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PostPosted: Tue Sep 01, 2009 11:38 pm 
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Location: wyoming
Background:
In 2004 I was hit by a car in the parking lot of my daughter’s school and became hooked on hydrocodone. I have been on suboxone for 4 months and have been able to start rebuilding my life; I have chronic pain from my accident and need to have arthroscopic surgery to fix a chondral lesion. (Do you think this is a very painful operation?) I have my first surgery September 9th.
I take 4mgs of suboxone 2 times a day. My doc said to stop taking the suboxone on the 6th of September and my orthopedic surgeon will take over pain control for 1 week. My suboxone doctor sent the surgeon a fax telling him the plan for my suboxone and that he will need to treat my pain for 1 week post-op. As I was leaving his office he said I hope your surgeon takes time to read this letter? What if he didn’t even read it?

Problem: :(
I'm so freaked out that I won’t have good pain control after surgery. I have been having dreams that I just had surgery and the doctors and nurses won’t treat my pain!!!! In my dream they don’t even believe me when I tell them I’m in pain. Is this my brain telling me I’m not ready for this or am I just over thinking it? I'm sacred of having post-op pain that my OS won’t know how to treat; I’ve read that hydrocodone wont work for pain after being on suboxone.
I have been thinking of not having the surgery but I know I need to I'm only 33yrs old and can’t go up or down the stairs; I can’t hike or play sports. I just want to be healthy and be active with my kids.

Is 3 days plenty of time to be off suboxone before surgery?
Will they know how to treat me because of my history with pain meds?
Will I even need pain meds?

I’m sorry I sound so crazy but as I said I’m very scared. I hope you can help me :oops:


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PostPosted: Wed Sep 02, 2009 1:05 am 
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Even if you are off Suboxone for 3 days prior to surgery, you will still need more painkillers after your surgery than an opiate-naive patient would need. You should talk about this with your surgeon before the surgery so you know he knows what kind of aftercare you will need.

I had arthroscopic surgery on my knee a long time ago to repair torn cartilige and a torn ACL. The pain afterward really wasn't that bad, but I don't know about your particular surgery...plus, everyone is different.

Another option you could take is to stay on a low dose of Suboxone during the week after your surgery. I had a kidney stone while on Suboxone, and the percoset didn't do much on its own, but when I took it with 2mgs of Suboxone it worked great and I had no withdrawals or anything. I think there was another doctor around here - Opiate Dependent MD - who has used this method for post-surgery pain control also.

I think it's just natural that you are freaking out a little about this situation. We all know how well we get treated as opiate addicts and the stigma against us, and then there's the fact that many doctors are ignorant about how to deal with pain control in patients that are on Sub. Good communication is going to be key here. You are going to have to explain to the surgeon that you have a high tolerance for opiates and why and make sure he understands and communicates with your Sub doctor.

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 Post subject: knee surgery
PostPosted: Wed Sep 02, 2009 12:04 pm 
Hi Kkenley! Sorry for what you are going through. Hey if that knee surgery is going to help you out in the long run - sounds like you better go ahead with it despite your concerns. Although I have never had knee surgery, I had a long career as an RN and have looked after a few friends after knee surgery, so maybe I can help a little. As Diary said in her post - typically arthroscopic knee surgery is not terribly painful so that's good to know. Seems like for the people I've watched go through it, the pain can be kinda bad the first 24-48 hours, then not so bad. One thing specifically you might want to request is called a femoral nerve block. Maybe a doc on the forum will chime in on this, but one of my nurse friends who had knee surgery was friends with the anesthesiologist on her case and more or less as a favor (as it's not that common a practice for all knee surgeries) he gave her the block along with her general anesthetic. Of course, the down side is that with the block you cannot get up and walk on that leg at all for 12 hours or so. The upside being - no pain during that immediate post op period and minimal to no need for opiate pain meds Something for you to think about.
As far as the three day thing - my Sub doc told me if I ever needed surgery or such - he'd pull me off Suboxone a week or so ahead, switch me to 'real' opiates, I'd go through the surgery and stay on opiates as directed by the surgeon, then switch right back to Sub 24 hours post last pain pill. So maybe a little different regimen than your doc is doing. In any event, I bet you are going to do just fine. Just remember - you may not feel the "buzz" you're used to from your post op meds, but that doesn't mean it's not doing anything for your actual pain. The other thing is - I bet you've suffered lots of pain before, with your injury, with withdrawals, and so forth - and you made it through. You will make it through this as well!
As far as your concern regarding how the docs and nurses will treat you - I wish I could say you're wrong, but unfortunately in a lot of instances you're right. They do treat "us" differently. I would just put it as - "you know I've been dealing with this injury a long time and have had to take a lot of meds so my tolerance is real high" Try not to be overly dramatic with your issues or complaints and show as much appreciation as you can for the nurses who do go out of their way to try and help you. There is no excuse for poor or uncompassionate care, but as a nurse I know the other side too!

Remember to use other methods for pain control also - prayer, meditation, distraction, visualization, whatever you find helpful. The mind is a very powerful thing - don't psych yourself out of getting something done that will improve your quality of life!

Please come back and let us know how everything went for you!


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 Post subject: Thank God For You Guys
PostPosted: Wed Sep 02, 2009 12:59 pm 
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Setmefree & Jack,

Thank you soooooo much! For replying to my post it is such a relief to have some input and support from you guys.
I have had a lot pain in the past I bet I can do it again. I will ask for the femoral block when I meet the anasesiologist. I have been so blessed with so much moral support from family & friends and a wonderful sponsor. I will also take setmefree’s advise on be thankful and kind to my nurse and doctor. Worked as a Dialysis Tec and know the frustration caring for a grumpy ungrateful patient Grrrrrr.

I will keep u guys up to date on my surgery and experience stopping suboxone pre-op and with post-op pain relief.
I think I will stop the sub tomorrow that gives me 6 days to clear my system, my sub doc said if I have w/d pre-op to ask the the surgeons office for hydro. But I think that would just set off red flags & I think its my sub Doc’s job to deal with the w/d issues pre-op they all just want to pass you on next doc. My sub Doc is lazy as hell and a pervert (he gets in my personal space just creepy) but he is the only Doc that will prescribe suboxone where I live (small north-western town).

And if anyone out there has some more input I would love to here from you.

[font=Lucida Console][b]Laughter is higher than all pain.[/b][/font]
(Good medicine!) kkenley


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PostPosted: Thu Sep 03, 2009 7:14 am 
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I was told that at LEAST 5+ days prior to your surgery. Good luck with whatever you choose and be careful with your "pain control" ... you know what I mean... ;)


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PostPosted: Mon Sep 07, 2009 7:09 pm 
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Hey,
Just wanted to wish you the best for the procedure.I am 36 and have really bad knees from being obese most of my life.Even though I lost a ton of weight, my knees are shot and I am in allot of pain.I have been on Suboxone for 2 years because the painkillers were a joke.I developed a dependency to them and things just got crazy, I am sure you understand.
I am frustrated because I hurt everyday.I can barely walk some days, but I am afraid of dealing with anymore doctors because they treat me like crap, I just don't get why they don't believe how much this hurts.Anyways, hopefully some day I will be able to get the help I need but til then- I suffer!.

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 Post subject: Just a update
PostPosted: Tue Sep 08, 2009 2:46 pm 
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Well I will be going into surgery tomorrow morning I'm feeling very anxious, apprehensive and scared. I just keep telling my self everything will be fine, I guess I have had so many bad experiences with Doctors and Dentists that I have a hard time trusting the medical community and I’m sure they don’t trust me!!
My surgeon has a reputation of being the best surgically speaking but has a crummy bedside manor. :?: If anyone has advice on dealing with poor bedside manor fire away!
I will keep the post updated I hope you all had a good weekend and thanks for all the support :wink:


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PostPosted: Tue Sep 08, 2009 2:56 pm 
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I wish you luck with your surgery. As far as bedside manner...it seems like a lot of surgeons have crappy bedside manner, at least in my experience. Fortunately, you don't really have to see him too much & most of the time you'll be under anyway. Its the nurses who administer the meds, the doctor just has to write the order.

Did you get things sorted out with him? Asking for the nerve block seems like a good plan. If the surgeon is gruff or impatient just try not to take it personally - it's not you, it's him. I've found, every time I've been in the hospital, that just being polite goes a long way. I know it's hard when you're dealing with pain - I totally yelled at a doctor and a nurse when I was dealing with a kidney stone (I apologized later) - so just do your best.

Let us know how things go.

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-Jack Kornfield


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PostPosted: Tue Sep 08, 2009 3:14 pm 
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I was wondering how I can best deal with my doc's poor bedside manner :cry: ???? Any ideas

Thank you so much Kim


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PostPosted: Tue Sep 08, 2009 3:28 pm 
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Hi diary of a quitter,

The doc’s nurse said I may be able to have a nerve block depends on the anasesiologist (sp?) If I can that’s what I want, I don’t see why they would say no in my case. Not that I’m terminally unique! :lol:
I will definitely have my best behavior with me tomorrow :wink: Thanks for all the help
Kim


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PostPosted: Tue Sep 08, 2009 10:40 pm 
Hi kkenley - Good luck with surgery tomorrow girl! You're gonna do just fine! Never underestimate the power of positive thinking and positive confession, right?!! I understand your concern about your surgeon's poor bedside manner. But the thing is - you really won't be dealing with him all that much. You said he has a great reputation as far as his surgical skills and that's what matters most. After all - you'll be asleep while he's doing his work.
It's the anesthesiologist that you want to make friends with (and the nurses of course)! Ideally, you would have visitied with anesthesia at a preop visit to the hospital here a few days ago. But when that doesn't happen, the anesthesiologist on your case will usually drop in for a minute (literally) and see you right before surgery. What I would suggest you do is this: Without going into a lot of detail about your addiction history, just tell him that you are really wanting to get by with as little narcotic pain meds as you can. You'll need to tell him some of your history so he'll know about your high tolerance for pain meds, however - very important. Main emphasis being on the fact that you are wanting as little narcotic as possible to keep your pain under reasonable control. I would tell him/her that "a friend of mine had a similar surgery and was given a femoral nerve block and said it did great for her and would he consider that for me" If he says something like - "well you won't be able to get up and walk as soon as normal", just say you've got plenty of help for when you go home (I'm assuming it's outpatient surgery) and promise him you will be very careful with getting up until the block wears off. Hopefully, he'll go for it.
As far as the surgeon goes (and most other docs for that matter), they love to have their ego stroked and they want to know that you know who's in charge here! Kill em with kindness in other words! I know it's a game and it's ridiculous, but what we care about is that you get taken care of - so I say "whatever it takes" If I've gotta suck up a little - so be it!
As Diary said - the nurses hold the golden keys to the management of your care - they're the ones that are talking to the docs about your needs and getting the orders. So you want them to like you! Be appreciative of their work and try to remember to ask questions/communicate your needs clearly. Nothing is more irritating than to have just been in a patient's room, fluffed and tucked em and asked what they need and be told 'nothing', go back to the desk to do some charting, and have that same patient call out 3 minutes later needing something! I know sometimes it can't be helped, but if you can, be considerate of them.
Most importantly - you deserve good care! I'm sure you'll have someone with you who will make sure your needs are met. In this day and age - I wouldn't leave my dog alone at a hospital!! As we discussed before - try not to be whiney, but do not hesitate to ask for what you need. If you're hurting and they tell you they've given you everything the doctor has ordered, you can ask them to request an order change from the doctor to try a different medication. Also - you might ask about a med called Toradol - it's like the Uzi of ibuprofen - non narcotic anti inflammatory, works real good for pain.
As you know, I'm not a doctor, not an "expert" about anything - but that's my best two cents worth. Hope it helps! I'll be sending good thoughts your way for a successful surgery and an easy recovery! Get up and get moving as soon as you can and push through the pain as much as you can - remember to relax, breathe, pray, whatever works for you! This too shall pass - and you've been through much worse!
Post as soon as you're able to let us know how it all goes!


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