An unusual reaction to a strong painkiller…
May 17, 2017 10:01 PM   Subscribe

Neil is in the hospital for a fractured ankle which needs to be manipulated before a cast is applied. The painkiller chosen is ketamine, which provokes an interesting reaction from Neil [LOUD babbling].
posted by Johnny Wallflower (38 comments total) 7 users marked this as a favorite
 
Kick doon, eh Neil!?
posted by Ambrosia Voyeur at 10:24 PM on May 17


I'll have what he's having.
posted by Abehammerb Lincoln at 10:31 PM on May 17 [5 favorites]


A man gets a boo-boo on his ankle and they pull out the serious drugs. But 25 years ago last week I delivered a 10lb 5oz baby and all they offered me was Demerol—in tablet form, no less, i.e., not injected.

Proving once again that it's a man's world.
posted by she's not there at 11:51 PM on May 17 [33 favorites]


Problem with strong drugs in birth is that they mostly transfer across the placenta to the baby. That's why epidural analgesia is common. Babies have enough to go through when they're first born without having to deal with mind-body disassociation.

Source: partner's a midwife who recently gave birth to a 9.7 pound baby.
posted by Silentgoldfish at 2:18 AM on May 18 [13 favorites]


Not to derail, but she's not there is generally right about how pain management is taken far less seriously for women than for men. From past experience, I'm guessing a woman in Neil's situation would get a little Tylenol and be tsked at for screaming.

(Ketamine? Really? You're kidding me.)
posted by tully_monster at 2:54 AM on May 18 [27 favorites]


I would like this every day until impeachment or global thermonuclear war happens.
posted by Cocodrillo at 3:04 AM on May 18 [8 favorites]


They should have had The Private Psychedelic Reel playing in the room while this was happening.
posted by hippybear at 3:15 AM on May 18 [6 favorites]


Don't know if it was ketamine, but I was offered a similarly dissassociative thing when I got my wisdom teeth out; I was uneasy about general anesthetic, and a local was similarly freaky.

They told me about the Twilight Sleep anesthetic, which they described as local combined with some sedatives. I had only one question - "can I listen to something psychedelic, like Hendrix while you operate?"

"Sure."

"Bring it on."
posted by EmpressCallipygos at 3:44 AM on May 18 [3 favorites]


I mean, seriously. It's an album by a band called The Chemical Brothers called Dig Your Own Hole with a track on it called "Lost In The K-Hole", and the closing track is 9m22s of what this guy needed to be listening to.
posted by hippybear at 3:52 AM on May 18 [4 favorites]


Aye, he's havin a wee party in his headcase
posted by Sebmojo at 3:55 AM on May 18 [7 favorites]


I couldn't make it to the babbling part; as soon as the doctor started talking about "conking [the ankle] back in" to re-set the bones or whatever, I turned green and noped right out.
posted by misskaz at 5:10 AM on May 18


The UK is quite a bit more willing to use strong painkillers than the US IIRC. That said, I’ve watched the odd episode of these fly on the wall hospital docs & to my recollection they’ve used nitrous oxide as a short term painkiller for this kind of fractured joint setting. But hey, Ketamine works too & wears off pretty quickly, so...why not I guess?
posted by pharm at 5:13 AM on May 18


I couldn't make it to the babbling part; as soon as the doctor started talking about "conking [the ankle] back in" to re-set the bones or whatever, I turned green and noped right out.

it's not gruesome in the slightest
posted by Sebmojo at 5:23 AM on May 18


I wish we had a better attitude about pain medication. The worst pain I ever felt in my life I felt like my head was on fire (abscessed tooth), and by the time I got to the dentist I wanted pain drugs so bad but was also terrified that if I just came out and asked for painkillers I would automatically be labeled a junky.

I'm glad this dude got doped up when he needed it.
posted by Ray Walston, Luck Dragon at 5:29 AM on May 18 [5 favorites]


Manipulation is brutal.
Ms. response had a badly fractured ankle that was manipulated 3x before it could be operated on. 3rd time w/ Ketamine, because she's super strong and it was messing with the doc trying to get the broken bits of ankle in a safe place.
The Ketamine experience was unpleasant, but she's glad they did it so there wasn't a time number 4.
posted by Glomar response at 5:45 AM on May 18


Ketamine is quite popular is US emergency medicine. Most have the sense to add a benzodiazepine or propofol to prevent wild freak outs. although it is a potent analgesic, i wouldn't describe it as a "pain killer," it's a general anesthetic at only modestly higher doses. it's the most popular anesthetic drug in the developing world due to its low cost and hemodynamic and respiratory stability (most of the time).
posted by a robot made out of meat at 5:54 AM on May 18 [7 favorites]


They gave my wife Ketamine when she delivered our firstborn via C-section, which resulted in a deeply unpleasant bad trip for her and everyone around her. She was screaming and crying in a way very similar to how one might if she were legitimately experiencing being sliced open, and afterwards insisted she experienced the whole thing in an out-of-body but very aware state.

Since then she's been careful to tell doctors she's "allergic" to Ketamine whenever asked. I don't blame her.
posted by Mr.Encyclopedia at 7:11 AM on May 18 [1 favorite]


That was fantastic.
posted by kitcat at 7:37 AM on May 18


This is hilarious and great and I really hope Neil thinks so and is not embarrassed (i mean, he had to sign off on the broadcast, right?). It really seemed like he was having a great time.

There's other ancillary reasons to be using ketamine for situations like this. I didn't catch the reason of his fracture, and it didn't seem like he was in distress but, if he fractured his ankle in a particularly traumatic way (assault, car accident, badgers, whatever) it's possible the hospital chose ketamine to reduce the chances that he'll experience PTSD symptoms down the line.

I've been told by a couple mental health professionals, that like a robot made out of meat says, it's not only popular in emergency rooms, but also in military hospitals. A couple of observational studies came out looking at PTSD rates in folks that received ketamine against other anesthetics and the rates of PTSD in the folks that receive ketamine are just way lower across the board. This has dovetailed into using ketamine as an after-the-fact treatment for PTSD and some of the co-morbid depression and anxiety symptoms related to it. There's been some resistance to the idea around this because of the psychotropic effects, but it's looking like a really promising treatment to add to the arsenal of medications to deal with those issues.
posted by furnace.heart at 8:05 AM on May 18 [6 favorites]


I'm not sure what they gave my Mom when she dislocated her elbow (she was playing follow the leader with her kindergarten class and was being an airplane and ended up slipping and falling down the hill. of course all of her kindergerten kids also rolled down the hill, but being 4-5 years old didnt get hurt at all) but my dad said it was an amnesiac. In essence it didn't remove the pain at all it just meant that she wouldn't remember the pain after it happened. I wonder if it was ketamine?

I was thinking that it was the perfect thing for a dislocated joint as the pain goes away once it is relocated and after all if you don't remember something did it really happen? (it probably helps that I was reading a lot of PKD at the time)
posted by koolkat at 8:48 AM on May 18 [2 favorites]


10lb 5oz Holy moley, she's not there. Respect. Mine was 10/2 nearly 30 years ago and I had to have him surgically removed.
posted by theora55 at 8:55 AM on May 18 [2 favorites]


I was thinking that it was the perfect thing for a dislocated joint as the pain goes away once it is relocated and after all if you don't remember something did it really happen?

For real, and this is a great question that medicine should be exploring. Like, instead of insane opiates if you could get the equivalent of a 'eternal sunshine of the spotless mind' zap after a procedure, would it ethically matter if you were in a shit ton of pain, but did not retain that pain in your memory?

At certain doses, lorazepam has amnesiac properties. I take it for serious dental work, it means the hassle of arranging a ride to and from the dental office, and calling the next day for billing and instructions, but daaaaamn it's so nice to know that I'm not going to remember hardly anything other than "yeah I went to the dentist yesterday" no details or anything. It's pretty great stuff, and the fact that it makes me not remember serious dental work, makes routine dental work all that much easier to do.

Minds are weird!
posted by furnace.heart at 8:57 AM on May 18 [1 favorite]


For real, and this is a great question that medicine should be exploring. Like, instead of insane opiates if you could get the equivalent of a 'eternal sunshine of the spotless mind' zap after a procedure, would it ethically matter if you were in a shit ton of pain, but did not retain that pain in your memory?

This has been studied a good bit; particularly in babies. The thinking 30 or more years ago was that for infants who are too young to remember anything, it is not worth the risk to anesthetize them even for major surgeries. That is not true for a number of reasons. Studies have shown behavioral changes in infants after procedures without anesthesia, such as increases in irritability, heart rate, and blood pressure when they return to a medical setting afterward. Acutely, painful procedures cause an increase in hormones such as adrenaline and steroids and can alter the clotting ability of blood; these changes can be harmful. Finally, even if nothing bad happened during a procedure that is painful but will not be remembered, it is very stressful for the caregivers and (if present) family to be involved holding down a screaming patient regardless of whether or not the patient remembers anything. All of this is true for patients of all ages, not just babies.

Ketamine is an interesting drug; it is often thought of as a relatively safe sedative because it does not depress the respiratory or cardiovascular systems as much as other drugs. Of course it has other side effects; increased secretions, nystagmus, and as mentioned already, unpredictable psychological reactions. I remember 3 patients in particular that I have given ketamine to (out of hundreds). One was a man who woke up after his surgery shaking and scared to death. Everything went fine, he was doing well overall, he was just scared and couldn't explain why. He had gotten a pretty large amount of ketamine as part of his anesthetic due to concerns about his blood pressure. It eventually wore off and he was fine. Another patient was a lady who woke up after an anesthetic that included ketamine just laughing her ass off. She couldn't explain waht was so funny, but was obviously having a great time. The last patient was very similar except that she was just fascinated by the cheap hotel-room quality artwork hanging on the walls in the recovery room. "Those colors are just beautiful!" I remember her saying. Ketamine is one of those drugs that seem to wax and wane in popularity among the medical community. Right now it seems to be enjoying a comeback; useful drug, but not without drawbacks.
posted by TedW at 9:28 AM on May 18 [10 favorites]


For real, and this is a great question that medicine should be exploring. Like, instead of insane opiates if you could get the equivalent of a 'eternal sunshine of the spotless mind' zap after a procedure, would it ethically matter if you were in a shit ton of pain, but did not retain that pain in your memory?

I know I'm being pedantic, but we're also going to add a requirement for FULL CONSENT BEFOREHAND, right? I don't want to land in an emergency room after a car accident and they're knitting me back together while I'm screaming but it's ok because in six hours I'll have no memory of it.
posted by aureliobuendia at 11:18 AM on May 18


would it ethically matter if you were in a shit ton of pain, but did not retain that pain in your memory?

I ain't going to remember fuck all when I'm dead, but I'd still rather not be tortured to death.
posted by howfar at 11:27 AM on May 18 [13 favorites]


This plays like a commercial for both Ketamine and people with lovely accents performing medical procedures.
posted by dirtdirt at 11:35 AM on May 18 [5 favorites]


It's pretty common for, say, oral surgery to combine local anesthetic with an IV benzo like midazolam that will sedate and produce amnesia but not knock you all the way out. Maybe throw an opioid in. No analgesia whatsoever I suspect is a much less popular idea. (When I had this sort of semi-awake procedure I definitely felt pretty messed up when I un-blacked-out regardless of the absence of stronger drugs.)
posted by atoxyl at 12:03 PM on May 18


Woo! Ketamine. Ex-cell-ent!
posted by byanyothername at 1:14 PM on May 18


I've been trying to remember who he reminds me of and now I know. It's your dad's best friend.
posted by howfar at 1:58 PM on May 18


I went back to listen to it again to confirm or disconfirm my initial impression, and I would say he loses his Scottish accent under the ketamine and sounds very American.

He also flushes in an interesting way.
posted by jamjam at 2:06 PM on May 18


Hi, American here, recently dosed with ketamine also for a broken ankle and dislocated foot. My experience:

Doctor says "you won't remember anything," and shortly after he administers the K I start feeling like I'm losing my grip on who I am, my Self is sort of slipping away from me, but it's pleasant so I just sort of let go. (Which is completely out of character for control-freak, straight-edge, didn't-even-start-drinking-til-26 me.)

Then I start seeing these amaaaaazing, hypnotic patterns of concentric rectangles, they're surrounding me in dimensionless space, and I'm just digging the hell out of it for what I think is an hour and a half, wondering where I am, it looks familiar... maybe because I work as a web designer?

As I'm coming out of it, the doctor asks, "How are you feeling? Can you hear me?"

I respond, "I LOVE the INTERNET!"

(This according to the coworker who sat by me through the experience. She says I was out for all of five minutes. I'm fascinated by the sense of time dilation.)

As I further come to, I feel happier than I have in years. I'm aware that my leg is broken, but I'm giggling and telling everyone it's totally OK that I broke my leg. It's really ok.

Further surfacing into consciousness, I realize those concentric rectangles are the HVAC vents in the ceiling.

I giggle for another hour or so, and just feel beatific and peaceful. The election is in another week. I ask the doctor if I can get enough of that to knock me out until it's over. He laughs uncomfortably.

The percocet they gave me for pain management afterward put an end to that peacefulness; it's nasty stuff, I didn't even complete the full course of it. I'm bummed I ended up taking something that countered the effect of the ketamine; I heard there's trials of ketamine as a treatment for depression, which I've had to deal with. The rumor was one or two doses can knock you out of depressive cycles for good.

The fact that I declared my love for the Internet under ketamine's influence strikes me as more profound than even that. I'm a woman who works in tech. I've worked in the digital rights/infosec sphere; some of my friends were victims of Jake Appelbaum. My network was hit hard by Gamergate. I've spent the past five years wondering why the hell I was ever excited about the Internet. For that to be the first thing out of my mouth... well, I tell you, I'm starting to wonder if Timothy Leary had a point.
posted by gusandrews at 4:47 PM on May 18 [9 favorites]


The rumor was one or two doses can knock you out of depressive cycles for good.

My personal experience with K and the analog methoxetamine (definitely not under medical supervision) was of mood effects lasting more like a couple weeks after a dose but of course that could be worth a lot if you're prone to deep depression. Big fan of that category of drugs - not something to let yourself get into doing more often than that though (that wasn't me but there are some bad stories).
posted by atoxyl at 6:59 PM on May 18


For a painful minor operation that required me to "be under", the doctors asked if i would consent to a study which was using Valium to dull the effects at waking. I agreed and never have experienced anything like those "dreams". So sharp and vivid and almost constant, it seemed to work on waking as i experienced no side effects, walked home the next day.
posted by clavdivs at 7:02 PM on May 18


I went back to listen to it again to confirm or disconfirm my initial impression, and I would say he loses his Scottish accent under the ketamine and sounds very American.

Everyone is American when they're on drugs
posted by Ray Walston, Luck Dragon at 7:03 PM on May 18 [7 favorites]


I'm in favor of anything to prevent bringing back ether, which is what they used to take out my tonsils when I was five years old. I remember being held down by a half dozen adults while they held the mask to my face (that number can't be right, given my size), visions of moons and people dancing arcing through my head (?), and the awful smell like it was yesterday.
posted by she's not there at 7:17 PM on May 18


Should have said "cartoonish people frantically dancing" because "visions of moons and people dancing" reminds me of Moondance and it was absolutely nothing like Moondance.
posted by she's not there at 7:26 PM on May 18


I remember…the awful smell like it was yesterday.

We haven't used ether anesthesia in the US since long before I trained (ca. 1990) but I have heard similar comments from people who had ether anesthesia decades ago and still get nauseated by the smell. It is a good illustration of how nausea is a far more potent negative stimulus than pain. People who break bones are often back doing whatever they were doing to break their arm or leg even before the cast is off, but if something makes a person nauseated they will often avoid it for the rest of their life.
posted by TedW at 10:15 AM on May 19 [3 favorites]


My dad was a veterinarian, and back in the 80s Ketamine was (and probably still is?) used in veterinary practices for small animals. Dad mostly used it with cats.

Their behavior going down, and coming back up, is entirely consistent with Neil.
posted by uberchet at 1:51 PM on May 22 [1 favorite]


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