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 Post subject: dentists....
PostPosted: Wed Apr 06, 2011 1:34 pm 
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Wow, I haven't felt like a low class addict in a long time...until today when I went to the dentist. I have an tooth abscess that I have been treating myself with antibiotics and huge amounts of ibuprofen...last month I was able to decrease the abcess and the pain was covered by Aleve, but now? It's really bad. So I started another course of antibiotics and called a dentist.
I got an appt today and he took xrays...and its a mess...2 different abscesses...and I knew it wouldn't be pretty....I can't afford a root canal and to try to save the tooth but he said it was not worth putting money into this tooth for various reasons. On top of this I had talked to the office manager and also explained that I would like to utilize one of their payment plans.

Well, I attempted to talk to the dentist about Sub. I realize sometimes people just don't need to know about this...but I have no idea what this whole thing is going to end up being...pain wise. So I was honest on the history form that I am on Sub and told him of my history addicted to opiates and how long I'd been in recovery. Seriously, the whole conversation was way over his head. I was prepared, had called my sub dr and told him what was going on, and copied a simple form from the forum to help him understand Sub and how to rx pain meds if I would need them. Right now the pain is so bad that I'm really nervous about how this is going to end up. My right side of my face is swollen, I have referred pain everywhere...and now am a little scared after seeing the xrays.

As I tried to explain the partial agonist effect and how Sub works etc etc he just looked lost...he then refused to give me sedation saying he didn't want me to relapse. I said I didn't need sedation, just a very dense local anesthetic....he went from being nice guy to looking at me and talking to me like, well, you know...and all of a sudden the two other dental assistants were listening in...no privacy what so ever..and he kept saying he didn't understand and what was Sub again? I tried to explain that it could mean i'd need a higher dose of pain med for a day after this little surgery (its a big tooth, with big problems, however) and he started shaking his head saying he's not comfortable prescribing this medication....(He thought I was asking him to prescribe sub! For fucks sake...) and I said, No I already AM on Sub....and then I said never mind...I don't need anything, just a good local anesthetic and I'll deal with ibuprofen...he walked out and 2 min. later someone comes in saying I need you to pay this right now before we get started.

And I know that is not SOP so I reminded them that I already asked for a payment plan and they said 'we don't do that with new patients'. I stood up and looked at her....the dentist was nowhere to be seen the chicken shit....and I said this is really how to treat new patients, patients who are honest about their histories, who are in excruciating pain? That I bet half their patients came in seeking opiates but I was here with a true emergency and I don't have $500 to fork out. I told her that in my career in anesthesia and as a therapist that I've helped so many patients, worked for free, done a lot of pro bono stuff for people in need and I was appalled at how I was all of a sudden being treated. I am usually not so overtly confrontative....but I have such an issue with this. I've never turned down someone for lack of upfront payment...but more importantly it was the decline of the conversation once he realized I was an addict...recovery didn't seem to matter...

I know I'm not the only one who has experienced it...but I do believe we need to speak up and I did try to not be angry and reactive but to speak professionally about it...although I did say shame on you right before I left.

I have found another dentist, going in an hour....I'm NOT going to say anything about Sub, tho and I'll just deal with the pain with 800mg ibuprofen every 4-6 hours. And I'm sure once the tooth is out and the abcess cleaned up the pain will be minimal....and I know they can't take it out today so hopefully I won't shoot myself at 3am like I wanted to do this morning when I woke up in pain. Wow...I am not usually a total wuss with pain...well, maybe that's not true...I've faked it so many times to get opiates that who knows if I am a wuss or not!

just needed to vent. IDIOTS. including me because I thought ok, i'll go in and show him this and we'll all get along just great and everything will be fine. Dumb ass...(me)


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PostPosted: Wed Apr 06, 2011 1:57 pm 
Oh my gosh! I'm so sorry Chinagirl! I had a tooth go 'bad' on me one time many years ago, long before I became addicted to opiates, and that was the worst pain ever! I can say that with all honesty.....I've had two natural childbirths with no epidural, no IV pain meds at all, and they were long, hard labors mind you....but that f...ing toothache literally did make me want to blow my head off! I'm so sorry for you. You need to get that thing out of there.
What a jerk, that dentist was to you! It's just so overtly discriminatory the way they treated you.
Oddly enough, I read your post after having recently spoken to a friend of mine who is on Suboxone and had to go the ER with chest pain recently. She was so pleased with how she was treated there. She told the doctor and staff about her addiction and recovery and that she was on Suboxone. Now, she did say that they really didn't seem to know much about Sub. What she did is just tell them simply, that it is an 'opiate blocker.' I'm starting to think that's the best way to go...to just give minimal information about it. Otherwise these guys (doctors, dentists, whomever) just seem to get blurry eyed and turn into assholes right before our eyes! I don't know....I personally have only had one incident in the ER during my time on Sub. I disclosed it and immediately said something like "It blocks pain meds" and followed that with "I do NOT want any pain meds." What happened to me and what happened to my friend recently was that we were both told that was fine, but "if the doctor decides you need pain medication, you will be given something, with your consent of course." So I and my friend were both relatively impressed with our emergency treatment. Yet I read over and over here on the forum about these awful experiences that others are having. It just makes me sad and and upset that we, as addicts in recovery, have to go through stuff like this. Obviously, if one is having a planned surgery or something of that nature, more care would have to be taken to ensure that all care providers were aware of and understood buprenorphine, etc. But in these other type of incidents, I'm leaning toward not disclosing or disclosing in only very simple terms.
In your case here, I completely agree with you not disclosing at this next dentist's office. You need to be treated. All you need to say is that you don't want any Rx pain meds. That should cover it. Why subject yourself to another rash of crap if it isn't completely necessary? I hate that this is how it is, but for now, I think that's your safest bet to get the treatment you need.
Let us know how it goes. Feel better soon!


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PostPosted: Wed Apr 06, 2011 7:10 pm 
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Hey Setmefree..thanks....seriously, the pain is excruciating and I had an ice pack on all day...I was chairing an AA meeting..and actually it helped take my mind off of the pain....I taken more ibuprofen today then in five years total...

But, found a new, compassionate dentist....who gave me a discount, let me pay payments...and whose uncle and father are in recovery...so things happen, right? He was really cool about the sedation...if I want it I can have it, and now issue with Sub....and was willing to work with me anyway I needed to get this done. So, tomorrow this sucker is out!

So, there are, obviously, caring medical professionals...one thing is i wouldn't allow anyone to treat me like that again...and on top of it the new guy is even cheaper!! before the discount. LOL....


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PostPosted: Wed Apr 06, 2011 7:43 pm 
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Chinagirl,

I was pissed when I read your first post, not at you silly, at that twit of a dentist. Now I just read your latest post and I once again find myself thinking how sometimes things happen for a reason. God works in our lives in strange ways sometimes.

Oh Yeah, you said, "although I did say shame on you right before I left.", OHHHH, we are going to have to wash your filthy mouth out with soap!!! hahahaha.....if it were me, I'm pretty sure a couple of F bombs would have been dropped!! :lol:

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PostPosted: Wed Apr 06, 2011 7:50 pm 
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You are not the dumbass, that bastard dentist is. I used to get furious over these stories, but now it just makes me want to cry. You go in there, an educated professional yourself, with all the pertinent information, and try to be proactive about your medical care, and they, in effect, refuse to treat you? Good for you for speaking up for yourself!
And I'm glad that debacle led you to the better, cheaper more compassionate dentist. I hope the next time you post your are feeling much, much better. Maybe when you're better you'll want to report the asshole to the ADA, or at least write a scything online review.
Feel better,
Lilly


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 Post subject: Aaarrgggghhhh!
PostPosted: Wed Apr 06, 2011 10:36 pm 
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Chinagirl,

Your post got me so stinkin' mad my fist had to be pulled apart with plyers! Like the old saying goes "No good deed goes unpunished".

So much for telling the truth, eh? But I'm glad it worked out and you were able to vent not only with us, but to them too. The "shame on you" part is really really good.

Thanks for speaking up for all of us.

Rule62


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 Post subject: support
PostPosted: Wed Apr 06, 2011 11:41 pm 
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Thanks for the support....I really appreciate it. Right now if I had fentanyl I'd do it...that is how bad the pain is...and I haven't had fentanyl since 1993 so that's saying a lot....so I'm here reading the forum to get my mind off myself and hopefully will be able to sleep.
I will let you know how it goes tomorrow...fyi for anyone else that needs emergency dental work. I, obviously, won't be stopping sub or doing that protocol....and I'll find out what and how much sedation I end up needing. I am currenlty on 6mg sub. altho today I took more due to this issue.
I like your idea Lilly...I am going to write a letter to the Editor...I've been waiting to write some kind of recovery /addiction op ed piece...mostly for marketing myself locally...wanting to try to write to educate the community etc...and this might be just the topic to start me off! the more I think about it the more I like it. And a cc to ADA will also occur....
We HAVE to take the time to do this stuff....educate others so we can make our lives better. We should not have to go through this hassle to get the care we need and deserve.
Well in 12 hours things hopefully will be looking up!


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PostPosted: Thu Apr 07, 2011 8:32 am 
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I didn't have the time to read the other replies, but I wanted to respond to you. First, I'm sorry they put you through that. I'm glad you were able to vent to us, because as you said, we do know what it's like to be treated like shit - even though we're honest and up front about our medical history.

I do NOT think you were confrontation at all! You simply were assertive and stood up for yourself. That's all. I don't consider that aggressive or confrontational. And you should pat yourself on the back for having done that. Maybe they will think twice about treating the next recovering addict the same way.

I'm glad you were able to find a new dentist. I, also, would not tell them about the sub. If I were you, and you expect pain after the procedure(s), I'd let them offer you the pain meds. If they do that, I would then call my sub doctor just to inform her/him. They might help you with the pain for a day or two. You will probably have to take double (or more) the prescribed dose (and your sub doc would know that). But, again if it were me, I would leave that option open. Although ibuprofen does help mouth/tooth pain a lot, it simply might not be enough. It's just an option and it's not like you would be doing behind your sub doc's back. You deserve pain relief and the truth is, taking opiates for pain relief does NOT place a recovering addict at risk of relapse. It's FAILING to treat the pain that actually places the person at risk of relapse.

Good luck to you and I hope the procedure(s) go well. Feel better.

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 Post subject: exactly
PostPosted: Thu Apr 07, 2011 8:43 am 
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Hi Hat,

I agree that recovering opiate addicts need pain control...and when they don't have it and are suffering they are at risk for relapse...for instance me last night....I seriously would have done fentanyl if I'd had access...not proud of that...but the pain was THAT bad.

I did call my sub dr and tell him the scoop. So he's on board. And I have accountability. Someone in program is driving me to the dentist and I live close to my sponsor who can dole out my pain meds...the dentist offered to give them to me and I had considered talking to him about Sub etc in case I needed a more potent med, but I'm going to keep it simple, not tell him about Sub and just get the lortab he offered. I really think once this abscess is cleaned up things will be fine.

I am so nauseated from the pain and from taking way too much ibuprofen yesteray...I tried to take it with at least a little bit of food to help my stomach but wow....hope I don't throw up at the dentist....how fun that would be for everyone. But at about 3am i fell asleep lying on the ice pack and actually slept.

So...thanks for the support and I'll give you all an update if I can get sedation amounts etc and how it all went.


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PostPosted: Thu Apr 07, 2011 4:29 pm 
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Hey chinagirl - If your pain isn't handled by the ibuprofin or the lortab, will your doctor give you a shot of toradol? I've had that with kidney stones, migraines and when I hurt my back and while it makes me kinda bitchy, it works really well. I know you probably already know all about it :) but sometimes it's hard to think when you're hurting so much so I thought I'd bring it up.

Good luck.

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PostPosted: Thu Apr 07, 2011 5:51 pm 
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Hey..just woke up from post op oral surgery....
Doaq the toradol idea is a great one and something i didn't think about...but right now don't need.

This is what happened today...and I'd recommend going to an oral surgeon for even a tooth exraction vs a regular dentist....I used to train these guys doing anesthesia and first off they are just usually a great group of surgeons (oral surgeons) and this one I went to is no exception. PLUS, they have had an anesthesia rotation for four months in their oral surgery residency so they know more about pharmacology then regular DMD's do. They are less fearful of prescribing what we all might need as well...he was totally comfortable with my whole situation. Plus I had the added benefit of both his uncle and father being in recovery so he was compassionate.
He didn't give me anything for pain preop but I don't think he thought the pain would be as bad as it got last night...and like I said was pretty nauseated from all the ibuprofen I took...I took massive amounts yesterday. A friend recommended taking an extra Sub last night which I did...so I took 6mg in the morning, my usual dose and 8mg last night around midnight.

This morning i took my normal 6mg of Sub prior to going in for the procedure which was scheduled for 1145am. I usually dose my sub at around 7am.

He started on IV and what he ended up using was O2 (and offered N20-nitrous, but I hate it and it makes me nauseated so I declined), then ondansetron which is for nausea, and 100mcg (2 cc's) of fentanyl and 8.5mg versed total for this extraction for me. It took about 30 min (the extraction...and it was one molar that also had maxillary sinus involvement). I thought I'd end up using a lot more fentanyl but I think he was smart in increasing the amt of versed rather then any more fentanyl in my opinion. I remember only a tiny bit...I think when he did the local anesthetic, but barely and I remember him one time saying to breathe. They monitored sats and ecg and b/p. Also, fyi in oral surgeons offices they sometimes use propofol for those those have more extensive needs or those who need more then fentanyl or versed due to tolerance levels. just fyi. also he used a longer acting local anesthetic since I still cannot move my mouth well yet...6 hours later...so that was helpful.

Post procedure I had a lot of pain right off the bat....and my friend drove me and got my Rx for Lortab 7.5/500 which I have had to use. So initially (I think I remember this correctly) I took four lortab and four ibuprofen within 15 min after the procedure....went home and fell asleep for 2-3 hours. Woke up with a little pain, not bad so my friend told me to take 2 Lortab and four ibuprofen which I did. fell back asleep and pain got better. So I had 6 lortab and 6 ibuprofen from noon-ish to 5pm the first day. I am having some aching now so I'm going to take another 2 lortab and 2 ibuprofen now. It should be fine by tomorrow is my guess. and he only prescribed #15 lortab which is fine by me. I didn't want 30.

He just called me, the oral surgeon and said it was all fine, no problems and reminded me of the amts he gave me which I would never have remembered! So over all a success...My friend, who is on Sub, is helping me dose and keeping me accountable so he'll help me figure out what to do tomorrow and how to deal with the sub...depending on if I need any more lortab or not. I'll let you know. I kinda like the idea of just having someone tell me what to take in this instance....and following those orders..it takes ME out of it, you know?

So in my opinion, after going to the regular dentist and having that experience and then having the oral surgeon do the procedure I'd never have a dentist do the extraction. The oral surgeon made it all very easy. Unfortunately the sedation was more costly then the procedure but I'm really glad I went that route. I also remember the regular dentist, the jackass from yesterday, making it sound like extracting this tooth would have been a huge ordeal, taking a lot of time with potential for tooth breakage etc etc and the oral surgeon said no big deal. and it apparently wasn't. Thank you God!

With as much pain as I had yesterday and the day prior this ended up being a pretty straight forward deal and I'm glad this tooth is out finally. If I had the money I would get an implant but maybe down the line.

Thanks for the suggestions and the support from everyone.


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PostPosted: Thu Apr 07, 2011 7:32 pm 
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I'm so glad it went smoothly - which it sounds like it did. And that you got a good oral surgeon. It sounds like your pain was manageable. I know very little about Lortabs (Hell, I don't think I even know what Lortabs are!), so may I ask, is the amount/dose you are taking above and beyond the "norm" to counteract both the sub in your system and the tolerance you've built up from the sub? And I assume it's enough to keep you out of withdrawals?

We've heard so many horror stories of people not getting any post-op pain relief, be it from surgical or dental procedures, so it's good to hear one that has worked out in the end not so badly. Especially since you didn't stop your sub before the procedure. Anyway, I'm glad you shared it with us. You might want to copy this post and put it under the "surgery" topic/category as well. That's where people will go to look for such stories.

Keep feeling better and keep us posted. :)

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PostPosted: Thu Apr 07, 2011 10:34 pm 
Good deal Chinagirl! I'm so glad you got that tooth outta there! Also so glad you ended up with an excellent oral surgeon to do this for you. I agree with you.....always a better idea to go with a good oral surgeon.
It sure sounds like things went as well as could be expected. I like that he upped your Versed, rather than the Fent. As you know, 100mcg is not an excessive dose.....I wonder how much if any of it actually made it onto your receptors.
As far as the Lortab....I can answer that for you, Hatmaker? I'm actually really surprised to hear that you don't know what Lortab is? For some reason, I would have thought you would be familiar with that. It's hydrocodone and acetaminophen. Maybe you know it better as "vicodin" or "Norco?" In any case, 7.5mg is not much. I'm pretty sure it would take at least 4 of those to do much in the presence of bupe. Unfortunately, with the hydro being mixed with Tylenol, you're getting more Tylenol than you should, Chinagirl. But I'm quite certain you know all that and will be careful. Also, you won't be on this for very long at all anyway.
Okay, again.....glad that baby's outta there! Feel better soon! Thank you for updating!


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PostPosted: Thu Apr 07, 2011 11:10 pm 
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Of course I'm familiar with Vicodin and Norco; however, I didn't know that Lortab was just another name for it and rather than make what could have been an incorrect assumption and look really stupid, I just thought I'd ask. :) So thanks for the answering my question. I do appreciate it.

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PostPosted: Fri Apr 08, 2011 8:44 am 
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Hatmaker...I saw that setmefree answered your question....vicodin, lortab, norco are all hydrocodone and come in 5mg 7.5mg and noros are 10mg. and all have varying amts of acetamenophin. So, what I took yesterday for pain was: initially right after procedure as local was wearing off 4- 7.5mg lortabs plus 4 ibuprofen (my stomach is still feeling it and i'm so nauseated so anyone doing this please eat something when you take these amts of tylenol and IB to coat your stomach) and then 2-3 hours later I took 2 more 7.5mg lortab with 2 IB and then 2-3 hours later took another 3-7.5mg lortab plus 2 IB for a total of 9 lortab the first day.

My last dose of lortab was 6pm last night...and its 830am..I just took 2 ibuprofen a half hour ago...so nauseated...and mild-mod pain, feels like I got socked in the jaw...although that's never happened to me before so not sure why I used that anaology.

I'm going to try not to take any more lortab today...and get back on sub tomorrow...I'm going to see if I can even dose at 4mg tomorrow...

So overall the whole thing turned out fine....It was a bit scary with all the pain I was experiencing, not having time to go off Sub, and do that protocol but it worked out. I mean 100mcg of fentanyl is nothing and I doubt it did anything at all..so it was basically the versed that put me out and it worked. I kinda thought he might want to give me at least 250mcg of fentanyl to see if I'd get any pain relief from it...but I wasn't about to micromanage....i know. surprising. As I said I didn't tell him about the Sub so he had no idea he was competing with that....He did a good job.

You know what was funny that one of his dental assistants said to me....we were all talking about my job as CRNA and the doctor was saying how he loves working with CRNA's...and then one of the assistants said "yeah when nurses come in here for procedures they sure need a lot more medication". Funny....she didn't say it in a mean or weird way, just an observation....and the dr made a joke about how happy CRNA's are....ok buddy...I get it! but we're not ALL addicted...lol....

I''l try to copy this over to the surgery forum...feel free to move it hatmaker if I don't get to it...I meant to rewrite it as a new topic so people could find it...


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PostPosted: Fri Apr 08, 2011 8:48 am 
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Re-writing the post in the other topic is fine or just copy and paste your one post about the surgery. That's about the easiest way to do it.

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