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 Post subject: Please help!!
PostPosted: Tue Apr 27, 2010 11:32 am 
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I've been a 8-16 mg suboxone user for the past year... Before that i was taking 80 mg OCs daily... and surprizingly my recovery has been smooth sailing.

My problem is, that on May 11th i am undergoing surgery with very painful recovery... I have a very high tolerance, and im concerned that my Dr, will perscribe me 10 mg Vikes or Percs... which will do nothing for me.

Does anyone have any experience with a similar situation? How did your dr's handle your post op pain management?

I am well aware i need to stop taking the suboxone Pre Op... My focus of concern is post op


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PostPosted: Tue Apr 27, 2010 11:41 am 
Pancake,
Read the other threads under this topic, especially the "official" article that hatmaker posted. There is tons of information here!


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PostPosted: Tue Apr 27, 2010 1:26 pm 
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Lilly.. Thank you for the response.. Ive been reading alot of the info on the site, and the article you referred was very informative.

Maybe i should just be blunt.

Im hoping that when i explain to my Dr. that i take suboxone, that he will prescribe me a strong enough painkiller that reflects my tolerance... like 20 or 40 mg oc.

Is this likely? Has this happened to anyone before?

Quite frankly, if this didn't turn out to be the case... i would just buy these pills on the street and manage my own pain. But obviously that is expensive, and id rather do things the right way.

I hope my honestly isn't confused for anything but what it is... i know myself, i know anything short of that will leave me miserable and unable to function during my recovery.


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PostPosted: Tue Apr 27, 2010 3:54 pm 
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I definitely would not buy drugs on the street........that could be a major set back plus you could be risking jail or getting kicked out of your sub program. I know your scared but there are other options. One thing you might consider is having your sub doctor talk to the Dr that is going to do the surgery. If your surgeon is not familiar with suboxone this could certainely help out alot plus your sub doc would know what is going on with you.

In the Surgery on Suboxone section Hatmaker posted an article on there that might also be helpful to your surgeon if they are not familiar with suboxone. There have been some good experiences and some bad but if you sub doc is very knowledgable about pain control while on suboxone he could definitely help your surgeon understand your pain tolerance. Just please look at some of these other options before going back to those old addictive behaviors and buying on the street because before you know your back on Oxy and you will be in worse shape. Good Luck on the surgery and keep us posted on your plans.

Jim


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PostPosted: Tue Apr 27, 2010 4:00 pm 
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Pancake - I'm sorry to say your concerns are valid. You might want to read the thread called "Planned upcoming surgery". I had surgery on April 19th and that thread's got great information from a lot of people. It helped me alot.

The best advice I can give you is to talk to your doctor about this now. If you don't have an appointment before the surgery, make one. Print out that article and take it with you. Share your concerns, because as I said, they are valid. They also need to put you on a high enough dose of whatever they give you to keep you out of withdrawals, too. In addition to going off it before the surgery, I also tapered my dose down for the 2 weeks prior to my surgery. I know that helped.

In pre-op, make sure you talk to the anesthesiologist about the suboxone, too. They, in conjunction with your surgeon, will give your orders for the recovery room.

I hope this helps. If after you've read that other thread you have more questions, we'll answer them as best we can.

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PostPosted: Tue Apr 27, 2010 4:09 pm 
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I had an emergency C-section and took 8mg that day. For four days they had me on a dilaudid dose that was like eight times the normal dose and it helped as much as advil. Eventually, they put me on a dilaudid drip and i was pushing the button so much I probably wore it out. On day four, my subutex withdraw was so bad even with the dilaudid, I started taking it again. My plan was to stop after delivery with pain meds, but if you ever have had IV dilaudid, you would know how strong it is-almost the strongest and I didn't feel a thing.

Sorry for the bad news if you were looking to stop after surgery, but I couldn't do it.

OH and this shows you how much the doctors know...they were still giving me subutex with dilaudid... HELLO!!!


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 Post subject: How are you?
PostPosted: Mon May 10, 2010 6:05 pm 
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Hey Pancake....I didn't comment earlier, but I did read the thread. I was wondering how you are doing. Are you still having the surgery tomorrow? WHat have you done about the sub? Did you talk to your doctor?

I was just thinking about you and hoping that everything has worked out....let up know how you do after the surgery when you are feeling up to it!

Good Luck!

Elizabeth

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PostPosted: Mon May 10, 2010 6:20 pm 
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Thank you all for taking interest in my dilemma, i was really surprised by that.
Unfortunately, my fears seem to be a reality: I told my surgeon that i have a high tolerance, and to call my sub Dr. to determine proper pain management... He didn't want to call him.. wrote me a prescription for vicodin, and insisted that if it doesn't help the pain, that i should just keep taking more. I insisted that vic 10s might as well be tylenol, bc they do nothing for me, and to just call my dr.... but he didn't listen, and sent me on my way. I just came from an appointment with my sub Dr. and he insisted that i have the surgeon call him if the vicodin doesn't work, but doesn't know what proper pain management would be for me with my tolerance.
Any thoughts?


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PostPosted: Mon May 10, 2010 6:47 pm 
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Pancake,

Did you taper down on your suboxone at all over this past week or two? When I had my last procedure I did a quick, temporary taper two weeks prior and that allowed the vicodin they gave me to help with my pain. That said, mine was a minor procedure and I get the feeling yours isn't minor. Did you read that paper I posted on the other thread? That will help you see what the doctors options are and how they SHOULD be treating your pain. (You can also find it under the "Links" topic.) You might want to print it out and bring it with you, so you have it to back up what you are telling the doctors.

If you have any specific questions, feel free to PM me.

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


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PostPosted: Mon May 10, 2010 8:30 pm 
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Pancake,

I was also wondering what kind of surgery you are having? If you are not comfortable talking about that, the more important part is the nature of the recovery (amount of pain, time to recover, etc). If you are going to be inpatient after the procedure, then this would be a good time to find out what your tolerance is, and how much pain medication you need. If the doctor sees that you are not having good pain control with "normal" meds in the hospital, he may be willing to reconsider.

Also, you said that your surgeon won't contact your sub doc, but what about that other way around....can your sub doc call your surgeon in the morning?

I would need the same info as Hatmaker in order to help out with more specific suggestions.....particularly your dosing info.

Elizabeth

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Subs Not Drugs!!!

"Don't hope for a life without problems. An easy life results in a judgmental and lazy mind."
- Zen Master Kyong Ho


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PostPosted: Tue May 11, 2010 8:33 am 
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This is not meant to scare anyone, I am just sharing my experience with surgery. I suffer from chronic advanced Hepatitis C and consequently, I require a liver biopsy each year to monitor the damage to my liver.

Prior to getting on the suboxone, they would give me a shot of fentanyl before collecting the liver sample and I'd be in la-la-land long enough for them to stick a needle the size of a ten-penny nail between two of my ribs and rip a hunk of my liver out to examine it under a microscope.

Fast forward to my last liver biopsy. I was on 6mg of suboxone, and I was told to NOT take it 48 hours prior to the procedure, which I did - I did NOT take anything for two days. I experienced some moderate withdrawal symptoms from that, but to my amazement, when they gave me the fentanyl IT DID NOTHING!

I told the doctor who was about to do the procedure, "hey, dude, I'm wide awake here, you need to give me more of that junk" and he said "I can't give you any more without an anesthesiologist present, so let's try to do this anyway."

I'll spare you the details, but that biopsy was NOT successful. I had to go back a few weeks later and go under general anesthesia to have the procedure done.


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 Post subject:
PostPosted: Tue May 11, 2010 12:08 pm 
Just my 2 cents. I'm on painkillers (first oxy 5/325 and then hydro 5/500) for my car accident and needless to say I didn't taper ahead of time. I told my Sub doc that I was taking them 4 at a time (and sometimes 6) with 600mg of ibuprofen, which did cover the pain. Maybe it was really just the ibuprofen working because it's a soft tissue injury and ibu. is an anti-inflammatory. Anyway, I'm taking tons of tylenol which its not good. The Sub doc seemed to acknowledge that the low doses wouldn't be effective but didn't offer or suggest to get me on a higher dose. I'm lucky enough to be doing OK, but honestly, I think a Sub patient in real pain would need to be prescribed at least oxy 30's. The problem is that this isn't usually prescribed for injuries or post op pain (even C-sections). So you need to reveal that you are on Sub to expain the need for the higher dose, while at the same time once you reveal it they think you are drug seeking.
I know, Mel, you really tried to educate the surgeon ahead of time to no avail, and that seems to be what commonly occurs. The only solution I could see would be to have our Sub doc work closely with our surgeon, but in my experience docs almost never communicate an work together.
My best advice (not knowing what kind or surgery you're having) is to take at least doulble your prescribed dose of vicodin along with a good otc pain med like ibuprofen or naproxin. I've heard other addicts say that torodol also helped them after surgery (it's a non-opiate). Good luck. I wish your doc would just go ahead an call the sub doc. Maybe we're pioneers of Sub treatment and sometime in the not too distant future Sub will be well understood and accepted (like SSRI's now are). Just my hope.
Take care,
Lilly


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PostPosted: Tue May 11, 2010 1:10 pm 
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I don't have any science, no research studies, no white papers that I can point to about this. However, I have read at least a dozen reports from patients on Bup that were not able to obtain narcotic pain relief after stopping their Bup for only 48 hours. I have also read reports from patients who stopped their Bup or reduced their dose only to find that they didn't feel much of a change for typically 72 hours and 96 in many cases. From these reports it would certainly seem like two days is not a long enough time and that three or four may actually be needed. The problem is, by the time you get to three or four days you will likely be starting to feel the effects of withdrawal - which is actually another point. The fact that most people are not feeling withdrawal after two days off Bup further tells me that it only makes sense when they say that narcotic pain medication did not work for them.

Clearly more work needs to be done and more information is needed about what to do when narcotic pain meds are needed by a Bup patient. It would seem that the "standard" two days is just simply not enough time to allow for "tradditional" narcotic pain medication to work.


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PostPosted: Sat May 15, 2010 9:58 am 
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I think you're right, donh. What's interesting is my doctor, who tells me he's been working with addicts for over 30 years, is the person who told me that I would be fine if I just didn't take my suboxone for two days prior to the procedure.

I went back and told him about my experience and, to his credit, he admitted to me that he was just "estimating" how long before the procedure I should stop dosing, and he even thanked me for reporting my experience to him and said he thinks he's going to tell his next suboxone patient that needs surgery to not take their dose for 3 days, instead of two.

Looking back, the WD symptoms I experienced after 48 hours with no bupe were definitely quite mild. I felt a little bit of anxiety (much of which could probably have been associated with being nervous about the procedure) and I was a bit restless and had a hard time paying attention to my work, but otherwise, felt relatively normal.

This tells me that there was still a HIGH percentage of receptors covered by the bupe. In fact the surgeon told me at the time that they had almost doubled the dose of fentanyl they gave me because they knew that the bupe would block most of it.

When I asked for more, he said one of the reasons why he couldn't give me more was because it might actually stop my heart and/or breathing.


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PostPosted: Sat May 15, 2010 10:21 am 
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Pancake, how did the surgery go? I've been wondering about you. I hope you have the time soon to check in with us and let us know how you're doing.

Take care.

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-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

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


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