Even preparation is no guarantee of easing a crisis

Pain while abroad leads to a difficult rationing of medicinal relief

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by Mary Shaniqua |

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I recently suffered a sickle cell crisis while on a trip to Jamaica, which was particularly difficult because my partner was also ill. I was in an unfamiliar location, and the pain was far worse than usual.

But I was prepared, I thought. A few years ago, I had a severe and life-threatening crisis as I traveled to Scotland. Living through such an experience made preventive planning important to me. I have tips in place to protect me from complications while flying and other circumstances sickle cell might throw at me.

Still, my disease can cause a range of problems, making it impossible to prepare for every potential scenario. I do track my health closely to identify my common problems and try to counteract them. That’s exactly what I did on this trip. I made sure I brought with me double the amount of pain relief I’d usually need over that time frame, as well as both nonsteroidal anti-inflammatory drugs and opioids.

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Sometimes preparation isn’t enough

Prepared as I was, I still suffered an extremely painful and prolonged crisis. My sickle cell has developed its own brain and is synced with my menstrual cycle, meaning I tend to suffer a crisis shortly before my period each month. I know this, but there’s something about being away on holiday that leads you to forget the stresses of life — and that’s normally a great thing. In this instance, though, I forgot about the crisis pain when my period was on the horizon.

In fact, even when the pain first occurred, I still didn’t realize the cause. Only on Day 3 of the pain, when I became quite distressed, did I call my mum and acknowledge that I couldn’t figure out why I was hurting. She reminded me that my upcoming period was likely to blame.

A strong support network is essential for those of us living with sickle cell disease or other long-term disabilities. But my support in Jamaica, my partner, was also ill.

Thankfully, though, God in his providence ensured that two friends of mine were also in Jamaica, close to where we were staying, at the same time. I was able to reach out to them for assistance in securing much-needed supplies. Because my crisis lasted a long time, the preventive measures I took were simply insufficient.

Emergency measures

I had to strategize once I realized the pain wasn’t easing. I also knew that if I continued to take my breakthrough pain relief at the prescribed rate, I’d run out — which would be disastrous.

I used nonpharmaceutical pain relief options as much as I could, but I also used ibuprofen, codeine, paracetamol (often known as Panadol), and my immediate-release oxycodone (often known as Oxycontin) to act as added breakthrough pain relief. Alternating these medicines meant I was getting some form of relief every three hours.

Lastly, I decided to increase my background pain relief (prolonged-release oxycodone), thinking that if I increased it for the short term, I wouldn’t need to take the breakthrough pain relief as frequently. This strategy wasn’t easy, and making the medication stretch by rationing meant a lot of soldiering through the pain.

Once I got back home to the United Kingdom, I spoke with my medical team to flag the emergency changes I’d made to my medication regimen. I knew I needed a weaning plan to get me back to my usual doses of these particularly strong medications and prevent withdrawal complications. I’m careful with my pain medicine, usually taking the minimum doses required. Without a stringent approach, they can cause issues because of their strength.

I’m not sure I can do anything to stop experiencing crises, especially when abroad. However, I’m endeavoring to hone my preparations, so should the worst happen and sickle cell rear its head, I’m equipped to handle it as best I can.

Note: Sickle Cell Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Sickle Cell Disease News or its parent company, BioNews, and are intended to spark discussion about issues pertaining to sickle cell disease.


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