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 Post subject: Surgery
PostPosted: Mon Aug 15, 2016 7:28 pm 
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This Friday I will be finding out if I will be needing surgery on my hand for a tendon tear. Anytime I have to deal with the possible need for post-operative pain relief, I get nervous. When I try to do the explaining to my surgeon myself on how the Subutex works I feel an immediate shift in their thoughts on treating me.

I have put off fixing this tendon for awhile..... Any suggestions?

I am positive that my sub doc will assist me with managing this situation but I still get nervous. I had an issue with my last hand surgery.... both my doc and the surgeons PA came up with a plan.... but after waking up I had absolutely no pain control. I left the surgery hysterical. I went right to my Sub doctors office and he fixed the pain medication situation himself.

I really just want to have this go smoothly..... but I am also realistic in that I know that there is Stigma and to them..... Any need for pain relief will be pain medication seeking behavior.


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 Post subject: Re: Surgery
PostPosted: Mon Aug 15, 2016 8:43 pm 
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Hi, my name is Queenie. I have been here a while and just came in to check on new posts.

I understand your worry. I had an amputation on Suboxone. If there is any way that your surgeon could speak with your Sub doctor, that would make you feel better. Your sub dr. could explain that you need more than normal pain relief. Talk to your surgeon and see if he is willing to speak to your sub doctor. I think that would put your mind at ease that your surgeon doesn't think you are drug seeking. For your peace of mind, if you need the surgery, don't schedule it until you have worked this out with both doctors. In my case, the drs. got together and agreed on my pain medication needs and it worked out just fine. I got adquate pain relief even after I came home. When my pain was gone, I went back on Suboxone.

Let us know how it works out. Good luck.

Love, Queenie


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 Post subject: Re: Surgery
PostPosted: Mon Aug 15, 2016 9:21 pm 
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Thank you for your response. The last time I had hand surgery we basically did what you just suggested. My initial post-op pain was terrible though. They refused to dose me at a high enough dose that would work. I think they gave me .5mg of dauladid

When I've had to be on pain meds I usually stay on 4 mg Sub and then take a pain med on top of that. I think my Sub doc will likely handle the post-op pain ..... It's just the initial pain management that's bad. The 2 times I've had surgery I've woken up screaming. I think the anesthesiologist might be the one who isn't treating my pain with enough of the pain drug which is why I wake up at a 100+. It's been consistent that I start hyperventilating just from the initial pain.

This brings up another thing..... The surgeon is aware of my being on Soboxone.... but I'm not sure the anesthesiologist is fully aware of sub's blocking effects.

I hope this goes better than last time.


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 Post subject: Re: Surgery
PostPosted: Mon Aug 15, 2016 10:39 pm 
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Hi MN, Reading your post just gave me chills! It is my worst fear to wake up from a surgery either while in the process or after in such pain with no relief in sight. I had a procedure done back in February that went very smoothly with my putting a plan in place! I met with the head of anesthesiology and gave him my sub doc's number. Two days before, I called my sub doc and asked if she had heard from the anesthesiologist and she said no. I called him and reminded him of his NEED to have a conversation with my sub doc. He did call her and all was fine. After surgery I was not in any pain that tylenol could not handle. So, if you ask me, it is all in the planning! Good luck!


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 Post subject: Re: Surgery
PostPosted: Wed Aug 17, 2016 8:09 pm 
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Here are the guidelines I give to surgeons who will be treating my patients: http://suboxonetalkzone.com/surgery.pdf

And here is a blog post about the same: http://suboxonetalkzone.com/post-op-pain-on-suboxone/

If you go to www.suboxsearch.com , you can search either this blog or my forum for information. Just search either, at that site, for 'surgery' or 'post-op pain' or related keywords.

If nothing else, you can print the things you find and give them to your surgeon. Most docs out there refuse to learn about buprenorphine-- so patients need to play an active role in protecting themselves.

Good luck!


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 Post subject: Re: Surgery
PostPosted: Mon Aug 22, 2016 10:44 pm 
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So It's official that I'm having surgery on Thursday. It's great that I have a good Sub doc because my surgeon who did my other hand surgeries down right out refused to handle post-op pain and anesthesia issues. My sub doc is helping me go down on my meds some and prescribing pain meds to be taken while staying on Subutex. My surgeon basically does not want the liability of handling any of it. It's to the point that I have been instructed to show up at the the surgery center with my own post op meds. I think it's unethical to tell me that while I'm admitted at this center that I am to take my own meds while under their care. This feels like discrimination to me... but what can I do... not much. If they ask me to sign papers or something releasing them of liability I'll be hesitant to sign it. Thanks for everyones help.

I wanted to mention how I planned for this surgery.

1. Since this surgeon did a previous surgery and had previously spoken to my Sub doctor they knew my situation. They seemed to have their guard up because the last time... even though they had spoken to my doctor... they still gave me a weak pain med. I ended up getting that corrected by my sub doc.
2. They asked me to speak to my Sub doctor and said they don't want to handle post-op pain. I have found it much easier to just have my sub doc deal with this as I know I won't have to explain how Bup works.
3. Gave Sub doc notice at his office that a surgery will be done and asked if he could handle post-op issues.
4. He agreed.
5. The surgeon asked me to bring my own meds to the surgery center--which still ticks me off... but whatever. I just need my hand fixed and then I'm done.
6. It's a minor surgery so it's not general anesthesia... so as of yet I don't know if I need to speak to the anesthesiologist. I think the last time they just skipped all pain treatment during surgery because they didn't want to deal with it. I'm not sure educating them will help. I've found that a lot of doctors just don't want to be bothered by my "special circumstances." Lets just hope and pray that one day I don't end up needing a major surgery. It would devastate me to be in terrible pain and be completely helpless at getting the doctor to actually help me. Yes... I'm an addict.. but I'm not immune to surgical pain and should be treated just like any other patient.


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 Post subject: Re: Surgery
PostPosted: Tue Aug 23, 2016 1:36 pm 
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Hi MN, God, how do they get away with that! Telling you to provide your own pain meds! Sounds condescending and ignorant! I understand your not wanting to change doctors at this stage, but this just sounds so unfair! I will be praying that all goes well on Thursday!


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 Post subject: Re: Surgery
PostPosted: Sun Aug 28, 2016 4:57 pm 
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My surgery went well but I thought I share a little about anesthesia. I brought the document about surgery and bup and gave it to them. In front of me the doctor looked at the 1st page and said " anti inflammatories should be used when possible." He then said " as you know my narcotic isn't going to work well on you." I didn't say to him that he would have to give me more as I felt he was not that willing to do anything different. I had a feeling this would be the attitude so when I woke up from surgery I took my own personal pain medication prescribed by my bup doc. On a positive note though anesthesia decided to do general for this minor surgery in hopes that this would help ward off a migraine that I always wake up with. This worked! I woke up a tad emotional but that lasted only 5 min and I had absolutely no head pain. I'm not sure why this would be different than sedation but I'm glad they were willing to try something different. If anyone has an idea why this worked let me know. Thanks for all the support...


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 Post subject: Re: Surgery
PostPosted: Sun Dec 10, 2017 11:05 am 
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I have been on suboxone for 8 years. I have had 3 surgeries and one colonoscopy during that time. One of the surgeries was an emergency and no time to taper. However, tapering did me little or no good anyway.

First the planned surgery. My sub doc said two weeks would be fine. I went off sub 14 days prior and took percocet to dull the withdrawals somewhat. Post surgery the morphine amounts administered did nothing to help the pain but it only lasted a couple of days tho, but a bad couple of days.

Emergency surgery. I had a bacterial infection on my hand that required cuttimg open and leaving open while administering iv antibiotics for 6 weeks. In recovery room the nurse could not relieve
My pain at all until she gave me a shot of demerol. That worked great. Immediately stopped pain and I went to sleep. I woke up in regular room in screaming pain. Regular nurses not allowed to use demerol outside recovery. docs cant write for it or so I was told.

Second planned back surgery. I knew 14
Days wasnt enough so I came off subs 30
Days prior and used methadone inhad left
Over from years ago to keep withdrawals at bay.

Long story short 30 days wasnt enough either. Morphine did Me no good in recovery at hospital and they refused to give me demerol. This was a Lower back
Very painful surgery and I suffered through a week with only nsaids and what little pain relief you get from suboxone.

Colonoscopy. I was half awake for the entire thing, but toward the end I Came full awake in tremendous pain. the doc was obviously pissed at me. I guess I had been squirming and or complaining all along but he said he was not authorized to give me a higher dose of Anything. He was using fentanyl but in a very low dosage I imagine.

IMO Docs just consider suboxone users drug addicts and care not one iota how much pain surgery causes. I believe they like punishing us. I am 64 and will go on medicare soon. Not sure I will be able to get suboxone paid for on medicare so I am worried about that, plus as we age so many things happen where pain meds are required. I have made it thru 3 surgeries this way but would not have survived that night with my hand without intravenous demerol. I know it works so before any more sugery i will have a heart to heart with sugeon. docs are More apt to have a discussion before charges are incurred that you have to pay. I dont believe they cannot write for demerol. It may get them looked at closly by the DEA but they cant be denied using the drug in certain instances. At least i dont think the government is that
Powerful yet.bas we age pain gets worse for lesser injuries. Not sure why, but I have found that to be true as have all my friends I have asked. When toure young a stubbed toe hurts. In your 60s it is a huge deal. I don't understant it, but having to deal with it and suboxone. It is a Miracle drug until you actually have to have painkillers for real.


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 Post subject: Re: Surgery
PostPosted: Sun Dec 10, 2017 2:39 pm 
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ymkmkrz,

Did you happen to read Dr. Junig's post on this subject in this thread? Scroll up and read the one under his user name of Suboxdoc. The only thing I disagree with is the statement of stopping the medication. But that is only my opinion. My huge mistake with having major surgery was going off the Suboxone. Never, never, again, will I stop the medication prior to surgery. A person will not get relief whatsoever from that plan. Pain meds work in conjunction with the Buprenorphine in our system. You just don't feel the high. The doctor needs to prescribe a larger dose which makes them very uncomfortable. Ergo; print the paper and give it to them.

If you read more recent posts in this section you'll see I posted a new topic about having minor finger surgery last week. Took my morning dose of Suboxone just like I always do and had zero problems with pain control. If I ever get a more serious surgery again I'll need to print out the paper Dr. J put up on his blog.

I winced at reading your surgeries and the stopping schedule. Ouch! My pain was through the roof when I tried that method. An educated and prepared patient is the only advocate you're going to get. A nurse at the surgery center I just went to never heard of Suboxone. That is unreal after it being on the market for so long.

Good luck going forward. If you ever face another surgery, please check in here first.

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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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