Wednesday, March 18, 2009

The grumpy beast has been sedated

All is well again in Beverly world. Despite a sore arm/back/ankle/head/knee, I was able to sort out my pain med debacle with a phone call to my doctor who called in a prescription for Vicodin for me. No, I am not sharing, I don't think my pain will run out before my little prescription will. So now that I am sufficiently relaxed, I am ready to tell the second part of my story.

I was dropped off in triage by my friendly EMTs and my vitals were taken. I went through the same run-through as I had with the EMTs, medications I was on, age, date of birth, allergies, blah blah blah. The triage nurse handwrote the info on my bracelet and got my birthdate wrong. After about an hour of waiting in the waiting room (where I got chastised by security for using my cell phone) I was given a bed in trauma next to a pregnant woman suffering from terrible back spasms and a woman who was in a gnarly car accident. A truck had made a wide right turn while she was trying to make a sharp left and pinned her car to a light post. I got to pee in a cup and change into a hospital gown which led to a very awkward conversation with the orderly where I had to explain to him that I was wearing a bodysuit in lieu of underwear. He blushed and said, "So no underwear at all?" So much for wearing clean underwear in case you have to go to the hospital. Thankfully they let me wear my bodysuit under my gown.

A nurse came to give me a shot of Tramadol in my ass, she said my arms were too skinny, and I dozed off for about an hour until my boyfriend woke me up by calling to check on me. He was stuck working on a jobsite upstate and couldn't come visit me until the job was done and his ride left for the city. Eventually I was taken to the Radiology waiting room where blessedly there was a tv and I got to watch the Family Guy. Unfortunately partway through the episode (the first part of the Stewie Kills Lois storyline) they moved my stretcher and I couldn't see it anymore and instead got to listen to a waiting room conversation about how terrible the show was and how it was the downfall of society. A few other semi-concious individuals lay around bitching but somehow my wait wasn't that long. A half-blind white-haired x-ray tech wheeled me into the room, told me my yellow toenails were cute, tried to talk to me about college and inquired about the Cult of Youth record in my tote bag. I unsuccessfully tried to avoid having to explain neofolk to him as he took x-rays of my foot.

He tried to wheel me back to trauma but I stopped him saying I was also there for a facial x-ray and a CT scan. Phew...and after about ten more minutes I was wheeled in for my first CT scan. It was weird to say the least. Laying there strapped down with my head taped to a neck rest knowing my brain was being scanned, it's super creepy. They also took an x-ray of my facial bones because my jaw was incredibly sore. I was wheeled back into a hallway and the slow hell of waiting really began. Two hours with no word on a stretcher in the hallway behind trauma. My neighbors were the car crash victim and a Puerto Rican grandma who was missing a shoe and kept cursing at everyone about her foot. She proceeded to eat an apple by taking little bites around the skin and spitting it out into a plastic bag until it was skinless and then munched everything through the core. Gross.

Behind me a man in police custody was handcuffed to his stretcher and another was wheeled by. Later on there was a hubbub of gossip coming down the hall that the second man in police custody had gotten violent and needed restraining. Still no sign of my doctor. I lay there waiting for it to be 8:30 so Sean could come in from the waiting area and keep me company, he'd finally made it in from upstate only to be told he couldn't see me for another half hour. I'd been in the hospital since 2:30. Someone finally checked on me and gave me some juice and a peanut butter and jelly sandwich. My pain was back but I decided to tough it out, not like anyone would listen anyway.

Finally my doctor reappeared, apparently there'd been some emergency that was life or death. Ergh, can't bitch about that. He told me everything was fine, no broken bones, no internal bleeding, gave me a diagnosis of multiple contusions (aka bruises) and told me that they weren't even that impressive. Fuck you bro, I'm hobbling around and can barely lift my arm today, feel twice as gnarly as yesterday...ugh. ANYWAY, he gave me a prescription for Ultracet and a note excusing me from work for three days.

So anyway, yeah, after telling the EMT, the triage nurse, and the orderly what medications I was one I was prescribed something that had a potentially life-threatening interaction with a drug I was taking. And it was the same drug they'd shot into my ass earlier in the day:

traMADOL (Ingredient of Ultracet) and Celexa (citalopram) (Major Drug-Drug)

GENERALLY AVOID: The coadministration of selective serotonin reuptake inhibitors (SSRIs) with tramadol, which has weak serotonin reuptake inhibiting effect, may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5HT1A receptors. Patients receiving this combination may also have an increased risk of seizures. Pharmacokinetically, coadministration with certain SSRIs, namely fluoxetine, paroxetine and possibly sertraline, may result in decreased plasma concentrations of the active O-demethylated (M1) metabolite of tramadol due to inhibition of CYP450 2D6, the isoenyzme responsible for the formation of the metabolite. The clinical significance of this potential interaction is unknown. However, M1 is thought to possess up to 6 times the analgesic effect of tramadol, thus diminished therapeutic response to tramadol should be considered.

MANAGEMENT: In general, the concomitant use of SSRIs and tramadol should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients treated with the combination should be closely monitored for signs and symptoms of excessive serotonergic activity such as CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia.

Sounds like fun, don't it? Good god.

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