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 Post subject: Thx all for support
PostPosted: Thu Jan 07, 2010 8:03 pm 
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I will definitley keep everyone posted for sure, you all seem like family to me on the way you care so much of someone you do not even know. That really hits my heart and makes me feel so differant about people who suffer through this type of ordeal in there lives. I use to look at drug addicts and roll my eyes and say why not just stop. Why do you have to be so dumb and keep using it. Even though im not your typical addict, I honestly do know now how this horrible epidemic controls people once it gets to far into there system. I have a differant understanding now and feel totally differant about this epedemic. I feel for everyone that has somehow got themselves in this predicament and pray for them to get the correct help and support to help them get cleaned. Its amazing how we have to go through this just to understand what really happens.

I am on my 2nd day on suboxone at 3 pm today it has been 48 hrs of suboxone at 8 mg every 8 hours. I still feel a bit more tired but cant sleep and stomach is uneasy. But overall I feel 80 % better and my doctor called me today so I could explain some things to him and he wanted me to cut the pills in 1/2 and start 4 mg 3 times a day and that should help with upset stomach and maybe 8 mg was to strong. I will start the 4 mg in 10 minutes which is 6 pm today.

The other thing I noticed is that my urine was really dark yellow now, and thought it might be my body flushing the old fentanyl out or this new suboxone. Im very paranoid of things since the whole ordeal. It all hit me and I never new this would happen to me. I am still nervous to even go down to 4 mg because i dont want to experience the 19 hours of agony I went through again. I sure hope tapering the suboxone when the time is right is much easier.

Now for the cows score, I do agree that I feel I went that long and it just didnt make any since why I was told to get to 25 before starting and that may still be to early. My wife was so stubborn and followed the doctors orders and made me wait.
As I know now I indeed process this fentanyl quickly than normal and I indeed was in withdraw even 12-14 hrs after the patch was put on. I honestly think I could have started the suboxone a lot earlier. But I can say now, Im glad that ordeal is over. I read several places on the net about when to start and all say MILD to moderate, and I even so video of a guy in a doctors office in mild withdraw talking and he looked down and clammy when he started but he sure didnt look like me bouncing off walls and rolling in agony before I started mine. That really confused me. But on a note after reading differant scenerios from people who say do not go too early or you will suffer and start the severe stuff if you start to early. In my mind im thinking holy crap some people said 96 hrs after the last patch. I would not been able to make another day like that. I felt I was in severe wd. So my mind is in scared motion still because im thinking it could happen again as i decrease down on suboxone.

Anyways lets see what happens at 4 mg every 8 hrs I pray to God that everything will be ok still. Well its 6 pm so its time for the 4 mg pill now. I will keep posting. Thanks everyone


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PostPosted: Thu Jan 07, 2010 10:12 pm 
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My wife reminded me of a strange occurance while experiencing wd's waiting to start suboxone. I decided to share this just in case someone has experienced this or I am truly a strange and unique case.

Around my 15th hour of withdraws waiting for my COW score to rise my I was having cramps in my stomach and suddenly jumped out of bed and threw up. When I laid back down my WD was completely stopped and I thought that maybe it just all passed and the Fentanyl actually was out of my system. I looked at her and stated that maybe I wont have to go on suboxone that everything just passed. I was puzzled and able to calm down for 15- 20 minutes and then all of the sudden it started again but was more intense. At that point I was so upset and it seemed to just get worse. Of course about 4 hours later I started the suboxone. I was at the end of the rope. Now why would a person go 19 hours with wd's and have 15 minutes of freedom then back to hell.

Sorry but my wife felt I should try and give every detail. She wanted to know if that is a normal occurance possibly.


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PostPosted: Thu Jan 07, 2010 11:01 pm 
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I'm so sorry that you had to go through those huge withdrawals unnecessarily. In fact, you were likely getting close to what precipitated withdrawals would have been like. Had your doctor been able to see you, he very likely would have told you to go ahead and take your first dose much sooner - thus the benefit of starting the induction in the doctor's office. It's all over now, but that feeling is imprinted on your brain and is going to stay there for a long time to come - sorry to say.

At least I do have some good news and that is, no, weaning off of Suboxone will not be nearly as difficult as what you just went through. You should not have to go through that ever again - unless you run out of Suboxone (for several days) while you are on a high dose. As long as you SLOWLY taper down over a long time and then get yourself into the .5 MG range and lower, you will not feel anything near those withdrawals.

You may want to mention what happened to your doctor and ask him why he wanted you to get to such a high COWS scale level (25) when the Suboxone manufacturer only suggests 5 to about 15. What you went through is done, but you may be able to help many other people who become this doctor's patients in the future from having to go through what you had to. By you relaying to him exactly how bad this was and how much it has scared you, he may re-think what he tells his future patients. Just a thought.


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PostPosted: Thu Jan 07, 2010 11:19 pm 
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I think with fentanyl you have to be extra careful doing a Suboxone induction, so that might be why your doctor had you wait until you were in more severe withdrawals than you would have to be for a shorter acting opiate. Other people have told stories here about switching from fent to sub and going through precipitated withdrawals because they didn't wait long enough. Better safe than sorry I guess.

I noticed you said your urine was dark - please make sure you are drinking enough fluids. Opiates tend to dry you out and dehydration can cause all kinds of nasty side effects. I know I wasn't drinking enough water when I started Sub treatment and I ended up with a kidney stone. Not fun.

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PostPosted: Fri Jan 08, 2010 11:11 am 
I agree with DOQ. I would think a Suboxone induction straight from the Fentanyl patch would be way less straightforward than induction from short acting opiates. I was really worried about Boxingofficial ending up in precipitated withdrawal. Maybe that's why his doctor wanted his COWS score way up there.
As far as the strange 15 minute reprieve you had in the midst of your horrible withdrawal - that's odd. I haven't heard of that before. My best guess is that it had something to do with the violent vomiting episodes and all that your were going through. Have you heard of sometimes like when a person is in a horrible accident and has terrible injuries but doesn't "feel" it at first? Like when they need to go get their child out of a burning building or something like that? That 'fight or flight' thing takes over to the point that you have a brief time frame of no pain. Totally just a guess. I don't know what it was, but quite strange indeed. I think your situation is just different in many ways!! But that's okay - we are glad you're better!
DOQ is right about the dark urine. No wonder, what with the vomiting and how sick you were in withdrawals. In all liklihood you just got dehydrated. Drink plenty of water and I bet it clears right up.


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PostPosted: Fri Jan 08, 2010 1:08 pm 
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I agree with setmefree it was probally because I had such a violent episode of throwing up really nothing but phlem and my body was just rolling and balling up and going through the motions. I havent really been able to eat very well in the last 2 weeks and especially the last few days prior to going into wd's. I was throwing up violently and most likely a huge dose of adreniline with thru me and played a cruel trick on me. One that made me feel like it all went away for that brief 15 or so minutes. And of course after that it was downhills from there.

On my 48 hour and cutting down to 4 mg every 8 hrs I am starting to be more confident and feeling better as the days go by. Thanks again all


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PostPosted: Fri Jan 08, 2010 4:51 pm 
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For whatever reason I find this topic very interesting. I just wish I could find the answer. Is not withdrawal - withdrawal and the COWS scale the COWS scale regardless of the drug that you are detoxing from? Why would a COWS scale of 15 be any different when you are coming off Fentanyl than when you are coming off oxycontin? Certainly the amount of time that it takes to get to a 15 may be different, but once you are at 15 why would you have to push higher just because of Fentanyl? If someone knows the answer or could explain any of this I'd be very interested. Something still tells me that the drug you are detoxing from doesn't have anything to do with anything other than the amount of time that it takes to get to the level of withdrawal that you are shooting for. Once you are there, you are there - whether that took 12 hours or 12 days. If I'm missing something here, I'd love to learn what it is. I still think that boxing was forced to wait and suffer without any rational reason. Once you are in mild to moderate withdrawal you are ready for Suboxone, regardless of the drug you stopped taking or hour many hours have passed since you stopped taking it. Correct?


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PostPosted: Fri Jan 08, 2010 11:42 pm 
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I don't know but I remember reading on the suboxone.com site that patients on long-acting opiates should wait for severe w/d before induction...

I think fent is weird because the opiate effects wear off long before it's actually out of your system. I think there's a tolerance issue as well. When you're on such high doses of really strong opitates, your tolerance is going to be higher than Suboxone can cover because of Sub's ceiling effect. So as you're experiencing withdrawal, your tolerance is also coming down to a level where a dose of Suboxone will actually be strong enough to stop your w/d symptoms. That's one of the problems with mmt patients switching over to sub. If they can't get their methadone dose low enough first then they have to abstain for like 3 days or they will get precipitated w/d because the Sub just isn't strong enough to meet their opiate tolerance. Does that make sense?

Here's the info from Suboxone.com

Quote:
High-dose transfer (from methadone-equivalent doses ranging from 30 to 60 mg):
No SUBOXONE or SUBUTEX sublingual tablets should be given after the last methadone or long-acting opioid dose until the patient experiences maximal withdrawal discomfort (at least 48-96 hours after last dose). Earlier dosing with SUBOXONE or SUBUTEX is highly likely to precipitate withdrawal.
Be prepared to administer limited amounts of withdrawal medication (eg, clonidine, loperamide, sleep aid, NSAID, etc) for symptomatic relief.
High-dose transfer patients need careful monitoring and dose titration according to the response of the patient. If withdrawal symptoms have not worsened or have improved within 2 to 4 hours after the first dose of SUBOXONE or SUBUTEX, an additional 4-mg dose of SUBOXONE or SUBUTEX is recommended. Clinicians have reported prescribing a third dose (2-4 mg) to be taken later in the evening if needed for withdrawal symptoms.
Step 4: Select initial SUBOXONE or SUBUTEX dose
Note: The dosing of SUBOXONE or SUBUTEX depends on the patient's existing dose of long-acting opioid (labeled as the methadone-equivalent dose in the following table).

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PostPosted: Sat Jan 09, 2010 12:52 pm 
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Hii Boxingofficial -

I'm catching up on the forum, and noticed that you were going to smaller doses multiple time a day.

I am wondering if you have hit 'normal' feeling yet? COWS of almost zero?

There is you 'pain' issue, but I am just wondering how you are doing with suboxone helping you feel normal off the fentanyl...

Thanks for an update!


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PostPosted: Sun Jan 10, 2010 11:49 pm 
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Boxingofficial - I'm on my 6th day, one of the things Ive noticed is that sleep comes faster and I finally feel rested, it gets better with each passing day. I hope this stuff works as well for you, it's been a blessing for me. My prayers are with you brother.


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 Post subject: Starting to feel normal
PostPosted: Mon Jan 11, 2010 5:19 am 
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You know since being on 4 mg every 8 hrs ive been getting better. Im starting to feel that normal again. I still have strange sleep patterns still. I sleep in 3-4 hr increments then im up. I never really get a full 8 hours of sleep mainly because im having to take a pill every 8 hrs and i set my alarm for every 8 hrs. By the time i take my pill it may take a few hours to fall asleep then when i finally do fall asleep my alarm goes off and im taking another 4 mg.

One thing that may be a side effect is that my skin itches all over since using suboxone. But my stomach is getting better as the days go. When I first started the suboxone my stomach was always upset.

Overall Im starting to feel like im headed in the right direction and feel so much more confident that this suboxone really is a miracle drug.

I want to thank everyone here who has been so passionate and caring and I will admit!! You guys/girls here have made it possible for me to get to where I am. I don't believe I could have done it without you.


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 Post subject: Patience !!!!
PostPosted: Mon Jan 11, 2010 8:25 am 
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Goog job, I've been keeping up with your situation, in time you'll dose 1 time per day, sleep today is a commodity for me, I have had more trouble sleeping than anything.. In a while you'll find that you wont need all the sub your using now, you will feel so good about everything when your able to cut back a little, suboxone is that wonder drug ,GOOD LUCK, Mike


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 Post subject: Update new dosage
PostPosted: Tue Jan 12, 2010 10:49 am 
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Well I made it into my doctors appointment for my 1st week followup. She wants me to start taking 4 mg every 12 hrs so essentially im on 8 mg a day now. Im on my second dosage of 4 mg and made it 12 hrs without any issues. In fact I took my 4 mg at 7 pm last night and actually for the first time slept for 6 hrs. The most since starting all this. Felt like it was good sleep. I fell asleep around 2 am last night wondering if I would wake up with some wd problems. I hope my body adjust to this 4 mg every 12 hrs with no issues. That will help with not breaking up my sleep issues having to get up every 8 hrs and take a pill.

My doctor gave me a prescription for 8 mg pills every 8 hrs just in case I run into issues. She stated that I could just keep breaking them in 1/2 so I get the 4 mg and always end up with extra meds just in case I needed them. I thought that was nice. Gives me confort that I will always have extra just in case someting happens in the future.

It would be really disheartning if my insurance started to give me a hard time later in the future or some odd thing like that. Having that extra may be like saving some money just in case.

I currently have retired military insurance so maybe im safe and just still paranoid.

My Doctor also wants me to wait about 3 moonths before I start any tapering to get off. Thats actually my time frame the 3 months but she thinks 6 months first. Im the one who rather get suboxone out of my system the earlier the better for me.

If I had know that taking fentanyl for 1 year would have caused all this, I most likely would have opt for another pain med option.

I would also like to know if you guys think that my old doctor that I fired who started me on the fentanyl in the first place was out of like.

We all know that I started at 12.5 mg and ended up at 50 mg every 48 hrs in the year on patches. If it wasnt for suboxone she would have had me at 75 mg at 48 hrs. I was more miserable when getting to the 50mg about 4 months ago. I had so much femtanyl in my system I could taste it in my mouth.

My old doctor prescribed me the 50 mg patch, then she gave me ritalin (speed) 20 mg 2-3 x a day to counteract the tiredness off the fentanyl, then some stomach medicine to counteract the nausea, then testesterone jel to counteract the low testosterone. Its almost as if she just kept loading me up with the fentanyl and tried to balance it with other meds.

I not once in the year ever had any blood test or urine samples just to make sure I actually wasnt getting toxic on the fentanyl. Is it standard practice not to have any of these test to make sure someone is not getting to drugged up.

I was in her office every month mandatory because of the class 3 type prescription, and remember telling her every month someting was terribly wrong with me. I told her my body was doing some really weird things almost every other day and I just couldnt pin point what it was. I went into severe depression and was so suicidal because of how I felt.

Its like my doctor just didnt care about anything but pumping up my dosage of fentanyl everytime.
I could not remember when I felt normal and tried numerous times to let her know someting is wrong with the patches.

Now that im on suboxone, I can truly say all my misery and unexplained feelings were from fentanyl. I am finally remembering how it feels to be normal again, now that im starting to get there.

I honestly believe if I didnt change pain doctors and was convinced by her to up my dosage to 75 mg I might not be here today.

A new pain Doctor and suboxone truly saved my life.

Everyone keeps telling me to stay on suboxone for some time so I dont crave fentanyl anymore just to be safe. But in honesty I never ever craved the fentanyl, It was my body reacting usually the next day and needing more I guess.

I always followed my prescription to the T and never used a patch to early. I was just that my body was in slight wd every other day and I didnt even know that at the time. Now I have a understanding of wd symtoms and been on the suboxone for a week. I can honestly say I know what a mild wd is now.

And for the questions about me having to go to a score of 25 before taking the suboxone. I asked my doctor why when everywhere I see that a person needs to be at 15 to higher or mild to moderate. And I garuntee I was sitting at almost severe before my 1st dose. I think I could have been spared some suffering.
And now knowing that I start to wd about 8 hours after putting on a patch, and my body going thru a mild wd waiting for a new patch. Now imagine me taking a patch off and getting to the 8th hour with no patch. I honestly think I was in full blown wd's 19 hours later.

That honestly will scar my brain for the rest of my life. I don't want to ever experience that.

Everyone is truly differant on how there body acts or reacts, and maybe I could have started the suboxone 12 hrs after my last patch. Who knows. Im just so happy to be where I am now.

I just feel the true love from everyone here supporting me. Its just so hard to comprehend how much everyone honestly helped me get thru some of this. I want to be here to help anyone else if I can.

Will see how 4 mg every 12 hrs goes. Thanks again all
My doctor to


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PostPosted: Tue Jan 12, 2010 11:40 am 
Thank you so much for the update. I think you'll probably be fine on your new dose, but if not, you are one of the lucky ones whose doctor is reasonably flexible with dosing. My doc is like that too. My first three months of treatment he kept my written Rx as 8mg three times a day so I was able to stockpile my meds and didn't have to buy any over Christmastime and probably won't need to buy any for a while.
Like you, I am glad that you persisted in telling your former doctor that something was wrong and that you ultimately got rid of that doctor and tried someone new. I'd hate to think that your prior doctor did not have your best interest at heart. I guess I'd rather think that she was trying to manage your pain and just didn't get what was happening to you. There is no excuse for what happened to you though. I just know from being in the medical field that it sometimes takes a "fresh pair of eyes" on the situation to see beyond your initial impression of things. Whatever the case, I'm just glad you've gotten the help you needed. My mother has chronic moderate to severe pain and she did not do well at all on anything over the 25mg Fentanyl patch. Her pain wasn't well controlled so the pain doc upped her patch dose - well it was NOT good! She was very depressed (not like her), had zero appetite (she only weighs 100lbs on a good day) and lost 10lbs, she just felt awful. Thankfully she has a good doctor who was aware that this drug can do this to people and he pulled her dose back down immediately. Unfortunately her pain is not well controlled and bless her heart, she is very careful about not taking more opiate than absolutely necessary (partly because of me). She gets by on her 25mg Fent patch which she swears doesn't do anything for the pain and one or two Lortab 10 a day at the most. It's a tough spot to be in, especially being that she is in her 70s!
Anyhow, went off track a minute! As for getting off Suboxone - I'd say you should listen to your doctor and take it slowly. If you read here on the "stopping Suboxone" section you'll see some stories about coming off Sub. There seems to be a common thread amongst the stories - long, slow tapers to very low doses before stopping work way, way better than coming off too high, too soon. So take your time. You've been through a lot and you deserve a chance to just be 'normal' for a bit.
I never got the impression that you were an addict, boxingofficial. I just feel you got into an unusual situation with reacting poorly to Fentanyl and I think you definitely had become and are opiate dependent. If that is the case I would think that you'd have an easier time, at least psychologically, with coming off Suboxone when the time comes.
I am not a doctor though. I'm just guessing and am not trying to diagnose you.....just giving my impression.
Anyway....so glad we've been able to help you out and I sure appreciate your posts.


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 Post subject: Congrats....
PostPosted: Tue Jan 12, 2010 12:27 pm 
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Hi boxingofficial,
Let me add my name to the list of people giving you the congrats you deserve!! I agree with you that the support from this forum is one of the best tools out here. You have come a long way and If things go as planned you should never have to go thru that again!! If you stick with the program and stay true to yourself you will be fine..... Please keep us in the loop during your recovery... :)
Best of luck

God Bless
TW


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PostPosted: Tue Jan 12, 2010 10:29 pm 
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I also have kept up with your story and want to congratulate you on your transition. I am glad that things are going well and I hope you continue on your way, Take care and I would enjoy you keeping us posted!!! :-)


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PostPosted: Tue Jan 12, 2010 10:50 pm 
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I'm glad that you are starting to do better. I am really curious though, you said in your last post that you asked your doctor why you had to be at a COWS of 25 but you didn't tell us what your doctor gave you for an answer! I'm really curious what her reason is! Also, how is your pain doing? Are you having pain management problems? If not, I then have to wonder if it's the Suboxone controlling your pain (not likely as it is not a very good pain killer) or perhaps you didn't need the Fentanyl to begin with in that your pain was already under control without narcotics.

I'm just really curious about these couple of items if you don't mind answering.


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PostPosted: Wed Jan 13, 2010 1:05 am 
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Well my new doctor still tried to avoid my questioning and told me that everyone is differant but he prefers his paitients to be at 25 points on the scales when on feteanyl patches. He believes that most patients still have the drug under there skin at least 72 hours as stated on Fentanyl sites. The fentanyl sites all claim that the drug is still in your system regardless of when you pull the patch off. He told me that I was just one of the people who really goes thru or my body breaks it down really fast and that is why I went to around 23 on my scale. He also told me that its in my best interest that I waited longer because I would not want to even experience severe wd's.

But in honesty I really think I was on the brink of severe so if I wasn't then omg was there more for me to get to if I had waited even longer.

As for the pain I now feel that the fentanyl was making me worse but since being on suboxone I still have trouble with pain but I can manage it better. Im using a tenz unit and doing physical therapy every other day, and having ultra sound and heat treatments.

I would rather go into more pain than to ever get back on fentanyl again. My pain level is still tough but I will work with it on a daily basis.

Well im still mad at my doctor for making me go thru the wd's I went through. I am certain that I could have started the suboxone when I was in mild wd and at a scale of maybe 15. I just didnt want to take a chance but I will never know now since we started my suboxone when I was at 23 - 25

Thanks

I do have more pain today because I had PT today and they claim it will get better as the days go by. We will see


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 Post subject: Hey Boxer
PostPosted: Wed Jan 13, 2010 11:06 am 
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Hey Boxer... Glad to hear you are doing better.

First off.. this is a pretty long thread so hopefully I won't repeat other good advice. But I do want to comment about the switch from the Fen patch to subs.

No doubt about what previous posters said about induction. I think your dr decided to error on the side of caution mainly because most people don't transition to Subs from the fentanyl patches. You may have been his first. I'm sorry you had to suffer so much with the WD's but it could have been worse if you went into the precipitated WD's. As bad as it hurt... I doubt there will be in residuals. Try not to dwell too much on that.

I too have [back/leg] pain issues though I doubt as bad as yours. Once again, I skimmed thru a lot of the thread and your most recent detailed post so I may have missed your injury/pain history info. Therfore... I don't know if it's chronic and expected to have some permanancy. If so, I don't know why your Dr would already be talking about taking you off Subs in six mos?? Even though you may not be considered an "Addict"... you do have an opiate dependence now so try and take things one day at a time and don't be worried about labels.

I see you are retired military. I got addicted to narcotics many years ago after being wounded in Vietnam. However, prior to that... I was already a drinker and pot smoker... and dad was alcoholic. So I had the predispostion. Anyway, don't be concerned yet whether or not you may possibly need to continue some kind of pain mgt meds. As you already know...there are worse options than Suboxone.

If the PT and Tens unit isn't enough to control your pain, then you may be confronted with some kind of long term maintenance... like many of us.

I'm kinda surprised you aren't treating with VA... or are you?


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PostPosted: Wed Jan 13, 2010 12:22 pm 
Suboxfreedom - I think you are right on as far as your thoughts on boxingofficial's difficulty with his withdrawal and his induction onto Suboxone. As several of us have commented - induction from Fentanyl patches is NOT the norm and has the potential to be a complete nightmare. It sounds like boxingofficial has a pretty good doctor and I truly believe her concern was to NOT put bxgoffcl into precipitated withdrawal by starting him on Sub too early. The COWS scale is great and is very useful, but like many, many things it is somewhat subjective, especially when you are rating yourself by yourself or with the help of a loved one, and the doctor isn't the one administering the evaluation tool. By 'subjective' I mean that the things being scored are not all things that can be objectively measured - human perception and emotion are involved and thus can throw the results to some degree. Did I explain that right at all?! In any case, again I will say, I believe the doctor erred on the side of caution by advising bxgoffcl to be higher than usual on the COWS scale. Perhaps we can let that issue rest now. After all, the doctor IS the doctor and has a lot more education than most of the rest of us! As long as bxgoffcl feels confident that his best interest are being served that needs to be good enough. He needs to be able to trust his care providers. Right? I think it's best if he can let go of the horrible experience he had with his withdrawals....it didn't go on forever....and he's feeling much better.
As I recall he's had pain for a long time. It sounds like he's pretty tough. And I hope he continues to make progress in dealing with it....and we're all here to help and encourage. I love this forum!!
Have a good day all!


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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