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PostPosted: Thu Apr 08, 2010 12:36 pm 
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Hi all,

I've got a minor surgical procedure coming up on Monday, April 19th. Some of you might recall my last procedure in December. There was a possibility of needing pain meds after that procedure and my sub doc told me to go off about 2 days before and just go back on them about 12 hours after my last pain pill. It turned out I did not need any pain medications after the procedure, just some in the recovery room. I got home and went right back on the subs with no problem.

This time will be different. I WILL need pain meds after this one. I normally take 8 mgs of sub 3 times daily due to chronic pain. In an effort to reduce my tolerance some, I decided to start reducing my suboxone intake starting this past Monday. I'm taking my sub only twice daily, for 4 days. Then I plan to drop to only once a day (still 8 mgs), and four days later I'll TRY to drop to 1/2 a pill once daily. After that I'll stop altogether 48 hours before the surgery.

Now I KNOW this is a very fast taper and I have no idea how it will go. Obviously dropping from 3 down to 2 pills a day is completely painless. Going down to one may be as well. However, this is a very flexible plan. I'm doing it this way because I fear the pain meds will be inadequate for my pain or my tolerance. The same doctor is doing this procedure as the last. Yes, I spoke to her about the suboxone, but even just in the recovery room last time they did not understand that I needed more to relieve my pain. No matter what I said, it didn't get through to anyone.

Some of you might have read the post I made about the NIH paper regarding treating sub/methadone patients for acute pain. I casually forwarded a copy of this paper to my doctor/surgeon. I can only hope that she at least peruses it.

If the pain meds they give me either don't give me adequate pain relief or leave me in withdrawals I plan to do as others on here have and take crumbs of suboxone to cover the gap. I think I'm more afraid of the withdrawals than I am of under-treated pain. If it gets bad there's always the emergency room, right? LOL.

As calm and pre-planned as I may sound, I'm actually more than a bit nervous. I'm anxious about the procedure and about afterwards - hell, I'm also just as nervous about the taper-down beforehand.

Like I said, I'm quite flexible with this plan. I'm going to keep posting on this thread as to how the taper goes and how it's going after the procedure.

Any support or reassurances will be utterly appreciated.

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 Post subject: Good Luck........
PostPosted: Fri Apr 09, 2010 10:26 am 
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Hey Mellisa,
Good luck on your upcoming surgery!!!! Also good luck on your taper down before the surgery... I hope everything goes well please us posted on your condirtion.... You will be in my Thoughts and Prayers...

God Bless
Tom


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PostPosted: Fri Apr 09, 2010 12:01 pm 
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The first 4 days went just fine. I dropped from 24 mgs to 16 with no ill effects. Today I started on my 8 mgs per day dose. Without thinking this morning I took one full pill. Because I normally dose 3 times a day for pain issues, my plan was to dose with half an 8 mg pill twice a day. I forgot to do that this morning. Oh well.

My biggest issue is the anxiety over this. I completely understand and believe that even though on the surface this drop seems large, I'll still be on 8 mgs a day (above the ceiling) so I should in theory be just fine. What I'm worried about is my next drop, down to 4 mgs a day. Then there's the normal anxiety over the surgery itself, which is practically doubled by my suboxone worries and how the doctors will treat my pain - afterward at home and in recovery. I mailed that NIH article to my doctor/surgeon and I really hope to hell she reads it or at least skims it! If she reads it I'll be so impressed. I was considering getting a new urologist closer to home, but if she puts in the little time to read that paper for me, I'll stick with her for the long haul. Seriously how many doctors would actually read a paper that a patient forwarded to them? Maybe they should, but I've never had one that would. (Maybe I've just had crappy doctors? LOL)

OK, I think right now I'm just venting more than anything, because I'm getting nervous. I'm going to go and be less nervous, because I've still got over a week and there's no need to be a nervous wreck that entire time!

Thanks for "listening" and I'll keep you guys posted.

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PostPosted: Fri Apr 09, 2010 7:22 pm 
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Update:
Having taken only one 8 mg pill this morning instead of splitting into two doses like I planned, I do notice a difference.

What I have is significantly increased pain. I didn't expect that right away, but I guess it makes sense, since suboxone's pain properties last about 4-8 hours.

Tomorrow I'll take half in the morning (4 mg) and the other half in mid to late afternoon. If at this lower dose it controls my pain I might taper down a little bit. I'll have to just wait and see.

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PostPosted: Fri Apr 09, 2010 10:16 pm 
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If I were you, in the recovery room dont try to explain to them, "i'm on this drug called suboxone and it prevents normal opiates from affecting me properly, therefore i need more medication to make the pain go away" instead just tell them simply "i'm still in pain very much so and need more medication" simple terms that can affect their tiny, one-sided minds.

sorry if i sound like a dick, i just hate it how so many people don't understand suboxone yet.


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PostPosted: Sat Apr 10, 2010 9:25 am 
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Last night my pain level was BAD! So much so that I took 2 mg of bupe - nothing! No pain relief at all. Dammit! So this morning I stayed on my planned taper and took 4 mg. Still little to zero pain relief. This is not good. There is NO way that I can spend the next 10 days in this much pain. That alone will be a deal-breaker for this planned taper to get my tolerance down before the surgery.

On the upside, at this reduced dose I'm experiencing no withdrawals and no cravings. Which is what I expected. The pain I'm feeling isn't related to any withdrawals - it's most definitely fibro pain.

As for in the recovery room, I'll definitely tell them if I still have pain. Since I had my last procedure at the same hospital they already know I'm on suboxone. And I plan to tell them again in pre-op. Since I know what happened last time, I've found it's pretty worthless to explain how suboxone works to them. They seem to have the mindset that they know more about my medications than I do. Hopefully since I mailed that NIH paper to my surgeon things will be different this time - plus if I stick with my taper that will in theory reduce my tolerance and help, too.


Thanks to everyone for the well wishes on this thread and via PM. I'll keep updating this thread.

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


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PostPosted: Sun Apr 11, 2010 7:02 am 
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Things are not going well. I'm still in a great deal of pain, which maybe I could handle - that remains to be seen. But this morning I'm having withdrawals! Not that I'm completely surprised - it was a big drop from 24 mg down to 8. This is just unacceptable. So I caved and took 6 mg this morning (that is, I took 2 additional mgs after the regular 4 didn't do anything.). Because there is no way I'm going through these withdrawals until the surgery. That's still 9 days away.

I said this plan was flexible, so I'm not too upset about having to adjust it somewhat. I'm just upset about all of this in general - the pain, the withdrawals, the surgery. This whole situation bites. I'll see how the day goes before I decide how to handle this for the next week or so.

Update: The extra 2 mg has helped somewhat. I think I can manage on this, although the next drop in dosage won't happen as planned. We'll see...

Thanks again for the support.

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


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PostPosted: Sun Apr 11, 2010 9:57 am 
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Melissa,

I am sorry this is sucking so bad! This is precisely why I avoided 2 surgeries for over 2 years. I didn't want to deal with it at all after the first one. You have done really well so far actually. But this is what I mean when I have posted a million times over that your body DOES go through withdrawal when you taper at higher doses and it is totally NOT TRUE that you won't have cravings or withdrawal at 8mg because you are above the ceiling. NOT TRUE. When you drop in dose too fast your body freaks out and wants the drug back in the system. It starts screaming.

So what? If you took 6mg instead of 4mg in the morning, did you end up taking 6mg or 4mg in the evening? How did you feel when you woke up?

Like you, I realized how much sub was doing for my pain when I got off of it. For me, ever being sub free is totally out of the question. There is no way I would want to live my life in that much pain. I can't wait until someday the docs start to realize how to manage surgeries with suboxone. I am pretty sure my last surgeon got it since he gave me a million oxycodone's even though I wasn't on the sub anymore. I think he must have talked to the anesthesiologist when I was under. The nurses seemed to know when I came out and the docs script pad typically had 2 options already typed on it. Like he would either give 20 vic and 40 perc OR he gave 30 vic and 60 perc. BUT for me I got 40 vic and 80 perc. I am POSITIVE that is because of the sub. Might not hurt that I have been to parties with my surgeon on a personal basis either :-) Whatever, I am pretty sure he talked to the anesthesiologist and gave more.

The nurses in the recovery room were a whole different story. They kept giving me these super tiny doses of morphine after surgery and they weren't working. They would wait forever and give me another tiny little dose. I told them to forget about it because they probably wouldn't be ABLE to get the pain under control. She said they HAD to get the pain under control in order to let me leave. So I finally just lied and told her the pain was a 2/3 so I could get out of there because OBVIOUSLY it wasn't ever getting under control at those doses. I couldn't even feel what she was giving to me. Ridiculous.

I hope you have a better experience than that.

Cherie


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PostPosted: Sun Apr 11, 2010 11:27 am 
Sorry you're having trouble with your taper plan Hatmaker. It was a good plan, made good sense to try and do that before surgery. But if it isn't working....it isn't working. You can only do what you can live with as far as dose reduction. Even if you're unable to drop as far as you had hoped, I would think any drop would be better than nothing.
I also wanted to reply regarding Jackcrack's post above regarding not getting good pain relief postop. I just want you guys to know that it's not really the nurse's fault. The nurse can only give what the doctor's order says she can give. If the nurse tells you she's given as much as she can give you, you should insist that she contact the doctor and get new orders for pain. It's important to know, also, that in the post op area, almost certainly the orders are written by the anesthesiologist, not your surgeon. Further, the post op orders are seldom written case-by-case, rather there is a standard post op order sheet that the nurses follow that is the same for pretty much every patient that comes out of surgery. You can see the problem here.......there is not much in the standard orders that makes allowances for things like a high opiate tolerance or buprenorphine use. So although there is a lot the nurse can do to make you more comfortable, one thing she cannot do is give you more or different drugs than your doctor has ordered.
Hatmaker, I have a feeling you know all this.....But for those who don't, maybe this information will be of some help.
Hope today is a better day for you.


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PostPosted: Sun Apr 11, 2010 11:53 am 
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Thank you so much, Setmefree!
I did not know some of that information you passed on. For instance I didn't know it was the anesthesiologist who writes the post-op orders or that they're standard for everyone. I've always told the anesthesiologist about being on suboxone, but it didn't seem to matter last time. At least now I know if I've got inadequate pain control post-op to request that the doctor be contacted. This is good information and I think that's the key to things going smoothly - or at least smoother.

I can't thank you all enough for your support as well as the benefit of your knowledge and experience. I'm so grateful.

I'm feeling much better since I took 6 mg this morning. This afternoon/evening I still have the other 4 to take. I'll stay at 10 mg/day for a few days and see if I can drop a couple more mg after that. And you're right any reduction in my dose is better than none. This experience has been positive though, too. Because now I know without a doubt that I can't drop down to this lower dosage when I consider how much additional pain I'm in. I'm practically worthless because every part of my body is tender and painful. Damn fibro! I had no idea the suboxone was helping me as much as it is. Perspective is everything in this case.

Thanks again everyone for the support.

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PostPosted: Sun Apr 11, 2010 12:33 pm 
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I don't know that I agree with the nurse getting the orders from the anesthesiologist because the nurses at my first surgery called my surgeon to increase the dose after, not the anesthesiologist. Also, after the second one when the doc came by and we discussed the pain, he said he had ordered IV morphine for me so in that case it was the surgeon and not the anesthesiologist again. Maybe it depends on the state or the surgery center.

I think it is the nurses fault if they sit there doing nothing and don't ask the doc if they can up the dose. Like in my first surgery after getting off sub, the nurse called the surgeon and asked to give me a higher dose right away when the first dose didn't work. The doc did authorize more and the pain was controlled. The second one the nurse just kept giving the same small dose over and over, waiting a long time in between, knew it wasn't doing anything, and didn't do anything different. If she really wanted my pain under control, she would have just called the doc and asked to give a higher dose like the first nurse did. She did eventually give me a couple vicodin orally, but at the pain level I was in she probably could have given percocet. I think the last one probably thought I was just trying to get high and therefore didn't WANT to call the doc. From having had at least 16 surgeries, it was pretty clear she was probably undercutting the morphine dose anyways because generally speaking, the standard doses will at least touch the pain and drop it one or two points. That was true for me even when I had surgery ON suboxone and didn't tell anyone. What she was doing wasn't doing anything.

I will also say this. When I had surgery on suboxone but I didn't tell the surgeon, I KNOW my tolerance was high at 24mg of sub. In recovery, my pain was VERY well controlled even though I had to keep asking for more. On the one after that, my surgeon knew I had gotten off the suboxone. I think he was being VERY careful and wouldn't give IV dilaudid. I heard the nurse ask him and he said only morphine, BUT he did authorize a very high dose. On the third one, I am pretty sure the nurse was undercutting it. Because the surgeon was EXTREMELY generous with the script so it would be odd for him to be tight with the IV morphine after, especially because joint surgeries are painful.

My point is, I think it makes a big difference on who you get for a nurse and I think their personal opinions do get in the way. The doc orders a max amount they want given. But nothing prevents the nurse from giving smaller than prescribed doses. They don't have to ask to do that and no one will know. There is a very high chance that somewhere between the surgeon, anesthesiologist, and the nurses, at least one of them will think that because you have a tolerance from the suboxone, they need to take efforts NOT to make the problem worse and at least one of them will be afraid of causing you to go back to active addiction.

Mel - I would make a copy of that article and I would give it to your husband. When he comes into recovery after surgery, he can always give it to the nurse if there is an issue and at least she will have some information on it. She can choose to read it or not, but if she does, it might be good for the next suboxone patient who comes through. I think most medical providers appreciate research articles being brough in by the patient (if they are any good). They don't have time to research all this stuff on their own for everything that comes up.

Cherie


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PostPosted: Sun Apr 11, 2010 12:57 pm 
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I think everything depends on where the surgery is and who the players are, be them doctors or nurses. And I will bring that NIH paper with us to the hospital. The paper also speaks of the misconceptions surrounding treating people who take suboxone. So I think it's fair to say I'm concerned about those misconceptions. I'll be the squeaky wheel, but a polite one. I know getting nasty won't help me one bit.

Talking this over with all of you IS helping me, because I feel that I need to have as much knowledge and information going in and different experiences and perspectives helps me to do that. Forewarned is forearmed - or something like that - LOL.

I already know my life is going to be better after the surgery, that's why I'm doing it. Being prepared for anything I hope will help in making the entire surgery a positive experience - as positive as surgery can be. Thanks again.

Mel

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PostPosted: Mon Apr 12, 2010 7:00 am 
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Doing OK this morning - at least I didn't wake up in withdrawals. Well, just some sweating overnight and I have no idea if that's related - I doubt it as I was able to sleep.

I'll be sticking to 10 mg for at least a few days before I try to drop again. I'll say this again, it's the damned pain that's making this so difficult. My entire body feels like a tender, throbbing bruise. This sucks!

In my first post I said if my temporary taper-down went well I would consider dropping my dose. Well, this has been an experiment in that sense and there's no way I'm going to do that. Not because I'm having cravings, because I'm not, but because of the pain. I'm now confident that I'm at the right dose. I normally take 2 or 3 eight mgs per day. And I know now that it's working and is just right for me.

I'm being quite repetitive, so I'll stop here.

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PostPosted: Mon Apr 12, 2010 12:27 pm 
Mel, it sounds like your on a smart plan and you've gotten some good feedback here, so there's not a lot I can add. I just want you to know that I'm supporting you in spirt for both your taper and surgery. You said you sent the doc that article but did you have a chance to speak to him? Hopefully he'll be one of the good guys and help you without judging. Also, I read in a couple of the other threads where people had emergency surgery thye mentionned a drug called torodol. I guess it's not and opiate, but is effective for pain. Maybe you could check into getting that after the surgery.
In the meantime, I don't know if you have tried soaking in epsom salts. They're super cheap at the drugstore and a lot of people swear by them for temporary pain relief.
Hope you feel better,
Lilly


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PostPosted: Tue Apr 13, 2010 10:39 am 
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Thanks for the encouraging words, Lilly. I've tried Toradol for my fibro and although it's a great kidney-stone medication, I've found it to be limited in terms of other types of pain - at least for me. BUT, it's always good to keep it in the back of my mind, so thanks for reminding me. Unfortunately I haven't been able to see my urologist nor will I until the day of the procedure. I just hope she wasn't offended that I mailed that NIH paper to her - I'd hate to think I may have made things worse. She's pretty cool though, so I'm trying to stay positive that it could only help.

Last night I wanted SO badly to take a full dose of suboxone to help with the pain. It feels like I've been suffering for weeks when in reality it's only been days. But when a person has chronic pain I find that it tends to skew one's thinking. I lose a lot of insight that way.

I've only got 6 days left before the surgery. It sucks that I find myself counting the days. I'm trying my damnedest to keep my mind occupied and stay somewhat active, though that activity thing is like walking a fence.

You all have been great. I find it very beneficial for me to be able to come on here and write about how it's going and how I'm feeling. Thanks again for all the support.

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 Post subject: About time....
PostPosted: Tue Apr 13, 2010 11:13 am 
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Hey Mellisa,
I'm glad you're finding some comfort in using the Forum to vent your feelings etc. ... It's about time the Forum gives something back to you! You are always here for anyone who needs a little advice or words of encouragement... It is good that its the other way around.... :D Again best of luck with your upcoming procedure and all that comes with it.... Know that you have many people out here that are pulling for you...... Take Care!

God Bless
TW


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PostPosted: Wed Apr 14, 2010 9:13 am 
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Ok, I've been stable on 10 mgs for 5 days now, so this morning I only took 4 mgs and will take the same this afternoon. This means I'll go down to 8 mgs until Saturday when I'll stop altogether before the procedure.

If I have trouble with withdrawals I know it won't happen until probably tomorrow or even the day after.

I spoke to the pre-surgical testing department this morning to prepare for Monday. I asked who writes the post-op orders for recovery and they confirmed that is is the anesthesiologist, sometimes in conjunction with my doctor/surgeon. So that's good to know. And we spoke briefly about the suboxone and she stressed that I explain it all to the anesthesiologist before the surgery. Which of course I plan on doing. I gotta tell you all, I still hate the part when they ask why I'm on suboxone and me having to admit I'm an addict. Is that damn shame ever going to go away? I'd like to think it's lessened a bit in the last year, but I really don't think it has, at least not very much - yet. I know in time it will, I've just got to keep working in therapy and be patient.

That's my update for today, let's hope this most recent small dosage drop will be painless.

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PostPosted: Wed Apr 14, 2010 10:07 am 
Glad you got the information you needed. It's totally acceptable to ask whatever questions you have. Throughout my career as a nurse, I never ever minded people asking as many questions as they wanted. An well-informed patient is generally a joy to care for. Things just seem to go more smoothly when you know what to expect. As I have said before, your anesthesiologist is a key player. You definitely want a good rapport there. The hard part is that usually there are multiple anesthesiologists for each institution and you don't know who you're gonna get until the day of surgery.
If anyone is set to have several surgeries or procedures over a period of time and you get a particular anesthesiologist that you like, you can put a request in to have that same one on subsequent surgeries. Especially in a case like yours, Hatmaker, if there is one of them who knows your situation and works well with your issues, ask to have him/her next time. It won't always work out, but it sometimes does. Even nurse-wise, it can work. Many times, I had patients come back and ask if I'd take care of them if I was working that day. It never hurts to ask.
As far as the shame thing.....I hate it too. In my opinion, there's nothing wrong with sugar-coating it a little bit. It wouldn't be the least bit dishonest to say something like...."I've had so many pain-related diagnoses over the years that I got too high a tolerance and got dependent on opiates. I am now on Suboxone to prevent further tolerance and control my pain. If you aren't familiar with Suboxone I have some information for you......" The most important thing is that you get the proper care and adequate pain relief. That is part of the over all standard of care that everyone is entitled to.....addict or not. Going in knowing that it may be a struggle because of our addiction is not right, but it is a reality. As I have said in other threads here about the subject of surgery, going in with a good strategy is key. You have done all you can to educate your care providers about your situation. All that is left is to go in with a positive attitude, expecting to receive the care you deserve.
I hope everything goes super smoothly for you. Hang in there.....it'll be over before you know it!


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PostPosted: Wed Apr 14, 2010 11:10 pm 
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Hey mel

sorry im just posting on this thread since you have been so nice to me and always seem to see your post on my threads so im hear to suporrt you now. Ive read most of the thread seems like your going threw a diffucult time with the taper and your pain. i know your pain cause like u know some days my 10mg doesnt do anything for me and my pain is so bad btu im sure not as bad as yours if you are going to have this procedure done. and boy i know the feeling of being in a hospital trying to explain what suboxone is and just get a blank look like im a morone. if you think about it, thats pretty scary cause these people r suppost to know everything about what meds u can and cant have but they dont even know what suboxone is so how can they know what could help me. one time i was in the er and a nurse almost gave me 30mg of hydro codone luckily enough my mom stopped them screaming her head off. but enough of me this is your thread. so what pain meds do they plan on putting you on or have u not talked about this yet?? and if so do they know how long youll have to be on them? glad to hear you had no problem switching right back to sub after the first procedure im sure youll be fine this time. their were alot of post so i read most of yours so if im a lil behind sorry. but im hear to support you in any ways possiable and i will put you in my prayer tonight.

Good Luck
Brent


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PostPosted: Thu Apr 15, 2010 7:28 am 
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Mel,

You have done an awesome job so far and I am totally impressed because you don't really complain much. I know you think you do, but you don't really. I would have had a hard time with the taper to begin with let alone dealing with the pain for days on end. I am totally pulling for you and so wish I could take some of it away.

You always handle yourself well, so when you get there I am sure you will be able to make everything work out just fine. Keep hanging in there.

Cherie


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Dr. Jeffrey Junig, M.D., Ph.D.

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

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