| Re: Post Fusion Questions
Hi John, Who is prescribing the pain meds, the surgeon, a pain management doc or both? Break through pain is pain that breaks through a base dose of some type of long acting med like meth. Taking norco every 3-4 hours doesn't really constitute as BT pain. It's just part of your daily regemin at this point. That's why your dependent even while taking meth. The fun part of withdrawal doesn't even start untill the 3rd day and with meth it lasts weeks if not months depending on how long you take it.
The post op pain from surgery will certainly break through your present dose of medication, unless your clear with your Surgeon about what and how your taking your meds, your post op experience could be pretty miserable.
When you talk to your anesthesiologist be clear about the amount of opiates your taking and for how long.
They generally use drugs to reverse anesthesia to save time in recovery and get you into a room. Reversing your anesthesia with an opiate antagonist like narcan will purge all the opiates from your system and you wake up with 0 meds working until the antagonist wears off. So you have to be clear that they can not reverse anesthesia and they must allow you to wake naturally, otherwise you wake in instant withdrawal and horriable pain.
I can't imagine any reason they would start you on methadone 1 month pre op. Surgeons are notorious for discontinuing meds when they feel ready, not when you feel ready. Meth is a horriable drug to discontinue abruptly so you need to ask what his taper plan is. Often docs , even PM docs have no clue just how bad withdrawal can be when the meds stop, which they will if it's a surgeon prescribing them.
A surgeon that continues the meds past 2-3 months is basically admitting his surgery failed. No surgeon wants to do that so he will DC the meds when he feels like it.
They don't think it's that bad because there are very few cases of death from opiate withdrawal but many cases of suicide. The meds will stop at some point because it's the only way to prove that the surgery has been succesful. You need to be prepared or at least discuss how he plans on tapering you off methadone and norco without labeling you an addict and sending you to detox.
If meth is not helping, Do yourself a favor and start tapering off that now. Decrease your dose by 5mgs a week untill your off the meth unless you plan on spending the rest of your life on it. By decreasing now you will have a small reserve to slow the taper the doc proposes which will be too fast. You can't just switch from methadone to any other opiate. Meth has properties other meds don't. Even switching to potent IV drugs like IV Dilaudid, you will still likely experience differential withdrawal if they don't continue the meth. The norco can be easily replaced with any opiate, but the meth will be a problem so I would start discontinuing it now.
Meth is a useful drug for patients that will not improve, that have tried every other method to manage pain and are looking at having to manage intractable pain for life. But to use it post op or pre op is absulutely absurd. Does he prescribe OxyContin for sprained ankles and morphine for ingrown toenails?
With opiate dependent patients with a higher than normal tolerance, managing post op pain is possible but the docs are in the position of having to use 3-4 times what they would on an average patient. They don't have the experience or are afraid of overdosing you so often you suffer needlessly.
I have had 3 back surgeries and was never given anything stronger than Percocet pre op and post op when I came home. The last was a 6 level fusion with 12 pedicle screws and 8 rods to replace the previous broken set. They use IV meds while your in the hosptal, usually patient controlled anesthesia "PCA" where you just press a button and the meds are delivered into your IV line. But with HMO's, I wouldn't expect more than a 3 day stay, IV meds the first 2 days and oral meds after that. With your tolerance....You going to need a whole lot more than a couple percs every 4 hours. What dipsh## doc did this to you.
I really don't want to scare you any more than I have, But knowing what I know now, Unless your doc is a complete pushover for narcotic meds. I would post pone surgery, taper off the methadone and then reschedule it.
I deleted the rest of the post because it will just upset you. I'm sorry I can't paint a rosey picture of a turd. Good luck with surgery and it's going to take tremendous strength and you arer going to have to endure more than you should have too because of the meds you are on. But alot is up to you as far as recovering and getting off the meds or just moving on to pain management and a life dependent on opiates. Surgeons discontinue pain meds when they are ready not when you are, if you fight you get labeled an addict.
You can move on to pain management and a life dependent on opiates, doctors,pharmacies,being treeted like an addict, etc etc. This is just too screwed up to explain anymore.
I'll be here and more than happy to help you develop a comfy taper off the meds but this doc has done you no favors by throwing meth into the mix and delaying surgery 7 months.
Good luck, Shore
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John
