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PostPosted: Thu Feb 04, 2010 8:02 pm 
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Hi everyone! I know that there are similar stories but everone is a bit different. So I will share my situation and ask my questions. First I love this site and think that it is great support for anyone trying to kick their habbit. I use the support on this site as well as tharapy to help kick my habbit. I've been on subs for just over a year now and have tapered to 8 mgs a day. Unfortunatly I have to have shoulder reconstructive surgery in a few weeks, the 18th. I just talked to my sub doctor and she told me that I have two options.

One: I can contenue to use the subs through the surgery, and not use other narcotics.
Two: I can stop use of subs 24 hours before the surgery, use narcotics, and then contenue subs later.

Does anyone have experince with these methods? I'm horrified of pain a think that I want to stop the subs before the surgery and use the Powerful narcotics. That brings me to my next question. How much narcotic do you think I will need to get the proper pain control. Like I said I have been taking 8mg a day. My sub doctor does not/ will not treat my pain so its all up to the surgen who probably will treat me as an adict which is worriesome. "well I am one. but it doesn't mean I will hurt less!" I just know that if the surgen gives me normal percs or say oxy 10's that it wont even take care of my withdrawls. My sub doctor was not sure on the dose of how much oxy, hydro, whatever I will need to take care of my pain.

does anyone know how much narcotics I will need? I would love to find some hard facts on it that I can show my surgen. any help will be great!! thanks.

Oh.. one more thing.. sorry.. My sub doc also said that I can controll my pain right now by increasing my sub dose. But that might just make things worse when it comes to tolerence and weening of before surgery right. Will increasing my dose even help control the pain? That means I would be taking more than eight mg's.

Anyway.. any thought on any topics? and sorry about the spelling and grammer I wrote this in a hurry.


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PostPosted: Wed Feb 10, 2010 3:07 pm 
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25 veiws and nobody has any advise??!! lol. I actually had a small conversation on another post.
Just for an update... I have talked with my sub doctor and she assures me that this happens all the time and the surgen will know how to handle my pain. I was really nervious about talking to him about it so.. I wrote him a letter explaining that i'm on subs and that I will have a very high tolerence. I faxed it to him yesturday, so I hope to hear from him soon. In the letter I asked him to call me to let me know how he plans to handle my pain. I think if I know ahead of time it might help me relax the day of surgery.
I'm thinking of asking him (the surgen) if I can have my perscription a day early. This way I won't have to go to the pharmacy right after I get done with the surgery. And I will not have to go through withdrawl before the surgery. "Im going to stop the suboxone 36 hours before surgery." Do you think he will give them to me early? is it even worth asking him?
Anyway my surgery is next thursday!! the 18th. wish me luck. for those who care I will keep you updated with the process.

Thanks


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PostPosted: Wed Feb 10, 2010 4:18 pm 
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Hey IrishSubs -

I think you wanted 'hard facts' which are hard to come by. I think mixed in various threads you will find different ways that people have approached surgery and suboxone. Pregnancy is another section to see.

Hard Facts you probably won't find. What you will find are people's experiences. I think some of the moderators have gone through some of this.

Common sense though should reign. If you are on a couple mg's of suboxone - you can probably 'shoot through' the suboxone with regular narcotics. If you are on say - 8mg or higher - 'shooting through' with classic opiates is likely extremely hard.

Whichever way you go, your experiences will most certainly help someone out!

Keep us posted on your decision.


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PostPosted: Wed Feb 10, 2010 7:38 pm 
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NO i'm just looking for some conversation.. I have looked around and have a good idea on what I will do. Hard facts would be nice and "I know they are hard to find." but any thoughts or experinces help.


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PostPosted: Thu Feb 11, 2010 10:40 am 
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I understand. I looked at a thread http://suboxforum.com/viewtopic.php?t=981

There was a note from Diary of a Quitter about passing a kidney stone that's pretty straight up as to pain control with opiates and sub. Maybe drop DOQ a PM and see if there is advice there.

I think this topic is the most concerning on the board. If I tell you something - that doesn't pan out - (which I don't have 1st hand experience) - then it's you suffer. I hope there are some here that have had surgery and can share with you the good/thebad/theugly - so you have something to think about. Otherwise, it's your TEAM's decision I suppose. Sorry I am not more help.


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 Post subject: post surgical pain
PostPosted: Fri Feb 12, 2010 6:07 pm 
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First, very important, 24 hours is not nearly enough time to clear enough suboxone out of your system. At that point any pain meds would be completely blocked. Second, in my opinion, suboxone is probably not going to manage your acute pain. I had thoracic surgery in March of 2008. I was in the hospital for six days before surgery and took no pain meds (or suboxone) other that OTC for the first three days. The next three days before surgery I took 2 percocet every six hours for withdrawal symptoms from suboxone and pain. I was on a pca pump with duiladid for 24 hours after surgery which took away 100% of pain. I was on oral pain medication for a week in the hospital with mediocre pain control. At discharge I stayed with my mother for four days and continued on oral pain meds until I got to my home, day 12 post surgery. I stopped pain meds and resumed suboxone and felt better immediately. If i had to do it over I would have discontinued pain pills and gone back on suboxone as soon as I was discharged . Most surgeons have their preferences for pain meds and you will probably be on the same schedule as everyone else. Good luck Jean


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PostPosted: Fri Feb 12, 2010 7:07 pm 
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Most surgeons have their preferences for pain meds and you will probably be on the same schedule as everyone else. Good luck Jean




Did yoou tell them that you where taking suboxone? I really hope that they treat me a little differently because of my tolerence.

Six days before with no pain meds didn't you go through w/dawls?

As for stoping 24 hours before.. I'm going to be weening down starting this sunday and will plan on taking only 2mgs tuesday night.( surgery is on thursday morning). So its about 36 hours. by then I think that i will have a low enough dose of bueprenorphine in my system that a strong agonist will "break through" the blockage. I really don't think that I will be completly blocked with that low of a dose. (but I can't be sure). There are other experinces on this forum where people have got positive effects from taking percs with a low dose of suboxone.

Still wating to talk to the surgen about his "plan" and to ask him if he can perscribe my medication a day before my surgery. I will let everone know.

Thanks for you advise!


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PostPosted: Sat Feb 13, 2010 1:54 am 
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Did you see my reply on that other thread?

When I was passing a kidney stone, I found that 2mgs of Sub and a percoset on top of that worked 100% better than just the percoset. If you find that your post-op opiates aren't strong enough, I'd recommend taking a small dose of sub with them, like 1-2mgs. It's not enough suboxone to block the painkillers, but it is enough to compensate for your higher tolerance.

Good luck.

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 Post subject: update
PostPosted: Wed Feb 17, 2010 12:34 am 
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I just got off the phone with the surgen and all my concerns are answered. he's going to take great care of me. He doesn't know what I will need but he said that it will be higher dose then normal. We are going to find out what works best for me a stick to it. He didn't treat me like an adict in fact he was shocked and very happy that I told them I was on subs. He said they do this sort of thing all the time and as long as the patient it honest then there is no problem. He told me to be honest and to let him treat his pain. (don't go and self medicate) he assures me that he will treat my pain no matter how much narcotics it takes!! The only thing different is that he wants to start weening down earlier then a "normal patient". After 2 to 3 weeks he will start reducing the meds I'm getting.
Thoughts.... .I'm so glad that I told the doctor before going into the surgery. If I didn't I could have really been in some serious pain. The regular percs or perc 10, or any normal amount of dilidud whould not even come close to helping my pain. But because my surgen is so understanding I will be able to get my mind off what pain pills I'm going to get, and focus of receovering.
This is the last day I've taken a suboxone(Surgery on thursday.. 11/2 days). I took 6mg at eight in the morning and didn't feel good all day. I wouldn't call it withdrawling but just an overall "crummyness" cigerettes tast nasty you know. Tomorrow might be harder but I do have some Darvocets laying around that might help. Remember surgery is on thursday!!


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 Post subject: Re: update
PostPosted: Wed Feb 17, 2010 10:14 am 
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I wish you the best of luck Irish and I am really interested and how well they do end up managing your pain. Keep us updated! I am pleased that your surgeon treated you with the respect that you deserve. Being an addict should not preclude you from compassionate medical care.
IrishSubs35 wrote:
I just got off the phone with the surgen and all my concerns are answered. he's going to take great care of me. He doesn't know what I will need but he said that it will be higher dose then normal. We are going to find out what works best for me a stick to it. He didn't treat me like an adict in fact he was shocked and very happy that I told them I was on subs. He said they do this sort of thing all the time and as long as the patient it honest then there is no problem. He told me to be honest and to let him treat his pain. (don't go and self medicate) he assures me that he will treat my pain no matter how much narcotics it takes!! The only thing different is that he wants to start weening down earlier then a "normal patient". After 2 to 3 weeks he will start reducing the meds I'm getting.
Thoughts.... .I'm so glad that I told the doctor before going into the surgery. If I didn't I could have really been in some serious pain. The regular percs or perc 10, or any normal amount of dilidud whould not even come close to helping my pain. But because my surgen is so understanding I will be able to get my mind off what pain pills I'm going to get, and focus of receovering.
This is the last day I've taken a suboxone(Surgery on thursday.. 11/2 days). I took 6mg at eight in the morning and didn't feel good all day. I wouldn't call it withdrawling but just an overall "crummyness" cigerettes tast nasty you know. Tomorrow might be harder but I do have some Darvocets laying around that might help. Remember surgery is on thursday!!


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PostPosted: Wed Feb 17, 2010 10:55 am 
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Way to go Irish!

Glad to hear it. It also helps us all, if we need surgery while on suboxone. Thanks! Please, as you are able, let us know how you are doing!


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PostPosted: Wed Feb 17, 2010 3:27 pm 
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There is probably a real good lesson in all of this. I see a whole bunch of people who complain about their doctors and how they either don't seem to care, don't take any significant amount of time with them, don’t provide the level of care that is expected, etc. While that certainly is the case at times, there is also a whole other side to this - that being the doctor's side. Having been on the other side of all of this - no I am not a physician but did provide direct patient care for over 20 years - it is very frustrating to try to take care of a patient who will not be honest to you or in other ways does not participate in his own care. I very clearly remember a patient who I treated that had a heart rate through the roof - like 180 to 200 beats per minute. I questioned him up and down and he denied any drug use. It was only after I gave him a dose of medication to try to slow down his heart - a medication that can be a bit unpleasant - did he FINALLY admit that he had done cocaine. Had he just told me that right away, I could have given him the correct drug to treat his condition. Physicians are not mind readers. I'm sure they can tell us many more stories of patients not being honest and not cooperating than we can tell them about poor quality physicians.

My point is just that in this case we have a patient who is very invested in their own care, has been completely honest with their care provider, and look what he gets in return - great medical care. This is not a coincidence. It is a direct result of being honest and being part of your own healthcare team. I can assure you that docs are often just as frustrated with patients as patients are with the docs. Please try and remember what happened with Irish, the next time you are tempted to hide the truth from your doc.

I’m sure you’ll do well Irish. And, by all means, please let us know how everything goes. Oh yeah, you made a comment about cigarettes being nasty. Um, well, yeah, aren’t they always? (that’s a whole other topic I guess)


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PostPosted: Wed Feb 17, 2010 6:14 pm 
Hey Irish! Good for you for being such a great advocate for yourself....that should go a long way in things going well for you with your surgery and pain control issues afterward.
donh, you're right...it's difficult to navigate our way through healthcare issues, addict or not. We all know that there are healthcare providers who don't seem to care as much as others. When possible, as in outpatient services (such as your Subox doctor) and you're not happy with the care you receive, it can be somewhat simple.....either work out the issues or find a new doctor. When that isn't possible, we must advocate for ourselves.
If we're not honest with our healthcare providers, we can't expect them to provide us with the best care, nor do we have the right to complain a whole lot when we don't get optimal care. Unfortunately doctors/nurses/others have been 'burned' enough by patients not telling them the whole truth about their histories, that they become kind of hardened to certain members of the population....addicts being at the top of the list.
I've got to share this story to go along with donh's. Years ago, a lady came in to the hospital where I worked in the throes of active labor, only a few minutes away from delivering. Unknown to anyone at the time, she admitted herself under completely false information....everything from her name to her medical history was a fabrication. Mind you, we're rushing around trying to get a doctor to the unit, asking her questions and so forth while providing the immedicate care necessary in this situation. She has told us that she had gotten prenatal care elsewhere, dropped in to our hospital because she's from out of town, and that her due date is about one week away. At a glance, she appeared to be term pregnant. We have zero time to do any workup on the gal at all before this baby is going to be born.
We had a hell of a time getting a line in her (no veins), finally got one started in her foot as the baby is literally crowning. We got a doctor on the unit in time, baby comes out just fine. However, baby is quite obviously premature...no prob, we had a baby team there because of uncertainty of what we had. Suddenly, the delivering doc says, "Oh my God!!....." We have not only another baby coming down to follow the one that just delivered, but it's breech and along with the legs/feet that are presenting are loops of umbilical cord wrapped all around it....and it's not coming down and delivering quickly at all. Neeless to say...it was a cluster! We race her back to the OR to Section her for the second baby as its in significant distress. Anesthesia makes it up quickly; the line in her foot is running good enough to go; he puts her under general anesthesia quickly and we get the second baby out.....it's all good. Obviously there were lots of personnel involved in this case, lots of blood and fluids and mess. No time to take the measures we'd ordinarily take to protect ourselves from infection....sure you throw a pair of gloves on, but that's about it! We're focused on taking care of this lady and her babies.
Obviously we were more interested in taking care of them than she was. She certainly wasn't interested in protecting any of us who were providing her with care. After all was said and done and records on this lady were received from other hospitals where she had dropped in, we learned the real truth. She knew she was pregnant with twins, she even knew the second one was breech. She knew that she wasn't due for another 2 months and she knew that she was HIV POSITIVE, HEPATITIS POSITIVE, and POSITIVE for all kinds of drugs in her system. Apparently she thought if she didn't divelge any of this, she'd just come in and deliver and walk out of the hospital with her babies, rather than running the risk of having to be investigated by DHS, etc. Thankfully, there were no needle sticks or accidents in that OR with her.....but still! The risk she subjected her babies to, her healthcare providers to, and even to herself was just enormous. Absolutely nuts! Crap like that is why healthcare providers sometimes act the way they do. They don't want to assume the risk of something terrible happening to you because you didn't tell them the truth. Nor do they want to subject themselves to that risk. Understandable when you think about it like that, huh?
Sorry....just reminded me of that story from years ago....completely true story!


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PostPosted: Thu Mar 11, 2010 9:08 pm 
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donh wrote:
My point is just that in this case we have a patient who is very invested in their own care, has been completely honest with their care provider, and look what he gets in return - great medical care. This is not a coincidence. It is a direct result of being honest and being part of your own healthcare team.

Well in all fairness when one is on Suboxone one can get pretty darned paranoid, frightened, and reticent with the truth owing to the general attitude towards "junkies". I have had several really bad experiences over the past year and whilst i recognize that it's my fault for being on Sub in the first place, i believe some of my experiences were far worse than necessary and were directly related to being completely honest about my medication. I'll probably post the stories when i get through my current situation.

I don't know if the professionals are frightened or ignorant or both, but no amount of advocating on my own behalf would change anyone's mind. No literature from NAABT, no PDFs from SAMSHA, no email exchanges with Dr. J., no calm rational discussion. A fellow goes to all that trouble and still suffers because he said he was a Sub patient, it works against his honesty.


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 Post subject: hand surgery
PostPosted: Thu Dec 22, 2011 4:05 am 
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so, i am on 8-10mgs of suboxone daily, but i have no prescription since finding a doctor around here is near impossible! i have an upcoming surgery for my hand which is said to be extremely painful for many many months. i think i will take the advice i heard earlier about telling the doc what i am taking, and making sure he understands that i do have a much higher tolerance than his average patient. i really hope he understands and comes up with the propper amount of pain management that will be right for me, or i could be looking at an excruciating year of recovery from the operation. in which it would be very easy to fall into the old self medicating patterns of "street" pain management to make up for the lack which the doc will give me. this is the last thing i want to happen. so i guess i am just wondering if anybody has any suggestions for me so i don't have to fall back in that hole where my dragon sleeps? thanks for any replies.


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 Post subject: Re: hand surgery
PostPosted: Thu Dec 22, 2011 5:22 am 
LockSmithDog wrote:
so, i am on 8-10mgs of suboxone daily, but i have no prescription since finding a doctor around here is near impossible! i have an upcoming surgery for my hand which is said to be extremely painful for many many months. i think i will take the advice i heard earlier about telling the doc what i am taking, and making sure he understands that i do have a much higher tolerance than his average patient. i really hope he understands and comes up with the propper amount of pain management that will be right for me, or i could be looking at an excruciating year of recovery from the operation. in which it would be very easy to fall into the old self medicating patterns of "street" pain management to make up for the lack which the doc will give me. this is the last thing i want to happen. so i guess i am just wondering if anybody has any suggestions for me so i don't have to fall back in that hole where my dragon sleeps? thanks for any replies.


There is not a dose of pain meds in the world that will break through 8 mg/day of bupe. MAYBE IV fentanyl, but that hasn't even been proven.

If you come clean with your surgeon, one of two things could happen. He could give you a higher dose (which will not break though that much bupe. You will need to taper WAY down if you plan on taking full-ags) to accommodate the (monster) tolerance bupe leaves you with, or he could give you nothing because you once had a problem with opiates.

It isn't fair. It is just how it is. I recommend you be honest with whomever is going to be anesthetizing you. It could be too dangerous not to.


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