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 Post subject: I am scared
PostPosted: Thu Aug 19, 2010 2:47 pm 
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Hey you guys, I've been reading a lot on here over the past couple of days. There is a lot of great support and info here, and a lot of scary stories too. I've printed the article as suggested to give to the surgeon and anesthesiologist. I have an appt with my Sub MD on Tues and I have started to taper my dose down after reading the posts here. I don't know what his advice will be but I see him on the 24th and my surgery is the 30th, and I take 24 mg of Suboxone a day. I've only taken 16 mg for the past 2 days and tomorrow I'm only going to take 8.

I am soooooo frightened! Thanks for being there to read this. Blessings to the people who were compassionate enough to answer me. It really helps, and I am very grateful for you.

~Rossma


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PostPosted: Thu Aug 19, 2010 3:09 pm 
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We're all here rooting for you Rossma! Keep us posted so we can help calm you down as the days get closer.
i'm sure everything will go fine:)


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PostPosted: Thu Aug 19, 2010 3:16 pm 
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What kind of surgery are you having? How invasive will it be? If you are going to need substantial pain management for your post operative recovery, you are going to need to be completely OFF the suboxone for AT LEAST 3 or 4 days PRIOR TO the surgery.

I'm not trying to scare you, but I've experienced this myself.

They gave me enough fentanyl -in the words of the anesthesiologist- to "knock out a rhinoceros" and I barely felt it. He was absolutely astonished that I was not drooling on myself. I was wide awake. They ended up NOT doing the surgery that day and I ended up going under general anesthesia. But I've gotta tell you this: A liver biopsy can be pretty painful and after the procedure, because I still had some suboxone in my system, the medication they gave me (I.V. Demerol) was useless.

Again, not trying to scare you at all, but you need to arm yourself with as much information as you can!


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PostPosted: Thu Aug 19, 2010 3:28 pm 
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Hi Rossma -

I hope that article from NIH was helpful. I know when I read it I felt a lot more confident understanding the options. I understand your fears and unfortunately I think they are probably well-founded. It can be hard to get good pain control after being on bupe. When I had my procedure/surgery in April (I, too, tapered down my dose before the procedure and stopped 3 days before), I only needed pain meds for about 2-3 days. All I got was regular vicodin. Of course because of my tolerance from the sub (I was on 24 mg at the time) I had to take a LOT more than the "normal" dose. The good news is that I did get some pain control from the vicodin. That said, mine was a pretty minor surgery.

If you need to, maybe have your sub doc consult with your surgeon on the subject of acute pain management. It's worth a shot. Planning ahead can only help.

Good luck and keep us posted.

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 Post subject: scaredy-cat rossma
PostPosted: Thu Aug 19, 2010 5:00 pm 
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YIIIIIIIIIIIIIIIIKES! Oh, the surgery I am having is a total knee replacement! The surgeon told me that they will do some sort of a epidural or spinal block that will remain in place for the first 24 hours, so thank goodness for that. It's just that, as a nurse, I guess I know too much and I remember as a student around 1990, I scrubbed in on 3 total knee replacements, and every graphic detail is indelibly emblazoned upon my brain! After seeing this surgery performed, I just keep thinking, "that's gotta hurt!".

I am afraid of the anesthesia not working, of waking up in the middle of surgery, of having unrelieved pain, and most of all, as already stated on the boards here, of the nurses and doctors.

I am pretty much on my own. My husband of almost 30 years is a very nice guy but he is a "normie" and he has never really understood about my addiction, and about the Suboxone. I have a 21 year old son who works and stays busy with his girlfriend and his friends. My older son lives out of town. My only sibling, a brother, lives out of town. My mother is in her 80's and homebound, and I have been taking care of her and helping her out as best I can daily. It'll be a worry when I am laid up and unable to go to her house but we have been working hard to get everything she will need in place beforehand.

I became disabled and unable to work at the end of 2008. My knee has gotten so bad that I can barely walk, and I can't go very far. I haven't been to a meeting in months, and have sort of lost touch with the many friends I had at work when I was there.

I have known I was having this surgery for about a month now, and have been able to put it out of my mind until now. I've put it off all this time because of the Suboxone, but I literally cannot walk now and I am only 51 years old. The worst part is, I am only too well aware that my fears are justified, and one might even say that they probably will come to pass, at one level or another. I guess the good part is, that whatever suffering happens I know there will be an end to it eventually, and hopefully I will be strong enough to stand it.

I'll be prepared with information and suggestions from my Suboxone MD, and really, after you do all that you can, you just have to hope for the best.

Thanks again for listening.

~Rossma


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PostPosted: Thu Aug 19, 2010 10:16 pm 
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Well,if you live in the NYC area I will be there fighting for ya!


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PostPosted: Thu Aug 19, 2010 10:54 pm 
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rossma -

I have an idea that you could possibly talk with your Sub doc (or your other docs) about.

This comes from my personal experience with passing a kidney stone while I was on Suboxone. Luckily, when I went to the ER, the shot of Dilaudid and Toradol that they gave me worked (I was on 4-6mgs of Sub at the time), though it did wear off kind of quickly and they gave me another dose on my way out the door. I didn't pass the stone while I was there, so they sent me home with a prescription for percoset.

The percoset by itself didn't really do much - it was barely enough to keep me out of withdrawal (from not taking my Suboxone). So, what I did was take a very small dose of Sub, like 1-2mgs, and then I took the percoset on top of that. It worked great. I didn't feel any withdrawal (from not having Sub) and I got good pain relief from the percoset. Then I passed the stone and went back to my normal sub dose.

The theory here is that such a small dose of Suboxone is not enough to fully occupy all your opiate receptors, but it is enough to occupy some of them. So the small Sub dose kinda "boosts" the short-acting opiate painkiller. This way, you stay out of withdrawals, and you get pain relief. If your normal Sub dose is 24mgs, taking a 2mg dose isn't going to block the effects of any opiates you take on top of it. But it might help you get some better pain control.

Quite a few of the members here who have gone thru surgery or dental work have said that the prescribed painkillers were barely enough to keep them out of withdrawals, let alone handle the pain. I've suggested this idea to people here before, but so far everyone seems scared to try it. That's why I'm suggesting that you speak to your doctor(s) about it first to see what they think.

I'm wishing you the best & a speedy recovery. Take care.

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 Post subject:
PostPosted: Thu Aug 19, 2010 11:34 pm 
Rossma,

Hi again! I am so glad you came back and posted. As you said, this place is GREAT for support.

Anyway, it sounds like you are on the right track with getting the info out to your docs. I think Diary of a Quitter has an interesting idea about taking a small amount of suboxone in addition to the other opiates you will need after surgery. I appreicated DOQ's suggestion to talk about it with your doctors and/or a pharmacist. Because as a nurse, you know the ramifications of doing it without an order.

It is hard to trust others, especially when we know as health care providers the sitigma and the lack of educaton about suboxone. Thats why we need to educate educate educate! In my other post to you, I quickly realized I used the word "asshole" instead of "uneducated in pain management and/or pain in general and/or addiction." Yes, some people are assholes, but most are under ecucated. So bring in those articles, hang one in your hospital room, ask a nurse to put one on the chart. That should go along way. Then, like you said, this is out of your hands.

Know that I will be thinking about you on the 30th and will say a prayer for you that day. So remember, when they wheel you in to that room, another "junkie" :) on some random message board DOES care and is here to support you. It helps me with my recovery when I can support another person too. It is a win-win situation for both of us!

Keep us updated! We are here for ya! Kire

PS. If you do ask your doc about DOQs idea, will you let us know what he/she says?


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PostPosted: Fri Aug 20, 2010 7:00 am 
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DOQ's idea about using small doses of suboxone along with a full agonist is, I believe, a sound one. This is actually one of the several ways to treat acute pain in bupe patients that is discussed in that article I posted, by NIH. So, it's not just a theory without scientific merit. This is why you all keep hearing me referring back to that article/paper so often - it's a really good one!

Good luck, Rossma. I sincerely hope your expectations are worse than it turns out to be. How is the temporary taper on your sub dose going? For me the worst part of it was that my chronic pain came rushing back. Let us know how it's going.

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


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PostPosted: Fri Aug 20, 2010 2:28 pm 
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I don't know why more doctors don't go with the mixed bupe/full-agonist route for acute pain management. It just seems to make good sense.

I wonder if it doesn't always work the way it should, in theory.

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You can't stop the waves, but you can learn to surf.

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 Post subject:
PostPosted: Mon Aug 23, 2010 1:39 pm 
Hi Rossma....I hope you're doing okay. I know your surgery date is rapidly approaching and I know how concerned you are about getting appropriate pain management. Everyone has already given you great support and information. I'm so glad Hatmaker shared that paper she found a while back about pain management for patients on buprenorphine. I haven't had to 'use' it, thankfully, but I found the information it contained to be most informative! I hope your healthcare providers will review it and use the information it contains.
I was an RN myself for many years, so I understand your concerns. It's a shame that being provided with excellent care across the board, doesn't seem to be the norm anymore. It seems to have only gotten worse and worse in many ways since I first started my career as a nurse 20 or so years ago. I suppose it has a lot to do with poor staff to patient ratios, less-than-adequate pay, and just poor morale overall among healthcare providers. It also doesn't help that there are many addicts out there who are not in recovery (yet) and do exhibit drug-seeking behavior which is, understandably, exhausting for healthcare providers. None of that, however, is any excuse to provide substandard care to ANYONE! But what really gets me is that you and others have been mistreated while obviously practicing solid recovery. For goodness sakes.....how much stronger can you get than being on a medication that blocks your former drug/s of choice! I just don't get it!
I'm sorry you're having to face this ordeal. But it sure sounds like you don't have much of a choice but to get that knee replacement done. I agree with the others about it being real important to taper yourself down as much as possible prior to surgery. How has that process been going for you? What have you gotten down to so far? And were you going to try to go ahead and take zero Suboxone a few days before surgery? I'm thinking that things will go even that much better if you're able to do that.
I wanted to offer some reassurance about your fear about waking up during surgery. I'm sure as a nurse, you're aware that the liklihood of that is extremely low. The buprenorphine shouldn't have any impact on your general anesthetic. I think you also mentioned that they would be placing some kind of a block like a spinal or perhaps some other type of nerve block affecting the leg. That is great! That should give you good pain relief for that first 24 hours or so which is some of the worst pain, as I understand. Again, your Suboxone shouldn't affect that at all.....hopefully it will work great. I think someone else mentioned Toradol. In my experience with patients, it works wonderfully. So I would definitely be requesting that as much as is safe. I know I used to give it IV as well as IM and I believe it was about every 8 hours. And it's non-narcotic, so it might be real good choice for you if your doctors agree.
As far as opioids go, I'll be praying that your doctors are reasonable in giving you adequate doses given your high tolerance. Not to make you more concerned than you already are, but I agree completely that knee replacement is far from an easy surgery and recovery to endure. You'll have PT afterwards and all that to deal with. So they have got to get you something that's going to give you pain relief. Personally I can't imagine that hydrocodone will do it for you. My Suboxone doctor told me that if I were to require pain management for surgery or even for something like dental work, that he would prescribe at the very least a pretty large dosage of oxycodone or maybe even hydromorphone for at home; and would recommend Fentanyl for the immediate postop period in the hospital. As "Junkie" stated sometimes it takes extremely high doses of even that to get relief. Apparently bupe just does its job almost too well!
In any case, I'm hoping (as I know you are) that your doctors will be informed and compassionate in dealing with your unique situation. You deserve only the best of care and that includes adequate pain relief. I remember reading one of your other posts about how poorly you were treated in a prior hospital experience. That was so grossly unacceptable I can't even tell you! If that happens to you again.....please, please do not tolerate it! Demand to see the nurse supervisor, or demand to speak to or see your doctor if there is any hint of that kind of treatment. If your pain is not being relieved by what the doctor has ordered, insist the nurse call the physician for new orders. With all the drugs out there these days, there is no excuse to not get you some relief. If you're a softer spoken or shy, real compliant and agreeable person, that's great, but in this situation you might have to get a bit more vocal, reminding yourself that you deserve to be well cared for and that what you're going through ain't no stubbed toe! Right?!
Well, I've gone on too long, but I want you to know that along with the others, you have my support and concern. I'm not an expert either....those were just some thoughts along with all the other good stuff everyone's already given you. Let us know how you're holding up. I'll be praying for you as you go through this. Do your best to think positively and not let the fear overwhelm you. You will get through it and it will be worth it when you have that new knee!


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PostPosted: Mon Aug 23, 2010 1:47 pm 
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Hi rossma,

I've been thinking about you and your upcoming surgery. I was wondering how you're temporary/pre-surgery taper down is going? How low have you gotten? Are you feeling any discomfort? Hopefully you're not. Remember to tell the anesthesiologist in pre-op that you stopped your sub, just in case you're having any w/d symptoms, sp s/he can give you something to make you more comfortable. I know that's what they did with me.

Good luck and keep us posted. I'll be thinking of you.

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


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PostPosted: Tue Aug 24, 2010 7:58 am 
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My sub doctor told me if I did another surgery she would keep me on some sub the entire time AND take the pain killers. I think that is a good option if available to you.

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Criticism may not be agreeable, but it is necessary. It fulfills the same function as pain in the human body. It calls attention to an unhealthy state of things.

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PostPosted: Wed Aug 25, 2010 4:47 pm 
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Hello, everyone!

I've been busy since I last spoke to you all. I have only been taking one 8 mg tab per day when I'm supposed to be on 3 tabs. I saw my Dr. yesterday. I had that article with me. I told him how scared I am. He told me that he has had patients go through major surgeries before and that he recommends staying on the Suboxone and then using a larger dose of narcotic pain medication. He sent a note to my surgeon explaining this. This is one of the choices in that article, "continue Buprenorphine therapy and titrate short-acting opioid analgesic to effect". I did not tell him that I had taken it upon myself to decrease my dose, but I think I am just going to stay on the one pill a day until then, now that I am here.

I don't know if it's from that or the fact that I had to d/c all ibuprofen on Monday, as they anticoagulate you for this surgery and ibuprofen can affect that. I have been taking 800 mg 2 X daily. I'm in so much pain now that I can barely function.

I printed out several copies of that article. I sent it to the surgeon, his PA, and also the the Head Nurse on the floor where I will be staying at the hospital, with a cover letter. The nurse actually called me, thawnked me for the info, and stated that she will be there for me and will make sure that her staff is educated with regard to Suboxone. In the past I have found that one of the most wearisome things is having to explain everything over and over to every person with whom you come in contact. The nurse sounded very kind on the phone, and I have to say that her call lowered my anxiety level significantly.

I guess I have done everything I can to be proactive, and at some point you have to let it all go and trust that things will work out as they should. I am profoundly grateful to all of you who took the time to write to me. If not for you, I would never have taken all of this action, and having done so, I feel a lot better. I owe it all to you guys!

My doctor gave me an rx for Oxycodone 10 mg in case I need it upon discharge, so I guess I am all set! I'd be lying if I said that was not afraid, but I am in a much better place than I was when I first posted here.

With love and thanks,
Rossma


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PostPosted: Wed Aug 25, 2010 5:00 pm 
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Hi Rossma,

Sounds like you've got everything covered. I think it's wonderful that your health care professionals are open-minded and humble enough to respond positively to you sending them that article. When I had my procedure in April I swear my doctor threw it in the trash. Never even said thank you and the way she treated me made it obvious that she didn't bother reading it. It's unfortunate that there are so many medical professionals that feel they have nothing whatsoever to learn from us, their patients. I know not all doctors/nurses/technician are like that, but it feels like that's all I deal with lately.

It's possible that your suboxone was treating your pain more than you realized. This would account for your increased pain symptoms. I take between 16-24 mg daily and when I try to lower my dose I can't because the pain always returns at lower doses.

I wish you the very best. Great job on all you've done!

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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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PostPosted: Wed Aug 25, 2010 5:02 pm 
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Rossma, I just wanted to make sure you understood one thing: During my biopsy, they put me under general anesthesia. I was intubated and everything, because for a liver biopsy, as you may know, you are normally awake and able to respond to instructions, such as "ok, take a deep breath and hold it" etc.

So, when they go the other way and do the general anesthesia for a liver biopsy, they really knock you all the way out to the point of stopping your breathing, so that the anesthesiologist can actually breath for you. Because when they collect the sample, they like to have you completely EMPTY your lungs, which tends to move them away from the liver, reducing the likelihood of puncturing or nicking the liver during the collection procedure.

Anyway, what I wanted to tell you was, the suboxone has ZERO impact on Propofol (also known as Diprivan) the stuff they used to knock me out. So, I think you should not worry about waking up during the procedure, the odds of that are astronomically slim.


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PostPosted: Wed Aug 25, 2010 6:32 pm 
Hey Rossma,

I am so glad you gave us an update! I looked for you today because I know your surgery is almost here.

That is so cool that you printed the article and the staff was appreciative of it. It will be awesome having that head nurse in your corner. If she can educate her staff on your situation and how suboxone works, there should be no problems. Just remember her name, and ask for her if you get treated badly.

I work on a hospital unit that has very very ill people. Some require very large doses of pain medication. There are still some very judgmental people in the world. One patient I had with pancreatic cancer was taking 12-16mg of IV dialudid every 2 hours. Very high dose. This dose was clearly orderd by the oncologist but a few nurses still had trouble giving it. One nurse said to me, "he really does not need it, he is sitting up in a chair talking to his wife. He CANT be in this much pain." This same nurse told me "he is using this to cope with the fact that he is dying."
I got sooooo pissed.

Remember, if you are having pain and you feel like you need pain medication, don't let a nurse like that tell you that you COULDN'T be experiencing it.

So good luck! I wil be thinking about you!!! Love, Kire


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PostPosted: Thu Aug 26, 2010 12:29 pm 
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Hello everybody,

I want to thank all of you again for your information and your support. You have made a huge difference in my life, and I can't tell you how comforting it is to me to know that you folks are rooting for me. As I said, I am quite isolated right now, and never dreamed that I would find this sort of support and encouragement from an internet message board.

I am still anxious about the surgery on Monday and as a typical addict, I just wish it would get here already so it can be over. I always have to remind myself to let go of things and to live one day at a time. I have three dogs and they are an amazing comfort. You'll never find more loyal companions anywhere!

Thank you again for all of your thoughts and good wishes and for taking the time to write back to me.

~Rossma


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 Post subject: Surgery tomorrow
PostPosted: Sun Aug 29, 2010 9:32 am 
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Well, so long everybody! I'm going in for my total knee replacement tomorrow morning. Thanks to all of you I am going in with a hopeful heart.

The doctor gave me Oxycodone to take if I need it when I get home. I filled it last week and it's still sitting there with all pills present and accounted for. I am here to tell you that in the days before Suboxone, that bottle would have been gone in two days, and I would have been left to suffer when I got home - my own doing. I still can't believe how wonderful this stuff is.

You folks have made a huge difference in my life, and I am so grateful for the suggestions and support that I received here.

See you on the other side. ~Rossma


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PostPosted: Sun Aug 29, 2010 2:17 pm 
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Rossma!
Go in there with the attitude that You are going to do something to better yourself in the end and look at this surgery as a good thing and get it done!
You will be ok!


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