A sound mind in a sound body is a thing to be prayed for.
The pain started in my mother's knee. It was a small thing, nothing to worry about. Mom was only in her mid-60s and she had always been healthy. Strong too. She wasn't overweight and walked and swam regularly. Unfortunately, my parents had the bad luck of living near two large hospitals, with two large orthopedic centers. Yes, bad luck, because when Mom went to see one of those orthopedic surgeons, he told her that the pain in her knee was being referred from her hip and he recommended surgery. If she had lived in England, where this brochure on osteoarthritis was produced, her family doctor would have recommended physical therapy or some other, more conservative, treatment. Surgery would have been far down the list of treatment choices. But Mom wasn't in England, she lived near a university community in the U.S. with many orthopedic surgeons. And so, in her mid-60s, my mother had her first joint replacement. Fifteen years later, my mother has had both hips, both knees, and both shoulders replaced. We used to call her the Bionic Woman, but we stopped because it quit being funny. We will probably never know which of these surgeries were essential.
I sat by a rheumatologist on my latest flight home from Michigan and when I told him my mother's story he said, "Well, if you get sent to a surgeon, they'll want to operate," as though this were the most natural thing imaginable. He said he'd seen it happen many times in his own practice. It's like that old maxim, if you're a hammer, everything looks like a nail. There are lots of hammers walking around in the Ann Arbor area looking for "nails," my mother just happened to be one of them. It's not that her surgeries were necessarily a mistake - taken one at a time. It's just that one surgery lead to another and then another and along the way Mom's pain got worse, not better. Her last surgery took place in September 2011 to "correct" one of her hip implants.
My mom can't take NSAID's, like ibuprofen, because they irritate her stomach. And so when her arthritic pain and joint pain recurred after surgery, her former family doctor began to prescribe opiate pain medications, including both Vicodin and Percocet at different times. When Mom switched doctors, about two years ago, her Vicodin was stopped and her Percocet was tapered down to one or two pills a day and she was put on morphine. Not an ideal combination because when she fractured her hip last December at age 77, she had no "big guns" left to manage her pain. And, now, she is "withdrawing" from these increased doses so that she can safely go home, i.e. go home without too much cognitive and physical impairment related to opiate usage. It continues to be an up-and-down process, with Mom still complaining about withdrawal symptoms a week after the tapering began.
Today, specialists in pain management are educating fellow doctors about the dangers of narcotic pain medications and patients are sharing stories similar to my mother's marathon quest for pain relief and battle with prescription drug addiction. The following video is well worth watching if you want to know more about this complicated and important topic. For more on this topic go to Physicians for Responsible Opioid Prescribing.
How can you tell if your aging parent or spouse is abusing prescription drugs - either intentionally or unintentionally? This article on Prescription drug addiction provides information on what to look for. Next time: more on chronic pain and opiate addiction and alternatives to surgery and pain medication.