April 23, 2010

going down the rabbit hole

Touch a hot pan and your hand withdraws automatically.  There is no conscious effort involved.  The nerves that carry the information are among the fastest conduction fibers in your body and bypass the any "thinking" centers of the brain.  It's quite an amazing system but we have a negative view of pain.  It's understandable.  After all, it hurts.  But look at it from a different perspective.  Your nervous system needs some way to communicate what's going on in all of these cells and when appropriately, it needs to respond with lightning quickness bypassing any executive orders.  It's an alarm system really.

On my recommendation, my brother is backing off on his pain meds.  My philosophy is "dose to effect".  Before the chemo started my brother's pain was a 4 on a good day (1 through 10 with 10 being the worst pain of your life) and a 7-8 on a bad day.  But society tells us to suck it up, to endure, to push past the pain.  As someone who grew up with football, I was taught at an early age to know the difference between playing with pain and playing with an injury.  Pain?  Suck it up.  Injury?  Stop before you make it worse.  I don't think we do that very well as patients distinguishing the difference.  So his doc upped the extended release morphine dose from 15 to 30 mg and bumped up the naproxen while continuing the short lasting hydrocodone.

A bit of time passes and his pain is about a 1-2 so he cuts out the hydrocodone all together.  Still a 1-2 so he takes a 15 mg ER morphine in the morning and a 30 mg in the evening.  Still a 1-2 and he now finds himself able to sleep in positions that he wasn't able to six months ago.  So he now cuts the naproxen dose down to an over the counter strength of 220 mg and here we are.

And his wife doesn't agree with this course of action.  She understandably likes him when he's not grumpy so why tempt fate.  But I know exactly what he's doing.  It's actually a bit surprising to see him conduct such a cold and calculated experiment on himself.  To be honest, I'd be doing the same thing.  Remember what I said about pain being a way of your periphery make itself heard?  He's determining if that calamitous concoction of a pacific yew tree extract (docetaxel), the precious metal of platinum coupled to chlorides and amine groups (cisplatin), and an acid with two phosphates (zometa) are working. 

If he decreases the pain meds and his pain is not an 8, that milieu of toxins is working.  It's not about reducing side effects, or having to take fewer pills, though those are added side benefits.  It's his way of putting up some antennae to see what his body has to say about those damned tumors.

1 comment:

Anna Van Sligtenhorst said...

[From the author's brother's wife] I am actually completely behind the process of cutting back on pain medications now.

I thought the argument for cutting back was to reduce negative side effects Josh was seeing with the medications. But he wasn't having any negative side effects. So why change anything?

But given that the attempt is to see whether the chemo + Zometa is working on eliminating the pain, I'm completely behind it. I'm not-so-patiently waiting for the scans in 3 weeks to see if what's happening inside my husband reflects the positive changes I've seen on the outside (his mood, pain management, etc.) and the one primary negative physical effect I've seen: hair loss.