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PostPosted: Thu Sep 23, 2010 10:07 am 
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[font=Arial Black] [/font][font=Arial] [/font] I had major surgery while on Suboxone maintenance. It was my second time having surgery of this nature. The first time was 10 yrs ago but I had no addiction to pain meds! So I wasnt on suboxone than either of course. About 1 yr ago I was put on Suboxone for a 9 yr addiction to opiates. My surgeon reassured me that he understands Suboxone and would make sure he'd treat my pain adequately. So I felt comfortable in my decision to choose him for my surgery. He told me to quit taking my subs 2-3 days prior to my surgery date. So thats what I did. Upon waking up in the surgery center my pain was absolutely horrible! The anestesiologist gave me one more injection of pain meds. (So I was told.) I couldn't feel any relief at all. My doctor told me to fill my script for pain meds and take a dose when I got home and I would feel much better. I was horrified to see he wrote me a script for just 30 Percocet 5 mgs!!! He called the next morning to see how I was. I was literally crying from pain when he called. I told him I could feel everything so could he pls call me in something stronger. He got angry w/me for asking and started yelling to the point I hung up on him! I had to take 6 of the percs at a time for any relief so the 30 didnt last long. I had no choice but to see the street pharmacist. But what was I to do? I had never been in that much pain in my entire life! PLS BEWARE OF THE SURGEON YOU CHOOSE IF YOU HAVE UPCOMING SURGERY! Sry for the long post. Just wanted you all to know the story so noone ends up where I was. Best of Luck! .......And F-U Dr. Howard Dash of Fishers IN. ;)


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PostPosted: Thu Sep 23, 2010 10:34 am 
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Dear Asclean,

On 8/30 I had a total knee replacement, and I did have 4 mg Suboxone in my system at the time. This was the recommendation of my doctor, and I was assured that my pain would be managed. In fact I take 24 mg a day and had taken it upon myself to wean down to 4 mg. If you are interested you can read the whole sordid tale below under "thinking about rossma".

For this surgery they remove your knee joint and place a new one: part of the new joint is a steel spike 'jammed' into the tibia. When I awoke from this I had absolutely no pain relief and nothing that they gave me worked. I can't tell you how horrible the pain was.

There is a NIH article about acute pain management for the patient receiving bupenorphine, which is often mentioned on this forum. It had been recommended to me to print this out and give it to my caregivers prior to the surgery. Thank God, I had done so. Even though I was in agony I still know that the people who were caring for me were very concerned and understood what was happening, and did everything in their power to help me, short of ODing me. Nothing they did helped until the Suboxone finally wore off. I can't imagine what would have happened if they had not received the information beforehand.

If anyone is having surgery I strongly recommend that you print this article and send it along with a respectful cover letter explaining your concerns to everyone who will be involved in your care. After going through this I even carry a copy of it in my purse, in case of an emergency. I have been an RN for almost 30 years, have three advanced practice certifications, and prior to going on Suboxone I myself was unaware of the pain management implications for patients on Suboxone. In fact I had never even heard of Suboxone! I think it is fair to say that most health professionals are unaware of the implications of this drug. Education is the best weapon against ignorance.

I am so so sorry that you had to go through what you are going through and I as well as many others here can certainly relate! I hope that you will start to feel better soon as your body begins to heal itself.

Sincerely,
Rossma


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PostPosted: Thu Sep 23, 2010 10:44 am 
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P.S.

I completely understand your anger and frustration, however:

I just noticed the last part of your post and I just have to say, and this is only my opinion, that things like this do not do much to further the cause of promoting education and understanding of our unique needs among the community of health care professionals and MDs.

~Rossma


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PostPosted: Thu Sep 23, 2010 12:39 pm 
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Hi Rossma, I'm sorry to have upset you. This Doctor told me he understands the medication and the problems in pain control while on Suboxone. If he did truly understand Suboxone and what it does, than I wouldnt have had to go through that. I absolutely believe that education is the key. The problem is some doctors/surgeons etc. wont get/seek this knowledge. One would expect that if a Suboxone patient comes through their office for a painful procedure, than said doctor would gain some knowledge about this medication for the patients benefit. He clearly knew nothing about Suboxone despite him telling me he understands the drug and its complications in pain treatment. He verbally attacked me while I was in the most pain of my life, pain so severe I was shaking! He should have looked it up or called someone about it. Unfortunately in some cases a doctor's own ignorance and/or personal views of us 'addicts' will prevent them from getting this education. I would hate to see someone else go through this. So if rattling off my ending sentence might be seen by a fellow Suboxone patient in my area, at least they have been warned of this situation. By no means did I mean to offend you or anyone. With all do respect, people have a right to know. I'm sure there are plenty of excellent doctors out there who would/do seek this education. I just found one who didnt. I wasnt trying to upset you. Sorry Again :)


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PostPosted: Thu Sep 23, 2010 1:54 pm 
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Well, I wouldn't blame either one of you for being furious. It seems that the common thread here is the fact that you didn't wean yourselves all the way off the suboxone, which, based on my own personal experience with a simple liver biopsy, would seem to be the safest course of action.

If you think of it in terms of the excruciating agony you had to endure -vs- the comparatively minor discomfort of a couple of days of strong withdrawal from suboxone, the choice seems pretty clear. Obviously, it's easier said than done, though, right?

Same thing happened to me though, albeit, on a smaller scale. I had to have a liver biopsy. Generally, that is done with a local anesthetic. What they usually do is give you a local, then they load you up with fentanyl to put you in "la la land" while they collect the sample. Liver biopsy is performed by inserting a large needle between two ribs and literally ripping a chunk of your liver out with the needle. Clearly, that would be pretty painful with no anesthesia. Well, the local worked ok, but once they got past my rib cage, it felt like I was being stabbed and I could not sit still so they had to abort. They gave me enough fentanyl to "knock out a rhinoceros" according to the intern who did the procedure, but it did -literally- nothing to me.

And I was told the same thing by MY surgeon - "stop taking the suboxone two to three days prior to the procedure and you'll be fine."

Bullshit! :evil: I was NOT fine. I was nowhere NEAR fine.

Next time, I will stop taking the suboxone at least 5 days prior to the procedure, if not longer, and I would urge anyone who is facing the same dilemma to carefully consider what has been posted in this thread.


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PostPosted: Thu Sep 23, 2010 2:26 pm 
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Yes, Junkie and I will be the first to admit that you personally tried to warn me ahead of time and I did not heed. As per most of the things in my life, I had to find out the hard way! I wanted to have it both ways and it doesn't work like that.

As far as MDs are concerned, word of mouth is a great thing, and you did not upset me Asclean. I just think that such things can be just as effectively communicated in a more respectful and polite manner. If I was dealing with the situation I would probably write that MD a letter communicating my feelings and disappointment in the way that I was treated. This in the hopes that he would perhaps listen and maybe the next unfortunate one of us whom he crosses paths with would be treated differently. But again, I am not the one who is dealing with it.

Junkie is 100% right and the only way to ensure adequate pain management after any surgery or procedure is to get the Suboxone out of our system completely. Also I feel that even if this is accomplished it still takes more opiate pain medication to adequately treat the pain. Our poor opiate receptors are quite weary I'm afraid. I know mine are.

Sincerely,
Rossma


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PostPosted: Thu Sep 23, 2010 4:32 pm 
I am so terribly sorry for what all of you have been through with trying to get pain relief while on Suboxone. This is one of the primary reasons that I wanted my dose as low as I could tolerate as quickly as I could tolerate it, and is one of the biggest reasons I do not want to stay on Suboxone for life.
Everyone who has read my posts before should know that I am not opposed to lifelong maintenance with Sub, but until the issue of ignorance amongst medical professionals about the drug is dramatically improved, and appropriate protocols are in place to treat acute pain in bupe patients, I do not want to even think about being on it forever.
Another thing that disturbs me some about bupe is that for a lot of us, going on it actually increased our opiate tolerance exponentially, especially if started on 16mg or more a day of Sub when the prior opiate abuse (in terms of dosage) was not all that high.
As has been pointed out, if a procedure is planned, one can stop the bupe a few days prior and that likely will indeed help. However, doing that alone is not going to put us in the position of a non-opiate tolerant patient. Our tolerance, as Rossma pointed out, is huge! Granted, it would be huge had we continued on our opiates of choice as well. But at least the 'blockade effect' wouldn't be there. I'm actually not convinced that it doesn't take a whole lot longer than a few days off Sub to diminish that effect significantly. I've read a few instances of folks being off Sub for a month or more and still not receiving much benefit of a 'normal' dose of full-agonist.
This is a real problem and the more I read stories like the ones above, the more nervous it makes me about the potential for ever needing pain management while on Suboxone.


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PostPosted: Fri Sep 24, 2010 12:06 am 
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I have had 3 surgeries as a suboxone patient. The first one I was told to go off sub for 3 days prior and I would be just fine. I found myself in the EXACT same position as you and was in excruciating pain at the time. I did not tell my surgeon I was on suboxone at the time. I only told the sub doc. I was given percocet (30 of them) and they didn't do ANYTHING! I was shaking, crying, and was horribly uncomfortable. I knew the doctor would give me a 2nd script for percs because he has done more than 15 surgeries on me, but they were so worthless, I just went back on the suboxone because at least then I wasn't in withdrawal too. At the time, I called the sub doc and was upset with him since he was the one who told me 3 days off subs. He didn't do anything for my pain either, but didn't complain when I took more subs than I was supposed to in order to manage the pain. He did do some research and then said it would be better if you were off the sub for 7 days.

The 2nd surgery I delayed for a VERY long time because I didn't want to go through that again. So I went off the sub entirely with full intent never to go back on it. I was off for about 2.5 weeks at the time of surgery. The surgeon was aware of the suboxone this time. He gave me a choice between vicodin and percs and I chose vicodin. That was stupid. The vicodin didn't really work. If I took 3 at a time it would get rid of my withdrawal symptoms and the fatigue, insomnia, etc. I was miserable a great amount of the time. I had 4 feet of incisions. I ended up getting some extra vicodin from a friend which helped for a few more days, but it was a HORRIBLE experience.

The last surgery I had been off sub for about 2.5 months. They did a left elbow arthroscopic synovectomy and debridement. It was a different surgeon who was aware of the suboxone also. At this point I had decided to go back on sub once I recovered from surgery. He gave me about 60 vicodin and he game me 80 oxycodones. FINALLY, with the oxycodone, and at 2.5 months off subs, it worked. I still didn't get really high off of it. Maybe a minor buzz, but if I took 2 oxycodones the pain was alleviated for the most part. Plus a ton of ibuprofin. By the 2nd week the oxycodone was gone and I tried the vicodin which was basically worthless still. At least this surgeon and the anesthesiologist were both awesome. In the recovery room they were giving me IV dilaudid or something and it wasn't working. They would wait a while and then give me another dose of it. But it wasn't doing anything. I told them not to worry about it because they probably wouldn't be able to get it under control. They said they were required to before they could discharge me. So eventually I lied and told them I was just fine so I could leave. I say this because they clearly WANTED to help. They wanted to fix the pain. But they clearly weren't prepared to deal with such a high tolerance and were afraid of overdosing me. They were also afraid of calling the doc I think and telling him this wasn't working, etc. That letter probably would have helped, but overall, it was ok because at least they tried. I just hate it when they treat you like shit. That is how I got into this problem in the first place was being undermedicated for pain and then finally going to the street to do it myself, only I was too ignorant to know what I was doing. I couldn't find vicodin so just took oxycontin. BIG MISTAKE!

Anyhow, from my own experience, I can say that our tolerances are sky high and even at 2.5 months off suboxone, there is a tolerance issue. It is something that eventually needs to be managed better by the medical community.

I do think that once you calm down, you may want to consider sending a calm letter to the doctor with a copy of that letter and tell him that you understand his predicament, DEA issues, etc., but that the research you have found shows there are unique issues with suboxone and pain management and that you are hoping to help prevent someone else from going through this. You don't want anything from him so he ought to be willing to read it and listen at this point. MAYBE....MAYBE!

Take care! Sorry you had such a horrid experience.

Cherie

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 Post subject: PLEASE...
PostPosted: Fri Sep 24, 2010 6:58 am 
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Dear asclean, You deserve to bad mouth that Dr all you want, by mouth, by forums or smoke signals, How dare anyone ever make you feel bad about saying F--k you to anyone, the Dr sounds like a asshole , and I wont apoligize, there.. Good Luck. Mike


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PostPosted: Fri Sep 24, 2010 7:24 am 
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I agree. I think there is very little patients can do when they are treated so horribly except spread the word about the doctor. No one should be treated like that. I just googled his name and your comment comes up on page 2. hahaha. Also, I did notice somewhere that you could do a patient review of him. You may wish to consider going there and giving a poor review. That ought to get his attention.

Cherie

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PostPosted: Fri Sep 24, 2010 11:37 am 
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oh, dear you guys, you misunderstand me. Anger toward that MD is perfectly justified. I have a chronic illness that is extremely rare and for three years I was in the hospital for a week to ten days, monthly or more often, on IVs, TPN, and in intractable pain. All the tests they did around here were negative. The doctors were convinced I was making it up. After three years I was finally diagnosed at the in-patient neurology department of the Cleveland Clinic and have not been in the hospital for this again, as it is now controlled.

During this time I had two doctors, both of whom discharged me citing the fact that they "could no longer maintain a doctor-patient relationship with me". I have been abused by the medical system more times than you could possibly imagine. Actually if I had the money and the strength I would sue them, but I do not. There is no doubt in my mind that I would have a case, but I really have PTSD from my hospital experiences and I cannot re-live them again. (This is the same hospital where I worked as an RN for 20 years!)

I only meant that if this doctor sees the FU he will likely say FU back, and the next Suboxone patient that he runs across will reap those benefits. That's all.

~Rossma


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 Post subject: It's a shame
PostPosted: Fri Sep 24, 2010 12:19 pm 
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I agree with Rossma. I have had 6 surgeries on my legs(bypasses) and I know PAIN. I have had good experiences with Drs. & nurses and bad experiences. Doctors take an oath but they forget it. I have had doctors that have yelled at me saying"Don't use me to get pills". I was really in pain. My legs were starting to get real bad. I had to have emergency surgery because doctors didn't believe me. I had the amputation and I had a great doctor. I was on subs when I had the amputation & I did not suffer. He admitted me to the hospital. He waited 2 days for the subs to leave my system. He would have the nurses ask me if I felt WD coming on. When it was getting uncomfortable, he gave me morphine injections every 4 hrs. My foot was ice cold & hurting, so the morning of the 4th. day, they took me to surgery. My left leg was amputated. I was in the hospital 2 1/2 weeks. They started with Morphine, then we started percs. I went home with percs & stayed on them a month and a half before I went back to subs. He made sure he Rxed enough percs because he said he understood my tolerance level and wanted me to be comfortable. Now, that's a Doctor.

So, yes, I would be very upset and can't blame anyone for saying f-u.

Next month will be a year since my amputation. I got a clot in my right leg in June of this year and had to have yet another bypass. The same surgeon did the bypass and we used the same method only we couldn't wait 4 days because I had a clot & it could travel in my body & kill me. So he had to do it in one day. I don't know what he did but I was able to tolerate the pain. It was uncomfortable because the subs were in my system but after surgery I got a lot of medication and was there 16 days and had to take percs for a month. I'm back on subs again & feeling good. I hope I can stay on the subs, taper & be free.

Love & hope queenie


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PostPosted: Fri Sep 24, 2010 3:17 pm 
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Yes I agree the hell with the doc. But now I'm sick to my stomach I'm haaving a 2 level fusion with 2 level disk replacment above and below the fusion on Nov 17 thats a very painfull surgery. I do have lots of time sure I have enuff to be ok but dame now I'm scared I was just thanking that I would start coming down from 16 mg a day to 4mg about 3 days before surgery and then just not take anything or go on narcotics, my surgon can't belive I'm not taking nothing for the pain now. But as all of you know it's worse being strung out then in pain. Sorry did not mean to steal the thread please forgive me just had to say that I'm going to be sick.

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 Post subject: I understand
PostPosted: Fri Sep 24, 2010 3:52 pm 
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I am so sorry you have to go through that. I know how you feel. I will think positive thoughts so that you get through it as painless as possible. Of course the scary part is jumping down so fast and being sick. Can your surgeon put in the hospital a few days before your procedure? They may be able to bring you down with comfort meds and slowly introduce pain meds so when you come out of the anesthesia you won't be in agonizing pain & a few days after, either.

I know exactly how you feel about being sick. We all do. I think about it all the time. All I know is that I don't want to be sick. I'm terrified of going into WD for whatever reason. I want my subs close to me. I hope you can go through as painlessly as possible. Then you can go back to your subs.

I will be thinking about you. Please try to keep me informed, if you can, on how things are going and what happens.

You can do it! Love & hope, Queenie


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 Post subject: AscleanascanB
PostPosted: Mon Sep 27, 2010 2:22 pm 
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Dear Asclean,

I've been thinking of you. How are you doing now? I hope that your pain is better.

~Rossma


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PostPosted: Wed Dec 29, 2010 12:30 am 
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setmefree wrote:
I am so terribly sorry for what all of you have been through with trying to get pain relief while on Suboxone. This is one of the primary reasons that I wanted my dose as low as I could tolerate as quickly as I could tolerate it, and is one of the biggest reasons I do not want to stay on Suboxone for life.
Everyone who has read my posts before should know that I am not opposed to lifelong maintenance with Sub, but until the issue of ignorance amongst medical professionals about the drug is dramatically improved, and appropriate protocols are in place to treat acute pain in bupe patients, I do not want to even think about being on it forever.
Another thing that disturbs me some about bupe is that for a lot of us, going on it actually increased our opiate tolerance exponentially, especially if started on 16mg or more a day of Sub when the prior opiate abuse (in terms of dosage) was not all that high.
As has been pointed out, if a procedure is planned, one can stop the bupe a few days prior and that likely will indeed help. However, doing that alone is not going to put us in the position of a non-opiate tolerant patient. Our tolerance, as Rossma pointed out, is huge! Granted, it would be huge had we continued on our opiates of choice as well. But at least the 'blockade effect' wouldn't be there. I'm actually not convinced that it doesn't take a whole lot longer than a few days off Sub to diminish that effect significantly. I've read a few instances of folks being off Sub for a month or more and still not receiving much benefit of a 'normal' dose of full-agonist.
This is a real problem and the more I read stories like the ones above, the more nervous it makes me about the potential for ever needing pain management while on Suboxone.



I feel the exact same way. I dread the day of ever having to have major surgery and have to deal with it without any effect from pain relievers. I am trying to taper now and am down to 3MG per day but am experiencing central sleep apnea which is a pain in the ASS! Hard to fall asleep. Per Dr. J is I increase back to 8per day at least this would help but what's the point? I want off!


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PostPosted: Wed Dec 29, 2010 1:20 am 
As others have said this is pretty much one of my biggest worries concerning being on suboxone. What if Im in a car wreck and a fire happens from it and I have 3rd degree burns all over my body and I cant get any pain relief. Thats just a worse case scenario obviously that probably wont happen but still it could. Its one of the reasons Ive considered methadone as an alternative, yeah methadone will raise your tolerance massively but it wont have that blocking effect like bupe, they say methadone does but its not true IMO. I know they say its nearly impossible to reverse a bupe overdose with naloxone but I wonder if a massive dose of it could precipitate withdrawal and then narcotics could be administered shortly after. It would be horrible to go through precipitated withdrawal but Im just wondering if it could in theory be done or if it realy is impossible.


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PostPosted: Wed Dec 29, 2010 3:43 pm 
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I totally get the point you were attempting to make. Just thought I'd say that if you indeed have 3rd degree burns, you would not have any pain. With full thickness (formally called 3rd degree) burns, your nerves have been burned along with the rest of your tissue. Strange as it sounds, patients with really bad, 3rd degree burns don't feel pain - unless then have 1st and 2nd degree burns too. Your point totally works when it comes to partial thickness (2nd degree) burns.

As for the naloxone (Narcan) question, all naloxone does is block opiates from hitting the receptors. It does not remove opiates or Suboxone from your body. So as soon as the naloxone wears off, the opiate/Suboxone/whatever will again start to work. Naloxone actually has a shorter half life than most opiates so there is really no way to have the naloxone put you into withdrawal so opiates could then work. If naloxone actually did remove opiates from your body, your theory might work. Because they only block, it won't.

In short, there really is no REAL GOOD way to get opiate pain relief while on Bup. There are ways around it and things that will help but there just simply is no way that a Bup patient will get the same level of pain relief that an opiate naive patient does. It is just, unfortunately, part of the price we pay for opiate addiction and Suboxone treatment.

Hope that helps.


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