Posted by: Kate | January 6, 2010

I Probably Should Lie

For all the pregnancy is going well, and I’m glowing, and looking great, and blah, blah, blah, I’m also dealing with one of the more difficult physical experiences of my life right now.  And it’s a controversial sort of thing, something that makes people shake their heads and tsk-tsk a little, even if they’re too polite to show.  And it’s hard, and scary, and upsetting, and I really wish it wasn’t an issue at all, and I probably should lie and act like it’s not happening.  I probably should just shut up, paste on a smile, and tell the world that everything’s just peachy.  I probably should log off until this passes, and then write about it in a light, amusing sort of way.

Since when have I ever done what I should?

I’m going through opiate withdrawal, and I’m 27 weeks pregnant.  It’s awful.  And important.  And hard.  And yet, one of the easier decisions I’ve ever had to make regarding my health and my child’s.

It started, I suppose, back in July, before I ever went and got myself knocked up.  I was taking a synthetic opioid, called Ultram, for pain, and it was working pretty well.  I was at a fairly high dose, but not off-the-charts or out of medical reason, and I could function.  I could do several loads of laundry, unaccompanied, and could even go hog-wild and choose to dry it on the line out back.  I could keep up with the kids, getting them to school or the park or the grocery store, and not come home completely miserable.  I could help with the tremendous amount of lifting and carrying and sorting involved in preparing for a yard sale.  All in the face of a permanent and painful diagnosis, because I was on a painkiller combination that worked for me.

I was also, incidentally, taking an antidepressant, because somehow the combination of an abrupt and you’ll-never-convince-me-it-wasn’t-personal layoff, a medical issue carrying news of chronic pain, having been told that I would not be able to conceive without medical intervention and nobody knew why, family discord, all added up to be more than I could glide through without a serotonin boost.  I was prescribed Zoloft, and it only took a moderate dose for me to feel appreciably more stable, even starting to feel like myself again.

Then that garage sale happened, and I interrupted the flow of things by having a grand mal seizure in the middle of the front garden.  It took a while, and any number of tests and consultations, but the final verdict was that it was triggered by the combination of Ultram and Zoloft, and if I stopped taking both immediately, I should be fine and safe and seizure-free again.  I did, and so far, they’re correct.  No more of that nonsense, thanks.

By that point in time, I was enough better, emotionally, that I felt safe to discontinue the Zoloft without replacement.  Not everything about my life had changed, but enough was better – Willem had a new job on the horizon, we were moving back to Massachusetts, I had the time and space to recover from the hurts of the layoff and the shock of the diagnoses – that I didn’t go back on another antidepressant.  And I still feel OK with that; better, actually, than I had for a long time prior, even before all the nastiness hit.

Physically… that was a different story.  I tried a series of different medications, and interventions such as medial branch block and epidural injections of steroids, in an attempt to cope with my pain in a non-pill sort of way.  No luck.  At all.  In fact, the medial branch block made things all sort  of worse for a few weeks, which took radio frequency ablation off the table as an option.  I lived in an area of the country in which alternative forms of medicine were not exactly plentiful, and even if they were, I’m not sure I can, at this point, alter my basic views on medicine and treatment enough to really benefit from them.

So I started on an opiate.  First Percoset, but that was leaving me loopy and sleepy and generally not as present and engaged in my life as I needed to be.  It dealt with the pain, sure, but it also knocked 30 points off my IQ.  And so I switched to Opana, both in extended and immediate release forms; it’s an opiate, a sibling to all of the other ones out there (Percoset, Vicodin, heroin, morphine, my oh my, what am I doing to my search criteria now?  Sorry, new strangers, I’m not posting ways to obtain the above).  It’s not particularly common, though it’s been on the market for 50-some years; I don’t know the details of that.  I do know that it’s a very strong pain medication, but that it does not have as strong a euphoric effect as the others.  I was back to being able to get through my days pretty well, especially once I got myself attenuated to the sedative effect and wasn’t sleepy all day, and I was pleased with its efficacy.  I felt like I could help with the move, particularly on the unpacking side because Willem remained in the house longer to do the packing while the kids and I moved into the apartment earlier.

It was OK.  I could live like this; not just function or exist, but live.  I wasn’t counting pills or worrying whether I would run out, and I was switched from monthly to every-three-month (trimonthly?) appointments at the pain clinic because my prescription was stable.

Then… I saw two pink lines.

I made several calls, that first day.  I sat in the minivan and watched the movers and Willem work – having been sternly forbidden to lift a finger, much less a box or piece of furniture – and warmed up the phone.  The first call was to my OB-GYN, to schedule bloodwork and an ultrasound, and ask about whether I should change my pain medication.  The next was to the pain clinic, to ask again about the drugs.

I was reassured, repeatedly, that I could – and, in fact, should – remain on the Opana for the time being.  That the process of withdrawal was actually more dangerous to the baby, early on, than continuing medication use.  That I could discontinue it, if I wanted to, at the start of the third trimester.  That was the safest time for the baby, developmentally and such, to do it after the magic that happens in the first two trimesters and well before the birth was imminent.

Although, they said, if you want to stay on the medication through birth, that’s OK, too.  The baby might not even be affected, given the dosage you’re on.  And if the baby is born with a physical dependence, then we can consult a neonatologist and deal with it then.  If you want.  Really.  Whatever.

So I stayed on the meds, but started to taper down, slowly.  Breaking a pill in half here, skipping a dose there, whatever I could manage.  Over the next six months, I whittled my daily intake from about 45 milligrams a day to about 30.  I plateaued there, and decided to stay on the plateau until after the holidays.

It wasn’t always a smooth process; Willem had strong and valid concerns about the safety of the baby, and even regular and encouraging ultrasound results haven’t fully assuaged those concerns – I think nothing short of holding his healthy baby will do that.  And in September, I went to New York City for a weekend, to spend some quality time with Job Stewart.  It was a fabulous time with my closest friends, and I felt physically as awful as I have ever felt, because I somehow managed to leave my medication at home.  After about 24 hours, I started having withdrawal symptoms, and they were just beyond awful.  That made me decide to get back on the meds as soon as I got home again… and that I would be withdrawing in January, come hell or high water.  Doctor’s assurances aside, there was no way on God’s green earth I was going to risk imposing that kind of misery on a newborn.

And thus we made it to January.  Immediately after returning home, I started the process of moving from one medication to another; from Opana to Neurontin, which is not an opiate, not addictive, and frankly not as strong.  But it is considered safe for the baby, at this stage of development, and it is also believed that now marks the time of comparatively minimal risk and discomfort to the baby.  (No one knows how much of this medication crosses the placenta, and so it’s impossible to gauge the experience  of a fetus.)

So, it’s time.

And, it’s awful.  Not always; there are periods of time, long stretches, even, when I feel pretty good.  Basically from early afternoon until bedtime, I’m honestly feeling damn close to fine; at least, as fine as you get when you’re seven months pregnant with spinal arthritis and such.  But I can make dinner, do light housework, help the kids with homework, have a long-overdue dinner with Gretchen, generally be OK.  Happy.  Enjoying my life.

But the overnights are hard, because sometime in the night I tend to start getting the symptoms… and by morning, it’s just bad.  It’s hard to describe, exactly, and I hope you don’t have personal experience with it.  But there’s a sense of electric shock through my whole body, like Restless Leg but bigger.  I have these sort of twitchy convulsions, which I simply cannot control; not seizures, because it’s a conscious thing, like a buildup of static electricity that I can only discharge by moving.  They’re strong enough that Willem and I can’t sleep in the same bed, because I keep him awake.  (He opted to move to the couch the first night, but I asked that I be the one to move for other nights – he doesn’t want to be the guy who is kicking his pregnant wife out of bed, and he’s really, truly not.  But I still have insomnia for an hour or so most nights, and it’s just easier for me to get comfortable on the couch and know I can turn a light on and read or knit for a while… honest.)  Then, I get muscle aches, I think due to the twitching.  And there’s a low-grade fever, and nausea, and general gastrointestinal unpleasantness.

And, of course, the back pain.  Lots of it.  More than normal, in fact, because I’ve read that a side effect of withdrawal is lower back pain, even if you don’t start out with it.  Great, thanks.

This lasts all morning.  Sometimes I can go back to sleep during it, and I have a medication, Clonidine, that is supposed to help with the withdrawal symptoms.  I don’t know if it’s working, but I don’t quite dare skip it to compare.

Thus, I spend my mornings whining, moaning, and generally being miserable, inside my head.  By early afternoon, I give in and take a small dose of Opana, having waited as long as I can but knowing I’m not supposed to just go cold turkey.  And then, an hour or so later, I feel better.  And I hate how much better I feel, because I know that’s in response to this medication… it’s a cycle, and a vicious one.

By the weekend, I’ll be done with the Opana entirely.  I opted not to fill the script for January, because I wanted this process all to happen while Willem is home on winter break and able to help – and help he has.  Housework, cooking, kids, he has really been amazing, and if I hadn’t already married him I would now.  So, very soon, I’ll be done, and will have a few more days of wicked discomfort, and then it will be done.  My back will still hurt, but without the extra symptoms, and we’ll cope.

So.  As I said, I probably should keep this all on the down-low, to avoid the negative judgments or the well-meaning suggestions that I try this or that – I know they’re offered in the best spirit, but I’ve done so much research and thinking about my situation and I really need to feel like my chosen path is the right one for me… but I won’t shut up, because what I need, more than anything else, is to be honest with myself.

And, apparently, with the rest of the world, sometimes.

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Responses

  1. Well, I can honestly say I’m glad I never had to deal with that. Pregnancy is too hard sometimes without the added pressure of “addiction”.

    I remember trying to give up my caffeine and that was hard enough.

    Hang in there (what else can you say?). I’ll keep you inmy prayers that the pain can be managed by the less stuff.

    Just keep your mind focused on that wonderous beauty that will arrive at the end!!!

  2. Oh, that’s awful. I’ve lived with someone going through opiate withdrawl, and it is hell. I also tapered my antidepressant before giving birth, and that by itself isn’t easy. Good for you for doing it now. As I’m sure you know, watching the baby go through withdrawl would be far more painful.

  3. I am so sorry you’re having to go through this and that the process is so miserable.

    Husband is going through similar pain management issues as you are for arthritis in his neck, and he’s now on some stiff pain killers. He’s very worried about possible addiction and withdrawal issues, and he’s not even pregnant.

    Hang in there.

  4. Thinking of you.

  5. oy. like you needed One More Thing… Hang in there. Hopefully Sunday’s massage will help… thinking of you.

  6. Dude. Anybody that judges you for this isn’t worth lending credence. You made sober adult decisions about your pain management and you continue to take steps to get to the optimal situation for you and for the baby. End of story.
    But here’s a hug anyway, because opiate addiction is, on top of everything else, scary: (((you)))

  7. I prayed for you last night and will continue to pray that you will get the strength and peace you need to get through this.

    Chronic pain is part of my life, too, because of fibromyalgia…although I’m thinking your condition probably involves a higher degree of pain. You are doing a very good thing, taking the hit of this withdrawal so your baby doesn’t have to. You are a good mom and you will make it through this!

  8. thinking of you…

  9. Kate there’s a website http://www.safefetus.com that allows you to put in your drugs and dosages and it lets you know what’s ok and what’s not and offers safer alternatives. Unfortunately, it’s being updated at the moment but is due to be available again ‘early 2010’. Tricky to manage I can imagine you don’t want a baby with opiate withdrawals on top of all this. I have a friend who swears by acupuncture for back pain relief. She isn’t pregnant but has been doing it for years.

  10. I’m actually in the same boat at the same time of my pregnancy on the same medication. I’ve been on it now for 2 years and I’m scared to death about the health of the baby I’m only taking 25 milligrams per day and its hard not having it. I’ve tried to cut back past here and am having trouble doing so. Next week is my cold turkey date. Ill be 27 weeks pregnant and ready to take the plunge into full blown withdrawl. Please tell me how this worked out for you. Thank you for giving me hope! I hope to hear from you. God bless and have a great day. Also I’d like to hear about your little one
    Thanks in advance


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