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 Post subject: Post surgery questions
PostPosted: Sat May 12, 2012 4:45 pm 
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I posted a few weeks ago that my husband had a bad fall and broke his calcanues (heel) bone and was having difficulty controlling the pain for awhile, probably due to being on subs (4mgs per day) and the full agonists not working as well. After getting some advice here, he started taking a tiny bit of sub (probably .5 mg) at a time along with his pain meds.
He ended up having surgery almost 2 weeks ago to repair the misplaced bone. Since he knew he was going to have surgery, he stopped the subs altogether a few days prior and just took his oxycodone as prescribed. Since the surgery, he has had a prescription of morphine and oxycodone which he has been taking as directed, and hasn't had any suboxone since the surgery. The bad thing about fracturing your calcanues and the surgery the occurs afterward, is that it is extremely painful. The day after surgery was absolutely horrible, especially when his nerve block wore off. the pain meds weren't even touching him. Another thing about this injury is that the pain lingers for quite awhile and recovery can take awhile. We contacted our sub doctor prior to the surgery to ask her what to do while taking the prescribed pain meds and her response was simple - take the pain meds as prescribed and don't take the suboxone. So now its been almost two weeks and my husband hasn't had any subs. He's not having withdrawals or anything because he's on other opiates. And he's also only taking his prescription pain meds as directed. He's not abusing them at all and this isn't a concern at this point.
However, what we do have questions about is how he will get back on his subs after all of this. He's still in a pretty good amount of pain, which is to be expected with this type of injury and surgery. He's taking morphine sulfate 3x's day (15 mgs) and instant release oxycodone (5mgs) 1-2 tabs every 4-6 hours for his breakthrough pain. Even with these meds, he's still in pain. So, do you think that he could start taking a small amount of suboxone every 4-6 hours to assist with this pain? Or would this cause withdrawal since he hasn't had it in almost 2 weeks and he's on other full agonist opiates? I really hope he starts to feel better soon, but I have a feeling he's going to be hurtin' for at least a couple more weeks. Anyone who can comment, please do. I truly appreciate all the guidance I've received on this forum. Y'all are so helpful and knowledgeable and I'm so grateful for that!


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PostPosted: Sat May 12, 2012 6:26 pm 
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Hi JenW,

I'm so sorry to hear about your husbands injury and the fact that he's not getting adequate pain relief. Back in 1997, I fell out of a tree and crushed both ankles, broke both legs and my left calcaneus was also shattered. The orthopaedic surgeon said my left heel bone had exploded into 18 pieces. He was quite impressed with how thoroughly I had ruined that bone, I wasn't nearly as impressed!

After 5 days, I was released from the hospital and sent home with Tylox (5mg oxycodone), the prescription said to take 2 pills every 4 ot 6 hours. I was opiate naive at the time and the 2 pills every 4 to 6 hours managed my pain just fine.

It sounds like the Suboxone your husband has been taking has raised his tolerance to opiates, which is understandable. I'm gonna go ahead and say that he should indeed start introducing Suboxone back into his system and that will help address some of his pain issues. However, I'm not fully sure of how to do this. I'm pretty sure there are some articles in the Surgery on Suboxone section that address this, here's the link:

http://suboxforum.com/viewforum.php?f=16

I wish you and your husband the best of luck, that is a painful injury he has, no doubt about it.

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PostPosted: Sat May 12, 2012 9:13 pm 
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Hi again,

As long as he takes a small amount of suboxone and it's way below the ceiling it shouldn't cause problems, but I say that with only my non-formal knowledge, based only on my only research and information learned from Dr. Junig and the internet. Did I offer you a copy of that NIH paper? In the section Romeo linked to you, it's in the first post/thread (it's a sticky). Read that paper and it discusses the different ways to treat acute pain in sub patients. (Just in case I didn't give you this info before (and for newcomers), although I think I did.) I haven't read the paper in awhile so see what specifics in gives about adding sub to full agonists.

At very low doses, suboxone is a full agonist - this is why suboxone is called a partial agonist. So my understanding (limited though it may be without a medical degree) is that it won't cause precipitated withdrawals in low doses when mixed with full agonists. But it all depends on the dose.

For example, my husband is a chronic pain patient (but not an addict). He'd been on oxy for a long while when he was switched to Butrans. It's buprenorphine but without the naloxone and at lower doses. He was fine with the switchover, no need to be in withdrawals. With suboxone, it's because of the high doses of sub (AKA "high dose bupe") that precipitated withdrawals become an issue.

I hope this helps. It's a damn shame that his sub doctor is so fucking ignorant about such important things. Maybe he can offer that NIH paper to his doctor? (If he's the kind of doctor that would be that humble.)

Good luck and I hope he gets to feeling better and healing soon.

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 Post subject: thanks!
PostPosted: Sat May 12, 2012 10:08 pm 
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Thank you both, Hatmaker and Romeo, for your responses to my post. Hatmaker, yes, you did post that link for me after I posted about my husband's injury a few weeks ago. After reading it, we decided that he would try to take a small dose of sub along with his other meds to help alleviate some of his pain. This was definitely helpful pre-surgery. Now that he's had the surgery and is trying to manage this post op pain, I think we will try the same thing to see if it helps. And yes, I will be printing this article out and showing it to both his orthopedic doctor and sub doctor. This pain he's been experiencing has been rough on him (and me too, even though i'm not feeling it like he is!).
Romeo - I'm sorry to hear you experienced such a terrible injury! I can't even imagine my husband having multiple injuries along with his broken calcaneus. If you don't mind me asking, how did you recover from everything, specifically the calcaneus fracture? You didn't mention if you had surgery or not, so i was wondering. I've read that several people who experience this injury have a surgery that involves plates and pins being implanted in the heel. Brian, my husband, actually had a fusion done (sans plates/pins) and he had shattered his bone like you did. Now i don't know if it was 18 pieces or not, but definitely in pieces. The surgeon explained a fusion would be better in the long run with regard to pain and arthritis, but he will lose some mobility in the subtalar joint... basically, if you were to pick up your foot to look at the bottom of your shoe, that kind of motion will not be possible in the future, but he will be able to point and flex his foot just fine. Anyway, I am just curious to see how you rehabbed your calcaneus and how you're doing now. If you have any advice, I would also love to hear it.
I want to thank both of you again for your input on this. I feel like I've gotten some of the best advice here and its great to have the support and feedback from everyone here.


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PostPosted: Sat May 12, 2012 11:01 pm 
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Hey Jen,

Well, I ended up having 7 surgeries over a few years to completely put everything back together again. The initial surgery, right after the accident, basically put things back in place. I remember the surgeon telling me that I had driven part of my calcaneous (5 or 6 pieces) up towards my calf muscle (obviously not all the way up to the calf muscle, but some of it went in that direction) and they had to pull it back down and get those pieces back with the other ones. Once the pieces were all in the same vicinity, he used his hands, clasped at the fingers, palms wrapped around my calcaneous to re-form it. A titanium rod was inserted at the proper angle to help the bones maintain the proper angle the calcaneous should be at. Then it was all casted up for months and months.

That initial surgery also addressed the broken bones of the right leg/ankle.

Some time after the initial surgery, I went in for 3 more surgeries on the left heel. They were all basically to clean up bone that wasn't where it was supposed to be. After the third surgery on my left heel, my pain was much more manageable, but not gone. I ended up getting that sub-talar joint fused.....one of the most painful surgeries I've had to endure. I still have two screws the size of your baby finger anchoring my calcaneus to the talar bone (I think it's anchored to the talar bone?)

As a side note, I ended up having the right ankle fused at the talar joint the next year. So, my left foot, I can move the joint up and down, but the sub talar joint, the side to side motion is locked. My right foot, I can move the ankle side to side, but the up and down motion is locked.

OK, here's the best part.....even though the fusion surgeries were the most painful surgeries I've experienced, after they healed, my pain was much, much, much better. I don't know if you've followed my story, but that accident got me hooked on opiates. I ended up abusing the hell out of opiates, then got on Suboxone, then quit it too. Today, my ankles don't really bother me anymore. If I've been on my feet all day at work, I'll take 2 Advil when I get home and poof, the pain is gone. Also, if you saw me walking down the street, you would have no idea at all that I've had such extensive work done to my ankles or have them both fused. I walk with a very, very minor limp, but it's because of the right ankle being fused.

As far as rehab, I did all of my rehab on my own. I had heard such brutal stories of how rehab hurt so bad, yada, yada, yada that I had set my mind to the fact that I was gonna figure out how to rehab myself and did. It's really basically common sense. As your doctor allows you to, you gotta stretch the muscles that hurt until your range of motion is normal. Once you get range of motion back, you start strengthening those muscles by adding resistance. You should be able to move that ankle in any direction (except the fused direction) without any pain, if there's pain, you gotta do more stretching and muscle building.

Recovering from an injury like the one your husband sustained is not easy, but it's certainly possible. If I could do it, then he certainly can too.

If he has any questions, tell him he can shoot me a PM, I'll do my best to help him out.

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PostPosted: Sun May 13, 2012 11:51 am 
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I just read Dr. Junig's latest blog entry - well, it's actually a slide show. It is well worth reading for you. It talks about treating pain in bupe patients.

Here's one excerpt: "If surgical maintained patient is KEPT on buprenorphine, and given 100-200 mg of oxycodone per day, the patient experiences NO withdrawal, provided the buprenorphine is not discontinued. Analgesia DOES occur."

Now, obviously in your situation this does not apply, because your husband has been off suboxone. It's been how long now? Two + weeks? What did you decide to do? Add the suboxone or wait or talk to the doctor or what?

If I were you, I'd check out his blog (go to the top of the page "TalkZone"). The first few pages are the history of opioid/opium, but stick with it because it talks about how sub works along with full agonists. It's quite informative. And the more you know about sub, the more you can help him with his treatment (both of you).

Well, here, don't go looking for it: http://suboxonetalkzone.com/uncoupling- ... lk+Zone%29

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 Post subject: Pain Meds and Sub
PostPosted: Sun May 13, 2012 12:40 pm 
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This subject gets me so very angry because of my own experience. My wife and I were discussing it again last night and we still haven't ruled out a lawsuit of my surgeon.

Today's doctors just don't know anything about Suboxone. I tapered down to 1mg and did the switch over to Lortab 10's after my first major surgery. The pain was a 10+ and something I never want to repeat. Talking to other patients who went through the same operation and are not on Sub, they all had pain relief and said the operation was not that bad. Arrggg!!

I begged and pleaded with my surgeon to research the tolerance level of Suboxone patients and he basically said no. Whenever I brought the subject up about not receiving adequate pain relief, he said and I quote "I don't want to discuss it". That was as far as I got.

The only good news was that the Lortabs did start to work after two weeks. But by then the pain had subsided on its own. Too late.

So believe me, I understand what your husband has gone through. But at least he got some stronger meds like Oxycodone. My Sub Dr. said I should have been on morphine or something very strong. Even a Pain Specialist wouldn't give me anything stronger than the Butrans patch. Now I'm seeing red again.

How can we educate the medical community about the tolerance of Suboxone patients when experiencing pain? NAABT surely hasn't done a very good job at it. Or it's just that Dr's don't read up on it.

Thanks, I feel better now. Hope your hubby does okay.

Rule

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PostPosted: Sun May 20, 2012 6:41 pm 
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[quote="JenW"]I posted a few weeks ago that my husband had a bad fall and broke his calcanues (heel) bone and was having difficulty controlling the pain for awhile, probably due to being on subs (4mgs per day) and the full agonists not working as well. After getting some advice here, he started taking a tiny bit of sub (probably .5 mg) at a time along with his pain meds.
He ended up having surgery almost 2 weeks ago to repair the misplaced bone. Since he knew he was going to have surgery, he stopped the subs altogether a few days prior and just took his oxycodone as prescribed. Since the surgery, he has had a prescription of morphine and oxycodone which he has been taking as directed, and hasn't had any suboxone since the surgery. The bad thing about fracturing your calcanues and the surgery the occurs afterward, is that it is extremely painful. The day after surgery was absolutely horrible, especially when his nerve block wore off. the pain meds weren't even touching him. Another thing about this injury is that the pain lingers for quite awhile and recovery can take awhile. We contacted our sub doctor prior to the surgery to ask her what to do while taking the prescribed pain meds and her response was simple - take the pain meds as prescribed and don't take the suboxone. So now its been almost two weeks and my husband hasn't had any subs. He's not having withdrawals or anything because he's on other opiates. And he's also only taking his prescription pain meds as directed. He's not abusing them at all and this isn't a concern at this point.





I know about the pain when the nerve block wears off!! I just wanted them to keep me in a constant nerve block!!

I recently had surgery on my rt. foot to remove bone and reattach my big toe to my foot. This was NOTHING like what your husband is going through, however. The pain was only bad for about 3 days.

I have had surgery before and taken these print-outs from Dr. J. and talked to my surgeon and my subdoc, but it does me no good...they do not want to read the paper. They know nothing about suboxone...and they don't care to know.

This time I decided I would be my own pain manager and would not come off the bup...I was on 16 mg. day and I got my subdoc to give me extras for the pain at my last visit which he gladly did.
I went into the hospital telling the surgeon and the anesth. I did not want any pain med. given me under any circumstances.
This was just a day surgery and If they had given me a bunch of pain meds and I had quit my bup before the surg..then i would have had to wait 12 or so hours before taking the bup again and the pain med would not have helped anyway.

Like Rule said...by the time the pain meds begin to work it is too late. So, I stayed on my bup, had the surg. and the block, and used the bup and prescription strength advil for the pain and actually did quite well.

Now I know you are in a completely different situation...but perhaps you should ask your surgeon for more pain med.?
Maybe he is not taking enough? And also adding the small amt. of bup would probably help as well. I guess what I am trying to say is you have to be your own advocate...nobody is going to help you but you. ...at least that is what I have found...

I hope he gets better and gets better pain control.

Slipper

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PostPosted: Thu Jun 21, 2012 8:45 pm 
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is it ok to take a sub the day before surgery or the day of surgery? does it have an affect on you for taking the medicaine? or should it not be taking the day before of the day of surgery? just trying to understand if its a good thing to do or not. thanks


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PostPosted: Fri Jun 22, 2012 8:16 am 
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Hi vis15 and welcome. Generally speaking, it's best to cease our sub 2-4 days before any surgery or procedure where we'll be receiving regular pain meds. If you take sub the day of the surgery, it's likely to be too close to the actual procedure and will block the opiates from working. That said, sometimes the 2-4 days still isn't enough time for the opiates to work enough to get good pain relief anyway. Suboxone is meant to block opiates and it's doing it's job.

Here's an article on treating acute pain in sub patients (like for surgery): http://suboxforum.com/viewtopic.php?t=1812

Did you stop the suboxone a couple of days ago already and are you asking because you're having some withdrawals? If that's the case and you just cannot stand it and absolutely HAVE to take something (I've been in that position), then I suppose you could take the very tiniest sliver of some suboxone. Believe me, it's that strong and that small amount should stop the withdrawals and make you feel somewhat better.

I hope this helps. Good luck to you.

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


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