Medical Journal: 9/29/18

Four more radiation treatments left. (I should have been down to three, but a power outage shut down the treatment facility Wednesday morning and I had to catch a train at 1pm. Second time that has happened. The facility blames Con Ed; this time it was apparently a manhole explosion.)

Met with Dr. Sanfilippo Tuesday. Seems to me his predictions about the time-course of side-effects is noticeably less sanguine now than it was before treatment started. He predicts that next week will be 15% worse than this week, and that from there on progress will be noticeable at the scale of weeks rather than days. So I’m unlikely to have a speaking voice until mid-to-late October.

The soreness in the throat isn’t noticeable when I’m just sitting down, but swallowing (liquids or solids) is consistently uncomfortable, and if I get horizontal it’s bad enough to keep me awake. I had been worried about building up a tolerance to Ambien; in fact, it failed decisively the fourth time I used it. So I’m ow using oxycodone and Ativan every night, which again probably isn’t sustainable for three weeks. (And yes, I know benzos and narcotics are a bad combination, but at 5mg. of oxycodone and 0.5mg of Ativan I’m not too worried.) I started at what turns out to be the maximum recommended dose of Ambien (12.5 mg., above that the frequency of weird sleepwalking behaviors gets unacceptably high; at the current dose I haven’t experienced any such impulses.

Hoping Tramadol isn’t completely cross-tolerant with the oxycodone; I think tonight I’ll try one of the 200mg. extended-release Tramadol, which is supposed to be good for a day but generally lasts me about 72 hours. Last night even oxy-and-Ativan didn’t actually put me to sleep right away, but it allowed me to drowse comfortably and without worrying or swallowing excessively. Seems as likely as not that I’m going to have topush up the oxycodone dosage to 10mg. before this is over. (Again, raising the dose of Tramadol is definitely not recommended, nor is any sort of extended use.) That wouldn’t be the end of the world; when my back was at its worst I was on 10mg. of oxycodone every six hours, so 10mg. daily is certainly tolerable. Still, as someone who can’t use NSAIDS because of their kidney risk, I’m really worried about running up my opioid tolerance. Mornings are difficult, but I seem to be reasonably clear-headed during the day.

I’m also using a Maalox-lidocaine-benzadryl combination to treat the soreness directly. It works moderately well, but tastes utterly vile (the only liquid benzadryl I could find was –yech –“cherry-flavored”). The other problem is that it leaves a coating on the already-swollen tissues of the throat, which after half an hour or so induces a horrible sort of barking cough that leaves the throat more irritated than before, despite my 3-a-day benzonatate cough medicine. Constantly using cough drops to keep my throat and mouth moist, but the result is continually irritating the throat by swallowing.

It seems to me that I’m getting (even) more forgetful, which is seriously annoying. I carefully packed everything I needed for a four-day trip to Boston for a conference, and just as carefully left behind the pill bottle where I’d put a four-day supply of the heart meds, the stool softener, and the benzonatate.(My crew in New York managed both to FexEx me some pills overnight and to persuade my internist to call in a four-day prescription to a pharmacy in Cambridge.) The only good news coming out of this is that I was deprived of any heart medication for thirty-six hours, with no noticeable symptoms, and in particular no shortness of breath, even lying down.

The other good news is that professional life continues to be going well, and I appear to be cranking out off-the-wall ideas at something like my usual rate.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: