Sunday, January 7, 2024

Not Even Not Zen 335: Biomythography - Note 79, On Novocaine (II)

On Novocaine
Part II

Every teen sustains occasional injuries. And when I did, my parents talked to me about seeing doctors. Usually, they decided it wasn't worth the expense. From my parents attempts to medicate me at home, I learned that aspirin made me sick but didn't do anything for pain or swelling. Motrin (ibuprofen) didn't do anything, either. Neither did diluted whiskey. Or anything someone rubbed into my skin. 

The 1970s were an age when treatments for pain were considered suspicious. The nation's participation in wars had led doctors to administer opiates to soldiers, who then became addicted. For that reason and for others, the federal government launched multiple campaigns against drugs. News channels told us there was a heroin epidemic. Even most of the known over-the-counter painkillers were, at the time, still opiates. Everyone was aware how horribly addictive they could be. The next best known painkiller was cocaine, great for topical relief. But it made complaints about injuries seem even more suspicious.

The societal opinion on pain was that it builds character. It's good. Individuals were responsible for their attitudes toward their bodies. You had to make your mindset a healthy one. 

Sometimes my parents waited a few weeks to see if my fractured bone or twisted joint would heal on its own. If it didn't heal, they made sure I got medical treatment. These were a few of the things that required nurses or doctors:

A high ankle sprain
An asthma attack
A bone fragment that locked my elbow
Double pneumonia
A crushed knuckle
A dramatic allergic reaction

When any of these started to seem threatening, my mother packed me up and drove me to the Kaiser Permanente offices. Kaiser rented series of red brick and glass buildings in Rockville where they kept their cheapest doctors and dentists in their insurance plan. From the staff there, I learned how prescription painkillers didn’t do much for me either. Codeine improved my symptoms at the cost of brain fog. I hated it. Percocet and Vicodin didn't do anything at all.

The doctors were awfully careful about the Vicodin anyway.

Only one treatment worked. It relieved pain but it wasn’t administered for pain. It relieved symptoms for sprains, asthma, and hives. The treatment was steroids. 

On a couple occasions, I got steroid shots. Once, after our neighbors burned a pile of poison ivy as I worked outside, I arrived at Kaiser in such alarming condition I not only got a shot but a prescription of prednisone to ensure I could breathe and, hopefully, see. Nowadays, everyone connects steroids to professional athletes cheating but, when they first came out in medical treatments, they immediately showed they were obvious improvements over the medicines they replaced. 

During the 1980s and 1990s, I noticed the standard treatments for pain were getting incrementally better. A few of them, like the prescription steroids, improved quality of life by reducing negative symptoms. Some other advancements did nothing much, medically. When I finally got health insurance and, years later, returned to a dentist, I discovered the procedure now was to give novocaine swabs prior to administering shots. It's a trivial improvement. But painless injections sure made me happier to go for my procedures.

Injuries that got no pain medication:

a broken bone in my foot
a fractured wrist
a broken metacarpal bone

Procedures worthy of novocaine:

root canals at the dentist
a vasectomy

A condition worthy of trying everything, apparently:

a zoster (shingles) infection

I didn't go to the doctor about shingles until it progressed so far I couldn't sleep. I was working multiple jobs and scheduling myself for five hours of sleep, maximum, so I really needed the unconsciousness part of my day to happen. But the disease kept waking me if I moved, eventually waking me even if I breathed deeply. (You know you've waited too long when the doctor brings in other doctors. The specialist even invited trainees to see my 'classic case.') At first, my GP prescribed tramadol for the pain and swelling. It did nothing. She upped the dose. I took four at a time. Still nothing. 

I returned to her office and told her honestly what I was doing and said I needed to sleep. She put me on hydrocodone. That didn't work, either. She moved me to oxycodone, the maximum legal amount of it. Again, popping them four at a time (the most I dared), I still felt no effects. I returned to her office.

"I just need to sleep," I said.

"Well, I agree." Hands on hips, she looked at my infection, which was improving a bit under the antiviral medications but still looked bad. "I wish the opiates did something for you. Clearly, they don't. I want to try you on something new, a nerve blocker."

"Sound good," I said without asking questions. 

"Read the side effects carefully," she said. She handed me a prescription for gabapentin. 

Gabapentin works - for me, at least. Although it took a couple days to build up in my system, I got to the point where I could take gabapentin and sleep. I had to be careful with the timing and dosage because I certainly couldn't do anything else. I couldn't drive a car. I couldn't walk without a hand on the wall. Gabapentin gave me vertigo like I'd never had before. But it was worth it. I slept at night. 

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