Alcohol & Pain – 21/07/14 09:38

I tried to write this post yesterday, but got quite distracted soon after starting. That wasn’t too much of an issue as I realised that perhaps this post needs to be written on my laptop due to the subject I’m writing about, and how it may need some research so that people understand exactly what I’m saying.

I only say this because together, alcohol and pain, it’s a subject which is quite hard to describe, because everybody reacts differently to both.

The thing is, it’s a shame really. I enjoy a drink just as much as the next guy. I really do! I’ve got a small bottle of Scotch Whiskey which I plan to have on the rocks, and I’ve still got near enough a full crate of Kronenbourg 1664 which was from Christmas. The only trouble is, I can’t drink very often. I’m not saying I’d like to have a drink everyday, because that would cause more issues than I have now, but having a drink once in a while is nice.

Yet at 20 years old, I’m not allowed to. I’ve been told by my doctors, consultants, and even others who are on the same meds as I am, that there is no way in hell I can have a drink, and it’s upsetting you know? That’s not the way things should be, I should be able to have a drink whenever the hell I like. A few years ago, when I had a drink, I most certainly had a drink. I’ve got many happy memories and fuzzy nights out of just being absolutely plastered, it was great.

If I’d like to do that now.. I have to not take any of my meds all day. Perhaps if I’m pushing it, I’ll take the first set of tablets in the morning, but I can’t take them throughout the day. This is because of the type of medication that I take.

One especially; Tramadol.

Tramadol is an opiate, meaning that the basic substance is ‘farmed’ from the dried milk of the poppy seed. It also means that it is in¬†the same group as Heroin and Morphine, slightly less powerful, yet just as addictive. It’s also the main reason why alcohol doesn’t agree with me, and why I can’t actually have a drink any more.

You see, Tramadol is a painkiller, and try as it may, it does hold off my pain and I can’t dispute that at all, without it I am in agony. Yet the first thing mentioned on the leaflet for this drug, is that the user must not consume alcohol alongside taking the medication. This is for a number of reasons.

Firstly, alcohol can basically¬†diminish the effects of Tramadol within the body. Completely. This is the one that effects me the most, even after just one drink. I can actually feel it happening. About halfway through a pint, or perhaps even after one single Vodka and Coke, my pain just appears, rather quickly, but gradually at the same time. The more I drink, the more the pain appears, and before I know it, I’m drunk and in agony on the floor. This may not be the same for everybody, but still.

This brings me onto the second point.

Drinking alcohol whilst on Tramadol gets you drunk quicker, but not in a nice way. Not in a nice way at all. Back in the day, I could drink a lot. At one point a litre of Vodka would be my best friend on the night, and surprisingly enough, I’d wake up with only a very slight headache and a craving for a cup of tea. Not exactly what I’d call a hangover anyway. Now though, I wouldn’t even think about it. 4 pints and more, will cause my pain to creep up towards the 7 / 8 on the pain rating scale. That’s not even taking into account that at the time I’ve started my 5th pint, I probably haven’t even had any painkillers for over 12 hours.

That right there, is an issue. I don’t just take my painkillers because I’m in pain.. Yes that is the main reason, but I’ve been taking opiates for about 3, perhaps 4 years now, and I’m addicted to them. I don’t go mental when I’ve not had one for over 6 hours, don’t get me wrong, but in this example, I would not only have been starting my 5th pint and probably well and truly drunk, I’d be in excruciating pain, my cognitive functions would have slowed to the speed of a snail, and on top of that, I haven’t had any painkillers for over 12 hours, which not only makes me feel like shit, but by now.. My pain is through the roof. Pain Rating of 0 – 10? 11. No doubt about it.

That’s the sad truth really.

Plus as well, this is all ‘external factors’. These are things which I can feel happening, yet actually inside of me, there’s another detrimental effect that the cocktail of alcohol and tramadol is having on my body. My liver is going into overdrive.

Your liver, as everyone knows, is the power horse of your body. It’s roughly 8 and a half inches long, and filters most of the substances that pass through your body, and tries to convert them into non-lethal substances. (I know the kidneys also do this too, but alcohol and opiates don’t really have a strong negative effect on them, as much as they do on the liver.)

The only trouble is, your liver can’t filter alcohol very well. Or at least, not as fast as it is usually consumed. When alcohol enters the body, it makes it way down towards the liver and is converted into acetaldehyde by means of enzymes and a process called oxidization, then broken down even further to acetic acid, then CO2 and water. This is fine, the liver can handle this process, and as long as the acetaldehyde is kept inside the liver, you’re okay. Yet after drink number 4, and shot number 6, your liver can’t seem to keep up with the amount of alcohol that you’re putting into your body, and the acetaldehyde can’t be further broken down quick enough, and starts to seep into your bloodstream. This is where it starts to kill of cells in the liver, and whilst it is doing this, the liver becomes even more powerless to convert the vast amounts of alcohol consumed. This happens over time, and with a lot of alcohol, so don’t be worried it’ll happen straight away on a bender. It really wont.

However, the liver is still under a lot of stress when you drink alcohol full stop. Here comes the issue though..

Likewise with alcohol, opiates cause a lot of stress on the liver. If taken for long periods of time, the liver can not effectively break down the chemical compounds, and instead they become toxic within the liver and start to cause damage. The same thing happens on a much quicker scale when somebody overdoses on opiates. If you overdose on opiates, within the space of hours, you can completely fry your liver. Scary thought, right?

So I’ve been told to take tramadol because of my pain, and I’ve been taking it for a long time now. So I can understand that my body has quite a high build up of the stuff, and actually a high tolerance too. My liver is constantly working away to convert the medicine down from it’s active substance, to other compounds so that I can basically get rid of it out of my body later on. This means it is under a lot of stress, constantly. When you bring alcohol into the equation.. This just makes everything 110% worse. Hence why people on opiates get drunk quicker. Hence, why we can have even more liver problems, and hence why we are told specifically NOT to drink alcohol.

The fact is.. It’s a worrying thing to think about when I realise that I can’t actually get drunk, because I know I’ll not only be in pain.. But it could actually permanently damage my liver.

Luckily for me.. I don’t drink very often, and now, people have a bit more understanding of exactly why. Yet, even after all of this, I can safely say that I’ll still be able to drink a fair few others under the table. Some people just can’t handle their drink because they’re lightweights. Others just can’t because their body wont let it.

That’s it for today though, I just thought this would be an interesting post to make, and hopefully give people an insight to exactly what happens when I consume alcohol, and why sometimes, I actually have to say ‘no’ because of the effect it’ll have, not because I don’t want to.

Pain Rating Today: 6Pain Rating

Disturbed Sleep – 19/07/14 02:57

I’ve begun to realise that my once ‘healthy’ sleeping state, is now much more disturbed than I’m actually letting on.

As you know, pain can sometimes keep you awake. It can also wake up the deepest of sleepers too, very sharply and suddenly. Yet I am, or was, not like that. My pain didn’t actually make my sleep worse, but in fact made it a bit better.

Sometimes if my pain is high on the rating scale, my ability to actually go to sleep, is compromised and delayed, purely because I can’t get in a comfortable enough position so that my pain can be reduced for the ~20 minutes it takes me to fall into a deep slumber. Once I’m actually asleep though… There’s no waking me. Seriously! I’ve slept through the bumps in the night, my dog walking all over me to get comfortable on my bed, I even sometimes don’t even wake up to sunlight!

This is because the only ever time that I’m out of pain completely, is when I’m sleeping. Completely knocked out, in the deepest of slumbers.

Now, whether this is a defense mechanism developed by my mind or body over time, or whether it is more a habitual ritual that I seem to fall into, I’m not really too sure. I can safely say when I’m having a flare-up and my pain is going upwards of about 7, perhaps 8 and even more, I am incredibly tired, more so than usual. Generally because I’m using that much energy in order to move and to mentally motivate myself to get up and stay up, that I’m just draining all of my energy, and this is even before I’ve started the day. Also, because I’m in that much pain, the only thing that gets me completely out of pain, or so that my consciousness doesn’t feel it, is when it’s not active. A.K.A Sleep.

Sleep has always been a big factor in my life though. My emotions and mood can sometimes be tied directly to how I’ve slept the night before, or more importantly, how many hours of sleep I’ve had. Although, the amount of hours sleep is generally becoming less of a factor, purely because I’m now a student, having finished my first year at university. I think after pulling countless number of all nighters and at one point, staying up for close to 60 hours on the go, my body has begun to realise that sometimes, sleep does have to come last.

I’ve never seemed to have a problem with it though, and a lot of people have said it before, once I’m asleep, I’m gone and it’s a real challenge to wake me up, unless it’s very nicely and usually consists of constant reminders and a cup of tea. Man, there’s nothing better than a brew in the morning. I don’t think I’ve been a day without one!

However, whilst I’m going on about how well I sleep, it’s something that the other half seemed to realise about how I actually am in my sleep, and regretfully, I actually kept her up for a few nights. (Heh!)

A couple of weeks ago, my mum and her partner went away for two weeks, and I was basically left in the house on my own, bar the pooch, which as company goes, she’s rather disloyal unless you’re quite cool temperature wise and / or are willing to bribe her with treats. So naturally, I was delighted when the missus said that she’d stay with me for the two weeks.

The first week was great! I was up in the mornings with her, making a brew and some breakfast, before I dropped her off at work and came home to chill. It was lovely just to have her there, waking up to her and falling asleep with her, it was actually incredibly comforting, and I thought I slept a lot better with her there.

The second week however, was somewhat of a disaster! The pooch decided it would be a fun idea to eat the folded up kitchen towel I’d used to catch the grease from my George Foreman, and then decide that over a course of a few days, try and throw it back up again. The other half was woken up at the start of the week, by a dog who was trying to be sick, yet failing. The night after though, again, the other half was woken up, yet the pooch had successfully thrown up the undigested kitchen towel, to which I swiftly disposed of and got back to bed. After that night however, that’s it, the other half just didn’t sleep well, and this is where I found out that my sleep patterns, may not be so plain and simple.

By the end of the week, she was knackered. I could physically see it in her face, she was drained, and I felt like I was responsible because it was my dog that messed it up at the start of the week, and she’s been living at mine for the past two weeks, in bed with me!

According to her, she’s successfully been able to determine when I’m in pain throughout my sleep, purely by how I am when I’m in the slumber.

Apparently, whilst in my sleep, I react to the pain I feel during the day, in a somewhat similar fashion whilst I’m asleep. At some points I was curled up in a ball because I needed to stretch my back out, leaving her with not a lot of space to get comfortable. This is one of the positions I’d try and relax in or get comfortable, if I was on a chair or lay down, whilst in pain. In other instances however, I found it more comfortable to be lay on my back, rather than my sides, as that’s putting direct pressure on one side of my pelvis. My memory foam mattress topper does wonders for my back, but I can still feel the pressure on my hips if I lie on one side. This naturally caused another issue for her, as when I’m on my back, I tend to snore… Yeah.. Ladies and Gentlemen, I’m a snorer. Dammit.

This next part however, is actually not expected, and something which I didn’t expect either!

A few months ago, I was prescribed a patch called a BuTrans patch, which is basically a painkiller that acts in the same way a nicotine patch does, and I have to wear it for 7 days.
I’d been prescribed 5mg to start with, and after a couple of weeks, I then moved up to 10mg as my pain wasn’t reducing in any way. Just before my mum went away, I’d seen my consultant who said that I could move upwards again, this time doubling the patch to 20mg. It was only halfway through the two weeks she was away that the missus realised I was only wearing a 10mg patch. I removed it, and she placed a 20mg one on for me.

This… Caused a few issues whilst I slept, and actually whilst I was awake, because it gave me terrible itches. Yep… Itching.
Boy, did I scratch like a motherfucker. I’ve actually still got a scab on my ankle about an inch tall, of where I itched continuously. It was irritating, and mixed with the warm weather… I was a nightmare to sleep with.

I was itching constantly in my sleep apparently. My body, my arms, my legs, my head, everywhere! This got so bad to the point that (and I actually remember this), the missus took my hand away from my itching head, and slammed it down over the other side of the bed. She wasn’t doing it to hut me, she was just sick of the scratching, because it was keeping her awake! I don’t blame her to be honest… It’s safe to say that I soon became irritated by the daytime itching and switched back to 10mg. The plan is to work up to 15mg first, but that’s for another post.

Now, itching and keeping the other half awake aside, another new addition to my sleeping pattern is actually voluntary. I purposefully wake myself up roughly 3 – 4 hours before I have to wake up, so that I can take some painkillers. This means that they have time to take effect, and by the time I wake up, it’s a lot easier and I’m not in as much pain.

This is fine, and I’m more than happy with this, but now it seems to have become an automatic reaction. For the past 4 nights on the trot, I’ve woken up on, or around, 04:30. It’s great, because it means no alarm, and I’m usually wide awake and I love that! Waking up naturally, and being alert and completely awake! The only trouble with this is… I have to go back to sleep, and with that… Means I have to wake up again, which would be fine, if I actually woke up in the same way. Usually when I wake up 3 – 4 hours later, I’m incredibly groggy.

Speaking of sleep though, I’ve realised that I’ve been writing this post for over an hour, and since I came in from work roughly two hours ago, I suppose I’d better get some sleep.

I just thought it was interesting how, on one hand, I thought my sleeping patterns were solid and that I hardly moved and that I was out of pain throughout the night, yet on the other, my partner is telling me that I’m curling up in a ball and switching positions because I’m reacting to pain, and that even in my sleep, my medication is having an effect on not only my cognitive functions, but also my physical ones too. I probably would have never woken up that morning, if she hadn’t have taken my hand away from my face!

I think that eventually, it’ll just be something that we’ll get used to when staying together. I won’t even get into her sleeping positions! You thought the exorcist had some crazy moves…

For now though, I’ll leave this post here and get some much needed shut eye. Perhaps I’ll make a post tomorrow, or Sunday, explaining how my pain in whilst I’m in work. Tonight I just fancied something a bit easier and nicer to write about, to take my mind off it.

Pain Rating: 6

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