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PostPosted: Thu Nov 05, 2009 1:01 am 
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Hi all,

I'm having cystoscopy, bladder biopsy, and bladder hydro-distention soon. I've been on Subox for 11 months now & this is the first time a possible need for pain meds has come up.

My suboxone doctor is also my family doctor, so he gave me medical clearance at the same time he gave me instructions regarding pain meds. He told me to discontinue my suboxone (I'm on 24mg/day) about 2 days before the procedure; take a fast or short-acting pain medication at a higher dose to address my tolerance, then after about 12 hours with no opiates I'm to go back on the Suboxone. He also gave me a wallet card with info for health professionals about needing more pain meds due to high tolerance. Because I have two chronic pain conditions, I really don't expect being off the suboxone for more than 3-4 days (hopefully).

Some questions/concerns, for doctors and non-doctors alike who happen to read this:

- Does anyone know what to expect after this particular procedure?
- Does suboxone also give a higher tolerance to general anesthesia? (Sorry if that's a silly question.)
- Does anyone know of more comprehensive info than a tiny wallet card if for some reason the doctors just don't get it, maybe info I can get online?
- This one might be weird, but here goes: I've heard horror stories and part of me fears when they will see I'm an addict they may make me tough it out with nothing.
- Is it possible that my suboxone alone can be sufficient to address the pain after? (I read I can lower my suboxone dose before the procedure, then increase it to address the pain.)

Any ideas, thoughts, words of wisdom, whatever, would be appreciated.
As always, thanks everyone!

Melissa


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PostPosted: Thu Nov 05, 2009 1:29 pm 
Melissa - Unfortunately I cannot answer many of your questions with any degree of expertise. However, what your Subox doc has recommended sounds in line with what my doctor has told me he would do if I were in that type of situation - stopping Sub a few days prior and switching to a short-acting opiate at higher than usual doses, medicating for pain post-procedure, then switch back to Sub asap.
I am pretty sure that Suboxone will not interfere at all with general anesthesia. However, anesthesiologists often do use opiates (commonly Fentanyl) along with the other anesthetics in the operating room. Your tolerance issues will be a problem with those types of meds. And of course for post op pain management opiates are the norm. I would hope that pain meds would not be withheld because of your addiction. That would be unethical to say the least. The problem will be with staff hesitancy to titrate those meds up high enough to control your pain. In most institutions, there are 'standing' type orders for pain control, nausea, etc after surgery which would have to be overridden by the physician to allow the nurses to go over the standard dose for you. If you have a pre op visit scheduled, be sure to discuss this with not only the doctor who is doing the procedure but also the anesthesiologist as he/she is usually the one in control of the immediate post op time period. Just be honest and clear about your history and your Suboxone use. Hopefully, they will appreciate and respect your honesty and take excellent care of you as they should. Your Suboxone prescribing doctor should be willing and available to consult with the other doctors to clarify for them if they are not familiar with Sub.
I am not very familiar with the procedure you are having done, but obviously it's all bladder-related. Since you're having this done, you've apparently been having problems with your bladder and know that it can be the cause of significant discomfort! You're probably also familiar with the med Pyridium. It works specifically on the urinary tract (no systemic affects) and it seems to work pretty well for bladder spasms which I'm sure you will have. I know also that there are a lot of other newer meds on the market for urinary symptoms. Maybe these types of meds will work welll enough that you won't need much opiate medications at all.
Unfortunately, I don't think Sub works well at all for acute pain no matter what the dose, so I'm pretty sure you're going to be much better off by stopping it about 3 days before the procedure. That way the full agonists should work okay for your pain after the procedure. What I have read is that pain meds DO work for Suboxone patients, they just DO NOT give the usual buzz. It may well be that there won't be that much pain beyond the first 12-24 hours after the procedure anyway. I hope not.
Overall, go in with a positive attitude knowing that whatever discomfort you may have will be temporary and you will get through it!
Hope that helps a little. Take care!


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PostPosted: Thu Nov 05, 2009 2:17 pm 
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Thanks, setmefree, for the kind reply. Yes, indeed - my bladder and I are at war! The urologists already diagnosed me with Interstitial Cystitis (sometimes AKA Painful Bladder Syndrome) a few months ago. Although I've been on Elmiron since then, it has still gotten worse. My uro is doing this as a treatment & using the opportunity to see the lining and do the biopsy.

I have a prescription for Pyridium, but I usually use an OTC called Cystex. I'm a contacts lens wearer and Cystex won't discolor them. They seem to work just as good. Plus I take Toviz and Flomax for the added overactive bladder symptoms. (Altho some docs say that's part of IC and not a separate diagnosis.) And after this is done, they'll do a trial of the sacral nerve stimulator. That - hopefully - will have me peeing like a normal person again! I sure took that bodily function for granted! LOL.

But seriously, your perspective really has helped me (the more information I have the better).
Thanks for reaching out.

Melissa


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PostPosted: Tue Dec 08, 2009 5:03 am 
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I can't answer all of your questions but I may be able to help a little. I believe that the advice from your PCP is a good idea.
It would be good to be off of the Suboxone for at least 24hrs pre-op. Using and Opioid agonist and antagonist should not decrease effects of the anesthesia. When placed under general anesthesia there are several different types of medications administered normally Fentanyl or Demerol for sedation Versed and Propofol. The only opioids are the Fentanyl or Demerol which are very potent I'm not sure of the medications that you were addicted to but high doses of Fentanyl should do well pre-op and the subox shouldn't interfere with that. Dr. Junig would know much more on that. Post-op most physicians use what is called standard of care which means what the text book says its called Opioid Titration to analgesic effect. Which means that we administer opioids in gradually decreasing amounts until pain is relieved or side effects prevent us from administering more. Morphine, Fentanyl and Hydromorphone would be the best post-op to relieve pain in someone who is opioid tolerate... I hope this is helpful. Good Luck!

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PostPosted: Tue Dec 08, 2009 10:08 am 
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Well, everything went OK. My bladder feels fine - better, which was what it was all about. Didn't even need pain meds after getting home. I made the mistake of going online to a couple of interstitial cystitis forums and read their horror stories. I really shouldn't have done that. It had me nervous sick for 2-3 days before the procedure - when in reality it was fine.

There was a little snag though - because I'm a smoker (they said) they had to intubate me. I have no idea what problems they had, but it's left me sore as hell from my jaws, throat, neck down to my stomach. I've been tubed before, but never had after effects like this.

In the big picture, it's a small price to pay. I'm really going to have to go back to those forums and try to keep others from freaking out like I did.

Thanks for everyone's support. You guys have always been great and I'm glad I can count on you.

Melissa


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PostPosted: Tue Dec 08, 2009 12:31 pm 
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Well I'm really glad you're ok Hatmaker as I'm sure everyone else is here. I have to admit to usually expecting the worst case scenario and then I usually find things aren't nearly as bad as I thought they'd be. The thing I've had to learn is just to try and not have any preconceptions and then things usually work out as they should but it's hard. I'm the kind of person who starts worrying about the prospect of worrying! lol anyways the fact of the matter is I'm glad your well and back on Suboxforum

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PostPosted: Wed Dec 09, 2009 9:35 pm 
Hatmaker - I am sure glad to hear everything went okay and that the procedure seems to have helped with your symptoms. Sorry you had to be intubated - always leaves a sore throat it seems!
I guess your Suboxone didn't turn out to be much of an issue after all? It's great you needed no pain meds after getting home as I'm sure that would have complicated things a bit.
Just wanted you to know I'm glad you made it through okay!


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PostPosted: Tue Dec 15, 2009 11:25 am 
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Thanks for the support, setmefree - and all of you who provided support for me.

You're spot on, setmefree, I think it was a VERY good thing that I didn't need the pain meds after all. They did give me something when I was in recovery, but nothing seemed to work. So I learned first hand how high my tolerance is. And since I went off the Sub 2 days before the procedure, I also learned just how much pain relief I'm getting with the Sub.

Thanks again to all of you and please know how much appreciate this forum and all of you. (OK, enough mushy talk! LOL.)

Melissa


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