Monday, Ketamin. Tuesday, Percocet. Wednesday, Tylenol. Thursday, NSAIDs. Friday, Scotch. Sat-Sun, grimace and sweat.
In the hospital ketamine is a wonderful “anesthetic.” Why the quotes? It is actually not so much an anesthetic as a dissociative. You kinda feel the pain, but you don’t care. It also tends to increase respiratory drive, as opposed to the depression of opioids at usual doses, although at higher doses it can legitimately kill you dead . The catch is that it is a dissociative, in the same class as PCP. It can cause dependence, hallucinations, behavioral changes. In short, any drug that interacts powerfully with your brain is something to be handled with great caution
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And how - I have seen folks go some dark and scary places at times when they were too much into ketamine. Or maybe being too much into ketamine was a product of the dark and scary places they were going…
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Give them credit. Sometimes they skip recruiting merely suggestive sales staff and move straight to professionals.
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I did once use ketamine for fun, it was kind of weird and at some point I couldn’t feel my fingers anymore, but I was surprised how lucid I stayed. All in all, not a bad experience.
I am a pediatrician, and in kids it works very nicely. This is mostly because kids don’t tend to freak out as much if a pink bunny hops past their bed! Seriously, the hallucinations are the biggest problem in “normal” anesthetic dosages. That’s why it is usually accompanied by Versed, so you don’t form memories of whatever the hell visions you are seeing and only remember that it wasn’t too bad an experience.
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During my recent stay in the hospital I was given a steady supply of fentanyl. I wasn’t quite out of it, but there are portions of my stay there that I don’t remember at all – e.g. I had three procedures where I was ostensibly conscious and I don’t remember any of them, which is just as well as far as I’m concerned. (The surgeon later described me as “pretty loopy” but not because of the medications.) It wasn’t until I got out (after 2 weeks) that I realized, “wait a sec – fentanyl? Isn’t that what killed Prince? And Tom Petty?”
(EDIT: I’ve since discovered that I also don’t remember being “out” for the angiograms.)
They sent me home with oxycodone, but a really low dose, and after a week and a half I didn’t need them anymore.
I feel lucky that I didn’t leave wanting more (based on the news I’ve read regarding opioids), but isn’t this how it’s supposed to work? Haven’t they been using opioids for decades? Were millions of patients hooked on the stuff and they managed to sweep it all under the rug until 5 or 10 years ago? I’m assuming the recent crisis is because phrama is pushing it more, but at the same time, I don’t see how modern medicine can get around using them altogether. (If I sound naive, well I guess I am and I don’t understand.)
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Well, speaking as a physician, I think a fair chunk of the problem is an increasing attitude being pushed that no one should ever experience any pain. I am not being cruel here, but a bit of pain after surgical procedures is very normal. Usually, non-opioid options work fairly well (ibuprofen, cold/heat, topical anesthetics) but none of them are as effective for total pain relief as opioids. That’s just the fact. For a long time now, the position of both the medical profession and patients has been that there should be no pain at all. To do that you really need a lot of opioids. Like, a lot. For a long time. And as a consequence, there has been increasing issues with addiction and dependence. For quite a while it was denied and yes, swept under the rug. It has finally been acknowledged and is being addressed, but the take home is that you are going to experience some “discomfort.” (In plain, non-medical English, that would be pain.)
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I had forgotten that toward the end of my stay they were giving me dilaudid injections, which I had always thought was the heavy-duty stuff (e.g. see William Burroughs’ character in Drugstore Cowboys) but I take it that fentanyl’s stronger.
There was still a fair amount of discomfort (and still a wee amount), but this suggests (to me) that they weren’t overdoing it with the pain meds. (Ibuprofen was (and still is) out…)
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Yup. The key is “just enough, and not more.” Sounds like your docs got it about right.
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