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 Post subject: Newbie needing surgery
PostPosted: Sun Oct 18, 2009 9:22 pm 
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I just tried to register and was surprised to find that I'm already registered (don't quite remember when I did that). :shock: I don't think that I've ever posted. But, I could be wrong. :roll: Either way, I feel like a newbie.

I have a two part question, if I may.

First part:
I've been on 16mg of Suboxone since July 30 of this year. I need to schedule foot surgery (a bone will be removed and a nerve cut), but I'm afraid. I told my podiatrist that I'm an addict and he suggested Tramadol, which I've never found to be effective to manage pain. He said that we could use an analgesic pump. Stupid-me thought that the pump was something that would deliver a non-narcotic medicine directly to the site (such as lidocaine or novacaine). Researching it online, I've discovered that I'm wrong. So, I'm assuming that he suggested the pump in order to remove the temptation to take more pills than prescribed. The more that I think about it, the more I think that I like the idea of smaller doses of a narcotic many times, instead of a massive dose and then wait for relief.

I'm assuming that I will need something more than my Suboxone because I have DDD and this issue with my foot and neither has ever been relieved by the Suboxone.

I have read where people have experienced the blocking effects of bupe up to TEN days after discontinuing it for surgery. Eeeeks!! That's a LONG time, guys!!! Has anyone ever heard of having a doctor prescribe narcotics to cover a Suboxone patient pre-op? Or is ten days an urban legend?

I know that Dr. Junig suggests decreasing the Sub dose prior to surgery, but I'm afraid of relapsing due to cravings. I still have cravings at 16mg, but they are manageable. I've toyed with postponing the surgery (AGAIN!) and wait until I'm off Sub. But, I don't know when that will be. Besides, I'm really afraid that if I don't have the surgery when I have Sub as a safety net for after the surgery, it'll just be a springboard to another relapse.

I do have hope that, someday, I'll be able to do life without Suboxone. I just can't fathom that at this point in my recovery. I'm having a hard enough time doing my very best to research pain management AND not look to find a way for a post-op opportunity to get high "accidentally." I know that it would be best to discuss this stuff with my doctor, but my doctor doesn't seem to know a lot about Sub (and I'm not just referring to the podiatrist -- does anyone else experience that in their local Suboxone medical community?) Because of this, I want to be informed, just in case.

On another thread, I found the following directions from Dr. Junig:
The third option would be to stop the Suboxone and then take oxycodone or another agonist. Unfortunately you DO have a high tolerance from being on Suboxone; you would need about 50 mg of oxycodone (per day) just to 'break even' and prevent withdrawal. So to treat pain, you would need about 15-30 mg of oxycodone every 4-6 hours.
Does anyone know the oxy dose (or morphine if my doctor and insurance company prescribe/allow the pump) for someone taking 16mg/day? If I'm put on oxy, I do have family who will dispense to me.

Second part:
I think that addicts experience different degrees of craving. I crave absolutely outrageously (hence the 16mg). When I was trying to quit c/t, even after the physical w/d was done, the obsession would get so bad that I would hurt myself to distract. Every time, I would relapse. I'm soooo afraid of waking that monstrous obsession. Does anyone obsess and crave so badly that you want to kill yourself or someone else because you just can't stand to be in your skin or in your head anymore??? If you know what I'm talking about... do you think that having a full agonist in me again will stir up that obsession if I'm very careful not to use to get high? It could be a very, very long couple of days of recovery.

I need and want this surgery. I don't want to be in agony. But, I can't screw up my recovery.

Thanks for the time that you've taken to read this and to reply.


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PostPosted: Mon Oct 19, 2009 3:12 am 
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If I was u get multiple opinions cause the thought of killing yourself or others is a lot more to worry about the take pain meds again. Anyways good luck!


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PostPosted: Mon Oct 19, 2009 2:32 pm 
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Christin, Welcome. You can read about my experience having surgery while on suboxone. It is not pretty. If your sub doctor is an expert on pain control with the added complications of being on suboxone, you might be able to find a way. I had major surgery while on 12 mg of sub and it was a huge problem. I stopped taking suboxone six days before surgery. Still had a problem getting effective pain control due to increased tolerance. I would suggest that you need an advocate. I was in the hospital for a week after my surgery. Although the doc's prescribed a prn of dilaudid iv for breakthrough pain I only received it twice because the nurses were reluctant to give it to me. Have an advocate if you have surgery. I was to sick to advocate for myself and my 87 year old mother was too polite to challenge the system for me.

I am not usually wordy, but i continue. Most of us find that after a period of time we want to lower our dose of suboxone. I started out at 16 mg and am now on six. If you could postpone your surgery until your cravings are decreased I think you would have less chance of relapsing. I went to outpatient treatment when I first started suboxone and it was helpful. It helped me get out of the self imposed isolation we so often put ourselves into when using. I also think that 12 steps groups and psychotherapy can help us get our lives back on track. Best of luck to you. Jean


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PostPosted: Thu Feb 04, 2010 8:42 pm 
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Sorry you are having so much trouble with the treatment. My sub doc does not perscribe pain meds to controll w/d pre op. I think that something like that is agenst the law!! You can go through surgery and stay on your suboxone but TELL YOUR SURGEN. If you don't and they give you an IV of oxy or something the naloxone will send you into bad withdrawls. I will have surgery in two weeks and am asking myself the same questions. but.. My sub doc told me that as long as I stop 24 hours before surgery then I will have no problem with the naloxone and they will controll my pain. The blocking power of the Buep will still be there but at that point strong narcotics will "trump" the buep.

For your secound part.... I have been recovering for over a year and still have cravings!! This is not a majic pill that will get ride of everything. Sounds like you need some heavy councling to help. I have triggers that set my cravings off, They can be anything, for instance chooclote milk shakes. Back when I was using I would have a milkshake, hence in my brain I have linked the two. you need to face the demons head on and find out the underlying problem, "the reason you started using", You really need to be ready to stop!! Not just not wanting to go through w/d, but who does. It doesn't sound like you are ready to be on a suboxone program.. but only you would know. Purhaps you could look into a methadone clinic. but overall I think you need a good tharapist.


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PostPosted: Fri Feb 05, 2010 2:22 pm 
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It is my understanding that naloxone will only put you into precipitated withdrawals by shooting up the suboxone/naloxone, not due to IV opiates. And some say it doesn't do it then either.

I had an out-patient procedure in December and I was only off suboxone less than 2 days. I received IV pain meds in recovery without any problems (except for the high tolerance).

Just my 2 cents.

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PostPosted: Fri Feb 05, 2010 2:36 pm 
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Yea I think your right. I don't know why my doc said that. maybe she wanted to make sure that I told the surgen or something. or maybe she just doesn't know. She is just a pain managment doctor andhas only treats a few with suboxone. Anyway...
How much was your tolerence raised do to the suboxone? I have poasted some questions on another post but have not recived any replies. The most important question is how much will my tolerence be raised? My doctor was unsure and thinks that it might not be a lot.. but... I think that my tolerence is probably through the roof. how high was your narcotic dose?


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PostPosted: Fri Feb 05, 2010 2:48 pm 
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I don't think I can offer any good answers. I just know nothing they gave me helped with the pain until finally they gave me dilaudid. And it was like pulling teeth to get them to keep trying, even though I gave them the information on the Suboxone wallet card.

As for gauging tolerance, it seems logical that the higher the dose of Suboxone the higher the tolerance. I take 8mg three times daily. The reason for that is we also use my suboxone to treat chronic pain.

I'm sorry I can't offer anymore insight that this.

Melissa

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-I'm only responsible for what I say, not for what you understand.


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PostPosted: Fri Feb 05, 2010 5:48 pm 
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I passed a kidney stone while I was on Suboxone - not exactly the same as surgery, but still hurts like a mofo.

Anyway - in the ER they gave me IV dilaudid which worked fine and I had taken 4 or 6mgs of Sub that day. For afterwards at home they gave me percoset (I didn't tell them about the Suboxone).

I found that the percoset by itself didn't do shit for my pain and I was feeling withdrawals from not taking the Suboxone as well. So I took a small dose of Sub, like 2mgs, and then took the percoset. Worked like a charm. 2mgs is not enough to block the other opiate from working, but it is enough to help compensate for having high opiate tolerance.

I don't understand why more doctors don't suggest this.

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PostPosted: Fri Feb 05, 2010 10:51 pm 
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I didn't think of that. I'm going to tell them that I'm on subs so hopefully they will work with me. If not I will try what you suggested.

That brings up another concern. lol. I don't really know how to talk about this with my surgen. I'm mean I'm basically calling him and telling him that I'm an adict or "recovring addict", but I need stronf pain meds. It just sounds funny. I'm really nervious about it. maybe i shouldn't be but I still am. I keep thinking that If i complain about pain after surgery there just going to think to themselves "he is just an adict trying to get his fix". I don't know.. I just want them to take me seriously, I haven't relapse for over a year, and I'm truly commeted to getting off. I'm just very concerned about the surgery at all aspects. Thanks for the help and support.


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PostPosted: Sat Feb 06, 2010 8:13 am 
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The posts on this thread are the main reason I'm not fooling around getting down to the lowest sub dose needed per day in my life, spine issues are the reason I fell in love with pain pills, I KNOW what REAL pain is, and don't deserve it, Good Luck, Mike


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

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