannot see having that stuff injected into my spine, and you betcha, I am scared to death of the side effects.

[Chief among them being an apparent predilection for suicide.]

Anyway... though I've much that wants to be written -- most of it about the French Open, some of it about the recent USAmerican drone strike that killed Ilyas Kashmiri -- my focus right now is laser lit on my various time pieces.

Because this methadone addict "jumped off" last night at precisely 6:30 PM.

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...

Leontina

oH sWEET mOTHER OF gOD! I managed to cobble together seven hours of sleep, with another hour of the twilight drool stage about half way through.

So *this* is what it feels like to wake up energized! I like it, I like it very much.

Poor Fred. Instead of being the protector of his sleep this morning, I must wake him in a few minutes, as we need to be out the door in just a bit, piled into Ruby the CR-V, and on the Yellow Brick Road to see Dr. ShoulderMan, my orthopedic surgeon. I cannot drive, unfortunately -- meaning that I am not licensed (I am, in fact, an excellent driver) -- so he chauffeurs me to all appointments. Most every scheduler with whom I deal knows to pencil me in for the early afternoon slots, as Poor Darling Fred and I are confirmed night owls.

At least, I was a night owl, before the days of osteomyelitis and infected orthopedic prostheses, CRPS, and all those other pesky comorbidities. Now I am a temporally unaffiliated owl.

The surgeon is going to render an opinion about the -- excuse me -- junky gunk both palpable in my arm and oozing from the incision (he last operated on 7/6). His PA's eyes bugged out last week when he examined that shoulder. Since then, though, I finished my course of Zyvox (all $2900 worth), and hopefully that will make a difference.

Yesterday, Fred drove me all around town and I had a great time. Conceivably, it wore me out enough, too, that I was able to sleep. Hmmm. If I can, I'll try and wear myself out again today!

What did we do yesterday? Well, I saw Dr. PainDude's nurse practitioner -- she is infinitely more helpful and, in my experience, more knowledgeable, than the good doctor. Plus she wears some killer shoes. Not that her shoes turn me on, or anything. No, it is just that I have not been able to wear shoes since May 2002. And I love shoes. Particularly Italian shoes.

Allison sported a pair of Leontinas: Supersexy red patent cocco kidskin mule with 150mm extreme heel and genuine leather sole, insole and lining. Entirely hand-made using highest quality leather and natural fabric by master Italian shoemakers.

She did share that her feet hurt.

We covered a wide variety of topics: the deleterious effect of celebrities who off themselves by misuse of pain medication (or, rather, in her estimation -- ill-advised combinations of drugs); the evil Dr. Scott Reuben and his own deleterious effect on the world of pain medicine; my particular situation (she used to work for my orthopedic surgeon); the price of Zyvox and tea in China.

Super shoes. Prescriptions for methadone, percocet, tizanidine, and amitriptyline. Could life get any better? [Shut. Up. I. Am. Being. Ironic. Sardonic. All. Kinds. Of. -Ics.]

I have worked out an effective pain management regimen, about which I keep her and Dr. PainDude informed. It's a combination of pharmaceuticals -- and that means as little drug as possible -- and distraction -- but mostly? Lately, I have resorted to heavy doses of meditation and basic relaxation techniques. It has caused some unrest here at Marlinspike Hall, deep, deep in the Tête de Hergé, as Fred, La Bonne et Belle Bianca Castafiore (a sister shoe freak), and the Four Felines all feel "cut off," deprived of my affection and attention.

Still, the pain is pretty bad. It hits me in those periods when I'm not covered by my "regimen." Like right now -- I need to take breakthrough pain meds, do some pendulum swings, work on my legs (a whole other post), and take a mental ax to the anxiety surging through my body at the thought of what the surgeon may propose. If forced to resort to the dreaded Pain Scale, I am at a 7.

And out of time! Think good thoughts -- think "no surgery--no surgery--no surgery--no surgery--no surgery." Cross the applicable digits.

[Thanks!]

Lunge! Riposte! Touché!

The Manor is in disarray; Marlinspike Hall calls out for my domestic ministrations!

La Bonne et Belle Bianca Castafiore, Fred, and the (now) *four* felines -- Little Boy, Marmy, Dobby, and Sam-I-Am -- have all adopted the feckless stare of the spiritless.

(Little Boy is Marmy's brother, and has been living as a stray for the past two years. Uncle to Dobby, he recently attached himself to the lawn around the manor moat, and Fred made a heartfelt appeal to adopt him into the inner circle once his various wounds became apparent. Initially known as Uncle Kitty Big Balls, the boy's tininess inspired a new moniker once his hopelessly matted fur was shaved off by the vet, and... well, once those Big Balls were, themselves, history.)

Little Boy shall hopefully have a name soon. He enjoys relative immunity at the moment, being in such rough physical shape. That is, the fact that he poops with great pomp after every meal in a spot that he relates to The Fredster... this fact is met with forbearance, good humour, paper towels, and multiple cleansers. Once he's named and physically fit? He'd best be pooping with great pomp in one of the containers specifically designed for that purpose.

I've never run across any actual surviving implement, written description, or fine art depiction of what was used in the Middle Ages or the Renaissance to contain cat poop and pee, although why I expect the amenities to be more hygienic than the facilities used by their human counterparts is just basic denial on my part.

Surely the Age of Enlightenment had something to rival, say, the CatGenie, "[t]he only automatic cat box that flushes waste away and, like a cat, washes itself clean."

My working theory is that Little Boy understands the concept of the litter box and will be perfectly compliant once his paws heal. He has a puncture wound on his left rear paw, and a huge abscess on his right rear leg. It cannot feel good to put those tender feet into litter.



Poor little guy. Despite the enormous amounts of food that he is downing, he has lost more weight, something that he can ill afford to do. Obviously a valiant soul, he has a wonderful, loving spirit despite an obvious history of abuse. He looks not unlike Bill the Cat (and on a bad day,too). I believe that when his hair grows back and his wounds disappear and he puts on some weight -- the boy is gonna be the stunning, dominant one among the felines. As it is, he basically suctions up any food within his sight: He chows down what is rightfully his, then elbows Sammy out of the way, eats Sammy's food, meows a few times, then scrambles to the kitchen where he swipes dry kibble from Marmy and The Dobster. And still, he lost a few ounces last week. The vet opines that it is due to fever / dehydration. Getting well is a rough workout.

Did I mention that he loves me? Can't fault him for that.

He kept me company through the night -- last night -- and is now catching up on his rest, though he wakes frequently to redistribute his weight. Those Areas of Ouch are nothing to sniff at. In fact, I wonder why the vet doesn't give him something, even something topical, for the pain.

My own Areas of Ouch, the oft-mentioned World of Pain? My pain management doctor -- who dumped my care to his Nurse Practitioner last year -- is offering me Dilaudid during this period of increased acute pain. I said "no thanks" initially but after nights like this past one? Bring it on. If I understand correctly, the Dilaudid will replace Endocet as the short-acting pain killer for breakthrough problems, leaving Methadone in place for the long-acting agent. Do I sound like a druggie? Fret not. A dedicated druggie, a real addict? They'd not be willing to feel the pain with which I live, with which I dance, against which I feint the parry.

The language of swordplay seems à propos.

Little Boy and I, we are StudMuffins in the battle against pain. StudMuffins, I say.

And so, the Manor will remain in disarray for a good spell longer -- and my domestic ministrations confined to intense cuddling sessions -- wounded cat, wounded person, perhaps, in this beginning. But in our ending?

SnuggleBunny to SnuggleBunny!
Lunge! Riposte! Touché!

Post Script: I decided against switching to Dilaudid.
1. I need to be able to assess this pain as acurately as possible. So let's undertreat it!
2. The memory of not being able to breathe is still fresh. I don't want to risk depressing my respirations. (Although there are moments -- known here at Marlinspike Hall as "Shoot-Me-In-The-Head Moments" -- when I am ready to stop breathing.)
3. I CANNOT SIT IN THE CAR FOR THE RIDE TO AND FRO! It just hurts too much. How is that for insane logic? It hurts too much to go get additional pain medication...