medical miscellany

[kaberett]

Despite having Firmly Told Myself that I was going to take All The Painkillers I got sent home with, and then see how stopping went, Because I Know What I'm Like... I decided that yesterday went well enough that I could try not taking them today. Somehow it was not until Adam woke me back up at around 5 p.m. (having had both morning and afternoon naps) that it dawned on me that the exhaustion might just possibly be related to the lack of painkillers...

Meanwhile on Sunday I got around to actually looking up the drug I'd had injected as a spinal block to get me through the first 24 hours post-surgically. I had definitely been aware that I was doing much better than I'd expected, in that when asked how I was my default response in that first 24 hours was "... surprisingly chipper, all things considered"? But the response "ah. ...that'll be the diamorphine." was something I was happy to accept but not something I particularly understood until I went and looked up the oxycodone they started giving me once said diamorphine wore off.

Friends. Friends, I do not know if it was that I never knew this fact or that I had merely forgotten it, but "diamorphine" is in fact the polite don't-scare-the-patients grown-up name of... heroin. I was feeling surprisingly chipper because I had had heroin injected directly into my spine. The heroin that is well known for inducing euphoria. That heroin.

Which does also explain why the terrible bonging machine was so unhappy about my respiration rate dropping below eight breaths per minute:

Post procedure, blood pressure, pulse, sedation, pain scores, oxygen saturation levels and respiratory rate should be recorded every 15 minutes for 1 hour and then every 30 minutes for the next 2 hours.

Respiratory rate, sedation and pain scores must be recorded hourly until at least 24 hours post procedure or longer if the observations are unstable, especially if additional opioids are given. The frequency of other observations may be reduced after 12 hours.

[...]

Additional opioid analgesia may also be given as prescribed provided it is clinically indicated with a pain score of 2 or more AND clinically safe: respiratory rate >8 per minute and sedation score 1-2.

... which would be why they kept the arterial line in until they were happy discharging me to the general ward, then.

Comments

[watersword]

But it was medically necessary heroin!

[vass]

...Well, that explains that. <333

[azurelunatic]

Thaaaaat'll do it!

[chiasmata]

I only (?re-)realised this the other day, when I was looking up Harold Shipman…

[rmc28]

Well the heroin did its job then!

[emperor]

Mmm, back in vet school we had the occasional post-op patient who needed diamorphine. The paperwork (and sharp glass vials) were not joyous.

[lebannen]

ahahahahahahaha! I am very glad that diamorphine works as intended for you, and hope that you make a swift recovery and find a balance of taking painkillers that works for you.

My dad was Very Unhappy after being given diamorphine, and complained AT LENGTH that he had HAD DREAMS, and described them in a way that he had never done before. They seemed like perfectly normal descriptions of dreams to everyone else - I did not know the word aphantasia at the time, but yeah we're now pretty sure that my dad was usually aphantasic, and the diamorphine was showing him a whole new world when he just wanted to sleep quietly.

[ludy]

gosh, that must have been incredibly disconcerting for him.

Thanks to this comment I have now realised the fun paradox of it being almost impossible to imagine having aphantasia with a phantasic(? assuming that must be the right word) mind!

[fyreharper]

Of course the part of this that I’m *actually* boggling at is pain score of 2 or more indicates additional opioid analgesia being appropriate. 2! 2???

[me_and]

This was pretty much exactly my reaction, yes!

[kaberett]

To be marginally fair, it's because they really do NOT want your pain to hit the kind of uncontrolled where they have to bring the big guns back out to have a hope of getting it managed again, and analgesia takes a while to kick in so you want it good and early!

Also they might be using a different pain scale to the one we are? I did not go digging...

[forests_of_fire]

yeah, that explains things. But daaaaamn that sounds horribly irresponsible of them. :( There's a reason that heroin is a schedule 1 (aka "no medical use, therefore illegal") drug here.

[ludy]

I don’t know where you are based so I can’t comment on your particular local laws but diamorphine absolutely has medical use and prescribing it appropriately is not horribly irresponsible. The British National Formuluary/National Institute of Health and Care Excellence documentation has many details:
https://bnf.nice.org.uk/drugs/diamorphine-hydrochloride/

It is obviously not something that should be prescribed lightly and I’m not surprised that kaberett had some pretty full on side-effects from it. But it’s really not the same as the hospital injecting them with street heroin (which is usually not pure diamorphine but is cut with all sorts of other drugs and contaminants and absolutely has no medical use)

[forests_of_fire]

Uh..... I wasn't looking for more info because it's irrelevant to me since I don't live in the UK. But thanks? I guess??

I live in the US, where (as far as I know) diamorphine and heroin are considered the same thing and it's a Schedule I drug with no legitimate medical use by law. I'm plenty aware that other nations have different drug laws. But I still remain horrified because, to me, it sounds horribly irresponsible. -shrugs- Consider it a cultural difference if you want to do that.

Anyways, I'm glad that kaberett had proper pain control. That's the only thing that matters, in the end.

[fyreharper]

Certainly makes one question the “illegal because no legitimate medical use” bit given the multiple… examples… just in this thread… of legit medical uses……….

[also in the US][also already aware of some instances of our drug scheduling being A Bit Crap, so not entirely surprised that another example might exist]

[forests_of_fire]

yuuup. The Controlled Substances Act has kept meds like ketamine (and apparently diamorphine) out of the hands of patients who can get a lot of use out of them. The fact that esketamine is actually being used for treatment-resistant depression is a pretty big step forward. But I suspect that it will take a lot more to get more of the potentially useful medication out of Schedule I.

[ewt]

Ah, yes, that would explain it!

[sporky_rat]

Ah, yes. My mother had that after her second broken back. I almost wish she could get it again, she was much more up to the world with it.

[sfred]

Ah!

[highlyeccentric]

Well that's exciting, you've now had the PUREST heroin there is.