Today’s post is a mixture of my continuing medical saga, and a rant about drug laws.
Follow-up on doctor stuff: I saw my primary care doctor on Friday 9/26. He listened to my symptoms, wrote a lot of stuff down, joked a bit (one reason why I like him), poked and prodded and did all those doctory things, and sent me on my way with a paper to take to the local lab. So, on Tuesday 9/30 (yesterday) I went to the lab and they filled up a lot of tubes with my blood and had me pee in a cup. I don’t have a problem with tests – gotta have them to see what’s going on.
Later that day I got an email with my test results! Wow is that quick or what? Turns out nearly everything is normal except for 2 tests that came back indicating inflammation. That could mean anything so no big deal; after all, I have had a fever for a very long time and lots of achiness and so on, so inflammation was kind of a no-brainer.
There are still 2 tests out, an ANA and a double-strand DNA, which look for autoimmune disorders specifically. So hopefully someone can see what’s causing the inflammation.
Edit (10/4): Got the labs back for the antibody tests…and they were all negative. Still, at the bottom of the report, it said
“The possibility of autoimmune disease remains.”
Your guess is as good as mine why this was included. I guess more testing is needed, though no one has called me to schedule any.
I have an appointment in November with a rheumatologist who, from what I could find out on the internet, is one very smart woman who studied at Stanford and Johns Hopkins (#1 place for rheumatology and autoimmune disorders), and wrote an impressive research paper on inflammation and cell function in autoimmune disorders. I didn’t understand most of it. Anyway, here’s hoping Dr. Okoye can get to the bottom of everything.
Original post: So I am not worried today. I am a bit concerned the other tests won’t show anything, as last time I was diagnosed with lupus they had to draw blood every week for months just to catch it when it appeared (that was 20+ years ago, though). It’s somewhat common for people to test negative, and it is also common for people to be told to forget about it when they do.
Since autoimmune symptoms are so weird and varied, there is always the risk of sounding like a hypochondriac – though at least my doctor could actually SEE the dry eyes and dry mouth (and fussed at me about not carrying around water at all times), validating the Sjogren’s diagnosis (which is an autoimmune disorder).
Of course he didn’t see the Raynaud’s (fingertips changing color in response to cold) as it wasn’t happening that day, but he felt my hands and said he could feel inflammation (how, I don’t know but his intern could too) and told me “the good news” was that I don’t have rheumatoid arthritis.
Edit (10/4): See? I could sort of see that coming!
Worrying doesn’t affect anything in the material world, so it doesn’t help for me to do it. I still feel crappy but at least I know it’s not as crappy as it could be. Oh and gross! He also scheduled me for a colonoscopy ewwwwww. I will get that at the end of this month but I won’t be happy about it! (Don’t worry, I am NOT going to blog about it!)
Tell you what, though, I am going to have it done without anesthesia, as I am afraid it won’t play nice with the pain meds I already take on a daily basis (if anyone would like to share if anesthesia is really warranted for this procedure, feel free)….which brings me to my main topic for today…
…pain medication and the controversies surrounding opiates and pain management. Medscape reports that a doctor (yes, just one) has come out with a statement on opiates for patients suffering from non-cancer pain (“New AAN Position Statement on Opioids for Noncancer Pain”, Medscape, 9/29/2014). Oddly, this is taken to be a policy statement from the entire American Academy of Neurology, even though there are no other authors or even other doctors who signed it in agreement.
This doctor, Gary Franklin, in my opinion, hasn’t seemed to have thought this out well enough, as he cites some statistics but comes up with some pretty weird (to me) interpretations of them. He starts out by saying (about the use of opiates for pain):
“The evidence of harm is high, and the effectiveness is low,” Franklin told MedPage Today, calling attention to a graphic in the statement that shows the imbalance. “That is the whole story.”
Is it really the whole story? As a former alcohol and drug counselor, I think it’s a bit more complex than that. Let’s take Pennsylvania as an example. According to The Philadelphia Inquirer (“Drug Overdose Deaths Up 7%, Far More in PA and NJ”, 8/20/2014) , we have moved from #14 in the USA for prescription overdose deaths to #7, in just a year. Yikes!
And if you look at the details more closely, you see that 55% of the people who died or had a problem with opiates got the pills “from a friend or family member” ( “Results from the 2010 National Survey on Drug Use and Health: volume 1: summary of national findings”. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2011). Yikes, again!
People are having their scripts filled and then handing them over to their friends or families? Um, I don’t believe so and I will tell you why in a minute.
But first I want to comment on these statistics: As you can see, the article about where people get their pain pills from is from 2010, and it is cited in a CDC report from 2011 (“Policy Impact: Prescription Painkiller Overdoses”). At the top of this article it states that
“This web page is provided for reference purposes only. It was current when produced, but the most current data can be found on the Drug Overdose Fact Sheet.”
It should be noted, however, that even this information is not current. If you follow the links, you find that, ultimately, this too is from 2011 (“Prescription Drug Overdose in the United States: Fact Sheet“) – oh, the article itself is dated July 2014, but the statistics cited/linked to are from 2011.
I don’t know what to make of it. I can understand the spin that anti-pain medication folks want to put on the (non)issue, but I have always had the utmost confidence in the CDC to get their facts straight. And they did, they are just not current. I can only imagine that this is due to bureaucracy.
So suddenly there is this big brouhaha about an epidemic of painkiller abuse and overdose deaths. As I continue my search for what’s behind this, I will get back to you on what’s driving this glut of “scare porn”.
But one thing that struck me is that NO ONE who quoted these stats in the various articles I read in order for me to cite them (thanks to a friend/mentor who suggested I do so) made any mention of what year the stats were from that they were quoting. That would cut down on the hysteria, I suppose.
Then there is the attempt to link this to heroin overdoses because, as quoted in a Medscape article dated 10/3/2014 (“Opioid, Heroin Deaths Continue to Climb, CDC Says” ), Leonard Paulozzi, MD, MPH, a physician and researcher with the CDC in Atlanta, said
“…about 75% of heroin users say they started out by using prescription opioids.”
Is it just me, or is anyone else reminded of the arguments against legalizing marijuana here? “Heroin users say” is about the most preposterous start to a debate about prescription opiates I have ever heard.
I take back what I wrote earlier about the CDC – my confidence in them is getting lower by the minute. How many heroin users smoke weed? Anecdotally, I can tell you that at every place I worked at as a d&a counselor, most – if not all – addicts routinely “tested hot” (tested positive) for that.
So would’ve the counselors, by the way, had the company tested them too!
There is no relationship between pot use and heroin use, any more than there is, say, between eating potato chips (which most of us do) and heroin use.
Between eating potato chips and pot? Well of course, but it’s the pot causing the munchies, not the munchies causing the pot smoking. See how stats can be twisted to say anything you want?
How many users take benzodiazepines and muscle relaxers? I will counter that with another question: how many people are familiar with the expression “holy trinity” as regards to addiction? Holy trinity: opiate pain meds, benzodiazepines, and muscle relaxers. Get you high as a kite and then often kill you. I guess those drugs are next in the line of fire.
Are we going to make those difficult to get, too?
Oh! How many heroin users smoked cigarettes before they tried heroin? Smoking is way down in PA (“Current Cigarette Smoking Among Adults – United States, 2005-2012″ by the CDC ) but, according to sources already cited here, heroin use is not, so…
And what about beer? Come on, people, let’s use some common sense here. Many (most, in my opinion just from work/life experience) people who use benzodiazepines, muscle relaxers, smoke cigarettes, drink beer, smoke pot, do NOT then go on to use heroin.
Our afflictions and journey to pain relief are so similar it is scary. I also have degenerative disc disease for which I was on prescription opiates and getting the runaround from Medical practitioners regarding dispensing of meds, therapy, etc. My adventures with post-chemo pain, suffering and medication could be used for an entire entry of your blog here. Life for the truly suffering among us is a nightmare and pain inducer all of its own. I look forward to further misadventures with, up and against big Pharma.
It’s a nightmare, indeed. I’m sorry you have had to have these experiences – I don’t know why a lot of places don’t have patient advocates (like they do in Minnesota). It’s really hard to deal with this mess when you don’t feel well, and that’s sometimes hard for other people to understand. When they get too cold-hearted about it (such as our fine Dr No-Opiates), I can’t help but think, “You’re going to really regret being this way whenever you become disabled.” Because, let’s face it, all of us – if we live long enough – will eventually get some kind of disability (at least deafness from all those Grateful Dead concerts!).