The Week In Tragedy...5 Things we can Learn. by Dr. Sharon Orrange/Primary Care Physician: at DailyStrength Doctors and Advisors

Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…

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LOCATION: Santa Monica, CA, USA

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Assistant Professor of Clinical Medicine, Division of Geriatric, Hospital and General Internal Medicine, Keck School of Medicine, University of Southern California

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The Week In Tragedy...5 Things we can Learn.

Posted in Abstinence & Ce... by Dr. Sharon Orrange on Jun 30, 2009

1) Demerol: I'll never forget a lecture I attended as a resident by a well known toxicologist who said Demerol should be pulled from the market...that it doesn't work any better than any other pain medication and patients love the high it gives them. The American Pain Society said in 2003 that Demerol has no role in acute pain management because it "offers no advantages over other opiods as an analgesic and has unique neurotoxicity." This same organization has said Demerol is "not recommended for the management of chronic pain." It is a terribly addictive drug and I cringe when I hear it's possible Michael Jackson was getting Demerol injections daily for pain. In my previous blog I addressed prescription drug abuse http://www.dailystrength.org/blog/532-danny-gans-dilaudid-and but Demerol use is really tragic to me and I blame this partly on those of us in medicine.

2) Pick a Doctor who is board-certified. There are many strange things about Michael Jackson's personal doctor including that he was paid 150,000 a month, now we learn that MJ's "cardiologist" wasn't board certified. Neither was the plastic surgeon who performed Kanye West's mom's surgery. Yes, doctors who ARE board certified get in to trouble as well and yes, getting certified and re-certified in your specialty is a PAIN...it costs money and requires many long hours of study prior to your test but DON'T YOU WANT THAT COMMITMENT FROM YOUR DOCTOR! We should all want to know that our contractors, architects and physicians stay current and up to date because they become certified by the Board in charge of their specialty. People please pick a doctor who is currently board certified!

3) So much is out of our control, let's try and control the things we can control: eating right, exercising, getting enough sleep, doing your form of a 5-10 minute meditation every day (bath, walk, prayer) and SCREENING...mammograms, pap smears, PSA tests, colonoscopy, bone density scans...let's screen for the things we may be able to see coming.

4) Billy Mays dead at 50. All of these stories have been so sad and I saw the interview of him the day before his death. My first thought was that he looked a little weary and gray during that quick interview and his wife reports he went to bed at 10 PM that night because he didn't feel well. If this turns out to be sudden cardiac death from coronary artery disease I suspect he felt nauseated and just not right the night before. I hear this story all the time from patients and their loved ones prior to suffering heart attacks. Remember angina is not always substernal chest pressure or pain radiating down the arm, it can be a vague sense of doom, nausea, sweating, weakness, pain or pressure in the throat or jaw. If you feel weird and you know its "weird" trust your instincts and go for help. My patients who say to me "I just don't feel right" scare me the most.

5) Leaving your job for 5 days: This story should get us all thinking about priorities, unrequited love and responsibility. If I were on call at the hospital and left town for 5 days I would be fired on the spot when I returned. I care less about the affair though it is an assault on his wife and sons; I care more about bailing out of the country when you are the Governor. There are so many times my interns and residents could cut corners in the middle of the night just to get 15 minutes of shut eye...and they don't......because when you have a job that carries responsibility (pilot, firefighter, doctor, nurse, Governor) you should know where your moral compass points.

"Why can't we get all the people in world that we really like and then just stay together? I guess that wouldn't work. Someone would leave. Someone always leaves. Then we would have to say good-bye. I hate good-byes. I know what I need. I need more hellos."

~Snoopy~

I'd love to hear your thoughts.

Dr O.

UPDATE 8/9/09: Well, it seems Billy Mays had Cocaine and Dilaudid in his system at the time of death and it appears likely the Cocaine contributed to his hypertensive heart disease which took his life. Another sad story of drug use and possible abuse.

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Demerol is horrible. My father ended up in the emergency room when he took it. My mother had similar bad reaction as did I. It made me extremely jumpy, I couldn't settle down or sleep. Worse than drinking 50 cups of coffee. My doctor in Mexico said it is banned there!

By buddhabay Aug 17, 2011

You're a doctor? I am scared. Learn a bit more about Demerol and it's uses before you make such base statements. People who are allergic to morphine do very well with Demerol and Demerol does NOT depress the respiriatory rate as much (esp. in infants) & has a shorter half-life. It is also used to treat chills induced by Amphotericin B. When pain medication is used for its INTENT, it is not to blame for addiction. Take it from me, Demoral works VERY well for pain, asp. post surgical and saves those of us who are allergic to morphine. And, BTW, there are plenty of morphine addicts out there as well. Most people like the way all opiates make them feel. MJ was an addict, to many substances. Don't single out Demerol. It's irresponsible of you.

By tippiejax May 09, 2010

Dear Dr. Orrange,
I am an RN BSN and have often heard Demerol claimed to be glorified Tylenol. I worked on a post-op floor and it was usually given with Visteril. I think it enhances the Demerol chemically or vice versa. I think we all need to be better educated patients and learn to take control of our our health and destiny while not completely relying on just the word of one doctor. (Sorry no personal dig intended)

By rnzrit Mar 24, 2010

You brought up a good point about controlling the things we can control including tests and physicals and of course eating right and exercise. But while I think preventive medicine is important, many Americans can't afford to just see the doctor for a check up because they have no [URL=http://www.goldenrule.com]medical insurance[/URL]or it doesn't cover check ups. I think we need to find a way to make sure every American gets an annual check up.

By SinVega Mar 04, 2010

Please remind me not to go to this doctor.

By Ching Jan 23, 2010

I went to the ER with a kidney stone, received a shot of Demerol and was sent home. Day two, still had the stone, went back to the ER, was given another shot of demerol and this time my kidneys failed unbeknowsted to the dr there. Severe exhaustion and sweats made me go to my pcp as I was beginning to think the ER dr was an idiot. This time my dr put me in the hospital for 3 days with iv fluids to wash out the demerol and the stone. my pcp saved my life.

I love reading your articles! Keep them coming!

By bobinmaine Jan 19, 2010

I guess my other comment must have gotten lost in cyberspace.

I just wanted to state that my son, 34, died from being prescribed methadone, restoril and soma. He was healthy but had chronic pain.

I believe the reason that he was given methadone was because he didn't have insurance and methadone is cheap. It also has a very long half-life and accumulates in the body causing horrific central nervous system depression and also heart arrythmias. Why is it allowed to continue to be prescribed? Follow the money trail. Methadone clinics make a lot of money for people.

I have read that there is another form of methadone that is not as dangerous, but our FDA, in it's infinite wisdom, allows this type of methadone to continue to be prescribed and the deaths keep on happening. Very sad.

Please be aware that methadone deaths keep on increasing every year whether the victims are addicts, people who take diverted drugs or people who trust their doctors to prescribe medications that won't kill them.

By Paineater Jan 17, 2010

How long does it take a comment to appear here? Thanks

By Paineater Jan 17, 2010

Thanks sleepydenise for your comment. I cant take NSAIDs nothing containing ibuprofen so percocet is a blessing for me. I wish I didnt have to take the narcotic route,but for some of us its our only option.

By andromeda7 Jan 10, 2010

Thought I'd post some recent experiences....
I had to have Demerol injections regularly this year - for nearly 4 months every 6 - 8 hours, then 3 a day for the next 5 months due to agonising pain and no other alternatives.
Despite being absolutely TERRIFIED of withdrawal by the end - my doctors, pharmacist, everyone were telling me I'd be addicted - I wasn't.
I stopped taking them 4 weeks ago when I finally got my surgery - didn't taper, didn't reduce and experienced absolutely no ill effects at all. Nothing. I have more trouble tapering my steroid dose when I have to.
I can't be that unusual, there must be many like me, so why do they instil so much FEAR into us?

By suey2y Jan 07, 2010

It makes me very upset when people abuse very worthwhile drugs, often making them unavailable to those who need them. I have CFS, and sometimes during a flare, I would love to take oxycodone for a few days. Its time release feature is wonderful, allowing you to maintain an even level of pain relief. However, where I live, oxy abuse is rampant, with abusers even holding up pharmacies to score. I understand they grind up the tablets and snort them up their noses. Go figger.....Hence, doctors are extremely reluctant to prescribe oxy, despite its rich benefits. Instead I take percocets during a flare - they effectively deaden pain, but cause the roller coaster on/off pain relief, which isn't the greatest. I have a healthy respect (fear?) for narcotics so I use them only when I feel I really have to - too bad others misuse these helpful substances.

By sleepyDenise Dec 30, 2009

Glad to see so many people that feel as I do.
I had a caesarean with only paracetamol/tylenol once the spinal wore off - I think I have a really high pain threshold, but obstruction, abscesses and constant surgery really hurt - what are you meant to do?
I'd love to know the suicide rates for those who just couldn't cope with constant pain any more.

By suey2y Dec 05, 2009

Chronic, severe pain patients are not looking for a high, unless they are already an addict. There is dependence and then there is addiction, not the same. Opiates do NOT make me high but help to bring about pain relief so I am able to function somewhat. Very few side effects and they work for pain relief. Too much ignorance from the medical community and many of those leaving comments here on the life of a human in severe, chronic pain. We want the pain to go away and docs are not handing out scripts like candy as someone here said. Most docs are part of the problem for under dosing meds that give us pain relief. I have pain that surpasses giving birth to my daughter without meds, not always that severe but I have it.

By AzSherryberry Nov 20, 2009

As a patient in intractable pain, I am saddened and also mad when I hear people putting medications that I use to be able to get out of bed in the morning and kind of live a semi-normal life. I have never been given Demerol, but I feel for those that are allergic to morphine and can only take Demerol. Why demonized one medication because an unscrupulous Doctor gave it to Michael Jackson????!!! Why punish those that need relief, because there are addicts out there that can pay personal Doctor's thousands of dollars a day to get their fix??

I wish that people that talk this way about the medications that keep me and others like me alive and sane would have to walk a day in my shoes!! I am 49 and lucky to walk 100 yards with my walker and in excruciating pain all of the time! And like there are thousands, millions of people in the World!

By tipper1207 Nov 19, 2009

Big pharma wants this to happen. Keep people hooked to strong opiates. There are alternatives, like buprenorphine, which actually make the immune system better and have virtually no addictive traits compared to oxycodone, hydromorphone, oxymorphone, fentayl, carfentanyl, omega-fentanyl etc... When everyone can come together and embrace love and caring over money and profits then we might be able to be happy as a race. As long as drug companies keep "patenting" modified opiates from p.somniferum there will be more deaths and more tragedy. Don't attack the junkies for having these narcotics pushed on them constantly. Ibogaine HCL would solve opiate addiction, but guess what, its Class 1! Big Pharma for the win! Than you Nixon for your most excellent classification system. Codeine up to 12.5 is OTC in the UK. I bet this alone would solve many "addict" pain sufferers.

By retrograid Nov 06, 2009

Its odd that whenever a celebrity od's, it is time to start pulling meds. It just goes to show you how inexact and inexperienced many medical people are. Thier insecurity shows at these times and makes us all feel helpless. When chronic pain strikes it can be anytime of your life, better hope you can find a non narcotic to help or you will be in for a huge surprise. Pharmacies are also in on the insecurity. I believe if you are afraid to write a script, then turn your pad in

By BJO25 Oct 30, 2009

I know I've commented before, but I've just read further back through all the posts and it makes me SOOOO sad.
Seems like a junkie can get a high whenever they need it, but the chronically ill with terrible symptoms are all too often dismissed as whingers and denied any adequate pain relief.
Surely there must be a better way? Surely those that suffer horribly ought to be given scripts for something that will help them, the doctors MUST surely know the difference between those who are horribly ill and those who just like the high???
I've had tonnes of surgery, terrible pain, obstruction, yet even now I still sometimes get dismissed by ER docs that don't know me. Not often thank God as my notes are so full of how ill I've been.
I recently ran a little opinion poll amongst people who suffer similar terrible pain constantly as me. Very few were allowed any proper pain relief to use at home but all agreed "addiction" would be preferable to constant suffering.
There HAS to be an answer.

By suey2y Oct 19, 2009

If they take Demerol off the market then I am pretty much in trouble because I am allergic to Morphine so I can't take any morphine derivitives. The tradgedy would to take Demerol away from the patients like me who can't take Morphine and its substitutes.

By Paige42986 Sep 30, 2009

If the pain managment experts had to live in cronic pain they would do as we do,come to think of it they sometimes do,they just don't admit to it.

By tusolome Sep 21, 2009

I would suggest you attend a pain management seminar - preferably one given by Maureen Carling.

When pain management medication is taken as prescribed it is ot addictive.. quite the opposite - most people in chronic pain situations would rather take less of the meds prescribed....

Further, uncontrolled pain soon becomes uncontrollable - demanding extraordinary high doses to get the pain under control and then titrating down... titrating up when pain is uncontrolled is agony for the patient.

Lastly, when did political commentary become part of doctoring? The Governor of SC did not have pain..... an, unfortunately, many of us with chronic pain often have to take five days off or are disabled and can't work....

By SCIslandGirl Sep 21, 2009

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