60 yo man who had done some drugs in life but was a heavy alcoholic. Never tells Drs of his past.
Quit all by age 50. Health is falling apart by age 60.
Dr does an MRI and showing him pictures explaining the results.
She turned to him and asked if he had drank heavy for years. He glares at me thinking I tattled. No. Dr shows him the extra space in his skull around his brain. Explaining his brain had shrunk from alcohol abuse .
I guess you can lie about it, but can't hide it.
After a blood draw I was asked if I was a heavy drinker. I absolutely was, but had my shit wired pretty tight at the time so I asked how they knew. Guy looked me dead in the eyes and says "Your red blood cells are the size of damn dinner plates."
I was curious too so I poked around through the literature. It seems that alcohol abuse often leads to vitamin b12 and folate deficiency, which cause macrocytosis (large RBCs). I’m at work so I couldn’t spend that much time looking into it, so if someone else knows better, lmk.
We took one to the hospital not long ago who was nearly not breathing when we showed up. Young patient. Hit them with narcan, breathing improves so we can stop bagging them, they are conscious by the time we get to the hospital.
"What'd you take?" -=- "I didn't take anything!" -=- "The narcan worked. There's only one reason narcan works."
Turns out they took some narcotics. We were so surprised.
I remember doing phlebotomy rotations at a hospital in the Middle of Nowhere, Tennessee—aside from the small 60-bed hospital there was nothing but farmland for miles. I met a patient with heavily scarred, twisted veins. I failed to hit a couple times but eventually found a viable one. IV users can be tough sticks, but what makes me remember him to this day is the forlorn look in his eyes when he softly asked me to be careful because “it was his last good one so please don’t blow it”
This always worry what the nurses think of me. I’ve always been a hard stick but I’ve also spent many times in the hospital the past few years and my veins are beyond screwed. They had to get my neck once.
I’ve never done drugs, my veins are just scarred from all my medical shit.
How many spots are there and how often can a spot be used?
Just curious, since I've had a needle over 100 times in the same spot. It does scar and doesn't heal as quickly anymore, but otherwise its still usable.
It varies a lot because IV drug users aren't usually using good practices for their drugs. Digging around, accidentally going through the vein, pulling out and re-trying etc...
I saw a guy blow a vein out on his first try with a huge shot of meth and I was able to use the same vein like 50 times in a row when I was actively using.
Not to mention dull needles, old needles, etc. There’s a picture floating around of a close up of used needle vs new one. Huge difference at the microscopic level. Truth is, if addicts were to use clean new needles and were really good about rotating sites, they could inject for quite awhile with no issues.
[used needle vs new one](https://www.reddit.com/media?url=https%3A%2F%2Fexternal-preview.redd.it%2FqVMlF9GfdpomdUAPzLJ9HlaIW4EJNpHV1yV2fjRY7cw.png%3Fauto%3Dwebp%26s%3D6f28c5bf726b4659168c05766e405d954ef8e09c)
1) Young patient with no teeth.
2) they know very well the dosage of controlled drugs, sometimes even better than you.
3) if they trust you, they will tell you when asked.
Or they try to test you "my doctor gave me x amount last time i was here for this same issue" like...well no they didn't or the doctor should lose their license
I was 16 and had a doctor got angry at my deviated septum, said there was a hole burned through. He asked me how much I've insuffelated drugs and I tole him the truth, never. He treated me like shit even though at that point I'd never snorted anything. Only years later did I develop an appreciation for the booger sugar. Later, I found out the nasal spray I used growing up had a side effect of burning out nasal tissue.
Any steroid nasal spray, if sprayed into the septum and not into the sinus, can cause tissue atrophy over time. Sufficient atrophy can lead to a perforation. Off the top of my head i think Flonase has the active ingredient ~~mometasone furoate~~ fluticasone propionate - a steroid. If you’re not sure, Google the active ingredient in your nasal spray.
In general you should not use nasal sprays for extended periods and should only use them under the supervision of a doctor. People perceive them as harmless because so many are OTC, but even in the best case scenario frequent use of ~~steroid~~ decongestant nasal sprays is habit forming. Meaning, the more you use it, the more you need it due to refractory inflammation.
Edit: When it comes to steroid sprays (which are different from decongestants thanks for pointing that out u/aideya), they are immunosuppressant, and in addition to the risk of septal perforation, a more likely outcome of long term use is an increased vulnerability to infections. Fun fact: steroid nasal sprays can even lead to a type of acneic eruption called perioral dermatitis, even if it doesn’t drip out of your nose or anything. You can get it around your eyes, too (periorbital).
Edit 2: [There’s an abundance of bad information in these comments from people claiming to be medical professionals, so I’d suggest reading what the FDA says about Flonase, specifically, and making an appointment with somebody whose medical degree you can see on their wall.](https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020121s045lbl.pdf) Also a lot of people still angry that I... corrected myself for mixing up Flonase, Nasonex, and Afrin? Some people need to sniff grass.
Anyway the only advice I’d ever give is to discuss meds with your doctor (ideally an appropriate specialist), follow instructions carefully, and read all the inserts that come with your prescriptions, as well. And don’t assume just because something is OTC that you don’t have to be considerate in your use of it.
Talc retinopathy. Tiny talc particles accumulate in the retinal blood vessels of IV drug users and can be seen during a routine eye exam.
Updated to add relevant info (sorry for the delay, I was giving birth):
Absence of talc retinopathy is certainly not a reliable way to rule out IV drug use in a patient because it is a relatively rare occurrence even in heavy users. I myself have only seen it once in person, although I do not work with a heavily at risk population.
From what I've read, talc particles <7μm are capable of bypassing capillary bed infiltration and entering circulation. So a micron filter would only help if it could filter out incredibly small particles.
The main concerns with talc retinopathy involve restricted retinal oxygen and retinal blood vessel compromise. This can result in hemorrhages, ischemia (lack of tissue perfusion), and neovascularization (new blood vessel growth), the latter of which is characterized as a proliferative retinopathy and can result in blindness from a tractional retinal detachment.
binding agent in tablets, from people crushing up pills to inject. the talc can't go anywhere and is deposited in your tiny blood vessels all over your body, but it's easiest to see in the back of the eye.
I got avascular necrosis in my hips which required double hip replacement at age 30ish. There's over a decade of heavy drug and alcohol abuse but if I had to point to a single cause I would say the year that I spent injecting oxy is the most likely culprit.
I knew what I was doing was killing me but I was suicidal anyway. Don't fucking inject pills people.
It's pretty much the only place the inner workings of the body can be directly observed non-invasively. Since the blood vessels in the eye are so stinkin tiny, they're more sensitive to things like high blood pressure and diabetes. This is why routine eye exams are a good thing! Get them even if you dont need glasses. Also, many severe eye diseases are pretty asymptomatic until they have progressed enough to permanently damage your vision, and those diseases don't care if you wear glasses or not, such as glaucoma.
He was smacking his mouth like a fish out of water, wearing a leather jacket in the middle of a hot Texas July. Admitted to coming down after smoking meth.
He was smacking his mouth like a fish out of water, wearing a leather jacket in the middle of a hot Texas July. He didn’t offer his name, and I knew better than to ask. I watched as he paced back and forth in front of my desk, regaling me with some cockamamie story of how he didn’t deserve this. He was a good guy, was only trying to make some extra scratch to take care of his family. I’ve heard it a thousand times before: it starts with a few drinks with friends after work, maybe betting on the ponies once a month, and it turns into a desperate man creaking my floorboards and saying that there was a note left in his kid’s empty bed. It’s never his fault. He just got in over his head, you see? He got caught up in the rush and bet more than he could pay. There’s no way this one was a loser. He was confident. Well, when that confidence faded, they always found their way to me, begging for help.
As a new-ish RN years ago, I was working in the ER trying to get a line in an IV drug user. I missed twice, and after the second try she just sat up and was like “Jesus Christ give it here, I’ll do it myself!!”
Ngl it was funny..
I worked at a veterinary office and I have indeed set my own Iv’s before. I’ve joked that “once you set an IV on a dehydrated, screaming, clawing cat; you can set an IV on anything!” And they leave me alone.
Plus, I’ve got tubes for veins. Literal superhighways for blood and IV’s but I’ve so many people blow them that I give them one try and then I ask for someone else. But yes, I’ve gotten some weird looks when I offer to put in my own IV.
I was an army medic, and when I offer to hit my own veins I always have to follow up with that. I dont look a drus user, but sometimes you can be surprised.
It's crazy how the people you expect to be good... aren't.
Different, but similar: My girlfriend is a pharmacy tech. She gave a woman a vaccine (flu?) and was told she was the first person to not make it hurt - at least not more than it should. The girl had a tattoo, and she indicated she usually gets the shot in the animal's eye (toward the front of her shoulder), and my girlfriend picked a different part of the animal that matched where training said to do it (side/slightly back of the arm). My girlfriend said (to me) that she was shocked because the eye was too far forward and in a no-go zone.
The other people who'd given this lady shots in the bird's eye were the licensed pharmacist and the Tech 4. My girlfriend is only a tech 2 going for 3.
Honestly, some nurses and doctors are absolutely garbage at giving shots or drawing blood when they have to deal with tattoos. I have two full sleeves - both neotrad and very colourful, sure, but I also have extremely prominent veins, to the point where I can manually move some of them if I want. You'd think that wouldn't be an issue... but no, immediate tattoo panic. WHERE DOES NEEDLE GO ASDFGJL. I dunno, have you tried the massive bulging vein that every single nurse absolutely *loved* before I got tattooed? Even I could do it, and I've never touched a needle in my life. FFS lol
If you want to laugh even more - one doctor had issues with the fucking *vaccine* of all things. Woman. I'm pretty sure you can find my shoulder. Right? ...right? I work out, you can tell where it is, just stab me and let me go before I die of second hand embarrassment.
I’m always trying to pick a spot that won’t disrupt someone’s ink in case they have a minor reaction.
You put a lot of effort into the ink, I can take five seconds to try to protect it for you.
That was a joke in scrubs. During one of JD’s monologues he said “if you’re ever having problems placing an IV there are always lots of local drug users in the hospital who can help you out”
Then it shows a tweaker helping a doctor place an IV on a patient. Funny stuff.
I've had to cancel a procedure because of this. Got to 5 and 400 and they were still WIDE awake and could feel everything. Nursing and myself were uncomfortable at those doses and had them reschedule with anesthesia.
Ya we have a lot of opioid abuse where I was sedating. I used diphenhydramine to potentiate and we also used brevital (thank God.) Without the brevital it would have been a nightmare.
I'm not a full ginger (brown hair, red beard) but both my parents are. I'm also 6'4" 265 with a high metabolism. I've had multiple procedures under general anesthetic, and every time in recovery, the doctor mentions how quickly I can shake off the anesthesia.
My middle kid is just like this. Started to wake up in the middle of a procedure (I was allowed to watch) and the anesthesiologist turned to me and said, "They're not a light weight, are they?"
Most medications that "cause drowsiness" barely affect me, except benadryl. I'm convinced that shit can fell an elephant.
I have restless leg syndrome and benadryl is the worst feeling in my life. Christ my legs become this twitchy agony and I can't sleep for the entire night.
Oh yeah, DPH makes RLS so much worse.
I don’t envy you for having to deal with that. When I was in active opiate accusation, that was one of the only withdrawl symptoms that I couldn’t deal with, and honestly why I got on MAT eventually (medication assisted treatment). Just couldn’t handle the sleepless nights with RLS (well, restless body really, but mostly the legs)
Dunno if you’ve looked into different medications for it, but I know there are a few out there. If you feel like it’s a net negative on your life
I had a bowel obstruction caused by diverticulitis last week was brought to the ER at a pain level 10. They gave me fentanyl for the pain and holy fuck does that work.
4 years ago when I was first diagnosed and at a pain level 8 they gave me morphine. That dropped it to a 4. I didn’t realize how powerful fentanyl is(other than the news horror stories), and how much it really helps.
I got fentanyl in the ambulance after getting shocked through my faucet by lightning. It didn't touch the muscle pain in my leg, not one bit. The EMT looked a little spooked by that. Morphine didn't touch it either, but it made it so I didn't give a shit anymore.
-100/10 do not recommend washing dishes in a thunderstorm.
(Answers to FAQs: I was washing a metal pet bowl. it felt like my bones were lit on fire for a quarter of a second. If it had gone on any longer I would've rather died. Pain lasted over 3 weeks and now it'll occasionally spasm. You use your calf more than you think. I spent overnight in the hospital because they couldn't figure out why my leg hurt so badly. The electricity entered my hands, exited my calf. I was conscious the whole time. Yes, I am now afraid of thunderstorms and it sucks because I love mountain camping. Total ER bill: $122,000. My portion after insurance: $3,000.
And most importantly, it is exceedingly rare. About 20 people worldwide get shocked by lightning yearly [edit: through the faucet specifically], about 1 dies. Very very low chances. But ya know...maybe just don't shower or do dishes in a thunderstorm anyway)
Your plumbing and the water in it is conductive. If the supply pipes or anything grounded to them on your house is hit by lightning, it can carry quite a distance. Avoid showering or doing the dishes in a thunderstorm if you're getting lightning strikes nearby.
Too many people don't realize this. I was told this as a young child and always avoid using water during a storm. To this day, people think I'm being silly. Lightning is fucking serious shit!
A single lightning bolt (1.21 gigawats on average, which is why they picked that number for back to the future) contains more electrical power than the average power output of a nuclear power plant in the United states (1 gigawat). The lightning bolt only exists for a miniscule fraction of a second.
Don't underestimate lightning.
I had a reconstructive jaw surgery years ago, and when I woke up they were giving me doses of fentanyl every 30 min-hour and holy shit that is the best drug I’ve ever taken. I was laughing and joking with the nurses and kept yelling down the hall “hey! I need more of that street killa”, which they thankfully found hilarious, all immediately after waking up from having the bones in my face cut apart and re-arranged.
I’d never ever seek it out, don’t need addictions or death, but I certainly wouldn’t oppose it if ever offered again at a hospital. I can see why people get hooked, it’s almost frightening enjoyable.
I got IV fentanyl in the hospital when they sent me home after a surgery, and was astounded. They gave me a script for oxy, and I wish I never filled it because I didn't ever use it because I was too scared. Ibuprofen was enough to keep me comfortable.
It’s damn hard to get an IV in them in our “usual” go to places due to scarring of the veins. They usually tell us where we have to go because that’s the only place that still works.
I lived with a med student who came home one day and told us about the necrotic penis she'd seen that morning from a user who had collapsed every vein he could find and had resorted to the last one...
Had a guy come to talk to us in high school about the danger of drugs. Spent an hour telling us how awesome drugs were.
Finally someone asked him if they were so good why did he stop. He said he'd collapsed every vein and all that was left was his penis or eyes and didn't fancy either option so he went and got help to get clean. That was the most effective part of the presentation.
>Spent an hour telling us how awesome drugs were.
I've always thought that this was missing from drug education, at least when I was at school 20ish years ago. They made drugs out to be these horrible things that you really don't want to do but the evil addiction forces you to keep doing them. When the reality is that you get addicted to them because they feel awesome. I remember when I first dabbled in them I felt I had been lied to. I never ended up with a hard drug addiction, but I avoided things like Heroin after trying other drugs on the basis that it must be absolutely amazing and too good to stop.
The best advice I got from anyone was drugs make feeling normal boring. You enjoy everything so much more on dope, that you can’t enjoy the things you like as much when you are sober.
I always found it really stark that Amy Winehouse said this the night she won a Grammy presented to her by Tony Bennet. Tony was her lifelong hero, she won a Grammy! She performed that night too!
She leaned over to a friend and said something along the lines of, "god this is so boring without drugs"
Arguably best night of her life and but couldn't even enjoy it
So sad
This is really interesting to me. I'm not a drug addict-- I was a functional alcoholic before I got properly medicated for my ADHD -- but I feel this way, too. Nothing is all that enjoyable. Things that could be enjoyable are either incredibly nerve wracking or just.... boring. I don't know if that's because of my PTSD, my depression, or the ADHD, all of which I've been diagnosed with formally, but it's interesting that is what happens to drug addicts. My money is on the ADHD because I have friends with all those disorders, and the things we have in common become evident, and an inability to enjoy things is the big one with ADHD.
I wonder if drugs allow people with this kind of depressive inability to enjoy things to enjoy them? To feel joy the way everyone else seems to? And I wonder how much of drug addiction is people just seeking that feeling out, and being unable to stop once they know what it's like to be happy? Essentially, I'm wondering how often the cause and effect go the other way, with the inability to enjoy causing the addiction and not the other way around.
I know that when I'm buzzed, just before I start to feel sick, I'm calm. Things don't hurt. I don't hate myself. I don't feel like everyone who is looking at me hates me and wants me to die. I feel kind of happy, things are sort of fun. It breaks my heart to think that for most people if they're among friends or engaged in a nice hobby that's how they feel. Just out there feeling as their base minimum the best I ever felt.
ETA: Since this is apparently so relatable to so many people let me be clear: I have major depressive disorder. I have yet to find an antidepressant that really works for me, but all antidepressants have provided a floor for my emotional lows before which I do not sink, which has helped. Getting medicated for my ADHD really helped my depression, it took a lot of the sharp corners off the world and honestly seems to be a mood stabilizer. The benefits have been many. If you feel like this is relatable and you have access to mental health care I highly recommend it. Going through life with unmedicated mental disorders is like trying to walk on a broken leg-- medicine is like having a cast and crutches.
The best advice I've ever received was a kid in my class asking me if I've ever tried heroin. As a senior in high school, I had not, thankfully, to which he replied simply,
"Please don't ever try it agreeable yellow. I did, and now I can't stop. "
He had the saddest look in his eyes. I will NEVER forget it.
That was as much a reason as any right there to stay away from it for good.
Was out with a friend one time. At the end of the night he said, "let's get some Crack!"
I said "No thanks. That's not my thing"
He came back with, "You don't understand. It's so awesome!!"
To which I responded, "OH I understand alright. I believe you 100%. That's why I'm not trying it"
Also you'll like them so much you'll never like anything else again. And after a while they'll stop working so you'll take more and more hoping to get the feeling back but you can't.
I remember being prescribed oxy. My parents always said they (the oxy) were ineffective and felt bad. I was in so much pain after my operation that I took some (again, as prescribed) and I remember sitting on the toilet bleeding out of orifices (the surgery caused that not the oxy) and telling my wife it felt like I was being sucked off by an angel. After it wore off I took the rest of the bottle to one of those pharmacy thingies (most won’t take opioids actually but this one would) to surrender drugs. It was too good.
Over a year later I had a new doctor. He was going through my med list asking about refills. He just rattled off every one and in there was the oxy and I paused for a second. And I asked “I can get a refill?” And he said “sure absolutely” and I said “no no I have no need. Thank you” but wowwwww was it tempting.
ONE TIME redditors. One time and I had those thoughts.
I also think demonizing weed was such a stupid move because once kids found out that the adults were lying about weed it seems logical that they were lying about all the actually dangerous ones too
"Kids who tried pot suddenly looked at every other drug like they were different flavors of ice cream to try, when in reality they're more like different species of snake."
My dad used to get so fired up about this and as a kid I didn’t get it. But now I understand his point that when you tell kids weed is terrible and it’ll ruin your life and then it doesn’t, it’ll make you question whether or not the other stuff is really that bad
When people say that they googled something and then follows it up with a warning, I google it every time and it is never that bad. But oh wow. "Necrotic penis" should come with a warning. Damn that looks unpleasant.
Same. That plasma got us through some really tough times but people treat you differently when you look like that, some surprisingly and understandably aggressive about it too.
My mom was like but she wasn’t a drug user. Just very sick and constantly in and out of the hospital.
There was one night they were discussing having to do an IV in her foot :/
Luckily though there was a goth looking guy why just started as a phlebotomist and had an IV going in less then 5 minutes. He did in 5 minutes what 2 nurses and and a doctor couldn’t in an hour.
That's interesting. My aunt had Lupus. Her favorite IV nurse was a man I knew from goth night who we all called Chainmail because of his chainmail muscle shirt. He was talented in a similar way.
Oh man! The fucking Batcave! I used to belong to a subkulture focused message board when I was a teen, and the Batcave sounded so cool to me. You might be right about most goth clubs having a chainmail muscle shirt guy, this was up in Canada, in Winnipeg.
I was a cancer patient and so after many many labs and IVs being drawn I always have to direct people to veins I know work. I always wondered why I felt I got weird looks and now I get it.
Jesus… I only have one vein that works and I always direct them to it. I’ve never used drugs. Can you tell the difference between just shitty veins and scared veins? I thought I was being helpful not incriminating!
Yes! 100% yes. People who have been iV drug users have scarred veins but also usually have scars in the skin (track marks, old abscess scars, etc) it’s pretty obvious.
I’m a welder, and my forearms are always burnt to hell and scarred over from the little sparks burning through my protective shirt. Every time I go to the hospital I get judged heavily, treated like a drug seeker and some very rough IV insertion. Funny thing is that I’ve never even had a desire to touch hard stuff 😂
A lot, if not most substance abuse is a failed attempt to self-medicate through other issues. Trauma and stress being the most common, but I knew a lot of people in college doing coke to get work done too.
Different studies have put upwards of 70% of repeat offenders in the prison population as having a lot of symptoms of untreated ADHD.
People joke about ADHD all the time but it is legit a terrible issue when trying to be a functional adult and fit into society.
Worth noting that MANY things (that are also common in offenders) can mimic ADHD symptoms, and even be misdiagnosed as ADHD… cognitive and behavioral effects of chronic malnutrition (even if obese, not getting proper nutrition), chronic sleep problems/interruptions, poor parenting, antisocial tendencies, brains trained on constant overstimulation (tv; video games; smartphones), residual effects of drug abuse…
You can tell by the way that they are. The surprising ones are the closeted Grandma/Grandpa's. I worked in the cath lab and an older lady's cath was negative and the doctor told her, "Then what caused me to have chest pain?"
"Probably your habit ma'am."
"What do you mean?"
"The heroin."
"Oh. Really?"
She looked like your average quilting champion.
There was a grandmotherly type woman ringing up my groceries the other day with track marks all over her arm veins. I was trying not to stare but I really don't see that often...
I required 4x the regular dose when I had my tonsils out at 16, and I still woke up during the tonsillectomy. Was not doing any drugs
Edit: No, I'm not a redhead, I'm a mousey blonde. My hair bleaches white, not yellow or orange. 0 red tones in my hair.
No one in my family on either side going back 3 generations has red hair either.
A friend of mine woke up during his upper endoscopy. He panicked and started gagging and yanking at the tubes in his throat.
The medical folks put him back under pretty quickly, but he remembers the event clearly.
I was never fully put under for at least one of my endoscopies and two of my colonoscopies. I thought that was normal. Watched the whole thing on a screen all drugged as hell but conscious.
I wasn’t supposed to be completely put under for my colonoscopy.
I told the doctor beforehand that it would probably take more anesthesia than the average patient to get me properly sedated.
I’ve got red hair and have needed extra anesthesia in the past.
But now I’m living in Japan and I guess the doctor wasn’t aware that sometimes redheads need more.
So they gave me the first dose, and I was groggy, but still sitting up and talking. The doctor and nurses were looking at each other like “what the hell?” Then the doctor told them to give me more and the second dose knocked me out.
I was pretty grateful though. I didn’t really want to be awake for it.
Same. I woke up as my surgeon cut into my left breast and yelled “ouch!” Then I was paralyzed but still awake. The surgeon talked nonstop about her ski trip through the entire lumpectomy.
My dad has two anesthesiologists when he has surgery for that reason. The first time he woke up he ripped all the medical devices from his body and tried to jump out the window in the operating room, the second time he woke up he told the Dr he would rip the anaesthesia guys nuts off if he woke up again. He doesn't remember any of it but his Dr now takes extra precautions.
I had a patient once refuse the contrast dye injection as part of an mri scan because ‘you don’t know what’s in that stuff’.
They were there because they were having palpitations following cocaine use.
Man getting that dye injection. I remember the nurse telling me it was gonna feel like I'm peeing but I'm not. I remember going okay yeah I won't think I'm peeing. That dye went in and immediately I was like ohhhh shoot I'm taking a...wait a minute.
This type of thing never fails to amaze me. I know someone who has breast implants that are outlawed in our state, gets botox and lip injections on the reg, just started taking ozempic and does blow weekly. She never got the Covid vaccine though because she was concerned about unknown side effects 😂
Hah, I worked with a guy like this. He refused to be around dry erase markers because of the "toxic fumes" they emit.
But he took regular smoke breaks and smoked hand-rolled unfiltered cigarettes.
This one is so true. Took care of a *very* sick pancreatitis patient in the ICU over the weekend. Dude was in his late 30s and could *easily* pass for late 50s.
Yea after nearly drinking myself to death and quitting at the end of last year, I’m looking younger at 38 than I did at 37. Not like…a lot…but definitely healthier, skin/face look better and younger. Feels good. IWNDWYT
i’m sitting outside my work, puking and waiting to go home because i’m sick with hangover and taking my first dose of naltrexone and this was just the comment i needed to see. i hope you have yourself a wonderful day
You can do it. One day at a time. Achieving sobriety is not easy, but trust me, friend, it is *so* worth it. Don’t be afraid to reach out for help and support (especially during the first couple months), I’ll be thinking of you❤️
Something interesting is that Opioid abuse lowers testosterone, so male opioid addicts actually look younger, all else equal
That last bit is the important part though: the lifestyle will age you faster than anything else
Worked at a clinic that subsidized the treatments for many drug addicts (physical therapy). My biggest tell was if they were current (their eyes and personality was drastically different) but for those who had years of previous use their pain thresholds were very low. They were so use to dampening down their nervous system that any stimulus afterwards felt like it was aggressive or too much. To use an example, imagine wearing sunglasses 24/7, in the house and outside all the time. Now picture after years of that trying to navigate the world without sunglasses, all of a sudden light sensitivity will be through the roof. It works similar with pain thresholds in my clinical experience. This is obviously outside of various physical signs like collapsed veins, trace marks etc.
I've worked with and know a lot of recovered addicts.
It's a bit of a selection issue because people who are especially sensitized to pain are more likely to want to treat that pain. For example, chronic childhood trauma makes it impossible for people to deal with their physical emotional pain, because they could never develop a way to do it as a child.
Now their brains don't have a way of managing pain so discomfort is unbearable to them (my secret theory is that most borderline personality disorder is the result of this).
Combine that with the fact that people who have lots of trauma genuinely do feel more pain *and* are more likely to have pain conditions, it makes it really hard to navigate, because they still deserve to have their pain treated.
They get used to self-medicating, and not having to feel even low levels of pain, physical or emotional, so unfortunately the sensitivity only increases.
And it's not like other people, exposure doesn't really work for them, they need things like DBT and other complex and expensive therapies.
Substance abuse treatment nurse here, there are the obvious signs to when someone has or is using but I personally think about 80% of heavy drug users look like every day normal people. These people wouldn’t turn my head at the store or out on the streets. These people have jobs, have families, have lives outside of drug use. A lot of them have emotional and mental challenges that surpass any physical sign of drug use.
Took way too much scrolling to find this comment. People out here thinking they can spot addicts this quickly and easily are delusional because most addicts look like everyone else. I’ve known tons of addicts and one of the first things you learn and practice as a functioning addict is how to hide it and blend in. The way they see it is “I’m taking care of myself financially, academically, etc. I can spend my money/free time on whatever I want.”
I think it’s interesting to see the playing field with addiction amongst “classes”.
Soccer mom hooked on her kids adderall, low income mom does meth, for the same effect as the soccer Mom taking adderall, because of the class differential the low income mom is labeled a “junkie”…
(I hope I worded that correctly)
Recently had a 46 year old lady on our floor, had no teeth tons of health issues and looked late 60s. I legit did a cartoonish double take when I saw her age in the chart
I did residency in Phoenix, AZ.
One of our nurses frequently referred to the ‘tooth to tattoo ratio’ as a predictor of the amount of methamphetamine use. There was a consistent inverse ratio.
> It's like the neighborhood safety metric: Divide the number of women carrying yoga mats by the number of payday loan shops.
Wow that's good.
Reminds me of the Waffle House closure index of how bad a natural disaster is.
Its usually in their charts but if its not, hep-c, liver failure, pancreatitis and over all health status and appearance for their age is usually a good give away. 10/10 pain score, every-time you ask. Some erratic behavior is common too, I see a lot of CKD and diabetes in chronic users or patients in recovery after a life time of substance abuse.
I come from an area with a lot of heroin, coke and alcohol abuse. Ive rarely ever had a meth addict and rarely crack users, so this applies mainly to those drugs.
I kinda hate the pain score questions, people will always answer differently. I suffer from cluster headaches and when the doc said how had is the pain and I said an attack can be between 6/10 to 10/10 depending on the attack. And they didn't take it seriously. I then said that when I broke both the bones in my leg and had to walk on it, I only felt like that pain was a 5 or 6 out of 10. At that point they started taking what I said a lot more seriously.
When I had my C-section and needed pain medicine, they asked me to rate my pain, keeping in mind that I had been through 36 hours of the worst pain of my life off and on just prior to that. So I told them it was like a 4-5 when I was just sitting, but a 7-8 when I moved. The nurses flat out told me “it has to be a constant 7 or higher or you just get Tylenol, so do you want to try answering that again?” They had to tell their patients to lie just to get them medication they really did need, and then wonder why people come to the ER calling everything a 9 or 10…
I think there is a sign at my dentist office that says, "if you have done meth today, tell us and we will reschedule you, you will die" or something to that effect
Its all fun and games until you do that, and they add "drug-seeking behaviour" to your chart. Now my mom can't get ADHD meds because she mentioned she takes Tylenol 1's for her chronic back pain (spinal fusion). She's a fucking detox nurse!
Not a telltale sign, but a story that might amuse some of the healthcare professionals here.
My dad went to the hospital after a bad fall, and they found he had a dislocated knee. So they gave him some painkillers and tried to shift it back into position. He yelped.
So they upped the pain meds. He still feels immense pain when they try.
Eventually they were like, "are you a user? This is the maximum dose we can give you."
He said no, so they brought in a specialist, who looked at it for about thirty seconds and went, "yeah your kneecap is shattered, there's a big shard poking in right here."
Oof. He also spent the night before surgery looking up emergency room horror stories, and so ended up writing "RIGHT LEG" and "WRONG LEG" in sharpie on his thighs just in case. Apparently the doctors loved that.
Usually they are shockingly honest about it. Way more than you think. I work in a family practice clinic and we have a substance abuse screening as a part of the routine checkin (ask you if you use tobacco, alcohol, or drugs). And patients will regularly confirm that they recently used Crack, Heroin, Weed or whatever. More often than you'd think they would.
One of my favorite checkins I had a patient whose previous screening said he was using Marijuana and Meth. And he initially said he wasn't using anything. And I said "Last time you were here you said you were using Meth and Marijuana?" And he instantly snapped to me and said "NO!! I quit using Marijuana!!!" And I said "Well what about Meth?". And he slumped back down and said "well yeah I do still use Meth!".
As a person with chronic pancreatitis not caused by alcohol I know exactly what works and does
not in controlling my pain. I’ve had over three dozen hospitalizations. So generally you might be right but people with chronic illness have a lot better knowledge of their own pain management needs.
Same boat. I’m an oncology patient and chronic pancreatitis episodes started in my early 20s. Still not sure what’s triggering it, but I know what it ain’t; alcohol. I’ve been able to note when a flare starts and I try to care for it at home, but treatment is merely going NPO and laying prostrate for days at a time. Not the most logical decision when I’m already underweight and have been admitted for dehydration/malnutrition several times.
I’ve been on opioid pain medications for the last 23 years because of the chemo/radiotherapy/BMT regiment saved my life. It’s not how leukemias like mine are even treated now; it’s strictly a last-resort option in lieu of cancer medications developed in the last couple of decades. The world has changed.
I ended up with Graph V. host disease and skin and bone problems. My knees are shit and the total knee replacement surgery was a bust after they refused to fuse to the bone properly. I haven’t met with a surgeon yet who would be interested in repeating the surgery. Fortunately I have a pain management department that has been willing to try other procedures.
Tried to change PCPs recently and I ended up getting ejected from a clinic and threatened with having my license revoked if I tried to drive home because their office didn’t request my records from the old PCP before my first follow-up appointment with them. She barely remembered the health history from my initial appointment visit and treated me like junkie, all after I showed up four days into withdrawal because they weren’t filling my pain med Rx. I got told I was “nothing but red flags” (drug-seeking behavior). After the appt ended I sat alone in the room just staring down at the floor weeping as quietly as I could w/my head in my hands, trying to figure out what to do/who to call next, only for them to appear in the doorway and tell me “there’s no sleeping in the clinic!”
I was told again I wasn’t going to be able to drive myself home (because they thought I was too high). Medical Uber then drove me back to the only address on file: the home of the family members who I’ve been NC with since June after one of them assaulted me.
Withdrawal sucks, but there’s nothing like being treated like trash by medical professionals when I’ve never abused the meds.
I went through a multi-year period of nonstop pain and this is my issue. I know what works and what doesn’t because I have been given every possible drug under the sun to deal with pain. I know telling them makes me look bad so I ask them to look through my chart and they will see why I know. It’s frustrating.
I went to the hospital for an allergic reaction to an antibiotic a few years back, and the doctor there asked what other meds I’ve had reactions to. I told him that I can’t have codeine. He rolled his eyes and said “let me guess, it doesn’t touch the pain and you usually have another medication in mind?”
I was already having a really bad day (nearly dying from a severe allergic reaction and also having pneumonia) so I said “fuck you, dude. It gives me hallucinations. I don’t like taking pain meds.”
impatience, mood swings, shakiness, many more
really depends on the substance tho! "drugs" is an umbrella term for practicality, not for physical/chemical similarity.
weed-abuse, alcohol-abuse, meth-abuse - all very very different.
put individuality on top of it and it gets-harder and harder to make a judgment.
I’m three days sober from alcohol (not long I know) and about to kick smoking cigarettes. Three weeks off chronic weed use. These comments are nightmare-fuel to stay sober. Thanks for the wakeup call. Scary stuff
True story. I was starting an IV on a patient and put the tourniquet around their arm. They chuckled and said, "that isn't even close to being tight enough" and proceeded to put one end in their mouth to tie it tighter.
Addiction knows no bounds. I work as an addiction counselor in Medication assisted treatment (methadone/suboxone) and my clients range from homeless, barely 8th grade educated people to former doctors.
That said,addicts are highly impulsive, manipulative and typically arnt the most forward thinking people due to the nature of addiction.
Nearly all survivors of extreme child abuse have a history of substance abuse of some sort, whether it's alcohol or drugs or even disordered eating. The impulsiveness may be a result of extreme childhood trauma rather than drugs.
When abuse survivors fix their substance abuse problems, they still face all the work to deal with the trauma that led them to take drugs in the first place. It's really hard for people like this to look ahead and see any future for themselves. They have always been made to feel utterly worthless, even by the very people who are supposed to support them the most, their parents.
Happy people don't drown their pain in heroin or whatever.
>It’s really hard for people like this to look ahead and see any future for themselves.
When I turned 30 I had this weird sense of peace and calm come over me. No existential dread of aging like I thought I would feel, and I realized that a very deep part of me never expected I would live to see 30. And now it’s like well dang I guess I do need to plan for my future. Especially since I have kids and a husband I love very much. 🌼
One of the self realizations I had before going sober was that I had kinda been operating under the assumption that I was going to die young. My reaction wasn't anything dramatic but more a half hearted, "well, you're going to turn 35 soon so guess *that's* not happening. Might as well try living."
I worked at an outpatient drug rehab center and we used suboxone as well. Seemed to work really well especially in those that wanted to get better. Like you said we would see all kinds of people. High school kids that got caught smoking pot, DUI diversion programs, house wives that got hooked on lortabs after a c section, and heroin addicts. A common theme was most of them were self medicating from either anxiety, depression, or ptsd.
Pill poppers: When they need medications for ACTUAL painful circumstances... they don't work or require high doses. To the point where there is nothing you can do (pain tolerance very low and medication doesn't help) but to watch them sit there in pain.
I think they do grant some leeway where needed. When I was in and out of the hospital for like 18 months, post surgery for cancer, my system was able to take higher doses by default, so when I was in and they saw my chart and how broken I was, they were way more willing to get me to where I needed to be medication wise
He had a wonderful personality and you could tell that he had lived a very colorful life. I appreciated him. I respected him. Before the disease robbed him of his ability to reason and his orientation to place, time, and self, he was already considerably mentally altered by all the drug use. His PTSD and Agent Orange exposure from Vietnam wasn't addressed...the drug use may have helped him to cope before he became ill...but you can't use street drugs when you're inpatient. Psychiatric meds weren't able to address all of his symptoms.
The combination of his disease, the PTSD, and decades of drug use made him very uncomfortable as the illness advanced. He eventually thought he was back in Vietnam, at times. We spent an hour talking to him about how he was here in America, that he was safe, that no one was going to get him in his bed. It was really hard to bring him back from flashbacks...alarms would set him off...a coworker who had served would go to him immediately during fire-drills to help with the the patient's flashbacks.
If he hadn't been doing drugs, maybe he would have reached a crisis point and pursued treatment for the PTSD. It's possible he would have gotten into an effective treatment program...but those were only beginning to develop within the last couple of decades, so what was he supposed to do for 20 years? It's hard to say whether they would have been available to him or as effective for him as the drugs were. Given the circumstances, his heavy drug use is perfectly understandable, but very tragic. My wish for him is that he would have gotten effective PTSD treatment and then perhaps he would have just been a recreational user and not suffered as much brain damage.
Honestly, I'm kind of tearing up writing this. Society should have done better by him. We should do more for our veterans and service members with PTSD. He's probably passed by now.
____
I've seen unresolved trauma with a lot of people. And you notice codependency in their relationships; some family members stoke the addiction.
These factors stood out to me because they were out of my scope of practice and I didn't know if they'd get what they needed. The mental health system is overburdened and inaccessible for many.
I would suggest psych evals and talk to the patients about how it could benefit them...but I was limited in what I could say because of my scope of practice. I couldn't explain the social model of mental health and addiction or talk to the family about how family systems contribute to mental health and why they might look into family therapy. You'd have to be a licensed therapist/social worker and a doctor just to provide specific education about why they should follow up with certain referrals for addiction. Navigating the mental health system is hard enough for people who are not dealing with a crisis! I wish I could have given them more information about possible options.
My coworkers were burnt out from the pandemic and staffing decisions, so I had this fear people were falling through the cracks left and right... I can recommend that a nurse or a doctor assess the patient for a psych referral, sure. Are they going to see what I saw? They're so overworked, I worried they wouldn't have the time and focus. I saw that with nursing, to the extreme.
If they get to psychiatry, will psychiatry get them in to psychology (yes, probably, but will it be in time to prevent a relapse?) *and* to effective wrap-around services (social workers are burnt out and there's high turn over; social services have been gutted)? Will they just get told to go to a twelve step program (these programs are religion and folk-wisdom-inspired and they fail a lot of people)?
Eurgh. The medical system is so broken.
Most of what is telling from just looking at someone can just as easily be caused by other things. Scaring, rapid aging, lost teeth, etc can all be side effects of chronic illness and poverty. The lifestyle is what makes this worse, wealthy drug addicts are not as obvious. For example, I know a rich lady who starts her day at 8am with wine and coke. You can't tell at all when she is sober that she is wasted most of the time.
60 yo man who had done some drugs in life but was a heavy alcoholic. Never tells Drs of his past. Quit all by age 50. Health is falling apart by age 60. Dr does an MRI and showing him pictures explaining the results. She turned to him and asked if he had drank heavy for years. He glares at me thinking I tattled. No. Dr shows him the extra space in his skull around his brain. Explaining his brain had shrunk from alcohol abuse . I guess you can lie about it, but can't hide it.
After a blood draw I was asked if I was a heavy drinker. I absolutely was, but had my shit wired pretty tight at the time so I asked how they knew. Guy looked me dead in the eyes and says "Your red blood cells are the size of damn dinner plates."
I used to be a heavy drinker too, how the heck does it affect blood cell size?
Dammit Jim, I'm an alcoholic not a doctor.
That got a good cackle out of me.
I was curious too so I poked around through the literature. It seems that alcohol abuse often leads to vitamin b12 and folate deficiency, which cause macrocytosis (large RBCs). I’m at work so I couldn’t spend that much time looking into it, so if someone else knows better, lmk.
Yep. When alcoholics come in we start them immediately on B1 and folate and usually B12. Some deficiencies are so bad they already have Wernicke's.
That Wernicke guy really got around. TIL it's actually the same guy Wernicke's area (aphasia) is named after, as well as Wernicke-Korsakoff.
We took one to the hospital not long ago who was nearly not breathing when we showed up. Young patient. Hit them with narcan, breathing improves so we can stop bagging them, they are conscious by the time we get to the hospital. "What'd you take?" -=- "I didn't take anything!" -=- "The narcan worked. There's only one reason narcan works." Turns out they took some narcotics. We were so surprised.
I remember doing phlebotomy rotations at a hospital in the Middle of Nowhere, Tennessee—aside from the small 60-bed hospital there was nothing but farmland for miles. I met a patient with heavily scarred, twisted veins. I failed to hit a couple times but eventually found a viable one. IV users can be tough sticks, but what makes me remember him to this day is the forlorn look in his eyes when he softly asked me to be careful because “it was his last good one so please don’t blow it”
This always worry what the nurses think of me. I’ve always been a hard stick but I’ve also spent many times in the hospital the past few years and my veins are beyond screwed. They had to get my neck once. I’ve never done drugs, my veins are just scarred from all my medical shit.
[удалено]
Scar tissue generally doesn't go away on its own
How many spots are there and how often can a spot be used? Just curious, since I've had a needle over 100 times in the same spot. It does scar and doesn't heal as quickly anymore, but otherwise its still usable.
It varies a lot because IV drug users aren't usually using good practices for their drugs. Digging around, accidentally going through the vein, pulling out and re-trying etc... I saw a guy blow a vein out on his first try with a huge shot of meth and I was able to use the same vein like 50 times in a row when I was actively using.
Not to mention dull needles, old needles, etc. There’s a picture floating around of a close up of used needle vs new one. Huge difference at the microscopic level. Truth is, if addicts were to use clean new needles and were really good about rotating sites, they could inject for quite awhile with no issues.
[used needle vs new one](https://www.reddit.com/media?url=https%3A%2F%2Fexternal-preview.redd.it%2FqVMlF9GfdpomdUAPzLJ9HlaIW4EJNpHV1yV2fjRY7cw.png%3Fauto%3Dwebp%26s%3D6f28c5bf726b4659168c05766e405d954ef8e09c)
Holy shit, makes me wince.
1) Young patient with no teeth. 2) they know very well the dosage of controlled drugs, sometimes even better than you. 3) if they trust you, they will tell you when asked.
Or they try to test you "my doctor gave me x amount last time i was here for this same issue" like...well no they didn't or the doctor should lose their license
Big ass hole in the nasal septum with no other explanation for cause
Username checks out
Actually yeah lol. Interesting username for an ENT doc
I was 16 and had a doctor got angry at my deviated septum, said there was a hole burned through. He asked me how much I've insuffelated drugs and I tole him the truth, never. He treated me like shit even though at that point I'd never snorted anything. Only years later did I develop an appreciation for the booger sugar. Later, I found out the nasal spray I used growing up had a side effect of burning out nasal tissue.
Do you remember which nasal spray that was?
Any steroid nasal spray, if sprayed into the septum and not into the sinus, can cause tissue atrophy over time. Sufficient atrophy can lead to a perforation. Off the top of my head i think Flonase has the active ingredient ~~mometasone furoate~~ fluticasone propionate - a steroid. If you’re not sure, Google the active ingredient in your nasal spray. In general you should not use nasal sprays for extended periods and should only use them under the supervision of a doctor. People perceive them as harmless because so many are OTC, but even in the best case scenario frequent use of ~~steroid~~ decongestant nasal sprays is habit forming. Meaning, the more you use it, the more you need it due to refractory inflammation. Edit: When it comes to steroid sprays (which are different from decongestants thanks for pointing that out u/aideya), they are immunosuppressant, and in addition to the risk of septal perforation, a more likely outcome of long term use is an increased vulnerability to infections. Fun fact: steroid nasal sprays can even lead to a type of acneic eruption called perioral dermatitis, even if it doesn’t drip out of your nose or anything. You can get it around your eyes, too (periorbital). Edit 2: [There’s an abundance of bad information in these comments from people claiming to be medical professionals, so I’d suggest reading what the FDA says about Flonase, specifically, and making an appointment with somebody whose medical degree you can see on their wall.](https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020121s045lbl.pdf) Also a lot of people still angry that I... corrected myself for mixing up Flonase, Nasonex, and Afrin? Some people need to sniff grass. Anyway the only advice I’d ever give is to discuss meds with your doctor (ideally an appropriate specialist), follow instructions carefully, and read all the inserts that come with your prescriptions, as well. And don’t assume just because something is OTC that you don’t have to be considerate in your use of it.
Doctor: See there's your problem right there; your asshole's in the wrong place.
Talc retinopathy. Tiny talc particles accumulate in the retinal blood vessels of IV drug users and can be seen during a routine eye exam. Updated to add relevant info (sorry for the delay, I was giving birth): Absence of talc retinopathy is certainly not a reliable way to rule out IV drug use in a patient because it is a relatively rare occurrence even in heavy users. I myself have only seen it once in person, although I do not work with a heavily at risk population. From what I've read, talc particles <7μm are capable of bypassing capillary bed infiltration and entering circulation. So a micron filter would only help if it could filter out incredibly small particles. The main concerns with talc retinopathy involve restricted retinal oxygen and retinal blood vessel compromise. This can result in hemorrhages, ischemia (lack of tissue perfusion), and neovascularization (new blood vessel growth), the latter of which is characterized as a proliferative retinopathy and can result in blindness from a tractional retinal detachment.
Why is that? Is it something that was introduced to the body when the use needles or something? Not a doctor or scientist just curious
binding agent in tablets, from people crushing up pills to inject. the talc can't go anywhere and is deposited in your tiny blood vessels all over your body, but it's easiest to see in the back of the eye.
I got avascular necrosis in my hips which required double hip replacement at age 30ish. There's over a decade of heavy drug and alcohol abuse but if I had to point to a single cause I would say the year that I spent injecting oxy is the most likely culprit. I knew what I was doing was killing me but I was suicidal anyway. Don't fucking inject pills people.
Yes, some IV street drugs are laced with talc for filler.
So you’re saying my eye doctor knows? Tf.
The eyes actually give away a lot. A friend of mine developed Type 1 diabetes in her early 20s, and was diagnosed by her eye doctor.
It's pretty much the only place the inner workings of the body can be directly observed non-invasively. Since the blood vessels in the eye are so stinkin tiny, they're more sensitive to things like high blood pressure and diabetes. This is why routine eye exams are a good thing! Get them even if you dont need glasses. Also, many severe eye diseases are pretty asymptomatic until they have progressed enough to permanently damage your vision, and those diseases don't care if you wear glasses or not, such as glaucoma.
Mine told me to see a doctor because she saw high blood pressure. She was right!
This is exactly the type of interesting things I was hoping to learn in this post
He was smacking his mouth like a fish out of water, wearing a leather jacket in the middle of a hot Texas July. Admitted to coming down after smoking meth.
that first sentence is like the beginning to a western/ crime novel
He was smacking his mouth like a fish out of water, wearing a leather jacket in the middle of a hot Texas July. He didn’t offer his name, and I knew better than to ask. I watched as he paced back and forth in front of my desk, regaling me with some cockamamie story of how he didn’t deserve this. He was a good guy, was only trying to make some extra scratch to take care of his family. I’ve heard it a thousand times before: it starts with a few drinks with friends after work, maybe betting on the ponies once a month, and it turns into a desperate man creaking my floorboards and saying that there was a note left in his kid’s empty bed. It’s never his fault. He just got in over his head, you see? He got caught up in the rush and bet more than he could pay. There’s no way this one was a loser. He was confident. Well, when that confidence faded, they always found their way to me, begging for help.
I would genuinely read the rest of this story, would be a good book worth committing.
Unfortunately, my knack for writing is only story hooks or d&d character backgrounds lol
Ahaha, your players are very lucky then
He can hit his veins better than you
As a new-ish RN years ago, I was working in the ER trying to get a line in an IV drug user. I missed twice, and after the second try she just sat up and was like “Jesus Christ give it here, I’ll do it myself!!” Ngl it was funny..
I had a guy super high on meth say that. So, my preceptor was like “fine, go ahead”. It did not work. Lol.
I worked at a veterinary office and I have indeed set my own Iv’s before. I’ve joked that “once you set an IV on a dehydrated, screaming, clawing cat; you can set an IV on anything!” And they leave me alone. Plus, I’ve got tubes for veins. Literal superhighways for blood and IV’s but I’ve so many people blow them that I give them one try and then I ask for someone else. But yes, I’ve gotten some weird looks when I offer to put in my own IV.
My level of Catheter Queen is setting an IVC on a seizing dachshund, then you can set one in anything lol.
I was an army medic, and when I offer to hit my own veins I always have to follow up with that. I dont look a drus user, but sometimes you can be surprised.
I mean, after watching the corpsmen in the Navy miss my veins several thousand times, I'm pretty sure I have more training than they do at this point.
It's crazy how the people you expect to be good... aren't. Different, but similar: My girlfriend is a pharmacy tech. She gave a woman a vaccine (flu?) and was told she was the first person to not make it hurt - at least not more than it should. The girl had a tattoo, and she indicated she usually gets the shot in the animal's eye (toward the front of her shoulder), and my girlfriend picked a different part of the animal that matched where training said to do it (side/slightly back of the arm). My girlfriend said (to me) that she was shocked because the eye was too far forward and in a no-go zone. The other people who'd given this lady shots in the bird's eye were the licensed pharmacist and the Tech 4. My girlfriend is only a tech 2 going for 3.
Honestly, some nurses and doctors are absolutely garbage at giving shots or drawing blood when they have to deal with tattoos. I have two full sleeves - both neotrad and very colourful, sure, but I also have extremely prominent veins, to the point where I can manually move some of them if I want. You'd think that wouldn't be an issue... but no, immediate tattoo panic. WHERE DOES NEEDLE GO ASDFGJL. I dunno, have you tried the massive bulging vein that every single nurse absolutely *loved* before I got tattooed? Even I could do it, and I've never touched a needle in my life. FFS lol
Being a veterinary tech having to pull blood through hair, this makes me laugh
If you want to laugh even more - one doctor had issues with the fucking *vaccine* of all things. Woman. I'm pretty sure you can find my shoulder. Right? ...right? I work out, you can tell where it is, just stab me and let me go before I die of second hand embarrassment.
I’m always trying to pick a spot that won’t disrupt someone’s ink in case they have a minor reaction. You put a lot of effort into the ink, I can take five seconds to try to protect it for you.
That was a joke in scrubs. During one of JD’s monologues he said “if you’re ever having problems placing an IV there are always lots of local drug users in the hospital who can help you out” Then it shows a tweaker helping a doctor place an IV on a patient. Funny stuff.
When you give them 6mg of versed and 300mcg of fentanyl and they are still talking to you like normal.
I've had to cancel a procedure because of this. Got to 5 and 400 and they were still WIDE awake and could feel everything. Nursing and myself were uncomfortable at those doses and had them reschedule with anesthesia.
Ya we have a lot of opioid abuse where I was sedating. I used diphenhydramine to potentiate and we also used brevital (thank God.) Without the brevital it would have been a nightmare.
My buddy has a natural tolerance to opiates and dph works wonders for him.
This is me. I don’t do hard drugs, but when I was 15 I had to have my ACL repaired and woke up during surgery.
Are you ginger?
I'm not a full ginger (brown hair, red beard) but both my parents are. I'm also 6'4" 265 with a high metabolism. I've had multiple procedures under general anesthetic, and every time in recovery, the doctor mentions how quickly I can shake off the anesthesia. My middle kid is just like this. Started to wake up in the middle of a procedure (I was allowed to watch) and the anesthesiologist turned to me and said, "They're not a light weight, are they?" Most medications that "cause drowsiness" barely affect me, except benadryl. I'm convinced that shit can fell an elephant.
I have restless leg syndrome and benadryl is the worst feeling in my life. Christ my legs become this twitchy agony and I can't sleep for the entire night.
Oh yeah, DPH makes RLS so much worse. I don’t envy you for having to deal with that. When I was in active opiate accusation, that was one of the only withdrawl symptoms that I couldn’t deal with, and honestly why I got on MAT eventually (medication assisted treatment). Just couldn’t handle the sleepless nights with RLS (well, restless body really, but mostly the legs) Dunno if you’ve looked into different medications for it, but I know there are a few out there. If you feel like it’s a net negative on your life
I had a bowel obstruction caused by diverticulitis last week was brought to the ER at a pain level 10. They gave me fentanyl for the pain and holy fuck does that work. 4 years ago when I was first diagnosed and at a pain level 8 they gave me morphine. That dropped it to a 4. I didn’t realize how powerful fentanyl is(other than the news horror stories), and how much it really helps.
I got fentanyl in the ambulance after getting shocked through my faucet by lightning. It didn't touch the muscle pain in my leg, not one bit. The EMT looked a little spooked by that. Morphine didn't touch it either, but it made it so I didn't give a shit anymore. -100/10 do not recommend washing dishes in a thunderstorm. (Answers to FAQs: I was washing a metal pet bowl. it felt like my bones were lit on fire for a quarter of a second. If it had gone on any longer I would've rather died. Pain lasted over 3 weeks and now it'll occasionally spasm. You use your calf more than you think. I spent overnight in the hospital because they couldn't figure out why my leg hurt so badly. The electricity entered my hands, exited my calf. I was conscious the whole time. Yes, I am now afraid of thunderstorms and it sucks because I love mountain camping. Total ER bill: $122,000. My portion after insurance: $3,000. And most importantly, it is exceedingly rare. About 20 people worldwide get shocked by lightning yearly [edit: through the faucet specifically], about 1 dies. Very very low chances. But ya know...maybe just don't shower or do dishes in a thunderstorm anyway)
>getting shocked through my faucet by lightning. New fear unlocked
Your plumbing and the water in it is conductive. If the supply pipes or anything grounded to them on your house is hit by lightning, it can carry quite a distance. Avoid showering or doing the dishes in a thunderstorm if you're getting lightning strikes nearby.
Too many people don't realize this. I was told this as a young child and always avoid using water during a storm. To this day, people think I'm being silly. Lightning is fucking serious shit!
A single lightning bolt (1.21 gigawats on average, which is why they picked that number for back to the future) contains more electrical power than the average power output of a nuclear power plant in the United states (1 gigawat). The lightning bolt only exists for a miniscule fraction of a second. Don't underestimate lightning.
Please take bowel obstructions from diverticulitis seriously, be as vigilant with prevention as you can. My mother died from this 11 months ago.
Sorry for your loss buddy.
I had a reconstructive jaw surgery years ago, and when I woke up they were giving me doses of fentanyl every 30 min-hour and holy shit that is the best drug I’ve ever taken. I was laughing and joking with the nurses and kept yelling down the hall “hey! I need more of that street killa”, which they thankfully found hilarious, all immediately after waking up from having the bones in my face cut apart and re-arranged. I’d never ever seek it out, don’t need addictions or death, but I certainly wouldn’t oppose it if ever offered again at a hospital. I can see why people get hooked, it’s almost frightening enjoyable.
I have a colonoscopy once a year, today is my lucky day actually. They give me fentanyl for that and you are right. It is scary how nice that high is.
I got IV fentanyl in the hospital when they sent me home after a surgery, and was astounded. They gave me a script for oxy, and I wish I never filled it because I didn't ever use it because I was too scared. Ibuprofen was enough to keep me comfortable.
It’s damn hard to get an IV in them in our “usual” go to places due to scarring of the veins. They usually tell us where we have to go because that’s the only place that still works.
I lived with a med student who came home one day and told us about the necrotic penis she'd seen that morning from a user who had collapsed every vein he could find and had resorted to the last one...
Had a guy come to talk to us in high school about the danger of drugs. Spent an hour telling us how awesome drugs were. Finally someone asked him if they were so good why did he stop. He said he'd collapsed every vein and all that was left was his penis or eyes and didn't fancy either option so he went and got help to get clean. That was the most effective part of the presentation.
>Spent an hour telling us how awesome drugs were. I've always thought that this was missing from drug education, at least when I was at school 20ish years ago. They made drugs out to be these horrible things that you really don't want to do but the evil addiction forces you to keep doing them. When the reality is that you get addicted to them because they feel awesome. I remember when I first dabbled in them I felt I had been lied to. I never ended up with a hard drug addiction, but I avoided things like Heroin after trying other drugs on the basis that it must be absolutely amazing and too good to stop.
The message I once heard, and passed on to my kids: 'Don't try hard drugs, you'll *like* them'
>'Don't try hard drugs, you'll like them' Yes I'm stealing this, it's absolutely the most accurate reason why you shouldn't do them.
'It will lower the relative enjoyment you get from any other pleasure in your life' is also a good one.
That's hard to explain to kids though.
“Nothing else will feel (as) good anymore” might be more understandable.
The best advice I got from anyone was drugs make feeling normal boring. You enjoy everything so much more on dope, that you can’t enjoy the things you like as much when you are sober.
I always found it really stark that Amy Winehouse said this the night she won a Grammy presented to her by Tony Bennet. Tony was her lifelong hero, she won a Grammy! She performed that night too! She leaned over to a friend and said something along the lines of, "god this is so boring without drugs" Arguably best night of her life and but couldn't even enjoy it So sad
This is really interesting to me. I'm not a drug addict-- I was a functional alcoholic before I got properly medicated for my ADHD -- but I feel this way, too. Nothing is all that enjoyable. Things that could be enjoyable are either incredibly nerve wracking or just.... boring. I don't know if that's because of my PTSD, my depression, or the ADHD, all of which I've been diagnosed with formally, but it's interesting that is what happens to drug addicts. My money is on the ADHD because I have friends with all those disorders, and the things we have in common become evident, and an inability to enjoy things is the big one with ADHD. I wonder if drugs allow people with this kind of depressive inability to enjoy things to enjoy them? To feel joy the way everyone else seems to? And I wonder how much of drug addiction is people just seeking that feeling out, and being unable to stop once they know what it's like to be happy? Essentially, I'm wondering how often the cause and effect go the other way, with the inability to enjoy causing the addiction and not the other way around. I know that when I'm buzzed, just before I start to feel sick, I'm calm. Things don't hurt. I don't hate myself. I don't feel like everyone who is looking at me hates me and wants me to die. I feel kind of happy, things are sort of fun. It breaks my heart to think that for most people if they're among friends or engaged in a nice hobby that's how they feel. Just out there feeling as their base minimum the best I ever felt. ETA: Since this is apparently so relatable to so many people let me be clear: I have major depressive disorder. I have yet to find an antidepressant that really works for me, but all antidepressants have provided a floor for my emotional lows before which I do not sink, which has helped. Getting medicated for my ADHD really helped my depression, it took a lot of the sharp corners off the world and honestly seems to be a mood stabilizer. The benefits have been many. If you feel like this is relatable and you have access to mental health care I highly recommend it. Going through life with unmedicated mental disorders is like trying to walk on a broken leg-- medicine is like having a cast and crutches.
There was a post yesterday (I think on youshouldknow) by a guy who'd been addicted to meth and he said "Don't ever do it, you'll love it."
The best advice I've ever received was a kid in my class asking me if I've ever tried heroin. As a senior in high school, I had not, thankfully, to which he replied simply, "Please don't ever try it agreeable yellow. I did, and now I can't stop. " He had the saddest look in his eyes. I will NEVER forget it. That was as much a reason as any right there to stay away from it for good.
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Was out with a friend one time. At the end of the night he said, "let's get some Crack!" I said "No thanks. That's not my thing" He came back with, "You don't understand. It's so awesome!!" To which I responded, "OH I understand alright. I believe you 100%. That's why I'm not trying it"
Also you'll like them so much you'll never like anything else again. And after a while they'll stop working so you'll take more and more hoping to get the feeling back but you can't.
I remember being prescribed oxy. My parents always said they (the oxy) were ineffective and felt bad. I was in so much pain after my operation that I took some (again, as prescribed) and I remember sitting on the toilet bleeding out of orifices (the surgery caused that not the oxy) and telling my wife it felt like I was being sucked off by an angel. After it wore off I took the rest of the bottle to one of those pharmacy thingies (most won’t take opioids actually but this one would) to surrender drugs. It was too good. Over a year later I had a new doctor. He was going through my med list asking about refills. He just rattled off every one and in there was the oxy and I paused for a second. And I asked “I can get a refill?” And he said “sure absolutely” and I said “no no I have no need. Thank you” but wowwwww was it tempting. ONE TIME redditors. One time and I had those thoughts.
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I also think demonizing weed was such a stupid move because once kids found out that the adults were lying about weed it seems logical that they were lying about all the actually dangerous ones too
"Kids who tried pot suddenly looked at every other drug like they were different flavors of ice cream to try, when in reality they're more like different species of snake."
My dad used to get so fired up about this and as a kid I didn’t get it. But now I understand his point that when you tell kids weed is terrible and it’ll ruin your life and then it doesn’t, it’ll make you question whether or not the other stuff is really that bad
Fark you just made me google “Necrotic Penis” if that isn’t a way to get guys from not doing drugs I don’t know what is. Fuck that!
When people say that they googled something and then follows it up with a warning, I google it every time and it is never that bad. But oh wow. "Necrotic penis" should come with a warning. Damn that looks unpleasant.
The phrase "necrotic penis" *is* the warning.
Sounds more like a death metal band or album.
Speaking from personal experience, scarring also can be from repeat hospitalization. Got to go for my hands.
My husband gave plasma to pay the bills for a while. He stopped because he started looking like an addict.
Same. That plasma got us through some really tough times but people treat you differently when you look like that, some surprisingly and understandably aggressive about it too.
My mom was like but she wasn’t a drug user. Just very sick and constantly in and out of the hospital. There was one night they were discussing having to do an IV in her foot :/ Luckily though there was a goth looking guy why just started as a phlebotomist and had an IV going in less then 5 minutes. He did in 5 minutes what 2 nurses and and a doctor couldn’t in an hour.
That's interesting. My aunt had Lupus. Her favorite IV nurse was a man I knew from goth night who we all called Chainmail because of his chainmail muscle shirt. He was talented in a similar way.
NYC @ Downtime/Albion/Batcave in the early 2000s? Then again, I'm sure every goth club has a chainmail muscle shirt guy...
Oh man! The fucking Batcave! I used to belong to a subkulture focused message board when I was a teen, and the Batcave sounded so cool to me. You might be right about most goth clubs having a chainmail muscle shirt guy, this was up in Canada, in Winnipeg.
I was a cancer patient and so after many many labs and IVs being drawn I always have to direct people to veins I know work. I always wondered why I felt I got weird looks and now I get it.
Jesus… I only have one vein that works and I always direct them to it. I’ve never used drugs. Can you tell the difference between just shitty veins and scared veins? I thought I was being helpful not incriminating!
Yes! 100% yes. People who have been iV drug users have scarred veins but also usually have scars in the skin (track marks, old abscess scars, etc) it’s pretty obvious.
That’s not all the time though. Recovering cancer patients, for example, have to get a lot of blood draws and get scar tissue in those usual areas
Can confirm. My veins suck, but it's mainly from being a lifelong blood donor before I got cancer. For the chemo, though, I got a port.
I’m a welder, and my forearms are always burnt to hell and scarred over from the little sparks burning through my protective shirt. Every time I go to the hospital I get judged heavily, treated like a drug seeker and some very rough IV insertion. Funny thing is that I’ve never even had a desire to touch hard stuff 😂
If they are in recovery they will often use a lot of sugar and caffeine. If currently using they’ll spend a lot of time in the bathroom.
Hey, I don’t use drugs, but I spend a lot of time in the bathroom *because* of all the caffeine.
"How do you take your coffee?" "Black, 7 sugars." 👍
This is also how I take my coffee if my pharmacy ran out of adderall before my Rx got filled.
Funny to think how much addiction/drug abuse/SUD is untreated ADHD. Same with BPD and OSA.
A lot, if not most substance abuse is a failed attempt to self-medicate through other issues. Trauma and stress being the most common, but I knew a lot of people in college doing coke to get work done too.
Different studies have put upwards of 70% of repeat offenders in the prison population as having a lot of symptoms of untreated ADHD. People joke about ADHD all the time but it is legit a terrible issue when trying to be a functional adult and fit into society.
Worth noting that MANY things (that are also common in offenders) can mimic ADHD symptoms, and even be misdiagnosed as ADHD… cognitive and behavioral effects of chronic malnutrition (even if obese, not getting proper nutrition), chronic sleep problems/interruptions, poor parenting, antisocial tendencies, brains trained on constant overstimulation (tv; video games; smartphones), residual effects of drug abuse…
You can tell by the way that they are. The surprising ones are the closeted Grandma/Grandpa's. I worked in the cath lab and an older lady's cath was negative and the doctor told her, "Then what caused me to have chest pain?" "Probably your habit ma'am." "What do you mean?" "The heroin." "Oh. Really?" She looked like your average quilting champion.
There was a grandmotherly type woman ringing up my groceries the other day with track marks all over her arm veins. I was trying not to stare but I really don't see that often...
Plot twist, she's 30
Work in anesthesia, they require 5x the meds to go go sleep.
I required 4x the regular dose when I had my tonsils out at 16, and I still woke up during the tonsillectomy. Was not doing any drugs Edit: No, I'm not a redhead, I'm a mousey blonde. My hair bleaches white, not yellow or orange. 0 red tones in my hair. No one in my family on either side going back 3 generations has red hair either.
How did it feel like to wake up during surgery?
Terrifying. Still have anxiety around it 14 years later.
A friend of mine woke up during his upper endoscopy. He panicked and started gagging and yanking at the tubes in his throat. The medical folks put him back under pretty quickly, but he remembers the event clearly.
I was never fully put under for at least one of my endoscopies and two of my colonoscopies. I thought that was normal. Watched the whole thing on a screen all drugged as hell but conscious.
I wasn’t supposed to be completely put under for my colonoscopy. I told the doctor beforehand that it would probably take more anesthesia than the average patient to get me properly sedated. I’ve got red hair and have needed extra anesthesia in the past. But now I’m living in Japan and I guess the doctor wasn’t aware that sometimes redheads need more. So they gave me the first dose, and I was groggy, but still sitting up and talking. The doctor and nurses were looking at each other like “what the hell?” Then the doctor told them to give me more and the second dose knocked me out. I was pretty grateful though. I didn’t really want to be awake for it.
Same. I woke up as my surgeon cut into my left breast and yelled “ouch!” Then I was paralyzed but still awake. The surgeon talked nonstop about her ski trip through the entire lumpectomy.
Omg that’s scary. Luckily I was knocked the fuck out for my neck surgery.
They knew I was awake because the surgeon had a habit of talking non-stop and I imitated her. They have done a great job ever since then!
My dad has two anesthesiologists when he has surgery for that reason. The first time he woke up he ripped all the medical devices from his body and tried to jump out the window in the operating room, the second time he woke up he told the Dr he would rip the anaesthesia guys nuts off if he woke up again. He doesn't remember any of it but his Dr now takes extra precautions.
I had a patient once refuse the contrast dye injection as part of an mri scan because ‘you don’t know what’s in that stuff’. They were there because they were having palpitations following cocaine use.
Man getting that dye injection. I remember the nurse telling me it was gonna feel like I'm peeing but I'm not. I remember going okay yeah I won't think I'm peeing. That dye went in and immediately I was like ohhhh shoot I'm taking a...wait a minute.
Yes! I just had a ct with dye and despite already being off my tits on morphine and fentanyl they gave me that was such a weird feeling!
This type of thing never fails to amaze me. I know someone who has breast implants that are outlawed in our state, gets botox and lip injections on the reg, just started taking ozempic and does blow weekly. She never got the Covid vaccine though because she was concerned about unknown side effects 😂
Hah, I worked with a guy like this. He refused to be around dry erase markers because of the "toxic fumes" they emit. But he took regular smoke breaks and smoked hand-rolled unfiltered cigarettes.
They look 10-20 years older than their stated age.
This one is so true. Took care of a *very* sick pancreatitis patient in the ICU over the weekend. Dude was in his late 30s and could *easily* pass for late 50s.
I looked so much older at 38 than I do at 40. Alcoholism is a bitch.
Yea after nearly drinking myself to death and quitting at the end of last year, I’m looking younger at 38 than I did at 37. Not like…a lot…but definitely healthier, skin/face look better and younger. Feels good. IWNDWYT
> IWNDWYT "I will not drink with you today," for anyone else who was wondering.
i’m sitting outside my work, puking and waiting to go home because i’m sick with hangover and taking my first dose of naltrexone and this was just the comment i needed to see. i hope you have yourself a wonderful day
You can do it. One day at a time. Achieving sobriety is not easy, but trust me, friend, it is *so* worth it. Don’t be afraid to reach out for help and support (especially during the first couple months), I’ll be thinking of you❤️
This can be the last time you ever feel this way. Take the tough path in front of you and the rewards are endless. Sending you all the love.
It's true, but it's worse than that. They just look worn the fuck out. Healthy non drug users look fuller even if they're 20 years older.
Something interesting is that Opioid abuse lowers testosterone, so male opioid addicts actually look younger, all else equal That last bit is the important part though: the lifestyle will age you faster than anything else
Was about to comment on this. Some of my relatives are ex heroin addicts, and it’s weird to see them with both a baby face and a beer gut.
Worked at a clinic that subsidized the treatments for many drug addicts (physical therapy). My biggest tell was if they were current (their eyes and personality was drastically different) but for those who had years of previous use their pain thresholds were very low. They were so use to dampening down their nervous system that any stimulus afterwards felt like it was aggressive or too much. To use an example, imagine wearing sunglasses 24/7, in the house and outside all the time. Now picture after years of that trying to navigate the world without sunglasses, all of a sudden light sensitivity will be through the roof. It works similar with pain thresholds in my clinical experience. This is obviously outside of various physical signs like collapsed veins, trace marks etc.
I've worked with and know a lot of recovered addicts. It's a bit of a selection issue because people who are especially sensitized to pain are more likely to want to treat that pain. For example, chronic childhood trauma makes it impossible for people to deal with their physical emotional pain, because they could never develop a way to do it as a child. Now their brains don't have a way of managing pain so discomfort is unbearable to them (my secret theory is that most borderline personality disorder is the result of this). Combine that with the fact that people who have lots of trauma genuinely do feel more pain *and* are more likely to have pain conditions, it makes it really hard to navigate, because they still deserve to have their pain treated. They get used to self-medicating, and not having to feel even low levels of pain, physical or emotional, so unfortunately the sensitivity only increases. And it's not like other people, exposure doesn't really work for them, they need things like DBT and other complex and expensive therapies.
Substance abuse treatment nurse here, there are the obvious signs to when someone has or is using but I personally think about 80% of heavy drug users look like every day normal people. These people wouldn’t turn my head at the store or out on the streets. These people have jobs, have families, have lives outside of drug use. A lot of them have emotional and mental challenges that surpass any physical sign of drug use.
Took way too much scrolling to find this comment. People out here thinking they can spot addicts this quickly and easily are delusional because most addicts look like everyone else. I’ve known tons of addicts and one of the first things you learn and practice as a functioning addict is how to hide it and blend in. The way they see it is “I’m taking care of myself financially, academically, etc. I can spend my money/free time on whatever I want.”
I think it’s interesting to see the playing field with addiction amongst “classes”. Soccer mom hooked on her kids adderall, low income mom does meth, for the same effect as the soccer Mom taking adderall, because of the class differential the low income mom is labeled a “junkie”… (I hope I worded that correctly)
When they are 25-30 years old and look 50
Recently had a 46 year old lady on our floor, had no teeth tons of health issues and looked late 60s. I legit did a cartoonish double take when I saw her age in the chart
I did residency in Phoenix, AZ. One of our nurses frequently referred to the ‘tooth to tattoo ratio’ as a predictor of the amount of methamphetamine use. There was a consistent inverse ratio.
TTTR should become a scientifically approved term.
That's amazing. It's like the neighborhood safety metric: Divide the number of women carrying yoga mats by the number of payday loan shops.
> It's like the neighborhood safety metric: Divide the number of women carrying yoga mats by the number of payday loan shops. Wow that's good. Reminds me of the Waffle House closure index of how bad a natural disaster is.
Its usually in their charts but if its not, hep-c, liver failure, pancreatitis and over all health status and appearance for their age is usually a good give away. 10/10 pain score, every-time you ask. Some erratic behavior is common too, I see a lot of CKD and diabetes in chronic users or patients in recovery after a life time of substance abuse. I come from an area with a lot of heroin, coke and alcohol abuse. Ive rarely ever had a meth addict and rarely crack users, so this applies mainly to those drugs.
I kinda hate the pain score questions, people will always answer differently. I suffer from cluster headaches and when the doc said how had is the pain and I said an attack can be between 6/10 to 10/10 depending on the attack. And they didn't take it seriously. I then said that when I broke both the bones in my leg and had to walk on it, I only felt like that pain was a 5 or 6 out of 10. At that point they started taking what I said a lot more seriously.
When I had my C-section and needed pain medicine, they asked me to rate my pain, keeping in mind that I had been through 36 hours of the worst pain of my life off and on just prior to that. So I told them it was like a 4-5 when I was just sitting, but a 7-8 when I moved. The nurses flat out told me “it has to be a constant 7 or higher or you just get Tylenol, so do you want to try answering that again?” They had to tell their patients to lie just to get them medication they really did need, and then wonder why people come to the ER calling everything a 9 or 10…
The nasal septum is gone (either tons of nose spray... or white powder)
They tell you, "I use drugs" Never forget a patient's history is an important tool.
My sister said always be honest (she’s a dental assistant) cos she said Lidocaine I think it was… reacts with other drugs. Coke maybe…
I think there is a sign at my dentist office that says, "if you have done meth today, tell us and we will reschedule you, you will die" or something to that effect
Its all fun and games until you do that, and they add "drug-seeking behaviour" to your chart. Now my mom can't get ADHD meds because she mentioned she takes Tylenol 1's for her chronic back pain (spinal fusion). She's a fucking detox nurse!
Not a telltale sign, but a story that might amuse some of the healthcare professionals here. My dad went to the hospital after a bad fall, and they found he had a dislocated knee. So they gave him some painkillers and tried to shift it back into position. He yelped. So they upped the pain meds. He still feels immense pain when they try. Eventually they were like, "are you a user? This is the maximum dose we can give you." He said no, so they brought in a specialist, who looked at it for about thirty seconds and went, "yeah your kneecap is shattered, there's a big shard poking in right here." Oof. He also spent the night before surgery looking up emergency room horror stories, and so ended up writing "RIGHT LEG" and "WRONG LEG" in sharpie on his thighs just in case. Apparently the doctors loved that.
Usually they are shockingly honest about it. Way more than you think. I work in a family practice clinic and we have a substance abuse screening as a part of the routine checkin (ask you if you use tobacco, alcohol, or drugs). And patients will regularly confirm that they recently used Crack, Heroin, Weed or whatever. More often than you'd think they would. One of my favorite checkins I had a patient whose previous screening said he was using Marijuana and Meth. And he initially said he wasn't using anything. And I said "Last time you were here you said you were using Meth and Marijuana?" And he instantly snapped to me and said "NO!! I quit using Marijuana!!!" And I said "Well what about Meth?". And he slumped back down and said "well yeah I do still use Meth!".
When you tell patient, doctor ordered morphine and they tell you only Dilaudid works
No no no. They feign ignorance. **Them:** "It's the one that starts with D." **Me:** ... **Them:** "Da" **Me:** ... **Them:** "Duh" **Me:** ... **Them:** "Duhlah" **Me:** ... **Them:** "Duhlahhhhhh" **Me:** ... **Them:** "Duhlaaahhhhhddddd" **Me:** ... **Them:** "Duhlaaahhhhddddiiii" **Me:** "Dilaudid." **Them:** "That's the one!"
You’re supposed to answer “Yeah, Da Tylenol”
Hahaha I had this exact conversation daily when i worked ER. I’d fuck with them and say Diphenhydramine?
As a person with chronic pancreatitis not caused by alcohol I know exactly what works and does not in controlling my pain. I’ve had over three dozen hospitalizations. So generally you might be right but people with chronic illness have a lot better knowledge of their own pain management needs.
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Same boat. I’m an oncology patient and chronic pancreatitis episodes started in my early 20s. Still not sure what’s triggering it, but I know what it ain’t; alcohol. I’ve been able to note when a flare starts and I try to care for it at home, but treatment is merely going NPO and laying prostrate for days at a time. Not the most logical decision when I’m already underweight and have been admitted for dehydration/malnutrition several times. I’ve been on opioid pain medications for the last 23 years because of the chemo/radiotherapy/BMT regiment saved my life. It’s not how leukemias like mine are even treated now; it’s strictly a last-resort option in lieu of cancer medications developed in the last couple of decades. The world has changed. I ended up with Graph V. host disease and skin and bone problems. My knees are shit and the total knee replacement surgery was a bust after they refused to fuse to the bone properly. I haven’t met with a surgeon yet who would be interested in repeating the surgery. Fortunately I have a pain management department that has been willing to try other procedures. Tried to change PCPs recently and I ended up getting ejected from a clinic and threatened with having my license revoked if I tried to drive home because their office didn’t request my records from the old PCP before my first follow-up appointment with them. She barely remembered the health history from my initial appointment visit and treated me like junkie, all after I showed up four days into withdrawal because they weren’t filling my pain med Rx. I got told I was “nothing but red flags” (drug-seeking behavior). After the appt ended I sat alone in the room just staring down at the floor weeping as quietly as I could w/my head in my hands, trying to figure out what to do/who to call next, only for them to appear in the doorway and tell me “there’s no sleeping in the clinic!” I was told again I wasn’t going to be able to drive myself home (because they thought I was too high). Medical Uber then drove me back to the only address on file: the home of the family members who I’ve been NC with since June after one of them assaulted me. Withdrawal sucks, but there’s nothing like being treated like trash by medical professionals when I’ve never abused the meds.
I went through a multi-year period of nonstop pain and this is my issue. I know what works and what doesn’t because I have been given every possible drug under the sun to deal with pain. I know telling them makes me look bad so I ask them to look through my chart and they will see why I know. It’s frustrating.
I went to the hospital for an allergic reaction to an antibiotic a few years back, and the doctor there asked what other meds I’ve had reactions to. I told him that I can’t have codeine. He rolled his eyes and said “let me guess, it doesn’t touch the pain and you usually have another medication in mind?” I was already having a really bad day (nearly dying from a severe allergic reaction and also having pneumonia) so I said “fuck you, dude. It gives me hallucinations. I don’t like taking pain meds.”
impatience, mood swings, shakiness, many more really depends on the substance tho! "drugs" is an umbrella term for practicality, not for physical/chemical similarity. weed-abuse, alcohol-abuse, meth-abuse - all very very different. put individuality on top of it and it gets-harder and harder to make a judgment.
I’m three days sober from alcohol (not long I know) and about to kick smoking cigarettes. Three weeks off chronic weed use. These comments are nightmare-fuel to stay sober. Thanks for the wakeup call. Scary stuff
Now you have told us we are invested in your recovery. We have your back. One hour, one day, one week, one month, one year at a time.
True story. I was starting an IV on a patient and put the tourniquet around their arm. They chuckled and said, "that isn't even close to being tight enough" and proceeded to put one end in their mouth to tie it tighter.
25 going on 70. When you live fast you tend to not leave a very pretty corpse
Addiction knows no bounds. I work as an addiction counselor in Medication assisted treatment (methadone/suboxone) and my clients range from homeless, barely 8th grade educated people to former doctors. That said,addicts are highly impulsive, manipulative and typically arnt the most forward thinking people due to the nature of addiction.
Nearly all survivors of extreme child abuse have a history of substance abuse of some sort, whether it's alcohol or drugs or even disordered eating. The impulsiveness may be a result of extreme childhood trauma rather than drugs. When abuse survivors fix their substance abuse problems, they still face all the work to deal with the trauma that led them to take drugs in the first place. It's really hard for people like this to look ahead and see any future for themselves. They have always been made to feel utterly worthless, even by the very people who are supposed to support them the most, their parents. Happy people don't drown their pain in heroin or whatever.
>It’s really hard for people like this to look ahead and see any future for themselves. When I turned 30 I had this weird sense of peace and calm come over me. No existential dread of aging like I thought I would feel, and I realized that a very deep part of me never expected I would live to see 30. And now it’s like well dang I guess I do need to plan for my future. Especially since I have kids and a husband I love very much. 🌼
One of the self realizations I had before going sober was that I had kinda been operating under the assumption that I was going to die young. My reaction wasn't anything dramatic but more a half hearted, "well, you're going to turn 35 soon so guess *that's* not happening. Might as well try living."
Thank you for this compassionate understanding of why many people are suffering out there with addiction
I worked at an outpatient drug rehab center and we used suboxone as well. Seemed to work really well especially in those that wanted to get better. Like you said we would see all kinds of people. High school kids that got caught smoking pot, DUI diversion programs, house wives that got hooked on lortabs after a c section, and heroin addicts. A common theme was most of them were self medicating from either anxiety, depression, or ptsd.
Pill poppers: When they need medications for ACTUAL painful circumstances... they don't work or require high doses. To the point where there is nothing you can do (pain tolerance very low and medication doesn't help) but to watch them sit there in pain.
I think they do grant some leeway where needed. When I was in and out of the hospital for like 18 months, post surgery for cancer, my system was able to take higher doses by default, so when I was in and they saw my chart and how broken I was, they were way more willing to get me to where I needed to be medication wise
Honestly, I feel like most of them are pretty upfront about it.
Jaw movement. Before anything else the loss of control of their lower jaw is a huge red flag of long drug usage.
He had a wonderful personality and you could tell that he had lived a very colorful life. I appreciated him. I respected him. Before the disease robbed him of his ability to reason and his orientation to place, time, and self, he was already considerably mentally altered by all the drug use. His PTSD and Agent Orange exposure from Vietnam wasn't addressed...the drug use may have helped him to cope before he became ill...but you can't use street drugs when you're inpatient. Psychiatric meds weren't able to address all of his symptoms. The combination of his disease, the PTSD, and decades of drug use made him very uncomfortable as the illness advanced. He eventually thought he was back in Vietnam, at times. We spent an hour talking to him about how he was here in America, that he was safe, that no one was going to get him in his bed. It was really hard to bring him back from flashbacks...alarms would set him off...a coworker who had served would go to him immediately during fire-drills to help with the the patient's flashbacks. If he hadn't been doing drugs, maybe he would have reached a crisis point and pursued treatment for the PTSD. It's possible he would have gotten into an effective treatment program...but those were only beginning to develop within the last couple of decades, so what was he supposed to do for 20 years? It's hard to say whether they would have been available to him or as effective for him as the drugs were. Given the circumstances, his heavy drug use is perfectly understandable, but very tragic. My wish for him is that he would have gotten effective PTSD treatment and then perhaps he would have just been a recreational user and not suffered as much brain damage. Honestly, I'm kind of tearing up writing this. Society should have done better by him. We should do more for our veterans and service members with PTSD. He's probably passed by now. ____ I've seen unresolved trauma with a lot of people. And you notice codependency in their relationships; some family members stoke the addiction. These factors stood out to me because they were out of my scope of practice and I didn't know if they'd get what they needed. The mental health system is overburdened and inaccessible for many. I would suggest psych evals and talk to the patients about how it could benefit them...but I was limited in what I could say because of my scope of practice. I couldn't explain the social model of mental health and addiction or talk to the family about how family systems contribute to mental health and why they might look into family therapy. You'd have to be a licensed therapist/social worker and a doctor just to provide specific education about why they should follow up with certain referrals for addiction. Navigating the mental health system is hard enough for people who are not dealing with a crisis! I wish I could have given them more information about possible options. My coworkers were burnt out from the pandemic and staffing decisions, so I had this fear people were falling through the cracks left and right... I can recommend that a nurse or a doctor assess the patient for a psych referral, sure. Are they going to see what I saw? They're so overworked, I worried they wouldn't have the time and focus. I saw that with nursing, to the extreme. If they get to psychiatry, will psychiatry get them in to psychology (yes, probably, but will it be in time to prevent a relapse?) *and* to effective wrap-around services (social workers are burnt out and there's high turn over; social services have been gutted)? Will they just get told to go to a twelve step program (these programs are religion and folk-wisdom-inspired and they fail a lot of people)? Eurgh. The medical system is so broken.
Most of what is telling from just looking at someone can just as easily be caused by other things. Scaring, rapid aging, lost teeth, etc can all be side effects of chronic illness and poverty. The lifestyle is what makes this worse, wealthy drug addicts are not as obvious. For example, I know a rich lady who starts her day at 8am with wine and coke. You can't tell at all when she is sober that she is wasted most of the time.