Uncontrollable Shaking

This is a bleary hello from Alaska.  It took me 50 hours of traveling to get here from Germany (well, including a 21 hour stopover in Los Angeles to stretch my legs and get some sleep) and then 10 hours later I was sitting in a surgery center with my friend S, trying to take in all the information that was being thrown at me about how to take care of her after they fixed up the mess she’d made of her shoulder.  The only good thing I can say about the shock of all that traveling (which was too much traveling for an old fart like me) is that it exhausted me straight out of my jet leg (which ordinarily dogs me for days).  Unfortunately, S’s cat, who is distressed at being locked out of S’s bedroom at night (due to the cat’s grim delight in leaping from the dresser to S’s stitched up shoulder) and also likes to be fed at 4 in the morning but not the food that S said to feed her because the stuff the cat likes to eat is ridiculously expensive, is doing her damnedest to swat my circadian rhythm back into some time zone somewhat east of the Mississippi.  And, having been sent out to fetch re-usable medical ice packs at Walgreen’s yesterday evening, made the mistake of coming back with not just the ice packs but a big bag of Tootsie Rolls and I can now tell you that half a bag of Tootsie Rolls has almost as bad an effect on a body as a couple of Percocets, but in the other direction.

But, OMG, taking care of someone (and this is a fairly light duty, because mostly I am feeding the finicky cat, dealing with icing S’s shoulder, opening and microwaving cans of soup, and chatting to one very bored, groggy person) is exhausting.  You’re sort of stuck hovering around, on call 24-7, and you don’t really have much time to do your own work (like all the writing you are trying to get done and out there to make a name for yourself and thus someday and actual living). I can’t imagine what it would take to be a nurse or any other sort of caregiver for months to years on end with people who have more demanding needs than S does.  Yow.

But, argh, I think I lost half a year of my life last night after S had a bad reaction to her pain medications.  The surgery center gave her two prescriptions for pain medication – oxycodone + acetaminophen and something called gabapentin, which is also an anti-seizure medication.  But they also hooked her up to a nerve blocker, at least for the first 3 days, which numbs the nerves in her shoulder and arm directly, reducing her need for pain medications.  This is starting to wear off, though, so yesterday was her first day of taking the o+a and the gabapentin regularly.

At 9:30 pm, she took her third o+a (she could have taken up to six yesterday if she’d wanted to) and her third gabapentin (which was exactly the number she was supposed to take).  Then, in the time it took her to get up out of the recliner and head down to bed, she started to shiver/shake uncontrollably.  By the time she’d brushed her teeth, she was panting in a horrible, shallow way, shivering violently (even though her skin temperature was normal and she said she did not feel cold), and she was weeping profusely (the first time in the 30 years that I’ve known her that I’ve seen her cry).

She was scared and I was scared and I had no idea what to do.  Except, obviously, call the doctors, although it was after 9:30 pm on a Friday night and the surgery center had long since closed its doors for the weekend.

Or I could call 911, if it was that bad.  But was it that bad?????

It’s a weird judgment call to have to make when you have no experience with this sort of thing.  (Although S used to be an EMT and she said no 911.  On the other hand, she was drugged up on pain killers and having some sort of semi-convulsions so why should she be talking sense at that point?)

Well, thank goodness for the Interwebs.  I usually use an not terribly effective but reasonably private search engine, but this was clearly a job for Google.  So I googled “opioid shivering” but all I got were pages devoted to opioid withdrawal, which was clearly not the problem here.  Then I typed in “gabapentin” and even before I got the end of the word, the list of auto-completed search terms popped up.  The first was just plain old “gabapentin.”  But number two was “gabapentin shaking” followed by stuff like “gabapentin side effects” and “gabapentin severe side effects”.

So, yeah, holy cow.  Gabapentin has a lot of severe but common side effects.  Luckily, it became quickly clear that “uncontrollable shaking” was on the list of severe but common side effects that were not dangerous enough to warrant medical intervention.

By this time, S’s shaking and weeping and shallow panting were beginning to die down, so we phoned the surgery center, whose phones were manned by an answering service who connected us to whatever nurse was on call to answer telephone calls that night.  S explained the situation and said she was not going to take another gabapentin, no way, no how, unless they thought she absolutely had to and there was a way to lower the dosage or reduce the frequency.  And the nurse was just, oh no, just stop taking them.  Every time one of our patients has a bad reaction to gabapentin, we just tell them to stop taking them.  Have a great night!

And I, still a bit weak-kneed from having been scared half out of my skin, was just like well GREAT!  Thanks for warning us about the highly common rather frightening side effects of the drug you prescribed!!!!  Because that was a terrifying experience that didn’t need to be terrifying for either S or myself, if they’d just taken five seconds to mention it as a highly likely possibility but no terribly big deal.

Anyway, at least today is a little quieter because, now that the nerve blocker is wearing off and the gabapentin is a no go, S is taking as much o+a as allowed, which means she is sacked out and the only creature who is making demands is the semi-senile seventeen year old cat who is also now sacked out after having exhausted herself yowling into my ear (and wiping her snot on my nose) from 4am to 6am because she didn’t like the food I gave her at 4, but at least ate the expensive stuff I broke down and gave her at 6).

And I did at least manage to get out for a 2 mile walk yesterday (plus the half mile round trip out for medical supplies/Tootsie Rolls).  There are big, snow-covered mountains here!  And they’re not that far away.  Also there are road signs that warn you that MOOSE next 2 miles.  Where I live, the worry is more about hedgehogs and ordinary deer.


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