The House Hold Assassin: Fentanyl

Do you know there is an assassin in our house that has killed more Americans than entire Vietnam

War? And it is only warming up? Fentanyl-related deaths have grown 10-fold in the last year. And

Fentanyl has become the leading cause of death by overdose (it is hard not to overdose, as it is

enormously powerful). It is coming for us, or for someone dear to us. One way or another, many of us

will be badly hurt, unless we do something. And right now, we are not very well prepared.

As a pain specialist and anesthesiologist, I was awed by the power of this super-drug, created to blunt

the worst pains possible (as in being cut wide-open during surgery). It is an amazing product, that

revolutionized our field. But in the operating room, we have the supporting and monitoring systems that

would allow us to safely drive you back to a pleasant, albeit fuzzy-headed awakening.

Imagine boarding an airplane, strapping yourself in for turbulence, taxiing, taking off, and flying at 32000

feet, then, gently descending to the ground for a precise and timely arrival, under the care of a

competent, caring staff.

Outside the OR, at a party, at home chilling, or vacationing in paradise, you have no such protection.

Imagine being launched from a cannon at 32ooo feet. What are you going to do? Same path, not the

same outcome.

Fentanyl is a fine powder, 100 times stronger than Morphine, cheap to create, and extremely easy to

conceal for transport. It has been used to spike, lace, and adulterate every form of legal and illegal drug

(sedatives like Xanax, antidepressants like Prozac, other narcotics like heroin, Percocet, Hydrocodone,

stimulants like crystal meth, Adderall, MDMA). The presumption should be that any drug coming from a

person you know may have passed through 2-3 more pairs of hands that you will never know. Reassured

yet?

And while kids and other vulnerable people (along with a sizable number of innocent bystanders) die all

around us die every day, it is comforting to hear that the CDC, the elite forum of experts and policymakers

tasked with our safety and well-being, finally decided to call an emergency. For moneypox.

These are not serious people. While Fentanyl floods us through our porous borders, there is minimal

leadership and guidance from Washington, which is too busy with its own self-serving interests taking

center stage in this busy election season. This time bomb is left for the local leaders of communities like

ours to try to defuse and develop defensive systems.

As an initial kit of simple advice, I would humbly suggest:

-Narcan (a reversing and temporary antidote) stations backed by Narcan-specific trained people

everywhere drug use can take place (which means everywhere). Note: a single dose of Narcan will not

last too long, but only be able to buy the time needed to call first responders, who will continue the

necessary treatment.

-Fentanyl-testing strips that can identify its presence in other pills, powders, and liquids to be made

available in a similar manner.

-if you take drugs, do not do that alone; have a designated guardian everywhere you decide to use.

-if you receive your fix from anywhere else than a medical facility or pharmacy, understand that there is

a chance in 3 it will be contaminated with Fentanyl.

-dust from contaminated drugs can linger or float around and be ingested or inhaled, with dire

consequences, especially for the frail or very young; so, best not bring it in your house.

It is beyond my set of skills to devise a policy and its mechanisms. A nimble and rapidly responding blue-

ribbon group of healthcare and other first-responders, school administrators, local industry, and civic

leaders, as well as any others with experience, deemed useful would be a good start. I will contact the

City Hall, as well as the 2 great hospitals we are fortunate to have and ask for guidance.

I also would appreciate your thoughts, advice, and input at csavumd@gmail.com

I hope you will hear from us soon. Until then, be safe and take good care of yourselves. God Bless.

Breathe

“Take a breath”, “room to breathe”, “catching your breath”. Not just a manner of speech, but wise

words, rooted in ancestral knowledge of the miraculous benefits of the simplest medicine you never

knew you own. Slow, controlled breathing slows down your heart rate, lowers your blood pressure,

clears up the stress hormones from your bloodstream, nourishes your organs and clears your mind and

soul.

Try this: close your eyes while sitting in a safe, quiet, comfortable space. With the eyes of your mind,

for about two long seconds, follow a little particle of air as it starts its journey from the tip of your

nose, through your left nostril, to the back of your throat, down the windpipe, then descending to the

bottom of your lungs. Let it gift your body with its precious oxygen for a fraction of a moment, then

very slowly, over 4-5 seconds, let it flow out, without pushing it, like the air seeping out from the tiny

pinhole in a beach ball. Imagine all your pain, anxieties, worries, your anger, and resentment flowing out

like dark dust, leaving you soft, relaxed, light, and clean.

Try this for a minute, then next time maybe for 3, then 5. And whenever you feel overwhelmed, or your

batteries are empty, and there seems to be no hope in sight, remember about this secret weapon and

use it to cleanse and recharge. You are more powerful than you think.

Take good care of yourself.

NSAIDs In Acute Pain

Non-steroidal anti-inflammatory drugs (Advil, Naprosyn, and the large over-the-counter, so-called NSAID

family) are probably the top category of drugs used in the US.

There is a problem with that. I’ll address the short-term use today and I’ll return for a second shot at its

long-term (mis)use.

A study investigating NSAIDs for acute pain showed a surprising increase in the percentage of patients

who progress to develop chronic pain when compared to those who didn’t receive this treatment. But it

makes sense. Any acute injury to our body (especially trauma and surgery), will trigger inborn

mechanisms of defense and repair that are truly amazing in their complexity and elegance. We are made

to heal, repair, and recover. In short, we are born survivors. Inside us, we have the best doctor,

therapist, and coach we’ll ever encounter.

The initial injury creates an acute inflammation, which is an immediate and positive reaction mobilizing

armies of cells acting as defenders, soldiers, EMTs, scientists, and planners who set up to repair the

injured part right away. In a way, there is no chance of repair without the initial step of inflammation.

Unfortunately, widely used NSAIDs are powerful inhibitors of this process, and while they prevent the

acute inflammatory process, little is known of their limited power to promote healing (probably

minimal). It is possible that an incomplete repair process may start a chain of events leading to the

development of chronic pain. Maybe at this point, all we need is to get out of the way, rest a bit, and

allow the miracle of creation end evolution to take its course. Tolerating some degree of pain and

understanding it is a signal our bodies are starting to work should be the initial step in the recovery

process. Acetaminophen (Tylenol), ice, a short period of rest, and limited, carefully monitored use of

minimal doses of opioids (none of which interferes with the repair process), just enough to allow

progressive return to activity (which turbo-charges healing) may be a wiser solution if the rules of this

process are thoroughly discussed and agreed upon with patients before its initiation.

Take good care of yourself!

Disneyworld Days of Our Lives

Imagine every day as a day-trip to Disneyworld. You show up at the entrance, and get a painful, stinging

shock when you’re hit with the ticket price. Uncomfortably and reluctantly, you fork up the money. And

then you’re in, and now you are free to have fun and enjoy the rides.

Apply this method every day. You wake up, and you hurt and feel like you don’t want to do anything.

Your price of admission in the fun park of your life is a brief exercise routine that loosens you up, and

strengthens you just a little bit, and improves your balance and stability. And after 10-15 minutes (or

even 5), it feels just a little better. Your blood gets flowing, your muscles, ligaments, and tendons wake

up and you move a bit easier. And in the process, you will get better, and stronger, more flexible, and

perkier. Then, whenever the pain is becoming unbearable again, don’t give in. Add another 5 minutes.

And keep going.

You’ll go to bed in better shape than when you woke up. And every day, your body will thrive, grow

healthier, and become more capable to serve you better. You need to be patient though. It will take a

while. Like anything worth something, you must pay a price. You may get a bit sore, and that’s ok. It is a

sign of our tissues waking up and shaking off our burdens. That is the discomfort described as the sound

of weakness leaving your body. Inside there is a kid covered in old man winter’s weight. You can slowly

dig yourself out. 

Take good care of yourself

Everybody Hurts

Everybody hurts. Not just an REM song (pretty good, actually). For those among us who suffer and have

a hard time doing anything and everything because of your pain, you are not alone. If you have that

particular type of pain, other people have it too. Some suffer more than others, some are more disabled

than others, some lives are affected more than others. In our clinic, we see those who are successful at

handling and managing their pain, and those who are not as fortunate. We apply not only our

knowledge of anatomy, and physiology, but also the lessons that we are taught by our patients. We

listen carefully to your story, and with each patient, we learn what works, what doesn’t, and what

makes the difference between a successful and a failed approach. When we give you advice, we are not

just quoting from textbooks and articles. We share with you the recipes discovered, adopted and proven

effective for other people, some just like you. 

We are working towards creating a space where you can

donate your advice, your wisdom and the fruits of your experience, hoping they will inspire those who

are about to lose their hopes and will to keep looking for solutions. Sometimes, it’s probably best to just

get out of the way and let you talk among yourselves. And we know we’ll listen too, because we’re in

this thing together (we hurt as well). 

Take good care of yourselves.