An Opiate Withdrawal Episode… didn’t plan on this!

•April 7, 2014 • Leave a Comment

I’ve never spent much time thinking about problems associated with addiction and dependence.  When I hear about other people having one of those conditions, I would usually chalk it up to a mostly controllable inability to simply stop taking the drug in question.   Boy, was I wrong.

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I learned there is a distinct difference between addiction (a compulsive drug use that effects the function of your daily life) and dependence (a physical adaption to the drug, and possibly, but not necessarily combined with addiction).  One can be addicted and dependant, or one can simply be dependent.  I was the latter.

After my recent cycling accident I was put on relatively high doses of oxycodone (an opiate).   The drug did wonders for my recovery.  It allowed me to breath, move, and deal with the severe pain I was experiencing.

After about six weeks, I decided it was time to get off the oxy.  I knew hydrocodone (Vicodin) was sometimes used as a “bridge” drug, and so I switched to that.  I was on 60mg oxycodone per day.  Unfortunately, this plan was a huge mistake.  My “only” physical reaction was severe pain (the very pain I was trying to eliminate), and my emotional reaction was a severe bout of depression.  It was not pretty.

I went back on the oxy…though, on a slightly smaller dosage.

Then, over the next six weeks, I started a disciplined tapering schedule after visiting my doctor.  60 mg, 40 mg, 20 mg, 15 mg, 10 mg.  When I hit 10 mg per day, almost three months after my accident, I thought, “NOW I can stop without any substitute”.

Wrong again.  The reaction this time was far worse.  The bout of depression was relatively mild (compared to before), but I ended up having most of the typical opiate physical dependence withdrawal symptoms: agitation, loose stools, irritability, endless sneezing bouts, runny nose, high resting heart rate, uncontrollable yawing, and the inability to get to sleep ‘cause I was like an out of control wind up toy in bed.

I went back on the oxy again – though, on yet an even smaller dosage.

Now I was on ½ a pill – 5 mg per day – for a few days.  Then I thought, surely, I can quit NOW!  Nope.  Same symptoms.  I was able to handle the symptoms on day one.  Well “handle” may be overstating it, as I simply slept the entire day.  It’s not hard handling something when you’re unconscious.   However, getting to sleep at night was nearly impossible.

Day two was OK, I got some exercise on my indoor bike which felt wonderful, I even worked up a sweat, but still I needed a way to sleep that night.

So, another doctor visit.  She said I fell off my taper a bit too quickly.  5mg per day is too quickly?  Apparently.  Now what?

She gave me three options:  cut the pill in ¼ and take 2.5mg at bedtime for few nights, or take ½ an Ambien, or try an OTC sleeping pill.  Well, there was NO WAY I was going back to oxy, so I tried the Ambien.

When I asked my doctor why kicking this drug was so hard she said it’s one of the most addictive prescription drugs on the market and some people are particularly susceptible.  She said people get dependent on it for two or three primary reasons: first it solves their pain problem, then some people get a slight high from it, and most get an overall good feeling from it.

While on this drug, when life comes at you, you almost always just “feel good”…so who doesn’t want to feel good all the time?   Other than The Buddha, I’m not sure any of us feel good all the time, and honestly, if I have to get that feeling out of a bottle, I’ll take not feeling good sometimes, thank you very much.  Bring on life, I’m OK with it as it is.  I’ll stick with my exercised-induced endorphin high.  It’s safer – as long as you stay on the bike!

On night two I took ½ an Ambien and conked out in minutes.  I had a restful sleep with no morning side effects.  The next day, day three, I felt energized, I got on the bike and did some intervals.  It felt wonderful.  However, that afternoon I conked out and slept several hours and had zero energy the rest of the day.  I may have overdone the workout, but screw it.

When I hit the pillow on night three I felt tired enough that I assumed I could do it “au natural”.  Well, I fell asleep but woke up two hours later practically hyperventilating with a racing pulse.  Going back to sleep unaided would have been impossible.  So ½ Ambian came to the rescue, and I slept till morning.

Day four: could hardly extract myself from the couch to go in the kitchen and make a cup of tea, was mildly depressed, and had zero energy.  I forced myself on the bike, indoors of course, ‘cause it was cold, windy, and really unpleasant outside.  I think all my energy was expired simply getting ON the bike, so once there the riding part was relatively mild.  But it was far better than being huddled in the fetal position on the couch under a pile of blankets.

The next few nights I took a half-Ambien to get to sleep, slept pretty well, and woke with a reasonable amount of energy.   Looks like this process will take at least a week, but I honestly think I’m over the worst of it.  Getting to sleep may still be a problem for a while, but I can deal with that as long as I’m not a fidgeting mess while trying.

What’s truly amazing to me is that when the doctors gave me the oxycodone prescriptions – a total of 5 doctors over the course of my recovery – not ONE gave me the prescription with a stern warning about how my body might become dependent on the stuff.  It was only after visiting my primary doctor after my first failed cold-turkey episode was I told of the problems I was about to face.

The next phase is building my strength and endurance on the bike up to where I was last year.  Now that is something I can get excited about!

Warning: oxycodone is nasty shit.

 

A slow day on the Plaza

•February 27, 2014 • Leave a Comment

One of the merchants (normally selling their goods) under the portal on the Plaza in Santa Fe.  It was a slow day.

(Olympus E-M5, Leica 25mm 1.4 lens (50mm effective) – ISO 200, 1/000 @ f/4.0, B&W conversion in Silver Effects Pro) 

Reading on the Plaza

My Spill of a Lifetime

•January 30, 2014 • 1 Comment

No matter how hard I try, the accident remains a blur.  I can picture it in my minds eye, but I don’t really know if what I see is real, or only imagined.

I know for a fact that it was a great day for a mountain bike ride with three friends on a moderately difficult trail that I never rode before.  Being a cautious downhiller, there were several sections where I walked the bike.  On the last section, “The Spine”, I walked on more than a few occasions.

I’m positive I rode that last portion, which included the final descent before the end, because that’s where I fell.

I “remember” seeing a rocky, sandy patch as I was making the final drop, and I seem to remember thinking that I might not make it safely around or over this section.  I seem to remember my front wheel turning in the sand and me lunging over the handlebars. That’s all I think I remember.  What I know for sure is that I crashed on those rocks.

Only a few cloudy memories stay with me from that moment until sometime the next day.  I also have some memories that were of hallucinogenic, out of body experiences.

Shortly after the accident, I clearly remember giving at least two people my wife’s cell phone number, which is kind of amazing considering that under normal circumstances I can barely recall it. I remember giving it to one of my cycling buddies, Brent, and also to one of the people in the helicopter as I was being moved into position for the ride.  I also remember complaining, tongue-in cheek when the paramedics started cutting my clothes, “You’re cutting my shirt and pants!  Do you know how hard it is finding a quality wool shirt in a small size!”

I also remember me repeatedly asking for my wife Alison, both on the helicopter and when being moved into the Trauma Center.  I remember having this deep need to have her by my side, and I think I might have gone on about this for quite a while.  Fortunately, she was there soon enough.

What I learned later was that I broke 7 ribs, suffered a “flail chest”, a punctured lung and spleen, fractured pelvis, a concussion, and that I hurt.

The first order of business when I reached the hospital was to get me into surgery to patch my punctured lung and spleen and to insert a drip tube for my lung.  My recollection of this process, and I think even during the surgery, were hallucinations while under the drug Ketamine, which is really awful stuff.  It’s under this drug that I felt an out of body experience, and was unable to grasp reality.

It was not until sometime the next day that I fully understood what had happened, and when I first became aware of my location.  It was also when I realized just how much pain I was in. They gave me Dilaudid, which was almost as bad as Ketamine, so my hold on reality was still tenuous at best.

Thank goodness Alison was by my side from the moment she arrived at the UNM hospital.  Sure, the Trauma Center may have saved my life, but there is no substitute for having a loved-one looking out for you when you’re in a hospital bed.   She was levelheaded, present, and constantly engaged when a doctor or nurse came into the room.  Which, of course, I was not.

Apparently the section of trail where I fell was not particularly difficult, and under other circumstances would be well within my capabilities.  This accident was clearly not the result of me being foolish, or pushing myself too hard.  It was just an accident; though, several unique circumstances may have contributed to the outcome.

First, I was on a new mountain bike, this being only my second time out.  Not only was it new, but it was a “29-er” with hydraulic breaks and full suspension, features all new to me.   I’ve been mountain biking for over 20 years, but never on a bike with this geometry or these mechanical components.

It was at the end of a pretty tough day, and I was tired and hungry.  It’s unusual for me to forget food, but in this instance I had.

The trail was new to me, and while I’ve gone out separately with these other riders, this was the first time mountain biking with this particular group, not that this necessarily contributed to the accident.  I like to think I “ride my own ride” no matter who I’m with, whether on the road or trail.

However, try as one might, a rider is always somewhat influenced by those in the group.  I’ve always believed that it’s important to be aware of that influence, and only let it have a bearing on your riding to the extent you choose to let it.  Mindlessly allowing yourself to be pushed by riders who are beyond your skill level is not only foolish and immature, but it can be dangerous.

Precisely why and how I fell will remain a mystery.  Fortunately, my injuries should heal just fine with time.  I was wearing a brand new helmet, which did not survive the fall.  The bike however, remained in perfect condition!

According to the doctors, there are a few things for which I should be very grateful.    First, the helmet saved my life.  Yes, I had a concussion, and the impact cracked the helmet, but if I was not wearing it, which would be an insane thing to do on a mountain bike, I would be either be dead or would have suffered a very serious brain injury.

Secondly, I’m fortunate that I was physically fit, with strong lungs. Apparently, the mortality rate for a flail chest is disturbingly high, and given my remote location, it could have had a much more serious result.

And most importantly, I give my thanks, and actually my life, to my riding buddies who knew how to handle me after the fall, and who convinced the helicopter dispatcher to send a rescue team.  The rescue dispatchers where not willing to send the helicopter because they said they needed an “official” authorization.  Henry, a retired fire fighter, would not take that as an acceptable answer, and as he monitored my vital signs, ultimately convinced them if they didn’t come, I might not make it.  It was the knowledge, common sense, and determination of my friends that really saved me.  For that I will be forever grateful.

So, did I learn anything from this event?  Yes, I leaned several things, and I also had some existing beliefs strongly reinforced.

First, I need to say that I get very cynical and weary of hearing people say, “that [fill in the blank] was a life changing experience”.  Usually it’s for something trivial, such as a vacation to India or Nepal, or is part of a difficult physical challenge.  Or, I’ve even heard it said about reading a book or listening to a lecture.  Nonesense.  If those are “life changing events” then your life isn’t very interesting.

Being told you are lucky to be alive, however, is different. So, what do I take away from this?

  • I will always remember the importance of having a loved one in your life that you can support when they need it, and that you can rely on when it’s your turn.  Pay it forward, as they say.
  • My next reminder is seeing the value of being in the best physical condition possible.  What happened to me could easily happen to anyone, even in, say, a car accident.  People who let themselves get out of shape are not only lazy, but more importantly, they are selfish.  If you don’t want to think of yourself, then consider your caregivers role after an accident.
  • I will never ride on a dirt trail without a helmet and never on a new trail, or a remote trail, alone.
  • When away from home, I will always bring a cell phone, and I will try to encourage others in my group to bring one as well.
  • I will never leave home without an ID and an emergency contact name and phone number.

Time to get back on the bike!

Baking Bread

•November 23, 2013 • Leave a Comment

Winter has come to Santa Fe, so it’s a perfect time to bake bread seeing that it’s WAY too cold outside to get on my bike.  I’m not desperate enough yet to ride when it’s in the 20′s and 30′s.

This first bread uses a hybrid Wild Yeast Starter (from my Mother Starter that lives in the frig) and a Biga-style which reduces the “yeastyness” a bit.  It also uses a combination of bread flour and whole wheat so that it’s a bit lighter than full whole wheat, but still is fairly dense.

It has 4 basic steps:  the Pre-Soaker (8 hours day 1), the Soaker and my Hybrid Wild Yeast starter (overnight into day 2), and the final mixture (afternoon of day 2).

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The second bread is a gluten-free bread I make for Alison.  Most gluten-free breads are, A) stupidly expensive if you buy them, and B) also have the added feature of being inedible.

This recipe I’ve been “perfecting” for about a dozen or more loafs.  It doesn’t use arrowroot flour as most recipes call for ’cause that stuff costs too much and has the density of fine cocaine (I can only imagine!), so more ends up on your clothes then in the bowl.    This one uses rolled oats and rice flour, plus a bunch of nuts and raisins.

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Jaroso Fire

•June 13, 2013 • Leave a Comment

Taken from my back deck on June 11, 24 hours after the fire started.  It’s 20 miles away, but at this point, the plume is 20,000′ in the air.

Jaroso Fire June 11, 2013

Northern NM Road Trip: Bisti and Angel Peak

•June 4, 2013 • Leave a Comment

A short road trip through Northern New Mexico included a stop at The Black Place (made famous by Georgia O’Keeffe), a hike at Bisti Wilderness, and an overnight camp at Angel Peak Scenic Area.  The two latter places are managed by the BLM.  What we saw was slightly different then the tour books and BLM website photo galleries.

The Black Place seen from a nearby vantage point

The Black Place as seen from a nearby vantage point

Drilling the Black Place

Between the Highway and the Black Place

The Black Place ready for more

Getting ready for more at the Black Place

Approaching Bisti

On the road to Bisti

The Road to Bisti

The Bisti/De-na-Zin Wilderness corridor

Bisti Horizon

The Bisti Horizon

Bisti

Inside the Bisti wilderness area

Bisti

The Bisti wilderness area

Chemical Pit at Angel Peak entrance

On the access road to Angel Peak “scenic” area.  This “Land Farm” is in fact a chemical leaching field for the oil and gas rigs at the park.

Gas Drilling at Angel PeakOne of the many Gas drilling stations at Angel Point.  The sound is 24 hrs/day, and reverberates throughout the canyon.

Angel Peak

More like what the BLM website shows for the Angel Peak Scenic Area… of course, minus the noise.

Photo Shoot for John Dole of “Interlachen”

•February 25, 2013 • Leave a Comment

Shot at Shidoni Gallery, Tesuque, NM

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