Opioids without addiction

Bob Nicklas -Fentanyl Saved My Life

Bob Nicklas underwent a complicated surgery to treat his lung cancer.  Fentanyl was the only drug that brought him real pain relief.  His doctors were vigilant about getting him off the drugs as soon as he could manage it.  

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Throughout my life, I’ve had a high tolerance for pain. I once played volleyball for two hours on a fractured ankle.

The doctor said you’re probably going to have some considerable pain. It gave new meaning for me to what considerable pain was.

Back in 2014, midyear, I developed shoulder pain, the type of shoulder pain you get maybe from lifting the wrong way. I went to an orthopedist. He suggested physical therapy. Went through physical therapy off and on for several months. It did not get better. Finally my wife said, “Look, there’s something wrong here.” We went to an emergency room, and within an hour the doctor came out and said, “I’ve never learned how to dothis any other way but directly – you have lung cancer. “

I had advanced stage three cancer.

In December of that year, I had what they call a lobectomy. So I had the upper left part of my left lung taken out, three ribs, various associated muscles, nerves. It was a seven-hour surgery. It was pretty extensive. To this day, I remember waking up in the recovery room, my wife Terri was there, so was my son Tim and my daughter-in-law, Karlee.

The first words that I remember out of my mouth were “Please someone help me with the pain.” I have never experienced pain like I had.

For the next what seemed like a lifetime, but it was over the next half hour to an hour, they played with a combination of painkillers which included fentanyl, oxycodone, a nerve medication gabapentin, and morphine. Finally, I felt like I was drifting off. The cocktail had begun to do its work.

I was in the hospital for six days. Once I got home I remained on gabapentin, fentanyl, and either oxycodone or Oxycontin -- whichever was doing the most effective job.

For me, fentanyl was probably the most effective. I was on a patch. I can’t remember exactly what the dose was but the patch was changed every three days. And I was on that for probably a good six weeks to two months after I was done with surgery. I still had pain throughout the day. Now some of that pain was just the surgical pain of having an incision, which went from the bottom of my neck down to below my shoulder blades. I could barely comfortably lean back. And that lasted for several weeks, even with being on the cocktail I was on. The fentanyl, though, was the most effective at keeping the pain down to a manageable level. And it was also the last drug I went off of.

Thankfully, I was at Johns Hopkins, and the doctors there basically, from the day of post surgery, were encouraging that I should take the drugs for as long as I felt I needed them but to be aware that the goal was to go off of them. Which was, I think, an important mindset because the pain could be really severe at times. But I was committed to try to go off of them in as rapid and judicious a way as I could.

I was a smoker. I was addicted to tobacco. So I had some firsthand knowledge of what addiction can do to you. I was in pain because of my addiction to tobacco.

My father was a doctor. He was in practice with someone who became addicted to heroin. And when my dad discovered it personally – I mean he walked in on his partner injecting heroin, and he left within the month. My dad was the one who – he would try to prevent people from becoming addicted. I mean, he knew the power of the drugs that he was at times providing. And I was bound and determined not to become addicted to painkillers.

As I was discharged from the hospital, I was given instructions that when I was ready, I could follow to slowly get off each of the drugs, and a suggestion as to which drug should go first, which should go second, which should go third. And the staff would regularly check in with me, and I had to check in with them. And they’d say, “Do you think you’re ready?” And at a certain point, I said, “Yeah, I’m ready. I want to try to start going off.”

I didn’t experience any withdrawal. And I think it was because of the phasing. My doctors had a good sense of which one to go first, second, third, and a timeline to do it.

I have been a lucky person. A very lucky person.

I’m Bob Nicklas and this is my story.