After the surgery, pill addiction?

It was my physical therapist who alerted me that I might be addicted to hydrocodone (Vicodin), a drug I have been taking for nearly three months since my hip replacement surgery.

I had told her that when I didn’t take it, I started to feel a stinging, achy feeling in all of my joints, similar to having the flu; and she said that sounded like I was addicted.

She suggested that it might not be wise to stop using it immediately. Didn’t the doctor say anything about how to wean myself from it?

He did not say a thing. Maybe he thought this 68-year old woman was not likely to get hooked. But anyone can get hooked, and many of the people who are addicted to hydrocodone are people like me, who started taking it after surgery and just couldn’t get off it.

Addiction to pain pills is rampant here in the state of New Mexico, which is now first in illegal use of these opiates that are routinely given for severe pain. Seems like any doctor ought to know how to help patients stop using it. There’s a drug that can be administered to assist in that transition; it’s called Suboxone.

Hydrocodone was first introduced in the 90s to replace codeine, allegedly to avoid codeine’s constipating effect. Turns out hydrocodone and oxycodone (Percoset) are just as constipating; all opiates interfere with the peristalsis of the stomach that accompanies digestion.

Over 50 additional side effects of hydrocodone are listed at Drug Rehabs, http://www.drug-rehabs.com/hydrocodone_side_effects.htm

Of course that list doesn’t include the much more serious side effects of taking acetominophen, which is always included in hydrocodone pills along with the narcotic. Acetaminophen in large doses causes liver damage. Warnings to that effect are now pasted on the bottle, but in the early days of hydrocodone use, patients were not informed.

This is the helpful painkiller we were given to replace codeine, and we may well ask what was so wrong with codeine that we needed a new drug with all these risks attached to it -- including that fact that it’s far more addictive, so much more addictive that it’s now in demand as a street drug?

PubMed lists only 16 side effects for codeine, which is a natural opiate, unlike the synthetic form used in hydrocodone. Codeine is still used, but if you want to get it for major pain like surgery you’ll have to practically stand on your head in the doctor’s office. Is this insistence on hydrocodone for our protection, or does it protect the market for hydrocodone? To my knowledge there are no advantages to hydrocodone over codeine.

After Julie, my PT, suggested the possibility of addiction, I found I was able to reduce the dose immediately to half a pill twice a day; but two weeks later, I am still taking that dose for the flu-like symptoms! It’s surprising how uncomfortable those aching joints can be, perhaps because my body starts thinking I have the flu and ought to be in bed.

So it’s not just the hip surgery one has to recover from – but the recovery!

Maybe medical marijuana would be a better solution. I’ve used it, it works … but that's a topic for another blog.

Through The Surgical Tunnel

  “I was very, very depressed after this fall,” R. said in her deep, soft voice – a soothing voice that must have been considered alluring during her youth, when she lived in Big Sur and worked as a server at the famous Nepenthe’s Inn.  Now she is 76. She fell one day around Christmastime last year, when walking her dog. A neighbor saw her on the street near her home in Santa Fe, unable to get up, and took her to the hospital. The hip was broken.

“I wasn’t sure I wanted to live any longer,” Sylvia added. “But little by little it’s getting better.”

I suggested that it might have something to do with the drugs. Painkillers are basically downers. Of course it’s also a shock to find that one has become so vulnerable. A tug of the leash, and the walk is over, for six months or more.

In fact, a hundred years ago, as my Buddhist friend Jay did not hesitate to point to me after my own fall, such a break would likely have been fatal.

You go to bed, and you lie in pain, waited on by unwilling relatives; and maybe the bone heals, maybe not; and maybe you “give up the ghost” (a wonderful old phrase that you don’t hear much anymore), and die.

Now you have surgery, the leg is set, you are up on your wobbly feet in two days, and then you start doing physical therapy. A few months later, you are on your feet again.

Given this illuminating historical perspective, it’s somewhat surprising that we don’t wake up after surgery stunned, but grateful. Instead of shouting, “I’m alive!” we may wish we had already died. Perhaps the nervous system, recognizing that the experience was life-threatening, does not know how to update itself.

Or this depression may be due to the ambivalence we feel, especially as we age, about the value of our lives, the death wish (thanatos, according to Mr. Freud) struggling against the life wish (libido) until, needless to say, death wins out.

But as I considered my own experience after a recent surgery, I learned that it is the anesthesia administered during surgery, more than the painkillers that follow it, which may have a very disorienting effect on many people.

There is even a name for this condition, and, naturally, an acronym: Post Operative Cognitive Decline (POCD). This decline was first identified in elders after cardiac surgery, but it turns out that orthopedic surgery can have the same result, even when it’s elective. (When surgery is mandatory, after an accident, one might expect POCD to be more common, as trauma is known to be associated with loss of control; and trauma can lead to depression.)

In any case, POCD is caused not by the drugs per se or by the trauma, but by the effect of the anesthesia on the flow of oxygen to the brain. This reduction of oxygen supply, however brief, is likely to have negative effects on cognitive ability. Now scientists are researching ways to minimize this loss, particularly in the elderly. In one study, research showed the value of “intra-operative monitoring of anesthetic depth and cerebral oxygenation as a pragmatic intervention to reduce post-operative cognitive impairment.”

That’s the scientific angle, the one likely to produce helpful surgical interventions. Now that we are living longer, it will be helpful if the various orthopedic surgeries some of us must endure do not accelerate cognitive decline! I have not had the opportunity to ask my surgeon, but I assume the cocktail used in my case was adapted for this very purpose. The nerve block I was given before going into the OR is intended to reduce the need for anaesthesia. I do know that I had no trouble breathing when I woke up, a good sign!

Even then, I definitely experienced a journey into the twilight zone that became more evident a week after the surgery and continued for about a month. Part of that experience was a curtailment of my ability to think clearly. But another part of it was more like Sylvia’s depression. I, too, wondered whether I wanted to go on living; the very question seemed to bring on a wave of hopelessness. My physical condition, though a temporary one, seemed chronic, timeless, a new state of being that I resented, that capped my ability to make up for whatever I had failed to do in this life thus far.

I had a lot of very colorful dreams, most of them bizarre and alarming.

Looking back, it feels to me as if I had entered a dark tunnel, not of cognitive decline per se, but of life review that seemed preparatory for death, even though I knew I was not dying.

It was a descents into a subconscious region, where it seemed the body itself, stirred and jumbled by the surgical intervention, released buried complexes regarding self-worth and purpose.

One morning, after a long meditation, I bumped into an old belief – that I needed to somehow be Great in order to deserve my life. That belief had been with me since childhood, an ambition passed on to me by my mother, who wanted to be a great writer herself!

Exploring this lifelong negative fantasy, I discovered that I did not have to have a justification for living – I did not have to reach for some vaunted, special goal in order to prove my worth.

I just had to set my sights on realistic, attainable goals, and try to be a good person while I carried them out.

This was quite a profound realization. Ultimately it offered great relief…but first I had to process the realization of how unattainable my goals had been all these years. I couldn’t get out of the tunnel until I had conducted this painful review.

Meanwhile, as time passed, my body continued healing. What a miracle that is! And as I regained the use of my legs and made my way into the light of day I knew the journey had fixed something more than the hip.

I had revisited an ancient complex held in the bone since childhood, when it was first discovered that my hips were out of place; and it had been released.

It had been, after all, despite the modern technology, a shamanic journey, and I had come back to life having retrieved a lost piece of my soul.

How NOT to Grow Old!

While ageing is inevitable, getting old is not. We do not have to turn into petrified zombies complaining about our aches and pains, wandering around in a sort of daze, or relegated to the rocking chair.  Now that many of us will live thirty years longer than our grandparents, it’s important that we find meaning and purpose in a time of life that was once viewed only with dread. The secret of how to harvest riches during older age may be to realize a simple truth: that we are not our bodies.

Many older people have experienced this puzzling realization. From the outside looking in – from the face in the mirror – we see an aging person; but we feel we are the same as ever we have been. It’s a paradox that dramatizes the gap that exists at every age between the way we perceive ourselves and how we are perceived by others; as the poet W. B. Yeats wrote, “Only God, my dear, Could love you for yourself alone and not for your yellow hair.”

We want to be known and loved for who we truly are, but who are we really? In youth, our physical attributes tend to direct the storyline, and so we embark on retirement with a habit of identifying with our yellow hair, our golf score, our youthful figures. Alas, we soon discover we have set ourselves up for terrible feelings of loss, as hair turns grey, figures grow round and our golf score drops. Despair seems to lurk around every corner as we encounter not only these physical losses but other losses as well – the loss of partners, for example, and friends. To age is to endure the pangs of grief. What on earth can be the point of it all?

Rabbi Zalman Schachter-Shalomi, beloved guru of the age-ing tosage-ing movement, sees these losses or “diminishments” as an essential part of the journey at this age.

I believe that coming to terms with these diminishments is a major developmental task of old age that helps awaken the elder state of consciousness, with its promise of expanded mental potentials, spiritual renewal, and greater social usefulness.

For him, new mental and spiritual powers become available to us as we age, powers we can put into service for the good of others; that is the purpose and the bounty of these extended years. 

Herein lies the opportunity of older age. As the externals begin to lose their dazzle, we may discover, by turning within, that great reservoirs of deep spiritual wisdom become available to us. We may experience what --- calls the “incandescence” of advanced age; the light of the inner flame seems to grow more intense as our identification with the body begins to release its hold. As we begin to realize that we are not the bodies, we discover that we are, in essence, this bright flame. We have the capacity, when tuning in to this essential nature, to discover with what is uniquely ourselves, and allow it to radiate through our bodies. Its gentle warmth will alleviate the body’s aches and pain, bolster our immune systems, and strengthen our vitality. For as much as the body’s limitations can affect the spirit, the spirit’s triumph invigorates and helps to heal the body, helps us to live with the various ailments and chronic pain that are likely to besiege us as we advance into our eighth and ninth decades.

But, we may ask, how to get in touch with that salubrious flame? Many of us enter our sixties having lost touch with our essential being. After decades pursuing careers, raising families, and investing our energy in material accomplishments, we may have forgotten how to access that reservoir. The psychic scar tissue of accumulated emotional and psychological wounds can also block our access to our fresh inner spirit. 

Happily, there are many avenues to explore that can help us remove those obstacles. In addition to counseling, which can be of great value during this transition, working with a life coach to redesign your life plan can be of inestimable value. There are also many valued physical therapies that unlock emotional pain that has been carried within the body. Releasing these containers of dense energy may release physical pain as well as help us open to the greater self that has lain buried all these years under old fears, negative expectations, and dull ways of thinking about our lives.

Spiritual practice – meditation of various kinds, yoga, chi gong and tai chi – is invaluable, both in physical rejuvenation and in freeing the blocked spirit.

Sometimes life will trip us up, forcing us to delve deep inside to liberate the buried self. It may be an illness, or a divorce, something planned or completely unexpected, a change of career, a move to a new place. These challenging and unpleasant circumstances may actually serve to free us from old baggage and open new doorways to experiences we did not realize were still available to us.

The opportunity for growth may arrive in dreary attire. Depression is often the trigger that informs us that some kind of change is needed. What is it we wanted from our lives that we forgot? Where did we leave ourselves behind in favor of a job or a relationship that demanded we try to be like someone else? What does this time of life required of us?

Finding the little light inside is very much the mission of this time of life. We’ve come to a critical juncture; the choices we make here may very well determine how we engage with the unique challenges of this last act of our lives. Will these years be a time of stiff denial or straightforward decline? Or, to use a concept advanced by Marc Freedman, can we turn this cherished, extended time – this gift of age -- into an encore that brings together all the themes of our life in a fine culmination? 

We can’t avoid aging, but when we begin to view this time as one of rich harvest and deep personal growth, we can live to be 100 without becoming old.

Stephanie Hiller is a writer and a life coach who helps people navigate this new territory of extended lifetimes. She lives in Sonoma, California.

hiller.stephanie@gmail.com

707 939-8272

Richard Leider -- "Repacking our Bags" as we age

The Conscious Aging Network of New Mexico, of which I am a member and current president, is sponsoring an exciting event Nov 11-12 in Albuquerque with renowned Life Coach Richard Leider.
Leider's lecture and workshop are designed to help participants discover their purpose in life as we grow older by guiding us in creating a "Life Map" to help us realize our dreams during this latest phase of our lives.
As long as we're still here, we might as well stay alive, continuing to create projects that express what we deeply believe and understand to be true.
We can look at these final decades as periods of steady decline (and watch ourselves declining!) or we can embrace this period of our lives as the culmination of all that has brought us to this time and place.
What we believe matters.  In the area of medicine, our beliefs about what helps us heal can be critical to our recovery. This "placebo effect" has been well-documented. As biologist Bruce Lipton has described, our beliefs about a particular treatment operate as a biological mechanism within our cells, yet another way that the mind and body collaborate, each but the mirror image of the other.
We can change the body by working on the body directly, but we can also inspire healing in the body by changing the way we think and feel. Negative beliefs and negative feelings tend to produce imbalance and dis-ease in the body; addressing and transforming those beliefs and feelings can have a dramatic effect on well-being of the body.
Many mechanisms exist to help us transform ourselves. Psychotherapy, coaching, shamanic healing, meditation, various forms of body work and energy medicine, all provide useful tools.
Coaching invites us to explore new possibilities of thought. It helps us develop a program or plan for realizing our goals. A strong relationship with an effective life coach fortifies us, guiding us to remove blocks that stand in our way and cash in stale, old ideas for new and exciting developments of our complex personalities.
Leider is a master coach with many years experience. We're looking forward to experiencing his approach to making change in our lives. Please join us if you're in the Albuquerque area November 11 and 12! You can register for the workshop by going to the Conscious Aging website at www.can-nm.org/
To learn more about Richard Leider, please visit his website, www.richardleider.com/ He has written many popular books, including: Repacking Your Bags: Lighten Your Load for the Rest of Your Life.
In this time of personal and public transformation, a lighter "load" certainly sounds like a good step toward a simpler, more rewarding life.

WELCOME!

Wasn't that a great movie, Saturday Night Fever? I always liked the Bee Gees song, "Stayin' Alive," for the name and the beat; but what a disappointment when I actually looked at the lyrics and discovered that it wasn't really about being ALIVE -- it was more like "hanging in there." That's what you do when the going gets tough; but even in the worst of times, we want more to life than getting up in the morning and dragging through another day.

As we turn 65, Staying Alive means something. It means not succumbing to our own ideas about growing old; and that means not succumbing to other people's ideas about aging. In our culture of youth, we start folding up our tents after thirty, saying, "it's all downhill from here." But why? Because the blush will be off the rose, and we'll start moving more slowly toward the dreaded "end"?

The older we get, the more precious is every day of this precious human life. And now that we are living longer -- most of us can expect to reach 85, if not 100 -- we find we have been given a new challenge with these added years. What shall we do with them?

Staying Alive means remaining vital, alert, and engaged in life no matter what Old Age drags in and drops at our door. It means savoring the golden light of an autumn afternoon and looking at the roses as we move along the path. Whether we are moving quickly or slowly as we head to the post office to pick up that social security check, we can still enjoy witnessing the marvelous unfolding of creation all around us.

How to do it? Well, that's what this blog is going to be about!