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PostPosted: Sun Dec 09, 2012 1:42 pm 
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I have not been on this Forum for a while. I was stuck on 1.75 mgs of Subs the last time I posted in the Sub titrate subject. I have a new psychiatrist, since my other one quit her practice this past summer. He is a God send. He says something happens when you are taking less than 2 mgs of Subs that makes the withdrawal scary, much more difficult to come off of. Kind of a woo-woo guy (gives me aromatherapy along with meds) but I like him. His theory is that if I started taking Subs in longer intervals (first 36 hours between doses, then 48 hrs. etc.), that it would be easier to wean. I have not been able to do successfully do this but he is very supportive of me and my decision whether to wean or not. I chose not to at least until now..

I have been putting off Carpal Tunnel surgery for a year, getting steroid injections in both hands every 3 months for the past 2 years. I was extremely frightened of the pain aspect of the Carpal Tunnel Release surgery, being on the Subs and all. I thought long and hard about whether to go ahead with a surgical treatment of this practically crippled thing in my hands. I was scared to tell the surgeon, fear of being "labeled". When the docs said they needed to do surgery because Steroids would end up not working, I finally went for it this last Wednesday. They did the left hand and are doing the right hand on the 19th. I did not want to go under general anesthesia needed to do both hands at once. I found out my high deductible was met so decided to do the other hand this month.

When I went in for "pre-op anesthesia" appt., I was scared sh&*%$tless to tell them I was on Subs. I told the pre-op nurse that I had been taking Suboxone for 2 years and was now on a low dose of 1.75. She handled it very matter-of-factly; asked me why I was on it. I told her I was addicted to opiates 2 years ago following an accident (which is not the whole truth, but it is a fact), she said "yes it happens all the time". I was reassured that the anesthesiologists were quite aware of Subs (“they see it all the time” ) and how to "medicate through them". I almost cried with relief. After the many horror stories I have read on the internet, this was the best news ever..I felt encouraged..

Day of surgery, I told everyone who saw me I was on Subs. Had taken my last dose 24 hr. before surgery per Sub doc. There was a little scare when the “ever-so-new-1st week on the job”-Nurse anesthetist seemed clueless about Subs-he was from Tennessee-,maybe they haven’t seen as many folks there in this situation? I told him it was an opiate blocker. Anyway when the Anesthesia doc came in, she was awesome-told me she was giving me Propophol (which according to internet sources does NOT bind to opiate receptors) during the procedure, plus a little Fentanyl and Versed. I breathed a sigh of relief. The surgeon came in, I reminded him I was on Subs (was in my chart); he gave me script for Percocet for 5 days. The surgery went well, I was “awake but somewhat dissociative” during the procedure-they said I was "kicking alot" during the surgery-probably withdrawal so they gave me the Fentanyl. I walked out 2 hours after I got there, with a very numb hand. I took 2 Percocets every 4 hrs. the first 2 days and have slowly been dropping my dose and not taking the Subs.

Fast forward, I am 4 days post op and taking only 1.5 of the 5 mg tabs of Percocet every 5-6 hours. I have definitely felt the Sub withdrawal at times. I have been awake several hrs. of the night the past 2 nights. At this point I am not in pain but taking as little pain meds as possible for withdrawal and no Subs for the time being. (I am working very closely with my Sub doc, who is available and very supportive about all of this)..Although I know the w/d will come if I choose to not go back on Subs, I feel supported by Sub doc, surgeon, all the people in the orthopedic surgery center (except the new guy on his first week on the job).. I am someone who did NOT want to tell ANYONE I was on Subs for fear of being judged. I am relieved beyond description that I have had the surgery and had a positive experience so far!!

Will keep you all posted…


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PostPosted: Sun Dec 09, 2012 4:46 pm 
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I'm so glad that you've had a good experience!!! It makes me very happy to hear that most of the medical team knew what to do with a suboxone patient! As a patient, and especially before a surgical procedure, you feel so vulnerable. That they were able to set you at ease is fantastic.

As I was falling down the stairs on my bum this afternoon, my mind flashed to, "Oh no! What if I break my tailbone?! They won't know how to treat my pain!" Luckily I just have a slightly sore bum, so no break. That thought is not often on the forefront of my brain, but it's always lurking in the back of my mind. It makes me feel better that you had a good experience.

Please keep us informed of your progress. How much thought have you given to stopping suboxone for good? I'm sure it's a tough call.

Amy

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PostPosted: Sun Dec 09, 2012 8:11 pm 
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Hi Amy-thanks! Wow, so glad your bum is OK! :) I know that fear all too well..

I had a nasty scare a few months ago when I was riding my bike and fell HARD-thought I had broken my leg..I went to urgent care and it turned out to be a sprain-crisis averted! I HATE the shame associated with telling medical professionals (total strangers) that I am on Suboxone. I feel an urge to explain myself and change their view of me, not wanting to be treated differently in those situations because of my history. I too have had the fear in the back of my mind that if I had a real emergency and needed pain meds, then what would happen? My Sub doc says I am on a low enough dose that it doesn't take much to "over-ride" the Subs. I feel encouraged that the Surgical center knew what to do. I would think an ER would have this knowledge as well but who knows? I have given my family intructions what to do if I am too out of it in an emergency situation, telling professionals about the Suboxone.

I have given much (too much) thought about quitting Subs. I spent much of the first part of the year beating myself up for not being able to "bite the bullet" and march through the withdrawal. I just was not up to it, many life events happened this year and I just decided to give myself a break. The plan was to get through the surgery and get back on Subs. But mentally I feel some freedom that I have not had "the little orange pill" in 6 days now...I realize I am still on some opiates, it just feels like a different mind set now that everyone knows what I am up to, and I am being monitored. I did however, yesterday morning wake up and thought "wow I feel more like me right now!" (No Subs, minimal pain meds). This made me happy!

For me, I want to think I will just "know" when or if it is the right time to discontinue Subs. This may be magical thinking on my part..but is all I have right now..My Sub doc even thinks getting off Subs right now and weaning off the shorter acting opiates (Percosets) may be the formula (for me with support).. I will have to see after the other hand is done in 10 days. The plan is to stay off Subs until after 2nd surgery then reevaluate whether to restart. There will be a gap of a few days in between when I will be opiate free. This will be the real test I suppose..Taking one day at a time!

Thanks for your support.. :)


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PostPosted: Wed Dec 12, 2012 9:36 am 
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Update 8 days post op. from CTS surgery (kind of long, I seem to get long winded about this stuff-some may call it obsession!) :?

I started weaning off the Percocets on Sunday. When w/d’s started I supplemented w/ some Hydocan (cough syrup I had from long time ago-limited amts-10 mg or so each dose). As the Percs got fewer and fewer, the worse the w/d symptoms. I can’t take too much of the Hydocan because of the other ingredient in it; bad stomach issues if I do. Last 2 days, have felt the creepy crawlies and that awful feeling when you are trying to get off opiates/subs. Then almost a panic set in yesterday when I started having throbbing in my hand and pretty bad pain. This was a concern because the Surgeon said would only have pain for a couple of days; a week at most (yesterday was a week). I have also been on 600 mgs of Ibuprofen every 6 hrs. which according to doc and many peoples' recounts of their carpal tunnel surgery, I should only need at this point. I thought about calling my Surgeon or my Sub doc to give me more Percs to tide me over until surgery on the other hand next week. I convinced myself to just go to bed and if I still had pain or crazy w/d this AM, I would call a doctor for help. I was pretty miserable when I went to bed. Then I woke up 2 hrs. later with the gawd awful restless legs..I guess that's why they call it "kicking". because I was kicking..ALOT..I got up and thought screw this! I took 1/8th of a 2 mg Suboxone pill. Basically .25 mg or so. I knew I was taking a risk of doing this because of the precipitated withdrawal danger but I took a chance. It was like a miracle!! I lay down and waited about 30 minutes and the restless legs-gone! The pretty bad pain in hand-gone! I slept like a baby for the first time since surgery. Woke up early this AM, but feel pretty good. Not going to beat myself up on taking the Subs. I will continue on as little of the Subs as possible until next Wed, when they do the other hand. Before the surgery, my sub doc suggested my post-surgical pain could be controlled with the Subs (or Subutex he said-gave me script) alone. I didn’t want to take that risk if the Subs did not work, I would be opiate blocked and have no relief from pain pills after surgery. However after last night, I am beginning to believe it actually may!
One issue is that I use exercise (running, biking, swimming, Yoga) to help w/my recovery. I am only able to go for walks at this point. Many of my coping mechanisms for w/d's are impossible, right now at least. I may be able to jog today-I am hoping anyway..

One question if anyone has thoughts; I know the half-life of Subs is 72 hrs., some say longer (my sub doc said 5 days?? )Took a total of 40 Percs (5mg) in 5 days, with Hydocan syrup supplement (last 2 days). I had a total of 3 Percs on Monday, 1 yesterday, then I am out today..Just trying to think ahead as to how to proceed after 2nd surgery. Is this pretty bad w/d I was having coming from the Subs w/d? I was off Subs for 8 days when it got really tough. Is this from weaning off the Percs over 3 days? Or both?

Hopefully I am making sense of it all so if anyone has any input, would be great…


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PostPosted: Thu Dec 13, 2012 3:59 am 
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I think you were smart to take the .25mg last night. You need to be able to rest if you want to heal.

My thought is that most of your withdrawal symptoms were from being off suboxone for 8 days and not having any percs to mask the withdrawal. People who jump off sub say that the worst days are from 7 to 11 days after stopping. I don't know that you've had enough percocet to be withdrawing from it.

I would probably stick with the same protocol that worked with your first hand. Between now and the second surgery, try to take as little sub as possible and then stop taking it 18 to 24 hours in advance of the surgery. Use the percocet to relieve your post-surgical pain, and after you are done with the percocet, see how you feel without the sub. You can choose from there whether you think you should go back on sub or not.

Amy

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PostPosted: Thu Dec 13, 2012 11:09 am 
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Amy-thank you, thank you, thank you! It is really nice to get feedback and supporting my plan. I had a sense this is what was going on. The w/ds were the worst after 5-7 days post op as I weaned off the Percs. The doc only gave me 40 of the 5mg. Perc. pills so hard to go down the addiction path with that. I will take the Subs as little as possible to hold off the w/ds before last dose on 24 hrs before surgery Wed. Then see where things are. Would love to be symptom free after my short stint on short term opiates and just stay off the subs. This is what my Sub doc thinks as well. It is nice to have your support! The last Sub I took was 18 hrs ago and I am just now feeling more w/d-not bad but the shaky stuff so will probably take Sub crumb this AM and treat w/d as needed until surgery.
If I can get off Subs through this experience, I will be so happy!

:)


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