Diary entry for June 7, 2011, 7:53 am

I did it: I signed a new order yesterday afternoon which restricts any future Demerol shots to 'necessity-only'.  In other words, I cannot get a shot unless my Amylase or Lipase are elevated, ending the two-year run of abject addiction; with no shots available, I should have no cravings and no desire to shut down the progress I'm making.

Diary entry for June 4, 2011, 10:12 am

Well, I wound up getting a shot anyway; it was exactly 4:00 when I got it.  The funny thing is, I didn't even think about it until I drove by the hospital around 2:30—which tells me exactly what I need to do to get through the next time: GET OUT OF THE HOUSE AND HIKE SOMEWHERE!  The  more I do that, the less inclined I'll be to let myself shut down when I don't need it.

Blake came by around 5:00, but I had to put off the dinner-and-movie night to tonight.  Then I felt like shit because I think I hurt his feelings...Blake is an awesome young man who obviously respects me; I fear that seeing me like that yesterday will have damaged that aspect of our friendship.  At least he got to see early on what I'm like on Demerol, and why I want and need so badly to stop using them period—unless I'm really hurting, which is why I'm changing it to "blood test required" next month. 

    [I'm tempted to request thata for the remaining two shots this month.]

YES!  I'm going to request that an enzyme-level test be done before I can get my next one.  It's time now...
Dr. Garren isn't in today, so I will call her first thing Monday morning and ask that she write up a new one (or I'll write it up and ask her to sign it).

YES!!!!!!!!

Diary entry for June 3, 2011, 3:06 pm

I didn't even think about getting a shot until about 2:30 when I drove past the hospital.  It didn't even occur to me last night at all; now I can feel the pull, though it's not as strong as it has been.

Now I'm trying to justify getting one: my leg has been hurting all day; James and I aren't going hiking until Sunday—besides, it's my life!  But...I will be pretty useless tonight if Blake comes over to watch [Lord of the Rings].

Demerol - The Cost - Pt VI

By July 2010, I'd finally had enough, and the "mature" part of me decided it was time to do something about the Demerol.  My options at the time were (a) go "cold turkey" and never get another shot again, or (b) go into rehab.  Option A was not a viable one, as stopping Demerol suddenly is akin to quitting Heroin; the withdrawals would most likely kill me.  Option B wasn't viable because I cannot be confined like that; I know to my core that I would mentally snap under such circumstances.  So what could I do??

I hit one day upon an idea, a compromise: go on a gradual weaning-off treatment plan whereby I would gradually space the shots out, reduce the number available each month, and after a few months, reduce the dosage amount from 150 mg to 75 or 100 mg, with the goal of eventually going off them altogether.  I knew this would take a long time, but I know myself well enough that I was certain it would work.  So, starting July 1, 2010, I wrote and signed a new "standing order" reducing the number of shots per month and spacing them out at least two days apart, which was readily approved and signed by my doctor.  I was excited!  I was doing something concrete to help, not only myself, but my partner.  I was on a mission, and I would move heaven and hell to accomplish it!

But I was not naive; I'd been through withdrawals before with other drugs, but they were a walk in the park compared to this one.  What I decided was basically to trick myself into letting go of the Demerol.  I'd already discovered that, without a shot available, I had no craving and no withdrawal symptoms!  By signing an order preventing me from getting a shot until the expressed amount of time had passed, I would trick myself into riding out longer and longer periods between shots—at least that was my theory, and I was desperate.  Would it work, though?

Demerol - The Cost - Pt V

Now, with paper in hand, I could justify getting a shot of Demerol whenever I "needed" it, but it soon became clear that certain restraints needed to be put into place.  By the end of 2008, my doctors and I decided to limit the number of shots each month to eight, though I still ran through them in the first couple of weeks of the month, leaving me with no shots available for the last two weeks.  After a few months of this restriction, I began to notice a trend in myself:  If I've used all the shots for the month and had none available, I experienced virtually no withdrawal until the next month drew nigh; then the craving became unbearable.  I filed this knowledge away, but never forgot it.

After a six-month tryst with meth in early-2009, I continued getting eight shots a month, all within the first two or three weeks of the month.  My ex made plans to come see me several times that summer and fall, and by winter we'd connected enough that he decided to move to Gunnison to be near me.  Understand that he and I had met 16 years earlier and would have been together most of that time had my 'spiritual path' at the time not dictated that we could no longer be together.  I've never been able to live two separate lives, one "moral and upright" and the other "decadence-incarnate."

He moved to Gunnison in December, 2009; at the time I was receiving eight shots a month of Demerol, at 150 mg per dose...about every other day.  In June of 2010, I moved to another home closer to town, and the stress of doing so sent my bipolar condition in a massive tailspin, much of which I took out on him.  Shortly thereafter, it became obvious that he'd had enough of seeing me virtually-catatonic most of the time, so I chose to act in both our behalves.  

Demerol - The Cost IV

One thing of note about the ultrasound the doctors performed is the fact the I awoke from the anesthesia right in the middle of the procedure and found myself gagging on this huge tube down my throat.  The anesthesiologist told me they'd given me the maximum dose of Fentanyl, and to try to stay calm.  It felt like forever, but I'm sure I was awake for only a minute or so before I passed out again.  This was one of the worst procedures I've ever had to endure.

Demerol - The Cost - Pt III

In June, 2008 I was admitted to University Hospital for acute pancreatitis.  After an hour of driving and a 3-hour stay in the waiting room, I was finally admitted and blood tests were made to determine how serious this attack was.  As it turned out, my Lipase was "off the chart," indicating a very serious condition, and that the pain was real.  After a couple of days of Morphine and no food, the swelling of my pancreas finally abated.  It was also the day before the pre-scheduled procedure, so I stayed in the hospital one more night. 

An endoscopic ultrasound involves a scope which is fed down the throat, through the stomach, and into the duodenum—a short bowel section which serves as a junction between the stomach, pancreas and gall bladder; real digestion begins here when digestive enzymes from the pancreas are introduced prior to entry into the small intestine.  This procedure allows doctors to see a very detailed image of the lining of the pancreatic duct, which is necessary for a proper diagnosis.

There are ten indicators doctors look for when determining whether one has “chronic pancreatitis," and a diagnosis is dependent on the patient matching at least four of the criteria; I matched five—including significant scarring all throughout the pancreatic duct, and a small cyst at its tail-end.  I was subsequently officially diagnosed with chronic pancreatitis, an incurable, painful and potentially-fatal condition.  Now I had the justification I needed to continue receiving Demerol injections!

Demerol - The Cost - Pt II

I learned a year ago that withdrawal from a drug like Demerol can have some serious effects on the body.  Your mind somehow creates real pain in order to trick you into getting another shot to stop the pain from returning.  After a while, I became trapped in a vicious downward spiral that became harder and harder to escape with each injection.  Then came the ultrasound.

In 2008, June found me in Denver a week and a half before that year’s District Convention of Jehovah’s Witnesses.  I arrived on Tuesday, with the endoscopic ultrasound scheduled for a week from that Thursday.  The friends at whose house I stayed were gone most of the week.  When they returned, she made a huge dinner; the next night, we all went out to eat.  By Sunday, I could tell that I’d eaten too much since arriving; as my abdomen was swelling and starting to hurt. 

By Monday morning, the pain was intolerable; the Percocet I’d been prescribed was not strong enough to dull the pain, even after taking two or three at a time, so I was admitted to University Hospital in Denver, CO.

Demerol - Escape! ...but at what cost?

In January, 2008, it was decided that I be given injections for pain as an outpatient, thus reducing the odds of me catching something during a hospital stay.  With dealing with a compromised immune system, this seemed the prudent thing to do.  It wasn’t long, however, that I became almost entirely dependent on Demerol for pain management.  At the time, I was prescribed 150 mg of Demerol, with 75 mg of Phenergan to ward of the inevitable wave of nausea that comes without it—and I could get one whenever I “needed” it. 

By March, I was receiving injections every couple of days.  The nursing staff became increasingly alarmed, and finally notified my doctor, “Tim M. has received 15 injections in the past 30 days.”  My MD was pissed!  One of the medical staff determined that it was time to ascertain whether what they were treating was “chronic pancreatitis,” or addiction to narcotics.  In order to discover the truth, a procedure known as an “endoscopic ultrasound” was scheduled in Denver, just a couple of months away.  It just so happened that a Jehovah’s Witness Convention was being held in June, and I was able to schedule the procedure for the week before.

Why was I allowed to get so many injections?  For one thing, my MD wasn’t aware at first that I had received so many, and when she did, she acted quickly in an effort to halt this now-apparent trend.  For another thing—and the most important one—I was in real pain.  I was in agony for months, and my blood tests showed enzyme elevations often enough that I was certain it was my pancreas.  I learned that one can die from this affliction, and I became scared.  It wasn’t long before Demerol became a source of solace; I stopped hurting and literally forgot my life for a day.  I thoroughly believed that my pancreas was constantly inflamed and my pain was real.

 I later learned that our minds have a way of really fraking with us... 

Demerol - the one that nearly got me

In February of 2007, I had a massive attack of Acute Pancreatitis. In the hospital, pancreatitis is treated by basically starving the pancreas for two or three days, allowing the swollen organ to rest. The pancreas produces our digestive enzymes, and two of them, Amylase and Lipase, are involved in an attack. The best way to describe the pain is: your worst "stomach ache" times 100—and it doesn't stop! It is excruciatingly painful and, if left unchecked, can result in death. Basically, the pancreas begins eating itself from the inside, leading to scarring in the pancreatic duct's lining. Over time, this scarring can result in necrotic (dead) tissue, leading to organ failure and death.

That year, I had at least five other acute attacks, a month or two apart. “No food and pain management” was the buzz phrase, and for the pain I was given Morphine every two to four hours. I was also administered Demerol at times to lessen the worst of the pain at the outset of an attack, since it relieved most of the pain in less than 10 minutes. During one hospital stay, I was administered Demerol almost exclusively through the night and by morning I had the worst migraine of my life. I was given one migraine reliever, but it didn't help at all. Then they gave me Toradol; the migraine vanished in five minutes. Too much Demerol had given me the emperor of hangovers.