How many of us are addicted to caffeine? If you miss a morning dose, the headache starts and you feel more groggy than normal. What do you do? You go grab some coffee or a soda to end the symptoms. Now, imagine symptoms 100 times worse, like being chilled to the bone, sweating, constant nausea, vomiting, diarrhea... and it lasts for several days or even weeks. This is what it is like to miss your regular doses of narcotics. All it takes to stop it is that missing dose of medication, but there is not a Starbucks for that one. You need a friend, a dealer, or you find other ways... like going to the doctor.

Your radar is always up for pain pill seekers as a doctor: 25 year-old coming in for chronic back pain... 30 year-old for pain med... . It takes a few years, but you begin to see who is playing you: The flattery outpour, an initial visit for a more intimate or personal problem before a second visit pain issue, the need for an immediate refill to avoid withdrawal since they just took their last pill, the inability to give any small amount of urine for a tox screen in clinic, the list goes on and on. But the majority of the time, patients are not trying to fool you. We doctors sometimes forget that fact, because getting fooled by a few patients burns in their memory and we want to avoid that deceptive game ever again.

Even with that constant radar, 20% of adults get a prescription for a narcotic when they go see a doctor. Narcotics are prescribed for pain, but patients notice the pills can also decrease the feelings of stress and create some euphoria. What starts as a short treatment for an injury, becomes a risky treatment for depression and anxiety. The body begins to need more for the same effect. It takes one month of being on a pain medication before your brain begins to change permanently to need the drug. The body becomes dependent on the drug to avoid the withdrawal, and the mind becomes addicted to the feelings of less stress and minor euphoria. The mind and the body both yearn for the drug.

Most of the time, people don't end up taking the pills though. So, 70% of those prescribed pills end up left over and sitting in a medicine cabinet for someone else to "borrow". I have heard of "pill parties" where teenagers will take meds from their cabinets at home and bring them to parties to share the mix of prescribed drugs with friends. The saddest stories I have seen are of the teenagers who get hooked on "oxy" or vicodin this way and end up ruining their lives. They may recover before it is too late, but that addiction lingers over them every day for the rest of their lives. When stress kicks up in life, like it did for Ryan Leaf in his recent saga, the body and mind begin to crave that lost partner to the point of making completely irrational decisions to satisfy the need.

My advice: avoid the pills if you can, because they can hook you without you having any intention of doing so. There are injuries and surgeries where a few days of pain meds are absolutely necessary, and some people have chronic pain where they have to have pills just to function at all. Ask your doctor for pain treatments that don't involve narcotics, there are usually other options that might work just as well and are safer.

You can Google opioid or narcotic abuse and find some great information, or sites to find help if you are battling pills. Here is a nice overview article on narcotic abuse: http://emedicine.medscape.com/article/287790-overview#a0101

I remember playing basketball against Ryan Leaf back in Montana. He was the cocky guy with socks pulled up to his knees who would talk trash constantly. In one game, he threw down a dunk and ran the length of the court the other way with a double finger salute. Boos would cascade down on him, yet he would give a cocky smile and just let the crowd know that he did not need them, he was doing just fine without them. Needless to say, he was not a well-liked guy.
 
I ran into Ryan a few times during my 20’s when I was out with friends back home in Montana. He was a lightning rod for people coming up to him and lambasting him for wasting his talents. He would get pissed and end up in some sort of scuffle half of the time. Montanans are all about hard work and dedication, I think people felt like he was giving the state the double finger salute again by wasting his opportunity in the NFL and giving Montana a bad name.
 
Now, we realize that Ryan is an addict, thief, and liar. The tragedy of how far he has fallen is a testament to the powers of addiction, yet for many that I know back in Montana there is a sense of “that ***hole does not deserve any sympathy”.  I am not one to pass judgment on Ryan. He was an athlete, not a role model. He could throw a football, not cure a disease. Yes, I believe athletes should be positive role models for their communities because of the emphasis we put on sports in our society, but let’s face it, it is not realistic to expect all athletes to be perfect people. It is those deep insecurities and their cut-throat drive that make them the athletes they are. Sometimes that does not translate to treating others with respect and compassion. Ryan is a good example of this.
 
So now, we enjoy the story of human tragedy that is Ryan Leaf. He fights a daily battle with addiction, which I would not wish on anyone. Ryan will never be a “normal” guy, but I hope he can give the same double finger salute to painkillers that he used to give to the crowds back in Montana. I will actually be cheering for him if he can do that this time.
 
Will post something on pain killers in the near future.

By Dr. Brett Daniel

A goal without a plan is just a wish.
  — Antoine de Saint-Exupery

I want to lose weight. I want to pay off my credit card debt. I want to quit smoking. I want to exercise more. 

Sound familiar? 

Chances are that these are at least a few of the New Year’s resolutions you or your friends have chosen to undertake this year. Maybe your resolution was produced on a whim or was a simple response to a common question during a New Year’s party. Or maybe it was a declaration of frustration from dealing with a daily reminder of your need to get out of debt or lose weight. 

Whatever the inspiration for your resolution, it is now yours to keep. Well, today you have less than a 30-percent chance of keeping that resolution past February. 

However, there are some simple ways to help you keep your resolution this year and toast to your success next year.

Set achievable goals

Most resolutions are too ambiguous: lose weight, pay off debt, exercise more. Others can be unrealistic. 

To be achieved, the goal has to be attainable and well-defined. Otherwise, there is no small measure of success, and failure is likely. Here are some alternatives.

Instead of “lose weight,” resolve to decrease caloric intake by cutting out dessert, switching from regular soda to diet soda or water, or not eating fast food for lunch. Choose one to start your year, and try to make all three permanent changes by the end of the year.

Instead of “pay off debt,” resolve to decrease your credit-card debt by switching to a bank debit card and only spending money that you have in your account, taking a sandwich and yogurt for lunch and spending the extra $5 per day toward your debt or making no major purchases for a car or extravagant vacation until your debt is paid off.

Instead of “exercise more,” resolve to improve your health by waking up a half-hour earlier to go for a walk or run before work, not using elevators for less than five floors or doing 20 push-ups and 50 sit-ups per day. Again, start with one resolution and build from there.

Find the time

The most common excuse that I have used and heard in regard to failing to keep a resolution is that there is just not enough time to get it done. To be successful with your resolution, you need to find the time. 

Evaluate how much time you spend on the computer, in front of the TV or working outside of the office, and dedicate some of that time to your health. 

Here are some ways to find the time in your day:

• Set your alarm clock so that you wake up 30 minutes earlier — If you get exercise done first thing in the morning, you won’t need to find the time when you are exhausted at the end of the day.

• Stay away from the television — You can browse through the news on-line quicker than watching it. Instead of watching Monday Night Football, listen to it on the radio for the first half as you go for a stroll.

• Spend less time on-line — Most Americans spend an average of three hours per day on-line or in chat rooms. Instead of surfing the Web at lunch, get out for a walk. Instead of hanging out in a chat room, get a running or walking group together to get out on the weekends.

• Take responsibility — It is easy to find reasons that you will not be able to achieve your goals. It is much more difficult to figure out ways to deal with those barriers. 

Sit down and come up with a list of potential roadblocks to your goal. Evaluate these barriers to your resolution, and try to come up with three things you can do to overcome each of these potential roadblocks to your goal. 

• Get a checkup — Your physician can be very helpful in helping you achieve your New Year’s resolution. He or she can make sure your body can handle the rigors that you plan to put it through over the next year. He or she can help you set reasonable weight-loss goals and work with you to find the best route for you to accomplish that weight loss. 

Whatever you choose to start or stop this year, I hope that this information will help get you started on your way to achieving your resolution for 2012. 

DR. BRETT DANIEL is a family-medicine physician at Pacific Medical Center. Pacific Medical Centers (www.PacMed.org) also has locations on Beacon Hill, First Hill and Northgate. He is also the “House Doc” for Seattle’s sports radio channel KJR 950 AM.

Rough week to be a Seahawk fromt he injury standpoint. But hey, they still have a shot at the playoffs... and worse draft picks. But that is for someone else to comment on.

Sidney RIce was moved to the IR after another concussion. Better safe than sorry with all of the money they had invested in him. Plus, everyone is different with a concussion. Look at Sidney Crosby, it took him several months before he was cleared to return to the ice. It happens. Rice has his whole life in front of him, and a few more years with the Seahawks. Hope things clear up for him OK and he will be have a productive career. The injuries are starting to add up for him though.

Russell Okung tore his pectoral and needed surgery to repair it. Bad news for an O-lineman. Tavaris Jackson can survive with an injured and weaker pectoral, offensive linemen need their pectoral to battle the defensive linemen. He should be healed up and regaining full strength by next season, but it just depends on his recovery.

The O-line for the Hawks really suffers in the long run because of the severe injuries to their young linemen this year (Carpenter's ACL, Moffitt's blown PCL and MCL, and now Okung). They all will have to spend a lot of time getting their strength back before they can regain their form and work on technique.

In regards to Moffitt being suspended, it sounds like he is on a stimulant for ADHD based on reports. This is not an uncommon drug for athletes, 5% of people in the U.S. have ADD or ADHD. It can really help people that suffer with problems focusing. For example, people that have a hard time with having to re-read things several times because of their mind wandering, completing or turning in assignments on time, or just being able to stay on task without their mind wandering in an amazing number of ways, can really see benefit in the medications. However, the medications do have side effects and are controlled substances, so John messed up by not reporting it to the league... if it was prescribed for him. If he borrowed the medication (Adderall and Ritalin are common ones) from someone else (very common on college campuses these days), then I guess he got caught doing so.

It is going to be really interesting to see how the O-line gels next year with all of these injuries.

Lots of knee injuries have popped up, so I thought I would give a little information to help you understand all of those three letter abbreviations that you hear about on the radio.

Rookie tackle, James Carpenter, suffered a torn ACL in practice this week. We have all heard of an ACL injury before. It stands for Anterior Cruciate Ligament. It starts in the back of your upper leg bone at the knee, then crosses to the upper front of the lower leg bone of the knee. It provides most of the core stabilization in the knee. This ligament usually tears when the lower leg bone is forced out quickly and snaps the ligament. Once torn in a football player, it usually requires surgery to repair it and means 6-7 months of rehab before returning. Sometimes it will take longer than that to regain all of the normal strength and explosion in the knee though.

Rookie guard, John Moffitt, suffered an injury to his PCL (posterior cruciate ligament) and his MCL (medial collateral ligament). Ouch. Tearing the PCL completely is unusual. The PCL keeps your knee from hyperextending. The MCL is on the inside of the knee and keeps it from opening up with outside force. It sounds like he completely tore both, so he is going to require a period of time for his MCL to heal before they go in and fix his PCL. He is going to take 6-12 months to recover from surgery and be cleared to play again. He too may need more time to completely regain his strength after that, though.

Keith Price also has a knee injury, but his ligaments are not torn completely. He probably has a mild sprain/tear of one or more of the ligaments that is causing some swelling and pain. He should be able to come back when the swelling goes down and he is not in much pain.

We usually grade ligament injuries as Grade 1, 2 or 3.

Grade 1 is mild tearing/sprain that usually recovers quickly, but depends on which ligament. You can have swelling and pain that require icing, bracing and anti-inflammatories.

Grade 2 injuries or medium tears/sprains that require a longer period before return to activity and are more painful.

Grade 3 injuries are complete tears and need surgery if it is the ACL or PCL, but may just need time and bracing if it is the MCL or LCL(Lateral Collateral Ligament on the outside of the knee).

Keep those knees healthy everyone!

Here is a picture of a right knee as if you were looking at someone to understand where all of these ligaments are in the knee: