Not for the faint hearted

Just a warning before you read this...it contains details which will not be at all surprising to anyone of a medical background, but may be slightly shocking to those that aren't.
I'm going to talk about my bowels.
Yes, I am.

Since the accident, I'd been using quite a lot of opiate analgaesia to manage the pain. This started with a lovely dose of IV morphine from the guys in resus, and continued with frequent doses of Oramorph and Tramadol when I got up to the ward (I was initially given codeine, but it had no effect on the pain. Interestingly my dad also reports no analgaesic response to codeine. A quick tutorial, codeine is a pro-drug and only becomes active when it converted to morphine by your body. Around 6-10% of the population have an abnormally functioning gene for, and therefore have reduced levels of the enzyme that converts the pro-drug, and so for them codeine has limited effect as an analgaesic. I'm assuming both my dad and I fall into this group)

When I got home from the hospital I was using 20-30mg of oramorph every 4 hours. The pain was so bad I felt like I wanted to use more, but having never had opiate analgaesia before in my life I was worried about how my body would handle such high doses anyway, and I was concerned about becoming tolerant to the effects and therefore being left with pain that didn't respond to the drug. I was also prescribed tramadol, but knew that there was a risk of interactions between that and my regular antidepressants so I didn't want to use too much of that.

I was interested to see how my body handled the new experience of opiates. With the first few doses in the hospital I felt quite swimmy and sleepy, but not in a particularly comfortable way. They also left me feeling just on the edge of losing control of my body, which is an experience I hated. This was particularly noticeable with the fentanyl I was given prior to anaesthetic. I've heard the anaesthetists describe the midazolam/fentanyl bolus used as induction like 'getting a large G&T', implying that it is a pleasant experience. I've also spoken to other people who have loved the feeling induced by these drugs. Not me. I hated that feeling on being right on the edge of consciousness.

Luckily I didn't seem to be prone to the nausea that opiates can cause in some people. I did seem to become massively sensitive to electric light, and I found it really hard to be in brightly lit areas. Interestingly this didn't apply to daylight. My balance was really affected and I kept getting limb jerking which I'm pretty sure was due to the drugs.

And, the constipation. Oh yes, I knew opiates caused constipation, I've managed plenty of people in hospital who are suffering from this side effect. In my own practice I never prescribe any opiate analgaesia without an antiemetic and a laxative to go with it. I myself have never suffered from constipation before. I'm active, I have a good diet, I eat lots of fibre. I'd never had to worry about not having a bowel movement.  But now, I was bed-bound, I was not eating anything much, I was dehydrated and I was taking regular oramorph. And I was, stupidly, not pro-active in preventing it.
On Wednesday (4 days since my last bowel movement) I started taking regular laxatives. I wasn't in any discomfort, but I was worried about how this might progress. On Friday, still no bowel movement, I was feeling quite 'heavy' and I added a second type of laxative to the first. On Saturday I sent Jason out to buy suppositories. Later that day I managed to finally go (without the suppositiories). It was intensely painful, exhausting and something I hope never to have to experience again.

Last resort.....

So, there you have it. Of all the side effects of drugs I have experienced, this is definitely the worst. It is comforting to know that you can take medications to correct the problem, but I will NEVER underestimate the distress that constipation is causing one of my patients ever again.

Victories:
Opening my bowels!!
Realising that this experience will definitely make me a better doctor