Done yesterday (20110630 Th)

[mdlbear]

0630 Th
  * up 6:50; W=197.4; drugs, nose, teeth, laundry, dishes, light
  * Amazon order:  2 otterboxes (3000 and 3250) and a Travel Case.
  & ended up getting in a bit late, but no harm done
  & lunch: Thai (Jasmine in Santa Clara) -- so no walk.
    way too noisy for comfort; I'll pass next time, & stick to my diet.
    also the service was very slow.  Tasty, though.  Barbecue Beef.
  @ Announcing Echoprint [LWN.net]
  @ DebWrt - not much there yet, though.
  & so of course Colleen's cast waited until I got home (and orthopedics was
    closed for the day) to shift and start hurting.  Now 9pm, after ~ an
    hour in the ER waiting room.  9:30 in a room but still waiting.
  : hydromorphone (dilaudid) should be ok for colleen - derived from
    morphine, not codeine (as hydrocodone is).  So, good. (11ish)
    11:30 finally got the fix, after having been lost in the shift change
    Colleen now in x-ray
    new cast installed somewhere after 00:00.  Hardening.
  % back spasm getting chair out of trunk on the way home; lost it several
    times.  No control over speech centers when stressed
  * splat a little before 2am

Not A Good Day. It got off to a mediocre start when I lost track of time ordering some otterboxes off Amazon, and came in late to work. (No harm done, since the Thursday am diagnostics scrum was basically a no-op, but I don't like doing it.)

I went out for Thai food with 9 other coworkers. The food was good. But the service was slow, and the noise level was simply intolerable -- I couldn't even carry on a conversation with somebody sitting right next to me. And of course no walk (though I got some exercise later). Next time I'll eat at my desk, as usual, and take my walk and stick to my diet (such as it is).

When I came home from work I woke up Colleen (who had been spending the day sensibly in bed) to find that her splint had shifted by about 3 inches, and hurt like heck. Naturally this was after the orthopedics clinic had closed for the day, so we had a quick dinner and took off for the ER. Again. (The splint, her second one, was supposed to go around her elbow to keep it at a right angle. Apparently she straightened her arm in her sleep. The doctor advised her to sleep in the sling.)

I don't think they charged us a co-pay this time. But we went in around 7pm, she fell into a shift change around 10:30, finally got pain meds at 11:30, x-rays a little after that, the new splint at around midnight, and home around 1:30. Meanwhile I had picked up a back spasm lifting her transport chair into the car trunk, and totally lost it a couple of times. I don't have much, if any, control over my speech when I'm sleepy, exhausted, and in pain.

June is officially fired.

On the plus side, we now know for certain that hydromorphone (dilaudid) is ok for her to take. She reacts very badly (i.e., was in a coma for three days) to cocaine or hydrocodone. I looked them all up online while waiting for the pharmacy to come to the same conclusion. We came home with a new prescription for percocet (ocycodone, also ok).

Colleen and I are both feeling much better this morning. See some of you at Westercon!

Comments

[quadrivium.livejournal.com]

I am so glad to read you are both feeling better this morning! Have fun at the convention. *HUGS*

[mdlbear]

Thanks! *HUG*

We will. I have a 45-minute concert slot on Sunday.

[acelightning.livejournal.com]

Is Colleen allergic (in the classic sense of inducing anaphylaxis) to codeine, or does it just not work right on her? Because some, but not all, of the "semi-synthetic opioids" (and a whole raft of other commonly prescribed drugs) are metabolized by the liver enzyme CYP 2D6 (http://en.wikipedia.org/wiki/CYP2D6). Approximately 7% of the population is deficient in this particular enzyme, and are called "poor metabolizers", because their bodies don't metabolize the drugs in question.(*) Usually this means that the drugs can build up to overdose levels in the body, but in the specific case of codeine it has a somewhat different effect. Codeine itself is not much of a painkiller, but it's normally broken down into morphine in the body. Without CYP 2D6, though, it all stays codeine, which not only doesn't do very much for pain, it also has some fairly unpleasant side effects. Other opioids that are metabolized by 2D6 are propoxyphene (Darvon) and tramadol (Ultram).

As far as I can determine, just about all the other opioids are metabolized by some other enzyme system. I certainly had no problems with the morphine they gave me post-op!


(*) I'm one of them. When I need painkillers - as after my recent surgery - I have to tell the doctor or dentist not to give me codeine, but rather Vicodin (hydrocodone) or Percocet (oxycodone). And when I have a cough, I can't take any kind of cough syrup; the usual cough suppressant, dextromethorphan, is so strikingly metabolized by 2D6 that it's actually used to test whether a person is a poor metabolizer. One spoonful of cough syrup has the same effect on me as drinking half a bottle of the stuff for a cheap high... except the trip is severely dysphoric to me. And guess what the only other common cough suppressant is? Codeine!

[mdlbear]

She appears to be a poor metabolizer: the last time she had codeine she was unconscious for three days. We've stayed away from hydrocodone as well; not sure whether she had a bad reaction to it or is just afraid of it. Oxycodone works fine.

[acelightning.livejournal.com]

Colleen and/or you might want to check which, if any, of her other meds are affected by the individual's level of 2D6. A number of common antidepressants are on the list, IIRC. Also, there seems to be a genetic factor in whether a person is a "poor metabolizer" or not; my husband isn't, but our son is, so your kids might also be 2D6-deficient.

[pocketnaomi.livejournal.com]

I'm glad she's able to take dilaudid; knowing more options for pain relief is always a useful thing.