The original title of this entry was going to be “Emergency Room,” but I realized that the first entry I ever made on a blog regarding my pain was named the same thing. Then, I went to the ER for pain meds; now, I went to the ER because of pain meds. If that’s not full circle, I don’t know what is.

Opioids are well known for causing constipation as either as an indication (loperamide) or a side-effect, as was my case. Opioid-induced constipation, or OIC, is frequently noted as requiring active prevention or it can be severe. Severe is an understatement.

When I originally started using opioids for pain I noted that, while morphine and thus codeine both caused severe constipation (requiring enemas), semi-synthetic hydrocodone (Vicodin®) did not. For a long time I used only hydrocodone to manage my pain and didn’t pay any attention to constipation because it rarely occurred. I also had low incidents of constipation when I switched to oxycodone (Percocet®) and methadone. After a while on methadone I’d have hard stool, but nothing too severe. It was nothing at the time because I had just come off morphine, which was far worse.

When I switched from methadone to fentanyl (Duragesic®) I figured since it too was a synthetic opioid and thus far I’d only had problems on natural opiates I didn’t worry much about constipation. I should have. My stool usually consisted of extremely hard nuggets and I rarely had bowel movements (maybe once a week). I tried taking low doses of docusate (Colace®) to help, but it wasn’t enough.

One day at work I tried to pass a piece of stool that was not only hard, but far too large to pass. After some severe pain I diagnosed myself with a fecal impaction. I left work early and went directly to the emergency room, as a bowel obstruction is nothing to play with.

While waiting an agonizing three hours to be seen my bladder seemed to get fuller and fuller, and yet when I attempted to urinate I couldn’t. I frequently have this problem in public situations (shy bladder), but I had a nice private bathroom all to myself and still couldn’t go. I knew something was up. When I was finally called back and got a room the physician that saw me concluded I was correct in that it was a fecal impaction and she manually attempted to break the large chunk of stool up by shoving her fingers up there and beating at it. This was, as one might imagine, less than comfortable. I thought this would be it, though, so I endured it and tried to used the restroom to no avail.

Next, the nurse prepared a large enema. I figured this would do it, since they had worked for me in the past and the large hunk of stool was no longer an obstruction (or so I thought). During this entire time I was becoming more and more uncomfortable due to my bladder being extremely full and I was still unable to empty it. I went through four very embarrassing enemas and runs to the bathroom from a largely incompetent nurse (I never saw the physician again until I got her $1,300 bill for the three minutes I had seen her).

Eventually I concluded that nothing was going to work while my bladder was so full. I told the nurse I thought my bowel was blocking my bladder from emptying, and vice versa. The nurse refused to consider this and tried to continue fruitlessly administering painful enemas. I told her to catheterize me, and until she did I wouldn’t allow anymore enemas. Eventually she talked to the physician and brought in a catheter. Now, let me tell you friends, being catheterized with no anesthetic and no pain medication (because I was honest with them about my medications, they refused to administer further pain medication despite my obvious suffering) is an extremely painful experience. It’s definitely a ten on the pain scale. After I was catheterized, they collected just over a liter of urine within five minutes. About five minutes later, I passed the still-huge hunk of stool and went home. As I had predicted, my huge colon and my distended bladder were preventing each other from emptying.

I spent the next two days recovering. I was in extreme pain from writhing around and tensing up every time they shoved a tube in either side of me. I was given no prescriptions upon discharge. I just had to ride it out, just like I had to ride it out under their care.

There are many lessons in this graphic story I’m sharing with you. The main point is that, don’t trust medical personnel just because they’re there; that doesn’t mean they’re competent. I spent over six hours in that emergency room and I have no doubt I would have spent another six had I not diagnosed and treated myself. Another is to stress the perils pain patients have to go through. I was suffering a painful condition caused by my pain medications, which I require to function in society. Despite this, they only saw a guy that was having a known side effect of opioids, and they never looked past that. They never saw the pain patient, they saw the opioid user. On this basis they treated me with no respect, likely assuming I was abusing my medication, and also refused to administer further opioids during my stay. Any other person with a fecal impaction that wasn’t caused by chronic opioid use would have received IV opioids for pain relief. No one should ever have to have a large, hard rubber tube shoved up their urinary tract with no analgesia.

Today, I’m very proactive about my bowel regimen. I take much larger doses of docusate and I’ve also changed my diet to include more veggies and less red meat. I also take in regular amounts of fiber, and my bowel habits are fairly normal.

So, even though my back pain is being treated, I was not treated for the pain caused by my medication because I was on such taboo medication. Shame on every medical “professional” I encountered at that hospital. Not only did they prejudge me and treat me stereotypically, they didn’t even fix the problem until I diagnosed and prescribed the treatment myself!

Doctors are sadists that like to play god and watch lesser beings scream.