Daycamp72
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Reged: 06/29/02
Posts: 284
Loc: Tara
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I have breast cancer reconstructive surgery coming up in 10 days. I had a total of 10 surgeries last year for reconstruction, all total failures and now I'm feeling strong enough to endure another round AND a new surgeon. I am prescribed three Bextra per day and three 10mg Percocet per day for breakthrough pain by my PM doc for lower back pain and I still find it necessary to use an OP when I run out of the meds early; substituting the Percocet with 10mg hydro.
During my past hospital stays last year, I found that I wasn't given enough IV demerol or morphine to take care of the post-op pain because of my tolerance to hydro.
My surgeon is well aware of my Percocet dose, as I made my PM doc aware of the upcoming surgery and he wrote a letter to the surgeon. The surgeon's nurse, after my explanation, exclaimed that taking Percocet for my condition is not a good remedy and that she hoped my PM doc had an "ultimate goal" in mind for me. It seems to me that the nurse thinks taking 3 10 mg Percocets is WAY high a dose for anyone.
My question to you guys........I'm a 5'8" 120 pound female and will I suffer from withdrawals in the hospital with my present narcotic daily intake? I can get by on the 3 Percs per day, but I'm much more comfortable taking two at a time; thus, running out early each month.
Should I try to taper down to almost nothing before this operation? I hate to think of my back pain coming back AND going into withdrawals in the hospital.
Also, I've made my pharmacist aware of the upcoming surgery. He's the only one I use and he is well aware of what I went through last year. He assured me that all is OK, as long as both docs know about each other. BUT, do I still take the Percs for my back PLUS whatever the surgeon gives me? This is very confusing.
Any advice is appreciated.
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doglover82
Board Addict
Reged: 11/20/02
Posts: 326
Loc: Idaho, US
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I would try to take just the amount prescribed until your surgery is over. That way they know exactly how much you are on and can adjust what you need. I had surgery a couple of years ago and didn't taper nor did the doctor know exactly how much I was taking. When I woke up from surgery I was in horrible pain. I have had numerous surgeries and that had never happened before. They immediately fixed it so I was comfortable but I will never do that again. So just let your doctors know exactly how much you take and stick to that.
Good luck on your surgery. We will be thinking of you.
Doglover
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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Hello Daycamp...
I can relate utterly to your situation. I was on a high dose of methadone prior to my abdominal hysterectomy. In advance, I specifically asked my doctor to order sufficient pain medication to treat my post-op pain. She increased the normal amount of morphine by 50%. The problem was, however, that the nurse on duty decided I was getting WAY too much morphine in combination with the methadone and refused to give me the prescribed amount.
After 2 days of excruciating pain, I finally was able to speak to my regular physician (not the surgeon) and complained about my treatment at the hospital. He sighed, and said "unfortunately, the duty nurses have discretion whether or not to administer what the doctor orders..."
I wish someone had told me that in advance. I would have simply brought my methadone to the hospital and taken my own medication. So, just in case, I strongly recommend you bring your Percs or hydro with you (don't tell the doctor, of course) and you will have them available if the doctors or nurses under medicate your pain.
Better to be safe than sorry. Good luck with the reconstruction surgery!
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Never underestimate the predictability of stupidity.
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debbrad
Member
Reged: 11/06/03
Posts: 100
Loc: Texas, USA
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Right on Night-Shade,
I had the same problem after surgery, and having some of my own meds with me got me through. Just remember to be carefull and don't overdue it. For goodness sakes, don't let nurses catch you. Nuff-said about that or we will get in trouble.
Peace
Deb
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BlackCat
Old Hand
Reged: 09/22/03
Posts: 403
Loc: Bed
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Since your surgery is 10 days away, you have time to get a consult and get hydro 10's (norco) from an OP (or you may not need it if you already have an OP and have norcos or hydro available for the hospitalization).
You could have someone bring the hydro pills to you in the hospital after the surgery so you can take them as needed for pain and to avoid withdrawal and keep yourself medicated to the level you are accustomed to.
Obviously, you have to be very careful in two ways: 1. safety and 2. discretion.
Safety: Make sure you know what they are giving you for pain (percocets, demerol, etc.) so you are safe and do not over medicate yourself. Based on your post, it sounds like they will be giving you what you have been getting for pain in the past, and you will just need to have a couple of norcos/vicodins, etc. a day available to you. Be very careful!
Discretion: Also be careful so the doctors and nurses don't see you taking extra pain medication since you haven't mentioned it to them in the past and you may not want to mention it to them now. Personally, I wouldn't want to risk the doctor cutting you off or treating you any differently by telling him about how you have been using an OP to get some extra hydro for breakthrough pain. I would either bring some hydro with me in my jacket before you check into the hospital or have a friend bring some to me after the surgery in a discreet small vile or small vitamin bottle that you keep hidden...I also wouldn't bring all of my remaining hydro in case someone steals it...
I'm sure some folks here would disagree with this appoach and tell you to be upfront and honest with your doctor and try to have him give you extra hydro or percocet so you don't go into w/d's. This is definately an option, but I'm not sure I would wnat to open this big "can of worms" right before your surgery and risk getting cut off in the future or treated differently. They could also view your purchase of hydro from an OP as illegal double dipping, even though you may just be taking it as needed for extra pain. You have enough to worry about with your surgery and medical condition to worry about risking getting undermedicated and going through withdrawals in the hospital IMO.
I would also use the next 10 days to try to cut back/taper as much as possible to reduce and possibly even eliminate your need for a few extra hydro pills a day for pain and to prevent w/ds while in the hospital recovering.
Just my 4 cents...
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LumbarSpasm
Silent Chaos
Reged: 05/07/02
Posts: 1538
Loc: USA
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Sounds like your in for an undermedicated post-op experience. I seriously hope not. Perhaps the surgeon feels different about pain control than the nurse?
I would cut down.
I like Black Cat's response.
Do what you have to do for yourself to be comfortable.
I hope your PM doc can educate the surgeon about tolerance.
Good luck to you and a speedy recovery!
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LumbarSpasm
Or just a pain in the butt?!
Edited by LumbarSpasm (02/10/04 01:21 PM)
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CeeBee
Member
Reged: 08/09/03
Posts: 186
Loc: garden state
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I too think you should try to taper down at least a week preop, and I totally agree with Nightshade and Black Cat, don't expect the hospital, doctors or nurses to be truly sympathetic to you, I would take some of my own medication with me or have a trusted person bring you some for the days you will be there. Absolutely!
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Firefairy
Member
Reged: 11/26/03
Posts: 147
Loc: Mississippi
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In the past two years I have had two completely different hospital pain medication experiences. In the same hospital, same floor.
In the first experience I was severely under medicated and did resort to having my mother (of all people) sneak my meds in on a daily basis to supplement their "pain management". Of course, I would never recommend this or tell anyone the best places to keep them, or best times to take them, or anything like that.
In October I went to the emergency room, my first comment to the doctor was " I normally take between 1-4 Lorcets Plus a day, I have taken six in the last four hours and I can't tell I have taken a thing!" My blood pressure was high and I was very obviously in pain, no one questioned what I had already taken, just shot me up with demerol, and went up from there. After major surgery several days later I was on a pump with dilaudid and being given other meds through IV push when needed.
My advice, taper now IF you can, be honest about what you normally take, and give them the chance to treat you in the manner medical science provides for. If that does not work, have a backup plan.
Also make sure you mention it to the anesthesiologist in the talk you have with him before the surgery. Sometimes people who have narcotic tolerance can be hard to put under. I made sure to mention it in the last several operations I have had. I had a couple that I remembered them putting the tube down my throat. I learned to tell that to the anesthesia doc and in the ones since then I don't even remember going to the OR.
I hope everything turns out well!
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Daycamp72
Enthusiast
Reged: 06/29/02
Posts: 284
Loc: Tara
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Thanks, y'all. Very good advice.
I'm trying to taper down to 6 hydros per day and go from there. Sounds like a LOT, doesn't it?
Thanks again, Lumbar, for your support. Black Cat, I remember when I had my mastectomy, I had the presence of mind to sneak in some hydros in a Versace lipstick case (they're shaped like a cylinder with a cap on the end.) Well, hubby found them and asked the nurse what they were! She said she didn't have time to look them up in the PDR. Whew! I was in agony until I was able to move my arms enough to reach into my purse for them...
Funny how the morphine/demerol drip didn't help me. Why's that? They just didn't give me ENOUGH??
Any other suggestions as to where to hide the meds? Jacket pocket is a good one IF you are able to get out of bed to GET to it. Perhaps I can cut a slit in the inside of an old pocketbook and put the meds in the lining....
Thanks again, guys. I really appreciate your replies.
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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That's the thing about the PCA pumps--they NEVER work for me. I get much better pain relief from injections (and in my case, IM rather than IV.) In the case of my hysterectomy, I got greater relief from Percocet taken orally than I did with the morphine drip. Doesn't matter what's in the pump...it just doesn't cut the mustard.
I would put the meds in a sock and wad the sock up and stick it in your shoe. You will have the perfect opportunity to do this when you get undressed prior to surgery. The hospital will put all your things in a plastic bag and send it to whatever room you will be in. Once you are moved to your room, ask the nurse to put your belongings next to the bed. Bring a book with you to put in the bag in case they question why you want your things.
And by the way--all of you copycats  --I TOLD HER TO BRING HER MEDS WITH HER BEFORE YOU DID! Why is Blackcat getting all the credit???  Really, just giving you all a hard time! 
Good luck, Daycamp!
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Never underestimate the predictability of stupidity.
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BlackCat
Old Hand
Reged: 09/22/03
Posts: 403
Loc: Bed
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In terms of locations for concealment - I guess you could always get one of those small bottles of OTC pain meds, like GENERIC tylenol (so no one expects the pills to have a Tylenol Imprint, and replace the "regular tylenol" that came in the bottle with your special "EXTRA strength tylenol" and put the bottle in your purse/shoe/sock/anywhere accessible post-op. In the REMOTE chance that someone finds them, recognizes them, starts asking too many questions, etc. - just make sure you leave the prescription bottle with your name on it at home in an accessible place for your husband to get in case you have to show someone at the hospital that you have a VALID prescription for them and you are NOT illegally possessing them.
If for some reason you can't reach the bottle post-op, you could ask your hubby or an orderly for your "tylenol" and he won't know that you are taking your "special EXTRA strength tylenol" if you don't want to get into explaining it to him now.
I'm not advocating hiding extra hydro usage from doctors or family members, but IMO now may NOT be the best time to "come clean" with all this stress and pain going on in the hospital with surgery. You can always tell him or your PCP, etc. if you decide to AFTER you're out of the hospital and the stress of this situation is behind you.
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Daycamp72
Enthusiast
Reged: 06/29/02
Posts: 284
Loc: Tara
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Thanks! The sock trick sounds really good AND the "Tylenol" bottle. I'll stick some hydro in the bottom and pack in some cotton, THEN fill with REAL Tylenol. I'll follow that with putting some magazines and books on top of the clothing bag they give you. BTW, I have an old hydro bottle, so that'll be my alabi, if needed.
You guys are GREAT!
Also, Night, the pumps NEVER worked for me. I also got more relief from oral Percs and IM meds. Wonder why? Anyone?
Thanks, yall, for being so interested and caring. I'll let you all know how it goes from here.
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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Quote:
If for some reason you can't reach the bottle post-op, you could ask your hubby or an orderly for your "tylenol" and he won't know that you are taking your "special EXTRA strength tylenol" if you don't want to get into explaining it to him now.
The problem with letting a hospital employee see your "Tylenol" is that they will vehemently object to a patient taking ANYTHING that is not supplied BY the hospital itself. Especially if she's given Percocet or another acetaminophen-containing product post-op for pain.
Besides, why would they want you taking your own meds for free when they can charge you/your insurance $2.50 a pill for Tylenol?!?
Good Luck Daycamp! I've been through the chop-shop 11 times myself!
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Never underestimate the predictability of stupidity.
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NJ_Hoss
Enthusiast
Reged: 10/29/03
Posts: 263
Loc: USA
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Whatever means you undertake to obtain the relief you require, please, please, please do it carefully. I'm sure you're well aware that with anesthesia and other op and post-op care, you are likely to receive substantial amounts of very powerful medicines that can pose interaction, potentcy, or other risks.
It would be a shame for you to be fighting such a terrible disease so valiantly and with such dignity and inadvertently put yourself at an even greater risk.
Hopefully you will have enlightened, empathetic, and compassionate healthcare professionals giving you the very best treatment at their disposal, including the willingness to focus on prescribing whatever it takes to ensure your comfort level instead of first focusing on their own.
Godspeed. Prayers abound.
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BlackCat
Old Hand
Reged: 09/22/03
Posts: 403
Loc: Bed
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I purposefully said to use a GENERIC TYLENOL caplet bottle since the pills are not imprinted with "Tylenol" AND each manufacturer's generic has different imprints and no two seem to look alike, which makes them very hard to identify if anyone scrutinized them. Therefore, your GENERIC hydro/apap pills with imprints on them like "Watson 853" or "M361", etc. would much more easily pass for a GENERIC Tylenol pill (which also has a crytic imprint).
On the outside chance you have BRAND NAME hydro/apap that is clearly imprinted with "Norco" or "Vicodin" (which I doubt), I also VERY PURPOSEFULLY suggested that you do NOT put TWO DIFFERENT kinds of pills in the same bottle (e.g. the generic hydro/apap under the generic tylenol), since this has a MUCH higher potential for causing suspicion if anyone were to get ahold of the bottle and empty out any of the pills and see two different kinds. Certainly you could pack the hydro/apap under some cotton, but there is no need to put two different types of pills in one generic Tylenol bottle since both pills have cryptic imprints. It's your call though if you are worried that someone might recognize a yellow "Watson 853" imprinted pill. 'nuff said.
I hope this helps you get the pain relief you need post-op. Also remember the sage advice not to put all your "eggs" in one "basket" in case something unexpected happens.
I also agree with Night Shade's comments about not letting even orderlies seeing you taking this Generic "Tylenol" since they may have rules requiring them to report any med usage the doctor didn't prescribe - even if it is OTC Tylenol.
BlackCat
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SBELL
Newbie
Reged: 11/04/03
Posts: 35
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Hi, I have a ? please. I may also have an up coming surgery. Will the morphine pump not help with wd? I went thru arm surgery 3 yrs ago. The surgeon gave me a block . The post op pain was very minuminal as the doc said it would be. This may be an option for you as far as the pain. I was thinking the morphine pump would help with wds, sure would like to know befour my surgery. Thanks, Sbell
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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Why do you ask if it will help withdrawal? I guess it would depend on what KIND of withdrawal. Yes, of course, it would probably PREVENT withdrawal in an opiate-tolerant patient at levels used for post-op pain. But it wouldn't do a thing for benzo withdrawal...etc.
Clarify your question a bit???
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Never underestimate the predictability of stupidity.
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Caveman6666
Enthusiast
Reged: 01/15/03
Posts: 218
Loc: Earth
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Quote:
Also, Night, the pumps NEVER worked for me. I also got more relief from oral Percs and IM meds. Wonder why? Anyone?
They're set by the Dr. or nurse to only dispense a dose within a certain time limit. If you push it at say 8:00, the setting may not allow another dose for 1/2 hour, or an hour, or whatever they set it at. Pushing it more often will not dose you, though it records it anyway, and if you're not getting adequate relief, they can see this and shorten the durations. Found this out during one of my operations.
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SBELL
Newbie
Reged: 11/04/03
Posts: 35
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Hi, thanks for responding. I was referencing to hydro withdrawel, since a person would not be taking any of their regular pain meds during surgery. Sbell 
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BlackCat
Old Hand
Reged: 09/22/03
Posts: 403
Loc: Bed
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I don't know much about Morphine, but it probably works in a similar way to Hydrocodone and is an opiate. I would think that if you had a morphine drip post-op that it would give you pain relief and also help you from feeling the effects of opiate withdrawal.
Of course, if you have been taking a relatively high dose of hydrocodone for a prolonged period, the morphine drip may not provide enough pain relief or enough opiates to prevent withdrawals. I would go in with some extra hydro that you have been taking to make sure you have a backup if you start feeling withdrawal symptoms and are not getting enough pain relief.
Of course it is best to discuss this with your prescribing physician upfront before the surgery so you can even get the hydro given to you by the hospital in the dose that is safe with the morphine. This is the SAFEST ROUTE TO GO - THE HOPSITAL IS DOLING OUT ALL MEDS AND KNOWS EXACTLY WHAT YOU ARE TAKING so you don't have any interaction or overdose risks!
However, it is likley that you have been ordering the hydro through an OP, and you may not want to let the physician know about this usage for whatever reason you have. It's your call in the end.
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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Morphine post-op in a PCA pump would almost certainly prevent any withdrawal from hydro. Considering the pump is an IV delivery and morphine is much more potent (especially IV) than oral hydrocodone, I would doubt you would experience any withdrawal symptoms--unless you are on an obscenely high amount of hydro.
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Never underestimate the predictability of stupidity.
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Reel_X_4U
Enthusiast
Reged: 04/24/03
Posts: 255
Loc: Queens, New York City
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I still don't get it. If the doctor knows upfront that he's been prescribing her 3 Percocets 3x a day for a continously period of time. Being a doctor he should also know, that's she's most likely has a degree of tolerance to the med. And what he needs to do is inform the surgeon, anesthesiologist, and most of all the nurse(S), since they will be the ones adminstratoring the med under a doctor's orders. Can't they just work out a formula where by knowing the degree pain relief "Percocet" provides to a patient and knowing the degree of pain relief "Morphine" provides to a patient and then just factor in the tolerance "Probability Level"(which they can figure out by dosaged that was used and time it was used for prior to surgury) and come-up a dosage (most likely it would in range) that would be sufficient to relieve her pain post-operatively. I've never taken "Morphine" before, but isn't it suppose to be much more stronger then "Hydro"? And after giving her the appropriate dosage (according to all the factors mentioned above) and of course, the dosage will be higher then suppose another patient undergoing the exact same operation but has little or no tolerance, cuz she wasn't prescribed any narcotics prior to surgery or had no histroy of narcotic usage in her medical records. All the nurses would have to do afterwards is just monitor her vitals, especially the respiratory rates (the number of breaths per minute) before giving the "Morphine" and her respiratory rate after they dispensing the "Morphine", there should a slight decrease in respiratory rate but not a sharp decline and if there is that might be a problem. If she's a lucid then they can asking her verbally (in term, of pain-relief) by starting with a "pre-determined base-line dose" and then adjusting the dosage accordingly, depending on her responses. And of course have a another nurse stand-by with pre-filled syringe of "Narcan", to reverse the effects of narcotics, just to be on the same side. Or they can decide on a different med altogether, I've heard that "Methadone", "Demerol" "Dilaudid" and "Fentanyl" can compete and in some cases beat "Morphine's" in it's pain-relieving properties. It's kind of risky bringing-in you own meds, you don't know what they are actually giving "U", the nurse comes-in and injects something in your glucose bag and then leaves, there's a potentiality for a bad interaction or a overdose, if "U've" taken meds from the outside without them knowing. Okay, if "U" still want to bring meds from the outside then someone has to be there (not that they won't already be there anyway), who can inform them what the med was and how much "U" took, if (God forbid", something went wrong), so that they can take the appropriate preventative measures necessary. I'm sure the medical professionals see this in alot from their patients and already have system of dealing with it. Just to be straight-up and honest about it and let them worry about the details, you're there to re-cover and heal pain-free and they're there to make sure it happens. I'm not a doctor, but I think all that is needed is an adjustment in dose (Morphine or another narcotic, they do equilvency charts at their disposal) and continous monitoring both by the "Human element" and the "technology" with parameters already programed in place, to inform medical personnel of a problem, both with visual and audible cues, that will inform them immediately. Let's hope that will never happen anyway and all goes smoothly. GOOD LUCK on the surgery and your recovery afterwards.
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Some men see things as they are and say "WHY"!!
Some men see things as they are and say "WHY"!!
I've dreamt of things that never were, and say "WHY NOT"!!
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