Notmilkman's Exorcism

This is a restless time for me. I do not remember
sleeping, but I must getting some sleep, because I
can vividly recall the nightmares

Every night, a clammy wetness materializes on my skin.
It feels more like a cold, dewy mucus than a dripping
warm sweat. I wake up with this discomforting feeling at
1:30 and again at 3:00 and then at 4:30 and once more
with the first light of dawn. With each awakening I smell
a metallic odor on my body and breath and wonder how tiny
white pills could create such systemic mischief.

Multiply this horror by every single night, 60 days in a
row. This represents partial payment one must pay for the
pleasure of eighteen months of drug-induced brain numbness.

In November of 2005 I suffered a serious injury to my
back. Things got progressively worse, and I had to seek
medical attention. I first consulted with Dr. Menachim
Epstein, a well-respected back surgeon and medical school
professor in his late seventies who wrote a well regarded
book on back injuries similar to my own. Dr. Epstein warned:

"After you start taking painkilling drugs, your body will
continue to crave more and more, sending out additional
false pain signals so that you feed the addiction."

I did not take this bit of advice seriously, but long after
his prediction, I now know how right he was. He issued a
prescription for Percocet as I requested, and sent me to a
Korean acupuncturist and a series of chiropractors, none of
whom provided any pain relief.

It got to the point at which things got so bad, I could not
walk five steps without having to sit down. As a result of
crushed lower lumbar vertebrae, the pain in my back, buttocks,
left leg, and left foot kept me from driving, traveling,
walking, sitting, playing racquetball, bike riding, and
generally living a normal life. Even sitting on the toilet
became a mini-traumatic episode. My medication increased.

I then met Dr. Mark Drzala, a brilliant surgeon in Montclair,
NJ. CAT scans and x-rays revealed the extent of the damage. The
doctor first did an epidural surgery in which a corticosteroid
was injected into my spine. That provided no real relief. I
had a second epidural one month later and there was an enormous
improvement. However, something terribly wrong occurred
during that procedure. I have no memory of the first epidural.
I woke up in the recovery room. The anesthesiologist assured
me that I would have no memory of the second one either.

I woke up during the middle of the procedure and felt the
needle go into my spine. I remember hearing the one word a
patient never wants to hear his surgeon say. "Oops." I also
remember struggling to rise up from the operating table,
feeling the needle and reacting to an intense burst of
pain as the doctor and nurses struggled to keep me still.

I was held down by many hands and I was immediately administered
additional anesthesia and again woke up in the recovery room,
retaining memories of this horrible surgical experience. I
was previously assured by the anesthesiologist that I would
remember nothing. After the surgery, I lost my sense of smell
and taste for nearly two months. Before that surgery, my blood
pressure had traditionally been in the 120 over 80 range.

One month later, my blood pressure registered 200 over 110
during a routine physical. I was rushed to a hospital emergency
room and administered intravenously a drug called Labetalol.
There were times when I felt as if my head was bursting
from the pressure. Did I suffer a stroke? I had double
vision in my left eye which lasted for about two weeks.

After this episode, I did a bit of research and found that
cranial nerve damage can occur during epidurals if the spinal
column is nicked. I believe this happened. Speak to 999 out of
1,000 doctors and they will insist that this is impossible.

I found references (Robert Henken, et. al.) in which such
damage can occur. My olfactory and trigeminal nerves were
negatively affected. My tenth cranial nerve, the vagus
nerve, was also affected. The smell and taste have come back.
The blood pressure continues to be controlled by Labetalol
and Lisinopril. When I stop taking these drugs, I hear my
blood. I feel my heart pounding in my ears. I can identify
the P-Q-R-S-T spikes in my heart beat. I cannot sleep.

Drugs stabilized my blood pressure so that I could endure
a third epidural. Unfortunately, that did not help to relieve
the pain. My surgeon determined that surgery was indicated.

Together, we spent many hours reviewing new CAT scans and x-rays.
I saw the damage from his perspective and agreed that I really had
no choice. On June 26, 2006, I had a spinal fusion operation (which
cost over $200,000) and had four titanium screws implanted into
my back. I was told that the healing process could take six months
or longer.

Instead of healing, the pain progressed. For whatever reason, the
screws began to rotate and the fusion did not take. During this time,
my surgeon prescribed pain medication. I was taking the equivalent
of about 20 milligrams of Oxycontin and/or Oxycodone each day. My
doctor also prescribed Fentanyl patches. Fentanyl is 40 times more
powerful than heroin. The patches sat untouched for a year in my
medicine cabinet. This morning, I threw them into the garbage. I
was never tempted to use them, despite the substantial pain.

After the surgery, I stayed overnight in the hospital and went home
the very next day. I was told that I would spend 3-5 nights in the
hospital. I have an enormous need to achieve, and told the doctor
before the operation that I would not stay for more than one night.
He doubted me, but agreed that I could go home after doing three
things. First, I had to be able to walk. Second, I had to demonstrate
that I could climb stairs. Finally, I had to fill a large beaker
with urine. Without getting too gory, let me tell you that I awoke
with a catheter inserted deep into my genital organ. Ouch! Removal
of same was one of the most uncomfortably painful events of my life.
Yet, I walked, climbed stairs, filled the damn bottle, and became
the only patient in my doctor's experience to spend just one night
in a hospital bed after a similar five hour surgery. I really
wanted to heal so badly and get on with my life.

During the next few months, the pain continued to grow. I
visited my surgeon once every two weeks and at each visit he
took a series of x-rays. At the three month mark, he ordered
a new CAT scan. The x-rays can only reveal so much. The CAT
scan confirmed that the surgery did not work. He immediately
recommended another surgery. The first surgery was performed
directly on my back as I lay on my stomach. The yet-to-be-performed
second surgery will be performed through my belly as I lay on my
back. There's quite a bit of intestinal material and body organs
to get through before accessing my spine. The thought terrifies
me. I am to have a piece of cadaver bone implanted this time.
Just what I need...nightmares of contracting a prion disease.

As time went on, the pain increased again. As the pain increased,
the medication increased. A few times during this process, I
went cold turkey and quit the medication, just to see if I
could. Withdrawal from a 20-milligram day Oxycontin addiction
is a challenge, but I succeeded each time (for a few days)
before beginning anew.

Sensing that I could do better, I consulted with a pain specialist,
Dr. Valenza of the Kessler institute in Saddle Brook, NJ. He upped
the medication even more. With each additional visit the dosages
were increased. I adored this man. He gave me everything I
asked for and then some. On a zero to ten scale, with ten being
the worst pain, I was at a constant 8-9 before seeing this new
physician. He helped bring the pain down to the 4-5 range.

By April of 2007, I was up to 110 milligrams per day. I lived
in a fog. I could not think. I could not finish the daily
New York Times crossword puzzle (which I previously did with
a pen and usually completed in under 20 minutes).

In July, 2007, the manufacturer of Oxycontin and Oxycodone
was fined $634.5 million for misleading the public about the
addiction risk of these drugs. By then, I was addicted. I
had subsequently learned that from 1996 to 2001, the number
of Oxycontin/Oxycodone-related deaths nationwide increased
by a factor of five hundred percent. I was using and abusing
drugs and could no longer quit.

The pain level was now a ten. I faced two choices. I could
increase the pain medication and begin taking two or more
80 milligram tablets each day. Or, I could immediately have
surgery and hope for the best. I decided to do something
unconventional. I decided to quit the medication and see how
bad the real undrugged pain was. Working with Dr. Valenza, I
followed his guidelines to slowly withdraw from the medication.
I considered checking into a clinic. I then decided that I
had to do this myself. I never imagined what hellish discomfort
I was about to experience.

Every night I went through three-four t-shirts and soaked through
my sweat pants and bed sheets. I would shake and suffer headaches
and stomach aches and all of the typical withdrawal symptoms
of a traditional heroin addict. It was hell. The drugs are an
unforgiving monster.

I vowed to beat this evil by September 1. On yesterday's date,
August 18th, I took my last 5 milligram pain killer. Today will
be my first drug-free day in nearly two years. As a final protest
my body is teaching me tortures which are exquisite in their
creativity. It will not let me sleep, and my entire system has
had an unprecedented semi-electrical shutdown. The last two
nights are nights to remember as a drug-denied system tries
every withdrawal trick in its repertoire to induce me to take
a pill. Each time I look this true evil in the face, I laugh.
I know that I will win the battle.

I still need a second and third surgery. I obtained another
opinion from an Emerson, NJ surgeon, Ari-Ben-Yoshei. No doubt
about it. One surgery will remove a partial source of my pain,
four rotating titanium screws from the failed first surgery.
The second operation will reconstruct my lower spinal column.
I've scheduled the first surgery for the first Monday in the
new year. Two daughters will then be home from college to
do chores around the house, to cook, clean, and help out
a dad recovering from his wounds. I will need the next few
months to prepare for all possibilities.

I've been told that the chances of improvement are 75 percent
percent. That puts the failure rate at 25 percent. Things
could get much worse. Things should get much better. I
approach this surgery with serious fear, yet, I recognize
that it is well worth the risk. Having lived through two
years of extreme unpleasantry, it is my decision to damn
the torpedoes and move full speed ahead.

When I met with my pain management team last week for what I
believe to be the final time, Dr. Valenza had two third-year
medical students under his tutelage. As I explained why
I no longer need medication and thanked him for his
brilliant guidance, he turned to the female student and
asked, "Do I really care about relieving this man's pain?"
His addition of the word "really" caused her to pause, but
while I lived through the experience and understood where
he was coming from, she was not able to answer correctly.

She thought for a moment and then responded "Yes, I
would imagine so." He smiled and said, "No, I really
do not care about that. What I care about his ability to
function." I smiled. He was so correct in his approach.
I felt that I was functioning well while being drugged
out of my mind. In fact, I was not. I had to teach myself
that the brain fog was a lesser alternative to living with
some pain and in doing so, recaptured my mind and soul.

I function. Therefore, I am.

I am now drug free and intend to remain that way. The
withdrawal symptoms should continue for another week. I
have been swimming and working out and expect to be in
fantastic physical shape before the new year begins.
I hope very much to see you in 2008. I expect to travel
the country to do a series of lectures and book signings.
There is much work to do, and my Notmilk past represents a
solid foundation. A first step.

I recall the title of an Ian Fleming book which I read in
my youth, "You Only Live Twice." The (poorly-structured)
Japanese haiku which inspired the title has always remained
with me:

"You only live twice, once when you are born, once when you
look death in the face."

Two nights ago, I suffered the worst night of sleep though
this entire episode, soaking five t-shirts. It was my body's
last scream for painkillers. Last night, I woke up only once
and this morning wore the same t-shirt I put on when first
coming to bed. I am now free.

This devil within me has been a bitch, and she has been banished
forever. I will return from this experience much stronger than
before and expect my mission to be proportionately more powerful.

Robert Cohen
i4crob@...