In 2003, the US Department of Veterans Affairs and the Department of Defense recommended the use of long-acting opioid medications to manage chronic pain
"If you find yourself alone, walking in green fields with the sun on your face,
. . . do not be troubled, for you are in Elysium, and you're already DEAD!"
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| Courtesy of Ridley Scott, the moving words of David Franzoni from "The Gladiator" |
"What we do in life, echoes in eternity!"
Another Veteran gone . . .
My telephone rang this morning, first day of Memorial Weekend. It was about my good friend USMC gunny-Sergeant SniperChuck.
His beloved "companion of life" had pulled herself together enough to call and tell me that Chuck was now in Elysium.
Chuck was a cool Bloke (Dude). He and became good friends, constant banter. A bright man. A tough man. A man who loved his kids and his woman without reservation. A gifted musician. In his Forties. A lot to live for.
A complicated man in constant physical pain. A Veteran with Post Traumatic Stress Disorder.
He never complained much. He even made jokes about serious events in his life. For example, why his left foot pointed in the direction that he was walking and why his right foot was at a 90 degree tweak:
"Between tours, I was back in California riding
my Harley. Out of the darkness came an old Cadillac with an illegal in it.
No lights, no insurance. The impact almost tore me in half . . . at the Balboa
Hospital, the surgeon told me that I would be better with a prosthetic than a
crushed leg . . .
Can you believe I did not know what the word
meant?"
When he explained the amputation process I told
him 'No, fix my leg' and he put it back on crooked.
I know I annoyed him"
Last week, Chuck emailed me and sounded chipper . . . five days l later and he is no longer with us.
"I don’t think I ever
had Lyme disease, but opioid induced endocrynopathy. I determined after reading
my HTPA numbers especially my testosterone went from 850 to 250. But the insurance co.'s tell the doctors what
is normal. I looked up what is a normal test level is for my age and it was
between 500-800, 250 is normal for a 90 plus yr old.
With the way the VA
was administering the opiates started the ball rolling. Since they are happy to
get you addicted to them but they suck at managing them. So I would take them
on an empty stomach to get the most out of them working and ease the pain. Then
I would eat breakfast usually a spinach & broccoli omelets and I would do
the same thing at lunch, starve myself
then take the medication and once I felt it kick in I would eat whatever
for lunch & dinner. Unbeknownst to me I was burning holes in my
digestive tract making it sensitive to everything I ate.
So with this latest
revelation I have discovered that chicken breast gluten free corn grits &
mild provolone cheese are the only things I can eat., everything else
caused a painful reaction gut & brain. As long as I stay on this diet I’m
ok. If I cheat even a tiny bit I’m f’d for a week.
That’s the long &
short of it. Hope all is well with you! "
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| USMC 4h Battalion Memorial May 26. 2012 |
So, I have shed more than a tear for my Pendleton USMC friend today. About an hour ago I drove up to the Marine Memorial on the side of the Volcano Haleakala which was collecting Pacific Clouds from California, so rain fell - sort of like the tears of the Ancients. As I stood in front of the three flags, a beam of sunlight lit them up. Chuck and the others in Elysium.
Chuck was an alert and intelligent man who participated in his own survival. Read his self-diagnosis again and then read the notes below. There was no way out for Sniper Chuck.
Opioid-Induced Endocrinopathy
- Stephen Colameco, MD, MEd;
- Joshua S. Coren, DO, MBA
In 2003, the US Department of Veterans Affairs and the Department of Defense recommended the use of long-acting opioid medications to manage chronic pain.1 This recommendation was based on data that suggested short-acting opioids (eg, oxycodone, acetaminophen) pose an increased risk of addiction or opioid-induced hyperalgesia and on the assumption that chronic pain requires continuous analgesia.1 Healthcare providers seemed to agree. As suggested by pharmaceutical sales, opioid therapy is far more common today than it was 10 years ago. One review3 analyzed sales data and determined that opioid sales increased 127% from 1997 to 2006.
However, as opioid use increased, so did the incidence of associated adverse effects. In the present review, we discuss the various symptoms associated with opioid-induced endocrinopathy and outline screening tools physicians can use to diagnose this condition. Treatment options are also described.
Conclusion
Opioids are increasingly used to treat chronic nonmalignant pain. However, long-term opioid treatment can cause endocrinopathy. Therefore, physicians must be aware of the various challenges associated with opioids.
Before initiating daily opioid treatment, physicians should inform patients in writing of all the risks and benefits associated with treatment—as specified in the Model Policy for the Use of Controlled Substances for the Treatment of Pain.65 Based on the prevalence of opioid-induced endocrinopathy, physicians should include specific mention of depression, fatigue, hormone deficiency, osteoporosis, sexual dysfunction, vasomotor instability, weight gain, and, in women, menstrual cycle irregularities as possible adverse effects.
After opioid treatment is initiated, patients should be routinely evaluated for signs and symptoms of endocrinopathy. Testosterone supplementation is the primary treatment option for men, while DHEA supplementation may be preferred in women. Because some opioids may result in less endocrine dysfunction than others, rotation to a different opioid may also be an appropriate treatment option, particularly for women.
- Received March 10, 2008.
Writing this post for my friend I was struck buy the obvious:
The "System" (VA, etc) let Chuck down in more than one way.
That when we consider the amount of Veterans that we are losing each day, for whatever reason . . . when you close your eyes and can see a face . . . they are not to be regarded as statistics. May that never be so.
"They are only dead when you forget them" Nope, I will not forget my cheeky mate SniperChuck. And his folks will grieve and miss him so badly. My (our) condolences to his wonderful son and daughter and his Sweetheart of 17 years.
And, by extension, to all of the other survivors of Veterans who are no longer with us. We do feel you pain.
THERE HAS TO BE A BETTER AND FASTER WAY TO HELP THESE VETERANS . . .
As noted in an earlier post, the most economical way to treat Veterans in pain and with PTSD for the Government, the most convenient way for their physicians is to just zombify them with large amounts of medication.
Time we all looked to other avenues to help these Veterans -- here is one that I advocate and support
GLOBAL STRESS INITIATIVE
This is why . . . so many of the Veteran's charities are nothing more than "cash-traps" using the Vet's for bait with less than 1o cents in each dollar going to a Veteran. The rest? Parties, cars, big salaries,etc.
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| Lorraine Cancro |
MS. CANCRO ALSO SERVES AS FOUNDER AND EXECUTIVE DIRECTOR OF THE GLOBAL STRESS INITIATIVE, (GSI), A PROGRAM UNDER THE AUSPICES OF ICAMI WHICH IS LED BY DIRECTOR, ROBERT CANCRO, MD, CHAIRMAN EMERITUS OF NYU DEPARTMENT OF PSYCHIATRY. THE GSI HAS 3 TIME EMMY AWARD WINNING ANCHOR AND BEST SELLING AUTHOR, RITA COSBY, AS SPOKESPERSON. AT GSI, THEY ADVOCATE FOR FURTHER RESEARCH AND TREATMENT FOR RETURNING MILITARY MEMBERS, THEIR FAMILIES AND CIVILIANS WHO ARE SURVIVORS OF TRAUMA.
GLOBAL STRESS INITIATIVE prides itself that the majority of funds raised goes directly to aiding and assisting actual Veterans.
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