Ketamine

Pain management has been a challenge my doctors have had to deal with. The only way any of my doctors have known to tackle this challenge is by increasing my opiod use. This was the case until one of the best doctors I've had the privilege of working with Dr. Viscusi (pain team) began to revamp the way they treated my pain. Instead of just giving me increased doses of morphine they added to the roster Ketamine. Ketamine is an analgesic drug known to be used for different health issues. It has recently been known to be used as a pain reliever for crisis pain in few cases. Ketamine affects the sensitization of spinal neurons and so affect the development of neuropathic pain.

Ketamine is sometimes used for emergency surgery. As a random aside: I've been told it has been used as a horse tranquilizer. It's a pretty intense drug with huge side effects. Many people on Ketamine have to be monitored since it can cause psychotropic side effects like hallucinations. When on this drug a nurse or doctor is assigned through a 24hr/day period to monitor me in the event something happens or if I need an extra dose.

The highest level of opiod I've been on was 1200mg a day of Morphine. Ridiculous right? It's insane to confess that even at that dosage I still wasn't getting adequate pain relief. 1200mg a day was only as an outpatient. Once admitted I would also be maxed out on dilaudid PCA yet still not get pain relief. So Dr. Viscusi suggested to the team of doctors and nurses working with me that I begin treatment with Ketamine. I would become the first sickle cell patient to use this drug for pain management. My morphine dosage was dropped from 1200mg-600mg a day and about six months ago the pain team decided that those high levels of opiod were actually contributing to my pain as opposed to alleviating it. So I began a tapper of the morphine that went down 10% every three days as an inpatient.

                                          Ketamine:

It was extremely tough to get off the Morphine since I've been taking large doses of it for years. I went through intense withdrawal. I kept asking myself how do drug users do this but in time I was finally completely off it and Dr. Viscusi suggested my not being medicated with any other opiod but instead manage my pain at home with alternative drugs such as Butrans (also help with withdrawals), nortryptaline, and Lyrica. As an inpatient include those drugs and an infusion of intravenous ketamine. The highest level of Ketamine I've been on is 40mg.

Since I'm no longer on opiods I've been finding it difficult to control my pain at home so the pain team has prescribed me with nasal ketamine. Once again I'm the first SS patient to be prescribed it. In the 2yrs (or more) I've been on Ketamine I never knew that there was a nasal spray for it. I was told that it is used in cases of people who have severe migraine's. Though I do have migraines I use it not for that but for my pain crises (attacks). Since my discharge from the hospital about a month ago I've used it once and I've remained out of the hospital which is a victory for me since recently I've been returning back to the hospital a week or two after my discharges. So staying out though its been only a month is a real victory. I only use the nasal ketamine when my pain is at its worst and I think I may have to go to the hospital. The less I use it the more likely it is to work when I do use it. So my goal is to keep from using it too much because if my body gets too conditioned to the use of this drug I fear that there are no more options for me out there. I was lucky Dr. Viscusi knew about this drug but my options are getting less and less. I don't know why my pain is as extreme as its been since graduating from college but I fear that if the pain that I go through scares me as it does now then what am I to expect in 5yrs or 10yrs? Thank God for Ketamine. If I wasn't on it then imagine what dose of Morphine I may be on now.

A step at a time, a day at a time!