mindy
Journeyman
Reged: 09/23/03
Posts: 57
Loc: Northwest
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Hello All!
I am scheduled to go in for surgery on December 4. Currently I am taking a break from my hydro so I can have maximum pain killing effect from my meds post-op. I am aware that we are not supposed to give medical advice on this board, but I would like input none the less on personal experience- I am not looking for medical consultation.
Question:
Has anyone taken Temgesic or Buph in the days leading up to surgery, and if so, so do you have any idea how it interacts with the anesthesia I will be administered? Any websites that may offer this kind of information would also be helpful. Ultimately I know I will need to disclose this information to my Dr., so perhaps someone could also give me some tips on how to talk to him about the Temgesic I have been taking. I am not sure if it would be wise considering I ordered it overseas. Thanks in advance for the input and opinions.
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poco
Enthusiast
Reged: 03/11/02
Posts: 215
Loc: Northern New England
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Hi Mindy,
I believe you would have to tell your Dr. about the Tems.
Revealing you take painkillers from an overseas source may raise a few eyebrows...
So can you go back to hydro a few days before the surgery at the very smallest amount you can handle?
I wish I had info on the interaction of Bupe and Anesthesia...
Good luck... Poco
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DEA = Practicing medicine without a license
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mindy
Journeyman
Reged: 09/23/03
Posts: 57
Loc: Northwest
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Poco...
I have a feeling that this would be the answer from some. I am trying so hard to take a week break from my hydro, and although my doc does know I take hydro, he has no idea I have some Tems on hand. It is kind of a damned if you do, damned if you don't situation as I know my health and well being takes priority over being worried or embarrassed about what he will say when I tell him. I am ging to try very hard to use the Tems until a day or two before the surgery (they don't do anything for my pain, so I am not in the least bit comfortable right now) and then take nothing or a very minimal amount of hydro the last two days prior. I have just heard too many things about having a tolerance to pain medication, and then not having them work effectively in a more extreme situation such as the one I am going to endure. It will be a hard couple of days, but I know it is only temporary and I will be so much happier with myself if I am smart about it. Thanks for your input, and everyone, please offer your suggestions. I value them. Thanks.
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poco
Enthusiast
Reged: 03/11/02
Posts: 215
Loc: Northern New England
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Hi again,
I tried after I posted my reply to do some research on google for you but, I couldn't get back on to DB for some reason?
Anyway, maybe you can find some info here.. It mostly talks about research in animals.
google search
I hope it helps some.
I do understand your problem... It's the proverbial rock and a hard place.. I would be afraid to tell the Dr. and would go to the hydros...
I hope every goes ok for you.. Let us all know how it went ok? Poco
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DEA = Practicing medicine without a license
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voyager
Board Addict
Reged: 04/17/03
Posts: 351
Loc: United States Virgin Islands
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Can't answer your question regarding temgesic but what i will tell you is to STOP the hydro (if you can) until after your surgery.
I had arthroscopic knee surgery on wednesday (25th of november. Prior to my surgery i stopped using the hydro for 1 week. It made all the difference! My tolerence was quite high before but i stopped taking it, endured a couple of uncomfortable days then was really glad after the surgery. Because it really worked much better.
Good luck. 
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dsack
Old Hand
Reged: 01/20/02
Posts: 485
Loc: midwest
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Since the Temgesic does nothing for your pain anyways, why not just quit taking it all- together? The last thing you need going into surgery is wondering if you'll ever wake up from the anasthesia or not. I don't know with any certainty what will happen if there's still some buprenorphine in your system when the anasthesioligist puts you under, but I wouldn't want to find out the hard way.
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yawkaw3
Pooh-Bah

Reged: 03/22/03
Posts: 1172
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Hi mindy,
My advice is to contact the anesthesiologist (or call your doc and ask for his number). Explain your situation, that you are taking buprenorphine to take a brief break from hydrocodone so you can help lower your tolerance. That's actually a very responsible move, and it may not be interpreted as badly as you might think (it's certainly better than admitting you have a growing tolerance and you simply plan to take extra hydro). He may be able to give you propofol or some non-opioid anesthetic.
My guess (and it is just a guess) is that you are not taking enough bupe to antagonize whatever opioid-based anesthesia they give you. If you were, the anesthesiologist would notice that you're not responding correctly to the anesthesia and probably assume you had a tolerance to painkillers anyway. But don't go by that, it is absolutely essential for you to tell the anesthesiologist what meds you are taking and in what dosages; this way he can give you the best care possible. Don't worry about him knowing about the bupe, I think he would respect the fact you are trying to lower your tolerance.
Good luck and please play it safe by telling the anesthesiologist about the bupe.
-yawkaw
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mindy
Journeyman
Reged: 09/23/03
Posts: 57
Loc: Northwest
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DSAK-
The reason why I cannot/ do not want to stop the Tems is for a very simple reason- I will experience extreme discomfort due to WD's. If you have ever experienced them before, you know how awful a process it can be. I would rather double my dose of hydro after surgery than go through cold turkey WD's ever again.
YAWKAW-
Thank you very much for your information. Because of the knowledge you have in the medical field, I value your opinion. You are right, it is better to be honest than worry about what my Doc thinks about me. I suppose I could say that I have had the Bupe laying around for awhile and do not need to disclose where I got it.
My Tems usage is pretty minimal- I am only taking about 6-8 a day so I think it would be pretty easy to stop a couple days prior to surgery. I was expecting a delivery from NWW this morning (Saturday) and they screwed up and now I won't get it until Tuesday. I am starting to realize that this is a blessing in disguise as having them in the house only tempts me when the pain sets in- I guess I will have to give Ibuprophen a try....maybe I will be pleasently suprised.
Thanks again Yawkaw and everyone else who took the time to answer my question or report on their own experiences of hydro tolerance and surgery! I will give the anesthesiologist a call on Monday.
Mindy
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zippypinhead
Stranger
Reged: 02/26/03
Posts: 24
Loc: West Coast
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I've had surgery twice while on Temgesic. Both times I made sure I had a 12 hour break from the tems, the pain meds and the knock out meds for the surgery worked fine. Had no problems.
KS
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flea
Enthusiast
Reged: 05/17/02
Posts: 267
Loc: Recently moved to Mid-West, bu...
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Mindy,
Unfortunately I am unfamiliar with Temgesic so in that respect, my opinion may not even relate to you at all. But I wanted to share it with you just in case it may work for you also.
I am not sure what schedule Temgesic is, or if it is something that is prescribed pretty regularly, but if it is a fairly common med, then maybe you should think about telling your doctor what I told my surgeon before my back surgery last year.
Now granted, I do not know how Temgesic effects anesthesia but because I was taking diet pills along with more pain medication than had initially been prescribed by either my regular doctor (which my surgeon had consulted with prior to my surgery) or my surgeon, I was really afraid to inform him about the amount of the pain meds I had been taking for several months at that point. I was so afraid that he would question me about the higher dose of pain meds I was now taking, since neither he nor my regular doctor had prescribed this amount to me. There was no way I wanted to tell him I used an OP because of my ever growing tolerance to pain meds. I thought that if I did tell my orthopedic surgeon this, that he would not feel comfortable giving me pain meds after my surgery and the thought of that was horrible, especially now that I was so tolerant to the meds he had been prescribing in such low amounts!
But I was so afraid that if I do not come clean about the meds I was taking that I would somehow wake up in the middle of my surgery and I would feel everything, but I would not be able to move (yes, I probably watch too much Dateline, 20/20, Primetime, WHATEVER!!!, but one day I watched in complete horror, the fact that this phenomenon had in fact happened to people out there.)
I FREAKED OUT!!!! Not only did I not tell him about all of the pain medication (actually he only thought I was on vicodin, but I really was taking MS Contin from a different doctor, and Soma (a lot of the Soma too!)but as I said above, I was also taking 60mg of Phentermine each day and even though I knew my surgery was around the corner, I had not gone off of them completely. I knew this was dangerous because once I was out, something could really happen to my heart and that would be it, bye bye!!!
So......(I am finally getting to the point of my story here) Because I did not want to risk the possibility that I could possibly DIE from this surgery, even though I knew the chances of this happening was so minimal, but I did not even want to take a minimal risk, considering the possible outcomes of such a risk.
Therefore, I called my orthopedic surgeon's office and spoke to the nurse. I told her that I have an uncle and a cousin who are both doctors. My uncle is an ENT Doctor and my cousin is an Ortho surgeon himself (this is actually true, and to be honest, in the past they have given me medications that I may have needed, and they used to give me and my family, a lot of the samples of meds that they would get. You know, mostly anti-biotic, but helpful none the less!)
So I was not really lying, except I told his nurse that because I had just recently gotten insurance, so before I came to him I had gone to my uncle because of my back pain and he was able to give me medication for the pain, until I had the proper insurance. Therefore, my tolerance was much higher and I found I needed more mg each day to help with the pain.
So I never had to say anything about an OP. Then, with the diet pills, I did not want to say that my uncle or cousin gave me any samples of that or that they gave me a prescription for it because I only really needed to lose about 10-15 pounds at that time and that would look a little unprofessional and they might lose their credibility.
So I said that even though I knew it was not the right thing to do as well as it was dangerous, I said that I had been taking my husbands phentermine for the last several months and because of this I was freaked out. Especially since I knew that my heart rate may be effected by taking it and I did not want to put myself in danger.
Yep, that was it. I was able to come clean about the meds, without raising too many eyebrows. Although that nurse told my surgeon right away and he called me back that same afternoon. I could tell he did not approve of my receiving meds from my family members. Especially since they were phentermine and MSContin. But I assured him I was no longer planning on taking these meds as I knew it was a bad decision and in the future I will only take the medication doses that are prescribed to me by him, or by my regular doctor.
He was pretty cool about the whole thing, in fact he mentioned that I had done the right thing by sharing this info with him, especially with the risks that could be involved.
Then he said that because of the diet pills, he wanted to have an EKG and an ultra sound of my heart, just to make sure everything was working properly. I actually thought this was a good idea and I felt so relieved when he said that!! Especially since I had tried Phen-Fen in the past but I never had the proper tests done to make sure I had not developed PPH. So I went and had this done before my surgery and I found out everything was fine!!!!
So when the day of the surgery came, I was not nearly as scared as I had been prior to coming clean! I just finally realized that being afraid to tell my surgeon about the other meds I had been on was nothing compared to the possibility that I may not wake up from my back surgery. Or that I could possibly wake up during surgery, but no one would know since I could be paralyzed yet able to feel everything that was happening. OH BOY, that one gets me, really!! I know I watch too much TV, but hey....at least it scared me into doing the right thing, you know.
If I were you, I would plan on telling your doctor about EVERYTHING you have been taking. You can either say that you have a doctor in your family, or that your best friend's sister is a doctor, or just tell him what you had said earlier, that it was an older medication that you had found and because your pain was getting increasingly worse, you wanted to see if your pain could decrease by trying it out again, but that you know it was a mistake and you will not do it again.
Good Luck, and even though others that have taken that med and have come out of surgery just fine, do not take a chance. Everyone is different and weirder things have happened! Really, it is not worth it.
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Flea
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mindy
Journeyman
Reged: 09/23/03
Posts: 57
Loc: Northwest
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Thank you Flea for sharing that with me. I am going to figure out a way to tell my Dr. about the Tems without disclosing the fact that I got them from an IOP. As for the hydro, I think I am in the clear on that one as he knows about the (small) script that he writes me each month and I have been clean of the 10/325's I get from an OP since last Thursday.
I will just talk to the anesthesiologist and let him know I may have a tolerance and to keep it in mind when he is gassing me!! Thanks everybody for your kind words of wisdom and advice!
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doglover82
Enthusiast
Reged: 11/20/02
Posts: 216
Loc: Idaho, US
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It is good to tell them everything. When I had surgery on my neck I didn't mention the hydro. I stopped a couple of days before surgery but it wasn't enough. When I woke up from the surgery I was in horrible pain. I have had numerous surgeries and never experienced that so assume it was due to my tolerance. They immediately gave me more medication so the pain didn't last too long but I will never forget it. Be honest.
Good luck.
Doglover
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mindy
Journeyman
Reged: 09/23/03
Posts: 57
Loc: Northwest
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Well, I called my Dr.'s office this morning and told them about the Tems. I fibbed and said that my roomate has them and I have used them in the past for cramps and they worked well, so I thought I would give them a try the few days before surgery to lower my tolerance to the hydro.
The nurse was very cool about it, but she immediately told me to stop taking them and just take the hydro since buprenorphine is not made in this country therefore they don't know how it will react to whatever they will be giving me on Thursday. I really do not want to go back to the hydro as I have been doing well despite a couple of slip-ups due to the pain being too much. Now I am freaked out, even though the nurse assured me that if I hurt post surgery, they will give me enough meds to kill the pain.
I feel that my tolerance is down...I hardly have to take any Tems to make it throught the day- maybe 6 at best.
I really hope my doc does not call me to scold me.... the nurse was adament about not taking anything that he did not originally prescribe me. I guess I did all I could- they put it on my chart, and I told them my concern about meds not working post-op. Not much more I can do. Now I am wondering if I should just switch back to the hydro tomorrow (don't want to) or keep up the Tems until day before surgery. Any suggestions?
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night_shade
Threadhead
Reged: 08/26/03
Posts: 905
Loc: The State of Hockey
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You have done all you can do. The pain medication post-op really isn't something you have any control over, and while I know you are worried, going into a surgery with expectations that something won't work for your pain may be a self-fulfilling prophecy. I know about post-op pain--I've had 11 major surgeries and most of them while on high doses of either morphine or methadone. I was ALWAYS honest with the anesthesiologist and the surgeon. You should disclose ALL meds (even Tylenol/Advil) you are taking during your pre-op exam.
It is also pertinent to note that even if a doctor orders extra doses or higher doses of pain meds post-op for opiate tolerant patients, the nurses on duty have the discretion on whether or not to give them. I also know from experience that if you are a clock-watcher (buzzing the nurses exactly when your next pain meds dose is due) that may cause some suspicion--even though the need may be legitimate.
Some people have good experiences with the PCA pump, but I got ZERO relief from the constant drip. But then again, at 100mgs of methadone, doses of pain meds need to be increased greatly in order to be effective. I always prefer the injections to the PCA pump. Just my experience and everyone's is different.
Best of luck and I hope you aren't in the hospital for long after your surgery.
I sent you a PM, hope you don't mind!
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Never underestimate the predictability of stupidity.
Edited by night_shade (12/01/03 10:58 AM)
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mindy
Journeyman
Reged: 09/23/03
Posts: 57
Loc: Northwest
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Thanks nightshade...
My surgery is one that I will be able to go home a few hours afterwards. Although I am getting general anesthesia, it is not a major surgery that will require I.V. medication (although I would not mind). I am probably over reacting, but I am mostly concerned with the anesthesia as I don't know how Tems would interact with it.
As for the pain meds- I am just a big baby, and I am trying to get all hydro out of my system so they work 100% afterwards.
Thanks again for your reply- I think I will be fine, I just have a knack for putting a fatalistic spin on most things unknown. Time for some positive mantras I guess.
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mindy
Journeyman
Reged: 09/23/03
Posts: 57
Loc: Northwest
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A big THANK YOU to everyone who helped with their advice and opinions.... I am going in for surgery tomorrow morning and I am nervous!!!! Hopefully this will put an end to my pain and I will be good as new when I wake up. Thanks again everyone....
Mindy
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lemniscate
Stranger
Reged: 09/24/03
Posts: 24
Loc: Jackson, MS
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DO NOT TAKE TEMGESIC BEFORE SURGERY. buprenorphine has mu-opioid agonist and antagonist effects. It has a long half-life 24 hours I think and will lessen the effects of any narcotics givin to induce anesthesia. Of course it won't have any effect on the versed and propofol as an adjunct and you wont remember a thing, but if you take an opiate antagonist before the administration of sublimaze to induce anesthesia you will find yourself in a world i dont like to think of. You wont remember pain afterwards, but you might feel pain during surgery, if adequate doses aren't matching the antagonist effects of the buprenorphine.
MY ADVICE NOT GIVEN: DON'T TAKE
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lemniscate
Stranger
Reged: 09/24/03
Posts: 24
Loc: Jackson, MS
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If its general anesthesia, it is I.V. anesthesia. You aren't overreacting. I've been through this exact situation. Unless you have a very compassionate anesthesiologist, I wouldn't take temgesic and I wouldn't say anything about it to him/her. If you have taken any buprenorphine within 48 hours prior to the induction of general anesthesia, it may interfere and I would definately say something even at the risk of being undermedicated afterwards. Trust me, they are there to put you out, I would say about 75% of the anesethesiologist I've come in contact with don't care about you levels of pain. They follow the same pattern and give the same drugs in the same amounts.
I don't mean to scare you or anyone, I'm just being honest.
If its been 48 hours since you've taken any, keep it a secret to you yourself. If you have taken it within 24 hours of going under, notify the nurse or orderly that begins induction.
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night_shade
Threadhead
Reged: 08/26/03
Posts: 905
Loc: The State of Hockey
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I strongly disagree. General anesthesia is NO JOKE and it is simply not worth risking your health (maybe even your life) by not disclosing which meds you take prior to being anesthetized. There is not one single anesthetic that all anesthesiologists use across the board for every patient. I've been under over 20 times with several different meds. It all depends on how long you need to be out and what sort of procedure it is, what meds you currently take, if you have eaten, etc. Too many variables to make an assumption about which meds will be used for sedation/anesthesia.
While we are educated in medications, I don't know a single person on this board who has claimed to be an anesthesiologist and I certainly wouldn't consider myself as thoroughly medically educated as those professionals. There is a limit to our knowledge and understanding of these types of medications and I think it is prudent to err on the side of caution ALWAYS in this regard and disclose anything your are asked in full detail.
Anesthesiologists probably will never see you as a patient a second time. I have been a patient of completely professional and compassionate anesthesiologists. And it is your surgeon's orders that are followed for pain control directly post-op, not the anesthesiologist's.
In this, my friend, honesty is simply the best policy.
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Never underestimate the predictability of stupidity.
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mindy
Journeyman
Reged: 09/23/03
Posts: 57
Loc: Northwest
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Not to worry nightshade...my Dr. knows everything. I talked to the nurse on Monday and everything is fine. Thanks so much for the advice and kind words you have offered in this thread!! 
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yawkaw3
Pooh-Bah

Reged: 03/22/03
Posts: 1172
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Best of luck to you, mindy. I hope your surgery is a success and when you wake up from whatever goodies you get for post-op pain, you will be good-as-new. Once you are in a state of mind to post, please let us know how it went.
-yawkaw
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mindy
Journeyman
Reged: 09/23/03
Posts: 57
Loc: Northwest
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Surgery went really well. However, I forgot how crappy one feels post anesthesia....it's like the worst hangover ever.
I am extremely sore, but functioning well with my good arm. I hope to heal quickly as I have to wear a very bulky cast for 2 weeks- UGH!! Thanks all for your help... I am signing off now as typing one-handed is very tedious!
~Mindy~
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night_shade
Threadhead
Reged: 08/26/03
Posts: 905
Loc: The State of Hockey
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Glad to hear it! Get off the board and get back in bed until you are feeling better! 
Update us when you are up to it!
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Never underestimate the predictability of stupidity.
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537
Veteran
Reged: 12/08/01
Posts: 700
Loc: west coast CA
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So glad to hear surgery went well. Best wishes for a speedy recovery!! 
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