Things are good here and I’m feeling lucky. We made it through knee replacement and my partner is going back to work fulltime next week, leaving me to my desk in the silence I crave. The caregiving and pain management have taken our relationship to a new level. No tears were shed. No glass was broken. No fantasies were squelched. We survived being together 24/7 and we’re both still here. Confetti! It was a big learning adventure and in hindsight I see the benefits of icky, because we shared some biology basics in a very visceral way.
Before the surgery we sat at the kitchen table and went through the Oregon Health Decisions workbook for creating our Advance Directives, including a coached discussion of talking points, a game-like multiple choice questionnaire, and finally the actual legal forms to be notarized and circulated to our healthcare representatives. The conversation quickly became a storytelling session about the illnesses and deaths of loved ones in gory detail. Those experiences shaped our preferences. Also, our recent knowledge of COVID-19 treatments and outcomes was a significant influence. As we approach 70, we are realists about our future and minimalists when it comes to life-saving care.
The surgical incision was another interesting exploration of icky. I consider myself a connoisseur of scars, their length and width, the sutures, staples, or glue that hold them together, the gaps and puckers, the shades of color. I’ve seen it all. Open heart, organ removal, tumor removal, trauma repair, joint replacement. Worst was my mother’s hysterectomy in the 1960s when doctors made a vertical cut through every muscle in her abdomen from her navel to her pubic bone. That was barbaric. Most curious was my father-in-law’s open-heart surgery where they wired his sternum back together without anchoring the end of the wire which poked through his skin for the rest of his life. In my partner’s case there were no Dr. Frankenstein stitches. The eight-inch groove in the middle of his knee was perfectly glued in a thin line with minimal puckering. Not as much of a souvenir as I imagined, but nicely done.
The icky that will probably have the longest lasting impact on our relationship was the revelation of brutal opioid constipation. Opioids are part of the pain management plan for knee replacement, and I’ve taken them on a few occasions when I’ve had a tooth pulled. I appreciate their efficacy. But our preparation and mitigation efforts were inadequate. The pharmacy gave us several pages of text emphasizing the possibility for opioid addiction, expectations for drowsiness, warnings to avoid operating machinery, no driving, blah, blah, blah. We assumed we knew all about that. Unfortunately, constipation was on page two with the worst possibilities on page three, which we didn’t read until the patient’s abdomen was chuck full of corn cobs. By then any solution was going to be painful.
Apparently, the drug slows down the gastrointestinal processing of food which gives the colon more time to extract water until the solids are dry and compacted as a Jersey barrier. Now I’m thinking we’re missing a strategic opportunity here when it comes to addressing opioid addiction. Maybe if every opioid prescription came with an enema kit people would be less likely to overindulge, and word would get around. We think of opioids as a buzz so good it’s dangerous. But we could be thinking, Is this buzz worth the constipation, gas, bloating, gut pain, nausea, hemorrhoids, laxatives, and explosive bowels? Fun! Also, continuous use of laxatives may result in your colon becoming dependent on them to move product. So, it’s a twin epidemic, opioids and laxatives.
Constipation is the opioid hangover no one talks about. It hurts and taking more pain relievers won’t make that pain go away. So, why is opioid constipation in the fine print and not in big bold caps on the label? It could be a deterrent. I say, let’s stop being polite about our biology and hammer the zeitgeist. Reducing opioid addiction could be one of the big benefits of icky. Let’s keep it real.
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Authored by Omeed Sizar; Rafaella Genova; Mohit Gupta
August 8, 2022.
National Library of Medicine, National Center for Biotechnology Information