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PostPosted: Sat Feb 28, 2015 8:05 am 
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Hi,
Please help me! I am having a liver stent put in a liver duct stricture I have this coming weds. The doc's nurse was so rude when I told her I was on suboxone, and she had absolutely zero clue about what that meant for my surgery and anesthesia. I also asked to be kept overnight because bleeding and pancreatitis is a side effect of this surgery, and I always have horrible effects from surgeries and end up in the er the same night anyway. How do I get them to keep me overnight? How do I make sure I have adequate pain control and sedation, and what do I have to tell them? The nurse basically yelled at me when I asked to stay overnight and clearly has zero compassion. The doc is supposedly the best dr around to do this surgery or else I would go elsewhere. I just need some advice....however I also asked the nurse if my psychiatrist could call and she said your phsychiatrist doesn't need to call she doesn't need to tell us anything. Total bitch. Ok, if you have any suggestions or help I can take all of it! Thanks,
Maya


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PostPosted: Sat Feb 28, 2015 8:36 am 
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Maya

Did you see the doctor or just talk to the nurse? Maybe the nurse was having a crazy day & came off rude, it can get pretty hectic in a surgeons office. I am not excusing the nurse's attitude just trying to troubleshoot. There is info on Dr J's talkzone to print out & give to anesthesiologist/doctors etc.

You must have seen the surgeon, did you tell him you are on sub? It is so sad we have to fight so hard to be heard and then we get negative attitudes for being on a medication.

Sadly, the insurance company's rule. If your procedure "normally" doesn't require overnight then it won't be covered. So as you have done in the past, if you have a fever or don't feel "right" go right to the ER.

I guess the strongest suggestion i have is to print out what Dr J wrote so it's coming from a peer vs a patient and the other suggestion is to have your psychiatrist call the surgeon directly. The psych will call and say I am "Dr A" and i want to talk to Dr B. I bet he will take the call and she can educate him about sub.


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PostPosted: Sat Feb 28, 2015 11:54 am 
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Is there anyway to call your sub dr and ask him? I'm having surgery Monday my Sub dr gave me a script for Vicodin to start taking instead of subs until after surgery then I will go back to my subs. I was afraid of anesthesia not working... Best wishes


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PostPosted: Sat Feb 28, 2015 2:30 pm 
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It sucks finding yourself in that position. I was there a fews ago and no one really knew what Buprenorphine is or does. My nurses were compassionate but my surgeon was not.

In your case I would try to get the prescribing doctor to talk to the surgeon and discuss your pain management. Kind of what csinny said.

You won't have any problem with anesthesia, it's the pain control afterwards that is the problem. Having the two doctors talk would be best. Or you can print out some of the articles Dr. Junig has written on the subject. You can find them on his blog and also look for comments in this whole section.

Been there, done that. I don't envy you but in the long run it should work out okay. They need to understand that by taking Buprenorphine you have jacked up the tolerance to opiates, making it hard to treat the pain w/o a large increase in your meds.

That's about all I can offer for now. Be nice, be polite, but be firm when explaining the situation. Don't demand. They plug their ears when patients do that. Calmly explain why you will have difficulty obtaining pain relief. Ask them to please research the drug so they understand your predicament.

Good luck on this one.

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PostPosted: Sat Feb 28, 2015 8:52 pm 
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Having worked in healthcare for nearly 25 years I have to say I've seen far more people trying NOT to be admitted or even taken to the hospital than wanting or demanding to stay. Be that as it may either decision is based on the medical needs of the patient dictated by the standard of care as well as what the insurance company will pay for. Just because a patient wants an overnight hospital stay dioes not make it medically nessisary. Now, getting proper pain relief is something else altogether.

So, to answer your direct questions:

"How do I get them to keep me overnight?" You don't and you can't. You'll just have to follow what they as medical professionals believe is tbest for you. If the standard of care for the procedure you will receive is day surgery, that's what you'll have to accept.

"How do I make sure I have adequate pain control and sedation, and what do I have to tell them?" This is clearly an area you must have some say in. Again there is somewhat of a standard of care here and the doctor should follow it. Ask him if he has treated any patients on suboxone in the past. Will you even require pain relief? Many stent procedures are not painful after completed. Some can be. Is yours? I would ask that first. You may not even have post procedure pain. If you will, the doctor must be aware of how the sub will effect how pain meds work for you

Finally, will you have general anesthesia? Or conscious sedation? If general - you are totally asleep, the sub will not effect that. If conscious sedation, it may be a cocktail of drugs, often including Fentanyl, that is used. This could effect how awake you remain. I would again ask. For a cardiac stent you are semi awake. I do not know about a liver stent. Be sure to ask.

I hope that helps. You should be a partner in your care and you have that right. Just remember, the people treating you are trained, expierenced and licensed. You'll have to have some trust in them and if you don't, you may not have the right medical team. Talk with your surgeon directly if at all possible. This again is your right as a patient.


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PostPosted: Sat Feb 28, 2015 10:18 pm 
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I explained to the nurse and she said that my psych doc doesn't need to call my surgeon, and I said oh yes she does. So I'm hoping my doc will call the surgeon. The plan was fentanyl and versed, and I told them there is no way that will knock me out...they said we need you asleep because you can't move. So, they are doing it in a hospital with a real anesthetist instead of just with a nurse in his office so that if they have to put me totally out, they can. I am going to talk to my surgeon before the procedure and I did print out some advice from treating pain on here and treating sedation for those on suboxone. I also called my psych and asked her if I would do better taking Vicodin before hand but haven't heard back yet. NOt much time to plan considering I prob wont' hear from her til Monday and my surgery is Wednesday. Ugh! Wish me luck and that the docs listen to me and don't just blow me off as some addict that is drug seeking...here I am not doing that...I'm just horrified of being in pain or not being asleep for my surgery.


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PostPosted: Mon Mar 02, 2015 9:49 am 
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Well I'm freaking out. Still haven't heard if my sub dr contacted my surgeon...surgeon's nurse still acting like this is no big deal (she has no idea what suboxone does)...and I'm still on my subs as of this am! So, what do I do? Stop taking anymore sub before surgery which is in 48 hours? I'm on 3.5mg a day, so if I stop the sub 48 hours before surgery will pain meds they give me help? Ugh!!! This sucks!


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PostPosted: Mon Mar 02, 2015 12:06 pm 
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Hello Maya,
You have said you have the best dr for this .Have alittle faith in him that you will be takin care of. I would reread whag Donh and Rule have posted here to you.
It all makes good sence.
It ll be the after care/pain relief that you may need. Go over to Dr Junigs TalkZone, and in the search box type in surgery and sub"
It is about tolerance . Dr J addresses this. I wish I had more experience with this, but the information is here .
I ll say this, the avg dr out there would say that 3 mgs of Buprenorphine is a low dose. Maybe just drop down more over the next day..
Do what You can do, not what you hope They will do. In the end, it ll be ok...


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PostPosted: Mon Mar 02, 2015 3:26 pm 
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Maya,

You're putting too much thought into this. Stop worrying about how you will feel after the surgery. 3.5 mg's is a fairly low dose like razor said. There should be no problem switching you over to either Hydrocodone or hopefully something stronger. You won't go through withdrawals so stop thinking about that.

There won't be any problem knocking you out. Go back and read donh's post again, he/she knows what they are talking about. Get the surgery done and if the pain isn't too bad go back onto your Suboxone again. Just give it about 18 hours in between pain meds and your Buprenorphine.

Stop thinking about how you feel and get this taken care of. It will be in the past soon enough, okay?

I wish you a full and fast recovery!

rule

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PostPosted: Mon Mar 02, 2015 7:59 pm 
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Versed and fentanyl are the exact cocktail I was referring to and are very common for conscious sedation. The more important drug here is versed which is a benzo and has no effect with sub. They often only give you 50 micrograms of fentanly anyhow and you should get at least double if not tripple that. You won't be "out", will still breathe on your own but if Done correctly you won't remember anything afterwards. Versed has great amnesia effects at high enough doses. I'd be more concerned if an RN were doing this. With an actual anesthesiologist, they have many other tools in their tool box they can use - diphrovan for example. You should be fine for the proceedure.

Did you ask if you will even have pain post proceedure? I'm bettering you will not and therefore won't even need pain meds. It sounds like what you really need is a little reassurance. I wish they would give you that but honestly what's hoing on here is this is VERY ROUTINE with a capital R. It's a huge deal for you but just another normal day at work for them. As others have said, you need to try to relax. This is going to go fine for you. The worst that could happen is they have to abort the proceedure and reschedule due to not putting you under enough. I've heard that happen to others - but they were at 16 mg of Bup not your relatively low dose and they did not have a doctor there to provide the sedation. You will be fine. You really will.

Now if you are still worried, stop taking your bup now. You'll have a bit of withdrawal but it will hedge your bet if opiates are needed. I really don't think you need to do that and will suffer withdrawls needlessly but if it gives you piece of mind, then do it. It won't hurt anything other than you having to deal with a day of moderate withdrawal.

YOULL BE FINE!!!!


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PostPosted: Mon Mar 02, 2015 9:32 pm 
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Hey Maya

How are you? You have had some great people here helping you along. Embrace what everyone is saying and relax a bit. I know that's hard but maybe you can find a meditation on u tube to guide you into relaxing...


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PostPosted: Tue Mar 03, 2015 10:38 pm 
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Well I have surgery tomorrow. My docs talked and there will be post op pain. I took 2
My sub today and won't take any tomorrow but surgery is tomorrow! The doc said he is putting me on pain meds for a few days---will they even help!? Ugh!


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