The Demons Within and Beyond: Opioids, Addiction, Depression – The Finale (for now)

Like it or not, this “mess” is a continuing saga. In the US. Around the world. This may be the fourth and “final” post in this Demon series, but the opioid and addiction menace  continues. I’m sure there will be various follow up posts dealing with this dilemma.

Some of us don’t like to read about it, while others suffer from it. Those supposedly not afflicted in some way, probably think the subject matter is boring. Illness and dependency of any kind are serious, sad, oft-times deadly, but never boring.

Still I find I must press myself to write on about these matters because I want to share my personal thoughts, trials, tribulations and fears, as well as that info gleaned from pertinent sources. In one way or another, all of us can relate.

These demons are persistent and sneaky. Depression can attack anyone. I know. Opioids prescribed by a physician can help. Again, I know. Addiction can easily take place in any of us. Fortunately, I don’t know first hand about this aspect, but I’ve walked that thin line. I do know how easy it is to become addicted to . . . whatever.

The AARP Bulletin ran a feature story by John Rosengren on the opioid mess and some of the startling highlights begin with:

  • Almost one-third of all Medicare patients — nearly 12 million people — were prescribed opioid painkillers by their physicians in 2015.
  • That same year, 2.7 million Americans over age 50 abused painkillers, meaning they took them for reasons or in amounts beyond what their doctors prescribed.
  • The hospitalization rate due to opioid abuse has quintupled for those 65 and older in the past two decades.
The Opioid Menace

Illustration by Gregory Reid

I don’t think I’ve taken as many pills in my life as I have these past four to five years. Even before my cancer treatment of specialized chemotherapy (not the old fashioned kind) – pills and IV – I took medicine to treat a weird outbreak of lymphoma on both legs. About the same time I had surgery for skin cancer on most of my nose.

In my mid-sixties, I was eventually diagnosed with Leukemia (CLL) and, via a three year clinical trial, took various treatments of experimental chemo medicine. That med saved my life: Venetoclax, which I still take.

I’m not trying to discuss my past medical history since nobody really cares about that, but I am admitting that I’ve been through a lot that I hadn’t previously experienced. Throw in my wife’s stroke and damaging my back when I tried to help her as she was having her stroke (I attempted to pick her up from the floor after she slipped from my grip, thus resulting in me fracturing a few vertebrae in my lower spine — oooooh, that really hurt, damn!), eventually led to me being on painkillers and subsequently a very good opioid.

Aside from the physical pain, there’s the mental aspect of dealing with cancer, being caregiver to my wife, living a lifestyle neither one of us wants and trying to still earn some kind of living when no one wants to hire someone over 50, let alone past 60.

You guessed it; that’s where depression, anger, frustration, anxiety and who-knows-what-else factors in. It would be too easy to say I’m going crazy. I’m not even sure how that would feel. Hey, as a writer, maybe I could sit down and interview my crazy self and compare how these two people coexist. That might be interesting; it may also be a potential script for a new Twilight Zone episode – for those of you of a certain age.

But with so many different things happening just involving Pam, my wife, that are bureaucratically stupid, my anger lashes out at Pam (not good or advisable) since I can’t fight what I can’t see. I’ve learned you can’t fight bureaucracy; you learn to deal with it. However, that doesn’t mean you accept it. I don’t.

In large part, this is where my opioid comes in. As I’ve mentioned before, I take Narco (Acetaminophen Hydrocodone 10-325) to help with the pain in my lower back but it also helps calm me. I’m also getting back on Duloxetine (Cymbalta) or Fluoxetine since these meds help keep a good balance in my brain to help keep me on a more even keel and less temperamental. I am not one for shouting matches but my circumstances these past few years have warranted medical help.

I sound like a potential addict, don’t I? I’m not, don’t worry, but it scares me as to how close one can come to becoming a statistic. According to the AARP report, nearly 14,000 people age 45-plus died from an opioid overdose in 2015 — 42 percent of all such deaths in the U.S., according to the Centers for Disease Control and Prevention (CDC). The actual number is likely much higher. Overdoses in older people are often mislabeled as heart failure or falls.

Drug overdoses killed about 72,000 Americans last year, a record number that reflects a rise of around 10 percent, according to new preliminary estimates from the Centers for Disease Control. The death toll is higher than the peak yearly death totals from H.I.V., car crashes or gun deaths.

Analysts pointed to two major reasons for the increase: A growing number of Americans are using opioids, and drugs are becoming more deadly. It’s the second factor that probably explains most of the increased number of overdoses last year.

1140-opioid-menace-drugs-chart-aarp

Credit: NICOLAS RAPP, AARP BULLETIN

Synthetic opioids are driving up overdose deaths. Strong synthetic opioids like fentanyl and its analogues have become mixed into black-market supplies of heroin, cocaine, methamphetamine and the class of anti-anxiety medicines known as benzodiazepines. Unlike heroin, which is derived from poppy plants, fentanyl can be manufactured in a laboratory, and it is often easier to transport because it is more concentrated.

According to the C.D.C. estimates, overdose deaths involving synthetic opioids rose sharply, while deaths from heroin, prescription opioid pills and methadone fell.

Where is treatment in all this? It has become increasingly difficult to quit “cold turkey” as in a smoking addiction. Talk therapy alone is not the answer. Medication and therapy? Could make for some odd bedfellows. But, hey, if it works . . .

In Oakland, CA, the Highland Hospital E.R. offers patients suffering from opioid addiction a dose of buprenorphine, a weak opioid that activates the same receptors in the brain that other opioids do, but doesn’t cause a high if taken as prescribed. It’s one of three medications approved in the United States to treat opioid addiction and works by easing withdrawal symptoms and cravings.

ER Treats Opioid Addiction

Dr. Andrew Herring of Highland Hospital in Oakland, Calif., left, gave a dose of buprenorphine – it eases the symptoms of opioid withdrawal – to a homeless man who collected cans to pay for bus fare to get to the hospital. Credit Brian L. Frank for The New York Times and reporter Abby Goodnough

Highland, a clattering big-city hospital where security wands constantly beep as new patients get scanned for weapons, is among a small group of institutions that have started initiating opioid addiction treatment in the E.R. Their aim is to plug a gaping hole in a medical system that consistently fails to provide treatment on demand, or any evidence-based treatment at all, even as more than two million Americans suffer from opioid addiction.

Highland has provided buprenorphine to roughly equal numbers of blacks and whites, with Latinos, Asians and other ethnic groups filling out the rest. Many of those patients are homeless and most are on Medicaid, the government health insurance program for the poor that, crucially for Dr. Herring’s program, California expanded under the Affordable Care Act. Buprenorphine can cost more than $500 a month, putting it out of reach for many of the uninsured.

Since February 2017, Highland’s E.R. has offered buprenorphine to more than 375 emergency room patients. Two-thirds of them accepted it, along with an initial appointment for ongoing treatment at the hospital’s addiction clinic.

The demons within are relentless. They never give up in their zealous attempts to get us hooked. What’s more, we can become hooked without even being fully aware of it.  Let’s face it, we humans are great at denial.

I hope this series of posts, or at least one of them, has gotten your attention and made you aware that these demons are everywhere. Depression, opioids and addiction of any sort are not to be messed with. Each one on its own can be deadly if not treated. More often than not, we usually experience more than one of them at a time. This makes it even more serious and mandatory to get help before someone plans a funeral.

The Substance Abuse and Mental Health Services Administration offers a confidential help line that can connect you with treatment services in your state. Call 800-662-HELP (800-662-4357).

 

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9/11: Let Us Never Forget

I personally hope this date stays in our memory banks. I fear, though, that as each year passes, so, too, will the memories of that horrendous day. Here is a piece I wrote back then simply because I had so much going on in my head that writing it down was the only viable therapy I could think of doing.

 

Madness

 

The word itself hardly seems to even come close to describe what has happened to America. What may appear to be a disease by some is for others a way of life.

The English language does not contain enough descriptive phrases to do justice to what took place this past Tuesday, September 11, 2001. Some have equated the terror to what Japan did in their surprise attack on Pearl Harbor. Others feel that Japan’s attack does not even come close to the horror wreaked upon the American psyche in this the 21stCentury.

Utter madness.

Like many Americans last week, I gazed into television screens almost everywhere I went. I looked upon horror and destruction in stunned amazement. I was numb. I am numb. I can not believe what I have heard, seen and still read about. It is absolutely unconscionable to me that other human beings would perform this type of horror. It also scares the hell out of me that these kind of people do, in fact, perform these acts of terror and not think anything of it.

A lovely, calm morning in autumn with beautiful blue sky all around serves as a backdrop to one of the most picturesque skylines in all the world. The Twin Towers of the World Trade Center standing tall. Standing proud.

Unbelievably, our world is rocked beyond comprehension when an unannounced commercial airliner slams into the side of the North Tower. This, we find out later, is no accident. If this was not enough to test New York’s mental mettle, let alone America’s, a second commercial airliner flies into the South Tower of the Trade Center.

Flames spew. Balls of fire erupt. Twin towers ablaze with smoke. My God, this is real. This is not Hollywood. Yet, it is so surreal to me.

Time and again I see in utter amazement the different angles of the planes flying into the buildings and erupting in flames. Lives lost. God help us all.

Why am I writing this? I guess it’s medicinal in some respect. I feel like most Americans a need to try and put this horror into some kind of perspective. But how can one think in rational terms about totally irrational acts? Simple: one can’t.

Is this a wake up call for America? In many ways it is. Terrorism, unfortunately, will probably always be with us in some form of perverted fashion. Wherever there is a disturbed mind to attract money and followers to perform unspeakable acts against mankind, there will be terror in our lands.

Society must deal with horror and terrorists. We must so that order and normalcy will be restored. However, society itself must change. How? The jury may be out on that for some time.

As terrified a sight as the Twin Towers engulfed in flames, what would we feel or think if Lady Liberty would have been hit and destroyed? Our symbol of Freedom, herself.

What if?

They hit the Pentagon. They may have been headed to the White House and Capitol. What about Air Force One? A flying target of power.

Thoughts and questions like these and others are crossing minds at warp speed everyday. At least mine. As often as I see television reports on the tragedy and read newspaper accounts of it all, I still find everything somewhat of a blur. It’s still almost incomprehensible to me that this type of terror can be inflicted on the most powerful and resourceful nation this world has known.

As one day turns into two and then into five, one can hardly get a grip on what is happening with recovery efforts in New York, the Pentagon, and outside Pittsburgh without being distracted about what else may be going on with other so-called cells of terrorists.

I hear that people are not flying at all now or far fewer folks want to fly the friendly skies because of uncertainty about the friendliness of those skies. We’re still frightened. Hell, we’re still numb and unnerved. We used to take for granted so many things when it comes to travel. Now, everything has changed. The rules are being rewritten as we speak. The price we must pay for Freedom and Liberty – again?

In this country, we pride ourselves on democracy and freedom of choice. Other nations not enjoying this way of life are jealous and bitter that they don’t have the type of life that America boasts. I fear that society will always have extremists among us, and people who are not in a right frame of mind.

Every so often, it seems, these people and their misguided mindset collide with society’s norms and tragedy strikes. Terror and evil play as if there is no tomorrow. For them, tomorrow will dawn with other “brethren” ready to continue the fight. We dawn with tomorrow as well, but to bury our dead and grieve and mourn.

The fight will continue. Our cause, humanity, is just. We will not rest. We can not. Our future generations depend on us as we have depended on our forefathers in paving justice and some form of normalcy in which to live and enjoy what God has wrought.

The planes. The planes.

Twin Towers.

Lives lost.

Madness. Mankind grieves.

The horror. The horror.

Tomorrow?

Tomorrow!

 

Let us never forget! Amen!

©2001, J. Fournet

The Demons Within and Beyond: Opioids, Addiction, Depression – Part 3

There’s not a day that goes by wherein I’m both surprised and not surprised about how far-reaching opioid use and depression is, both in the US and abroad. When you add addiction into the lethal mix, the impact on society is horrific.

As I have written about in both parts one and two of this series, I can relate directly to using opioids and being depressed. Thankfully, I am not addicted to anything but I can understand how easy it is to become addicted.

Taking an opioid (Narco or Hydrocodone Acetaminophen, in my case) helps me deal much better with both the pain I have in my lower back and my overall feeling of depression and, at times, lack of motivation and hope. I also take something else for the anxiety and depression (Fluoxetine). It helps my brain’s circuitry play nice with one another. I guess that’s what I get for having so much bad crap going on in my life these past few years.

Those of you not knowing my recent background should be aware that in 2014 I was diagnosed with Leukemia (CLL) and late that same year my wife suffered a stroke. Presently, I’ve attained Complete Remission status and my wife is still rehabbing. Life has not been fun and remains so.

Serving, in part, as a counter balance to this “bad” is why I develop and write these blog posts. They help me keep my creative juices flowing, and I feel a responsibility to share information on certain topics with those who may find them useful, perhaps even entertaining. I have another blog dealing with creativity and innovation.

One thing I have learned these past few years is this: Addiction and depression do not discriminate. They don’t care who they attack or whose bodies they overtake. They don’t care about one’s celebrity or lack thereof.

Going back in time to the small screen and a “little” franchise known as Star Trek, there came to be a new generation: Star Trek-The Next Generation. Onboard that starship Enterprise was a young doctor’s son, Wesley Crusher. The actor who portrayed him is Wil Wheaton.

startrekwesley7

Wil Wheaton as Wesley Crusher in “Star Trek: The Next Generation.” Video screenshot by Bonnie Burton/CNET

Depression knows Wil well. Too well. His story is remarkable and probably relatable to many of us around the globe. Here is some of his story, excerpted from Medium.

Wil Wheaton

Photo by Kaelen Barowsky

Hi, I’m Wil Wheaton. I’m 45 years-old, I have a wonderful wife, two adult children who make me proud every day, and a daughter in-law who I love like she’s my own child. I work on the most popular comedy series in the world, I’ve been a New York Times Number One Bestselling Audiobook narrator, I have run out of space in my office for the awards I’ve received for my work, and as a white, heterosexual, cisgender man in America, I live life on the lowest difficulty setting — with the Celebrity cheat enabled.

I struggle every day with my self esteem, my self worth, and my value not only as an actor and writer, but as a human being.

That’s because I live with Depression and Anxiety, the tag team champions of the World Wrestling With Mental Illness Federation.

And I’m not ashamed to stand here, in front of six hundred people in this room, and millions more online, and proudly say that I live with mental illness, and that’s okay. I say “with” because even though my mental illness tries its best, it doesn’t control me, it doesn’t define me, and I refuse to be stigmatized by it.

So. My name is Wil Wheaton, and I have Chronic Depression.

When I was a little kid, probably seven or eight years old, I started having panic attacks. Back then, we didn’t know that’s what they were, and because they usually happened when I was asleep, the adults in my life just thought I had nightmares. Well, I did have nightmares, but they were so much worse than just bad dreams. Night after night, I’d wake up in absolute terror, and night after night, I’d drag my blankets off my bed, to go to sleep on the floor in my sister’s bedroom, because I was so afraid to be alone.

When I was around twelve or thirteen, my anxiety began to express itself in all sorts of delightful ways. When I was thirteen, I was in an internationally-beloved film called Stand by Me, and I was famous. Like, really famous, like, can’t-go-to-the-mall-with-my-friends-without-getting-mobbed famous, and that meant that all of my actions were scrutinized by my parents, my peers, my fans, and the press.

All the weird, anxious feelings I had all the time? I’d been raised to believe that they were shameful. That they reflected poorly on my parents and my family. That they should be crammed down deep inside me, shared with nobody, and kept secret.

When I tried to reach out to the adults in my life for help, they didn’t take me seriously. When I was on the set of a tv show or commercial, and I was having a hard time breathing because I was so anxious about making a mistake and getting fired? The directors and producers complained to my parents that I was being difficult to work with.

When I was so uncomfortable with my haircut or my crooked teeth and didn’t want to pose for teen magazine photos, the publicists told me that I was being ungrateful and trying to sabotage my success. When I couldn’t remember my lines, because I was so anxious about things I can’t even remember now, directors would accuse me of being unprofessional and unprepared. And that’s when my anxiety turned into depression.

I was miserable a lot of the time, and it didn’t make any sense. I was living a childhood dream, working on Star Trek: The Next Generation, and getting paid to do what I loved. I had all the video games and board games I ever wanted, and did I mention that I was famous?

I think it was then, at about 34 years-old, that I realized that Mental Illness is not weakness. It’s just an illness. I mean, it’s right there in the name “Mental ILLNESS” so it shouldn’t have been the revelation that it was, but when the part of our bodies that is responsible for how we perceive the world and ourselves is the same part of our body that is sick, it can be difficult to find objectivity or perspective.

And that’s the thing about Depression: we can’t force it to go away. As I’ve said, if I could just “stop feeling sad” I WOULD. (And, also, Depression isn’t just feeling sad, right? It’s a lot of things together than can manifest themselves into something that is most easily simplified into “I feel sad.”)

People who reach out to get help for their mental illness are brave. I’m not brave. I’m just a writer and occasional actor who wants to share his privilege and good fortune with the world, who hopes to speak out about mental health so much that one day, it will be wholly unremarkable to stand up and say fifteen words:

My name is Wil Wheaton, I live with chronic depression, and I am not ashamed.

Wil’s complete remarks are available through Medium.

The United States of Worry

Though Mr. Wheaton is but one individual, albeit a famous one, millions of others around the world suffer. Remember the citizens of Nigeria discussed in Part Two? In a recent study by Good Rx and Tori Marsh of its research team, domestic use of anxiety and depression prescriptions is on the increase.

Anxiety and depression are closely related but distinct conditions; people coping with these conditions are often prescribed several medications before finding an effective therapy that helps them. These medications include commonly prescribed drugs like diazepam (brand name Valium) and alprazolam (Xanax) for anxiety and sertraline (Zoloft) and fluoxetine (Prozac).

United States of Worry

Of all depression and anxiety medications, sertraline (Zoloft) is the most widely prescribed, accounting for over 1.5% of all prescriptions in some regions. Zoloft is an SSRI (selective serotonin reuptake inhibitor) used to treat depression, anxiety, obsessive-compulsive disorder (OCD), and social anxiety.

Northeast (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New Jersey, Pennsylvania)

Of all regions, fills for anxiety and depression medications are the highest in Northeastern states, accounting for almost 10% of total prescription fills. New Hampshire, Massachusetts, Maine, and Rhode Island fill the highest amount of depression and anxiety medications.

This trend resembles recent data from the CDC  revealing that suicide rates are increasing at an alarming rate especially in Vermont and New Hampshire. 

Midwest (Illinois, Indiana, Michigan, Ohio, Wisconsin, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota & South Dakota)

Just like the northeast, the Midwest has also seen high fill rates for depression and anxiety medications. In April, fills accounted for 9% of all fills in the midwest, and that number has only continued to increase.

According to prescription fills, midwestern states like North Dakota and Iowa cope with the highest rates of anxiety in depression. What’s more, compared to all regions, the Midwest has seen the highest increase of fills for depression and anxiety medications; in just four years, fills increased by 17%.

This data aligns closely with CDC data indicating that people in Ohio, Indiana, and Kentucky experienced a higher number of mentally unhealthy days characterized by feelings of stress or depression. 

South (Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia, Alabama, Kentucky, Mississippi, Tennessee, Arkansas, Louisiana, Oklahoma & Texas)

In the south, fills for depression and anxiety medications accounted for 8% of all prescription fills, a rate that has been steadily increasing since 2016. Alabama, Kentucky, and West Virginia saw the highest fill rates, while fills for anxiety and depression medications accounted for only 6% in Georgia.

These results are supported by research done by the American Psychological Association.  The survey also found that people in the south understood the impacts of stress and how to manage their stress more than participants in other regions. 

West (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming, Alaska, California, Hawaii, Oregon & Washington)

States in the west fill the fewest amount of depression and anxiety medications, about 6% of total prescriptions. Unlike the other three regions, where fills have been steadily increasing, prescriptions for depression and anxiety medications have remained relatively consistent in the west coast, hovering around 6% over the past four years. Of all states on the west coast, Montana fills the highest amount of prescriptions for depression and anxiety. Not surprisingly, Hawaii seems to be a relatively happy state, as only 4% of prescription fills are for anxiety and depression medications.

NOTE:  If you or someone you know is struggling with depression or has had thoughts of harming themselves or taking their own life, get help. The National Suicide Prevention Lifeline (1-800-273-8255) provides 24/7, free, confidential support for people in distress, as well as best practices for professionals and resources to aid in prevention and crisis situations.

Previous posts in this series can be found in Demons: Part 1 and Demons: Part 2.

To be continued . . .

The Demons Within and Beyond: Opioids, Addiction, Depression – Part 2

This is always a particularly difficult week for me. I lost my Dad forty years ago, August 20, 1978. This Wednesday, I go see my oncologist at MD Anderson Cancer Center for the first time in several months, but my first time since he moved to Anderson.

I feel trepidation every time I go to the Texas Medical Center. And I’ve never even been inside MD Anderson. It’s a major complex within a very major community, the largest medical center in the world.

GULP!

I know depression fairly well and as I write this, I’m experiencing very mixed feelings about every word in the title of this post. Yet, I’ve decided to tackle part of this problem in a three-part series, knowing that there will still be much to talk and write about. Alas, it is never-ending.

Opioid use, addiction and depression is, I’m afraid, getting even worse; it’s like a terminal societal disease with no known cure. However, what it is not is just an American epidemic!

In an amazing story out of Nigeria, opioids are rampant. Thanks to BuzzFeed News and Monica Mark, West Africa Correspondent, for doing a special report on this crisis. Some excerpts follow. What was amazing and interesting to me when I first read about the epidemic, is the drug of choice: Tramadol.

I’ve taken Tramadol, as has my wife. It’s a relatively mild pain pill. But when taken in excess or in combination with other drugs or “questionable substances,” it can be a lethal cocktail.

******************

Millions of Nigerians are dealing with an addiction to tramadol — a number that’s set to soar as Africa’s most populous nation becomes increasingly hooked on the painkiller.

Less than a decade ago, beds at certain treatment facilities were filled almost exclusively with working-class people struggling to wean themselves off locally brewed alcohol, heroin, and cannabis. Those using tramadol — a synthetic opioid and cousin of powerful prescription painkillers like morphine, oxycodone, and fentanyl — were rare cases, almost entirely confined to young men doing hard labor or people who’d become addicted through medical prescriptions.

“Eight years ago, I’d be surprised to see a few tramadol cases [a year],” said Audu Moses, a psychiatrist and one of a handful of addiction specialists in Nigeria. “Now, I’ll see around 10 patients in a month, and every year it’s going up.”

Today, Nigeria stands on the brink of a catastrophic epidemic. BuzzFeed News has found Nigerians of all ages are popping millions of pills daily, washing them down with codeine, another drug based on opium poppies, or as part of a cocktail that includes “purple lean” and Rohypnol, the date-rape drug.

Senior military officials told BuzzFeed News that stashes of tramadol recovered from Islamist militants often outnumber bullets found in their hideouts. College students use it as an aphrodisiac. Subsistence farmers say it keeps them going for hours on end, a phrase echoed by sex workers in southern urban centers.

Unlike heroin or morphine, tramadol isn’t eye-wateringly powerful, nor does it give extreme highs. I’ve taken tramadol, I know. Indeed, it is relatively mild compared to say, Norco or Hydrocodone Acetaminophen, which I’ve also taken. Tramadol is like certain candy, but with a little bit of a kick.

Nigeria’s epidemic is being driven by its ready availability — the result of an international loophole that means manufacturers can legally produce vast, unregulated quantities in Southeast Asia, from where it’s imported to Nigeria.

Tramadol-Nigeria

Tramadol packets on sale in the streets of Nigeria.    Emin Ozmen / Magnum Photos for BuzzFeed News

For medics in Nigeria struggling to fill a gap in pain management medication, in particular for cancer and post-surgery patients, tramadol is an obvious choice. Doctors Without Borders classifies the drug an “essential medicine,” arguing that pain relief shouldn’t be a luxury in developing countries.

The world’s second-biggest importer of tramadol, behind only the US, is Nigeria’s tiny neighbor, Benin, whose entire population numbers less than that of the state of New York. Why? Benin is a notorious smuggling hub — its porous borders mean drugs can flow freely into Africa’s most populous country.

Yet another strange irony about tramadol: It’s precisely the drug’s lack of potency that makes it so ubiquitous. “Tramadol will relieve pain, but what you feel is a certain calmness, like a numbness. No one exclusively abuses tramadol — they won’t get enough out of it. They throw tramadol in as something to spice up the mix,” said a former pharmaceutical executive who spoke on condition of anonymity.

 

Drug Dealers-Nigeria
Drug dealers in Apo Park in Abuja. Emin Ozmen / Magnum Photos for BuzzFeed News

Just like in the US, where a lack of insurance leaves millions of impoverished people with addiction lacking access to care, most people with addiction in Nigeria’s 190-million strong population struggle to find the kind of ongoing support addiction requires amid the country’s bare-bones health care system. For those dealing with chronic mental illnesses, the consequences can be disastrous.

It takes around two years for the brain to adjust to coming off opioids, but those coming out of detox have a lowered tolerance, meaning relapses are potentially fatal. Instead, the US federal government recommends medication-assisted treatment over detox. In Nigeria, with the state unable to provide a support network, it’s falling on local communities to pick up the pieces.

Moses, the psychiatrist, said that the country’s few clinics weren’t capable of stemming the tide of addiction. “Tramadol affects memory. So [these kids] can’t continue work, they can’t go back to school. And even when they learn some skills, they can’t concentrate, so they give up on contributing to society. Some of them will die.”

Making matters worse is when the drug lords are busted, one prosecutor noted, “The frightening aspect is that most of these hard drugs found in the accused’s possession are expired drugs, which when [they] found their ways into the market would have posed serious danger to the lives of innocent people of Nigeria.”

Furthermore, when busts are made, rather than the 50 milligrams typically sold in pharmacies, wraps often contain 225-milligram pills. That’s close to what’s considered a safe upper limit in the US for severe pain — in a single pill.

Street peddlers of drugs
A drug market in Lagos where street sellers provide all kinds of drugs from wholesale dealers. Emin Ozmen / Magnum Photos for BuzzFeed News

And yet, stop and ask your average Nigerian in the street what they think of addiction, and odds are they’ll label it a moral failing, or an affliction of criminals or “lunatics.” That outlook characterizes the official approach, too. Struggling to shake off the “lunatic asylums” label slapped on psychiatric wards until the 1960s, mental health patients are still routinely classified as “inmates” who are “detained” until they can be “released” back into the general population.

“I saw this driver smoking,” said a recovering addict. “I just looked at him. I won’t lie — I had cravings.” He felt bewildered once again at how easily three months of work had seemed to come undone.

“I’m not a bad person; I just made bad choices. This is a controlled environment,” he said. “But outside? There’s everything that you left. Everything will come back at once, and the world doesn’t really wait for you to get your shit together.”

As I mentioned in Demons: Part 1 of this series, I’ve come to realize these past few years how easy it is to become addicted to opioids if one is not careful. At times, everything around us contributes to stress, depression and an over-abundance of anxiety. Hence the need for calmness or some numbness.

Yet, we still may need legitimate pain relievers like Tramadol or Norco or some other, doctor-prescribed medicine. It can be a fine line we walk in getting relief.

 

To be continued . . .

 

Note: Apologies for the formatting screw-ups above. And, no, I’m not on Tramadol!

The Demons Within and Beyond: Opioids, Addiction, Depression – Part 1

I’m not suicidal, I’m depressed. Or is it the other way around? Okay, now I’m confused. I always get those mixed up.

Yeah, right!

Don’t worry, I’m not suicidal; I don’t need a rubber room or padded cell (and, no, the freight elevator doesn’t count). Alas, I have been fighting depression for several years now. Longer, probably, but it’s only been within the past few years that I’ve been taking some medicine for it. Unfortunately, it seems there is a majority of us out there.

I prefer to write about positive and creative things; however, this blog is about my personal journey through life and my “enjoyment” of all the potholes I have traversed. There are times when I feel it necessary to write about troubling issues and aspects of survival that are, well, not too prideful.

This is one of those times.

It has taken me awhile to actually get these words on paper, so to speak. I realize that some folks who know me may be surprised while some may take pity or even be appalled that I’m admitting this type of stuff.

Too bad!

Who knows, maybe this and subsequent posts will help someone get a better perspective on their “Hell.” Maybe this will help them get a better grip, especially when Hope and Faith seem to be all but dried up.

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“Pamela’s Voice” from Rod Serling’s Night Gallery

It has also taken me quite a long time to get my head around how I want to approach this topic of depression, and the various meds to help deal with it. The problem is complicated with not just one solution.

Personally, it’s not merely depression; I’m also putting up with back pain I suffered a few years ago when my wife suffered her stroke. I fractured a couple of vertebrae and messed up portions of my lower back. Since then, I’ve been taking pain meds – opioids.

I can easily see how people can and do get hooked on some of this stuff.

I am not, however. I am, though, probably taking more prescription meds than at any time in my life. Can’t be helped, I guess. The pain med, the lone opioid, is hydrocodone or Narco for short. The “anti-depressant/anxiety” med is, currently, Fluoxetine. It’s less expensive than the first one I was prescribed.

The nice thing about Narco, for me, is the overall relaxed state it gives, allowing me to de-stress and be almost pain free. Yet, I’m no longer taking them at present. I’ve run out and don’t know how soon I can get another Rx.

I’ve never liked being dependent on one thing like a drug to get by on a daily basis. As I’ve gotten older and, unfortunately, contracted Leukemia (CLL) several years ago, I am taking a special drug specifically for Leukemia, Venetoclax, every day. However, I’m in complete remission and want to stay that way, so my taking of this miracle drug may continue for some time to come.

Pain meds are another matter and this country, along with others, has its fair share of addicts, not to mention those folks who legitimately need these drugs to help them through their days.

Because of a variety of reasons and personal conflicts this past year, including my wife’s continued but difficult rehabilitation, there have been days that I literally don’t want to get out of bed. I don’t care to do anything.

It scares me when I don’t care or am not interested in some aspect of creativity. That’s what drives me. That’s why I try and keep writing, keep thinking, keep the creative juices flowing. When I would take a Narco in the morning, it would relax me and help me maneuver. It improved my attitude and, yes, lessened my back pain.

There are still days I miss not having any to take. There were days that I thought, “Geez, am I on the way to becoming an addict?” It is so very easy. But, I’m a far cry from an addict looking for his nearby needle for a fix.

Others, however, are not so lucky.

Gut-punching ad campaign

According to an article in a recent issue of AdAge/Creativity, there’s a long-running anti-smoking campaign, Truth, which is now combatting another epidemic of addiction: opioids–and it’s not pulling any punches in a new series of ads that go to painful extremes to illustrate the severity of the problem.

The “Truth About Opioids” campaign doesn’t shy away from scenes of brutality, in these cases self-inflicted.

The campaign features four true stories of young people who fell into opioid abuse. Each of the protagonists find themselves caught in a cycle of addiction to painkillers, and the only way to get more of the prescription drugs is to end up in the hospital. Those who can’t wait for an injury manufacture one instead. There’s Amy and Chris, who are addicted to Vicodin and Kyle, whose weakness is Oxy.

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Careful, this series of ads will make you flinch.

The campaign was created in partnership with the White House Office of National Drug Control Policy and the Ad Council, along with creative agency Haymaker. Amazon, Facebook, Google and YouTube, NBCUniversal, Turner and Vice have already agreed to run the spots.

“We understand that opioid misuse is a complex issue that needs to be tackled from many angles,” says Robin Koval, President and CEO of Truth Initiative. “We are deeply grateful to the young men and women featured in the launch effort for sharing their painful and powerful truths about opioids misuse to educate others about the risks.”

Whether or not we want to admit it, we all have demons, within and beyond. The more we can hone up to that, and talk about it, at least to some degree, the better. I’m at a stage in my life where I feel I’m undergoing another transition. As before, this time has its dark sides but with various little sprinklings of hope.

To be continued . . . 

Personas, Personalities and Peanuts

Ever feel not quite right or out of sorts?

Ever feel like you wanna be someone else?

Sometimes we need to be serious, while at others, we need silliness.

If we can’t make fun of ourselves, then who can we make fun of (I know, there are endless possibilities)?

Do you have a photo of yourself on your resume? I do not. Critics have said that you should not include one because it just aids hiring authorities in weeding you out. That would depend on how the resume is being used, for what kind of job. If you’re an actor or voice talent, you betcha; a welder, not so much.

What about a photo version that is not so professional or serious? You wanna illustrate your sense of humor, just be sure you do it in good taste.

Oh, wait, I forgot; hiring authorities usually don’t have a sense of humor.

Then there’s LinkedIn and Facebook. What kind of portraits do you have posted on these sites? What sort of personas shine through? I hope they are different since the nature of the two sites is different.

LinkedIn is, presumably, more professional oriented while Facebook is not. That doesn’t mean one should have the stereotypical, stuffy photo attached to your profile. It does mean that you should have a photo that serves you well.

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Taken by a professional photog friend of mine, this portrait has served me well for many years.

The same should be said for your website. Our presence on these social media outlets is an extension of our personalities, our personas. We shouldn’t be embarrassed by that.

Since I’m in a creative field, I’m aware that folks not familiar with me or my work want to see what I’ve done over the years as well as recently. I need to make sure that my online presence reflects this, and does so in a positive way. I also like to have fun.

I just recently changed my LinkedIn profile photo, updating it a bit. There was nothing wrong with the photo of myself I replaced but I thought it was time to have a different look.

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This is current LinkedIn version. Really like the straw; adds a bit of panache.

I use a totally different “photo” for my Facebook page (had to convert my FB profile to a page so I could still use the WordPress software in linking the two). I wanted to have some fun and used a program that the Peanuts Movie folks provided so that one could custom design one’s own Peanuts character. I think Snoopy and I look rather dapper in this illustration, don’t you!?

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Oh, to be reincarnated as a new Peanuts character. Whatchathink, Snoop?

Every one of us is different. Each is unique. We should treasure that and exhibit our uniqueness whenever possible.

I’m a Gemini, the Twins. I definitely have a split personality (Snoopy has quite a few); I can be quite serious while other times very silly. However, I try at all times to exercise my imagination, to let my creative soul voice itself.

That’s in part why I decided some years ago to create two different blogs, one for personal stuff and one for business and creativity. My topics, as you might think, vary as does the tone of my messages.

I’m currently working on a future blog post dealing with depression and medication, especially opioids and addiction. The tone will be decidedly different from this post’s tone. It needs to be. It reflects a different type of me, another persona.

There are days when we feel like crap, when we really don’t give a damn. There are others wherein we feel a bit relieved of stress, a bit more relaxed. I cherish those times more because I don’t like being depressed; too many things do I worry about and when they all seem to gang up on me, my personality takes a nose dive.

I hope you have more than one persona, so you can fall back on it when you get down and depressed. Don’t be afraid to let your silly side come out and play. Creativity resides in all of us, just to varying degrees. We owe it to ourselves to explore our personas and let our imagination take us to wherever it needs.

Oh, and should you see me and Snoopy around the neighborhood, be sure and say Hi!

 

 

 

A French Quarter Tale: The Can

Note: This is a different kind of blog post. It’s my take on a short, short story; a brief tale, if you will. It’s also my take on where my imagination lead me following a dream I had recently. Submitted as a tribute in memory and in honor of the late Rod Serling, whom I regret I never got the chance to meet. Maybe someday. 

The corner store. The neighborhood grocery. Every town has one, except there’s no town quite like this one. There’s no store quite like this one. It befits its neighborhood, however. Both are quaint, old and, like the city, both have history.

Some would say colorful. Some, macabre.

By all appearances, this quaint neighborhood grocery store is not unlike many others. The shop owner is friendly, if not a bit surly at times. He stocks a small but ample variety of goods in keeping the interests of his neighbors in mind.

However, this is no ordinary neighborhood grocery. Shelf life, for some items at least, can seem to last longer than the items would like. Whilst sitting on the shelf and being on display, what goes through their minds?

Oh, come now, you say; they’re inanimate objects, they have no minds. Well . . .

Our tale centers around an everyday object in an everyday place; however, this object can’t see; it can only experience and sense. What it “sees” is hazy, blurry. It can sort of “hear” but it’s not sure what the sounds are or from whence they come. It doesn’t know where it is or even what it is. It only knows it is content and happy to be wherever it may be, peering out through some hazy blanket of blur as the world passes by.

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Courtesy of Pixabay & Photorama

This is our brief tale on life’s perspectives from a can on a shelf in a grocery store in the French Quarter in New Orleans . . . as told from The Twilight Zone.

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“There’s that blasted ringing, again! For some reason, everytime I hear that, a voice says ‘Hello’. A form of greeting?”

“Why can’t I move? Am I supposed to move? How long have I been here, wherever I am? I don’t seem to have any connotation of time or even what form I’m in. I don’t know why but I sense there are others around and beside me. Are we all the same?”

“Why do I have so many questions? Am I even supposed to “think,” whatever that is. Why is everything blurry? I get a feeling I’m inside somewhere. Wait, I see movement in front of me, but there’s something between me and the movement. ”

“What are those objects? They move in both directions, and some even stop and look toward me. Then they move on by. Why?”

“Whoa, what’s that? I’m moving! I’m being lifted off this shelf-thing. I, I’m being turned on my side. Hmmmm, I didn’t know I had sides. What’s happening to me?!”

“It’s blurry. Some figure is right in front of me and, whoa, I’m being put back on this shelf-thing. Why? What did I do? This figure in front of me seems to be picking up something next to me. But, wait. The figure takes it, emits a sound and drops it in some sort of carrying device. Why it and not me?!”

“Though I can’t quite make it out, there appears to be another figure pressing up against something and looking in. What is that? Wait, it appears to be looking right at me. Should I feel nervous, even though I don’t know what nervous is?

“Wonder what it’s like on the other side of that something? There appears to be lots of movement beyond me, in both directions.”

“There’s that ringing again. And the ‘Hello.’ Am I imagining all this? I dunno. Wait, now I think I see more figures slowing down in front of me. They both have those carrying devices like before.”

“Oh, boy, here we go again! I’m being picked up, turned on my side . . . and, nothing. What’s going on? ”

“Whooooaaaaa! I’m airborne. I’m upside down, then right side up, then . . . OUCH! I seem to have left my shelf-thing. Now, I think I’m on my side. Could it be I somehow landed in this figure’s carrying device?”

“WOW, what a different sensation!

As an aside, our can is now experiencing a sensation it has not “felt” in some time; not since it was first shipped to the store, unpacked and carried to the “shelf-thing”. It doesn’t know how long it’s been in the store nor where it’s next destination will be. 

“What’s happening to me? I feel like I’m moving, yet I’m in close quarters with other objects all around me.”

“Wait, what’s that? I sense that I’m in a different type surrounding than before. There are a lot more blurry figures all around. Is this “outside,” wherever that is? I don’t know what I’m feeling but my sides are getting warmer, and things seem to be, uh, brighter?”

“Where are we going? I demand to know! Put me down this instant!”

“What’s this? We seem to have arrived somewhere. There are more blurry figures but I think we’re inside some other place now.”

“Ah, finally, my colleagues and I are getting out of this contraption. Whoa, here I am again, airborne!”

“‘Umph!’ rough landing, there. Okay, I don’t recognize this place but there seems to be a lot of activity here. Good. Maybe I can acquaint myself with some of the others who made this jaunt with me.”

“Wait, I’m getting dizzy, I’m going upside down. What’s happening to me? Gaaa!”

“I’m being shaken. Whoa, this is not good. I, I’m losing something. Oh, my, it appears to be what I’ve been holding inside me all this time. What is that? I can just barely make it out; it’s blurry but it appears to be . . . Ahhhhhhh!”

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Courtesy of Pixabay & markusspiske

“I’m airborne again, twisting end over end; getting dizzy and lightheaded. Now, what. All has stopped. I’m not moving. Everything is dark. I feel funny. I don’t like this.”

“‘OUCH!’ What the . . . something just landed on top of me. Where am I? Hello, anyone there? Hello . . .?”

The hustle and bustle goes on. The blurry figures continue with their appointed tasks. This kitchen, you see, is busy getting orders ready to serve their demanding customers. A variety of culinary delights are being prepared with ingredients from all over the city. Even though fresh vegetables and fruit are a vital part of this kitchen, every once in awhile, canned goods are utilized in a mix of seasoning. Simple but tasty.

Our subject in this tale has involuntarily offered up its flavorful contents to please the palate of a waiting and hungry patron. Its journey has ended as it now rests among others experiencing a similar fate: The darkness of despair, which some of us would refer to as a garbage heap.

Postscript: This brief tale is offered up to the everyday shoppers, consumers and others who go about their daily lives perhaps pondering if this is all that life presents. The curious among us may pursue but we suggest one simply enjoy what some may deem merely an imaginative tale from the perspective of a can in the French Quarter . . . as told from The Twilight Zone.

 

Cancer, Caregivers, Breakthroughs and Birthdays.

Cancer and Caregivers

Recently, June 2, the nation celebrated National Cancer Survivors Day. Appropriately, the Texas Gulf Coast Chapter of the Leukemia and Lymphoma Society (LLS) presented a workshop geared toward cancer patients, survivors and caregivers. As a CLL (chronic lymphocytic leukemia) cancer survivor, I attended the workshop and wanted to share some info I learned.

According to LLS, the emotional, physical, and educational needs of patients and their families change over the course of the cancer experience. This special Health and Wellness for Caregivers workshop provided information and resource materials on how caregivers can maintain their own health and wellness while caring for a person with cancer. We learned about strategies to deal with changing family roles, coping with stress and fatigue, and about resources available.

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Brennan M. Parmelee, MSN, RN, CNE, with Houston Methodist Hospital Cell & Gene Therapy presented some interesting facts.

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Some highlight slides:
(Please excuse some formatting weirdness)
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For more information, contact: Erika Pomares at 832.463.3613 or Texas Gulf Coast Chapter, 5433 Westheimer, Ste 300, Houston, TX 77056 | 713-840-0483

Patti Robinson Kauffman First Connection Program

Finding out you have cancer can be a very lonely experience, so First Connection peer volunteers are in a unique position to provide one-on-one support and community resource information to others facing a similar medical journey. Requests are matched by disease, mode of treatment and experience. Support is open to patients, caregivers and cancer survivors who were treated anywhere, and we’ve made connections around the nation.

If You’d like to talk to someone with a similar diagnosis or treatment, give them a call:

Toll-free: 800-955-4572

 

Breakthrough Treatment

Recently, the U.S. Food and Drug Administration (FDA) announced a promising development for patients with chronic lymphocytic leukemia (CLL) and small lymphocytic leukemia (SLL). I’m excited about this news because this is the treatment I’m currently using and have used the past couple of years during my clinical trial.

The FDA expanded the approval of a targeted therapy called venetoclax, giving patients with CLL, the most common leukemia in adults, and SLL, a closely related blood cancer, the opportunity to take an oral-based, chemotherapy-free regimen. This regimen might allow patients to stop their treatment after about two years.

Venetoclax, or as it’s known commercially as Venclexta, is now approved for use in combination with the antibody therapy, rituximab, which I’ve also taken, or alone for patients with CLL or SLL who have relapsed or did not respond after at least one prior therapy. Before the decision, venetoclax was only approved for certain CLL and SLL patients with a rare subset known as 17p deletion, in which a portion of a chromosome that suppresses cancer growth is missing.

Since 2002, the Leukemia & Lymphoma Society (LLS) has invested more than $15 million in pioneering research through their Specialized Center of Research grant program.

 

Joe’s Birthday Fundraiser on Facebook

I have a birthday coming up this next Tuesday, June 19, and have decided to use that day and this month to raise awareness of blood cancer and leukemia, specifically. I’d appreciate it if you helped me by donating whatever you can to my cause. Thank you!!

someday is today - LLS logo

 

(In)action By Louisiana Legislature Height of Stupidity.

Morons! Not all, but most. I’ve read with disgust the goings on in my once second home Baton Rouge and the state’s legislature over their repeated inaction to pass a budget that realistically works for the fine people of Louisiana.

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Louisiana State Capitol Building – Associated Press

I’m a native of the Pelican State even though I’m now living in Houston. Because I have fond memories of my growing up in Southwest Louisiana (Lake Charles), I try to keep up with what’s going on back home.

I also have a fondness for politics, especially the home-grown variety served up Cajun style. While at LSU in the mid-seventies, I served in the state Senate as aide to then Senator Bill McLeod. I learned a lot back then, especially considering that’s when the legislature was debating Right-to-Work.

Intimidating Victor Bussie, the Godfather of the AFL-CIO. The birth of LABI, Louisiana Association of Business and Industry. The professional “hit” on lobbyist Jim Leslie across from LSU. The Jupiter Incident, with mobs and tempers overflowing.

Them were scary times! And deadly.

Another Edwards was governor then and he knew how to work a legislative body. Alas, times were very different, even when it came to partisan politics. However, both houses just seemed to get it done despite various differences.

Not now!

As recently as today, June 8, Gov. John Bel Edwards called for yet again another special session (3rd one) beginning on June 18 and ending on June 27. This version will be the seventh budget-focused special session since Edwards took office in January 2016.

The upcoming third session is a “final” attempt to address and fix the $650 million budget gap or “fiscal cliff” Louisiana faces in its budget that begins July 1. You see, more than $1 billion in temporary tax measures expire June 30 unless the gap is closed.

Two competing proposals – one would extend one-third of the expiring 1% sales tax and the other would extend one-half of the sales tax – have been at odds, with this last session having “debate” (another word for arguing and name-calling) right up to the midnight hour when the session was bound by law to end.

The difference between the two proposals means to the taxpaying consumer a relatively minimal 17 cents on a $100 purchase, for example.

All three previous special sessions, at a cost to the taxpayer of $60,000 per, have not accomplished a damn thing other than to raise tempers and frustrations.

A scary aspect of this last-minute approved budget in the House is that it has no major revenue-raising measures. So, deep cuts to higher education, public safety, various state services including health care (though it may very well get protection before all is said and done), services for the poor, inmate housing and others are quite likely. The state’s food stamp program could be eliminated altogether.

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Louisiana Legislature House Chamber – Associated Press

It appears a small bunch of conservative Republican House members want to stubbornly stand on an anti-tax platform while Rome burns to the ground. Nobody really like taxes but they are necessary in certain places. Thankfully, even some conservative Republican colleagues believe that because these proposed cuts would be too severe, they couldn’t vote for this bastardized budget.

Yet, pitiful, putrid, partisan politics is having its way in Baton Rouge and from what I gather from readers of The Advocate and other news sources, the citizenry is fed up. Reporter Elizabeth Crisp has done a wonderful job of keeping tabs on all these shenanigans. It’s not as if the legislature has just recently become aware of the mess; they’ve had the past two years to do something about it!

And, they have: NOTHING.

The Louisiana Legislature, especially the House of Representatives and in particular a minority of conservative Republicans, is acting like a bunch of buffoons. It’s embarrassing and the fine folks of the Pelican State don’t deserve this.

Though I think it unlikely, it is possible that tremendous, damaging cuts are yet to come to the state’s colleges and universities. If this happens, a worse-case scenario could end up right smack dab in the Legislature’s front yard: Can you imagine the revolution arising from no football on a Saturday night in LSU’s Tiger Stadium?

If that happens, the citizenry should run the bastards out of town.

What’s on the Horizon for CLL, Chronic Lymphocytic Leukemia?

I was diagnosed with CLL about four years ago. Since then, I’ve learned about the importance of clinical trials, shared decision making about treatment, and I’ve paid special attention to the types of resources and research that the Leukemia and Lymphoma Society (LLS) provides.

A recent webinar on the history and current status of Chronic Lymphocytic Leukemia, CLL, was presented by LLS and the recording is posted on their website.

Though a transcript is to be provided later, please give this new presentation a listen. It’s important for both patients and caregivers to hear the latest on such topics as: Diagnosing CLL, New and emerging therapies, Supportive care and side-effects management, Importance of shared decision making in discussing treatment.

Those of you newly-diagnosed with CLL will no doubt be learning about the medicines mentioned in this lecture. Those of us who have been participating in a clinical trial like yours truly, have been well versed in these almost unpronounceable meds.

Rituximab, Obinutuzumab and Venetoclax are all meds with which I am very familiar. During my three year clinical trial at Methodist, I have been on all of them at some point. I am currently using only the Venetoclax as the Trial has wound down to completion. It’s also the only drug of which I am aware that is just now being introduced to the commercial market by abbvie and Genentech.

Its name: Venclexta.

The lecture highlights recent studies touting various combinations of these and other drugs, depending on the type of cancer one has as well as the makeup of one’s DNA. We’re all unique; so, too, is the treatment.

We’ve come a long way from the days of standard chemotherapy treatment where the main downsides were hair loss and nausea. Since I was first introduced to chemo treatment, my initial phases centered around pills and IVs. Not too bad.

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Dr. Matthew Davids, MD, MMSc of Harvard Medical School leads the presentation and subsequent Q&A.

All due respect to Harvard Medical, we’re fortunate here in Houston to live near the Texas Medical Center where the likes of Methodist Hospital, where I undertook my clinical trial, and MD Anderson Cancer Center are located.

Dr. Davids Bio from May 8 CLL

His bio is offered in both JPG (above) and PDF (below).

Dr. Davids Bio from May 8 CLL