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  • Questions about having surgery while on Methadone.

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    Old 08-20-2008, 04:57 PM   #1
    scrappinmaniac
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    Questions about having surgery while on Methadone.

    I live with chronic pain everyday. To help control my pain, I'm currently taking 90 mg's of Methadone a day...I take 30 mg's of Methadone 3 times a day. I also take Percocet (5/325mg) for breakthrough pain...my doctor rx's 8 Percocet pills to me per day.

    I recently found out that I need another surgery, which is a bummer, but may relieve me of some of my pain so I'm all for it. As my surgeon and I were getting ready to schedule me for surgery he told me that I had to be completely off Methadone before surgery. He said I could continue to take Percocet but not the Methadone. I tried to explain to him that there was no way possible for me to live only on Percocet. I have a 2 year old son that I take care of 24/7 and I know how aweful I feel taking care of him now being on Methadone, I can't fathom how terrible I would feel trying to take care of him while only on Percocet. My surgeon won't budge whatsoever. He couldn't even give me a good reason to want me off the Methadone before surgery...he said he needed me off of it because he was not "authorized" to rx it postop for me, which I know is a big lie, doctors don't get to pick and choose what they will and won't rx. He also said if I don't stop taking it prior to surgery he won't be able to control my pain post-op, which is another lie.

    I know many of you here on the board have been around the block a few times and I respect your knowledge and opinions...what do you think? Is my surgeon telling the truth, or should I start looking for a new one? Are all surgeon going to want me off Methadone before surgery? I would appreciate any advice. PLEASE HELP ME!

    Take care,
    Scrappin'

     
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    Old 08-20-2008, 10:50 PM   #2
    Shoreline
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    Re: Questions about having surgery while on Methadone.

    Hey Scrappin, There is no reaon like dangerous intractions between meth and meds used for anesthesia, The danesthesiologist just needs to know and acountfor it when usinf other meds that also cauise repirtory supression, If it's major surgery and your on a vent, then it really doesn't matter at all as far as safety.

    IMO, The porblem, is simply a matter of comfort with this surgeon. There are still alot of surgeon that haven't had to deal with high dose CP patients and when they do they don't feel they need to treat them any different than any otyher patient. Surgeons use these meds for post op pain and discontinue them as the healng process occurs. The goal wold be to manage you imediate post op pain and send you home with short acting meds with the goal of complete reductoin of medication.

    I'm not saying this is how I would do things or what the right thing to do is, at best you get a surgeons opinion, If he doesn't agree with the long term use of opiates when he's plannning on fixing you, he's going to make these kinds of demands.

    It doersn't mean no surgeon would touch you or that every surgeon is going to have the same opinion. There are some docs with very liberal vies on opiate use and some with very narrow veiws about the role opiates should play in post op and PM. So there is the extreme left, the extrem right and everything n the middle. We don't live in a eutopian PM society where every doc is going to give us what we feel is enough pain medication,. Post op pain is certainly more difficult to manage whe someone has a high tolerance and many dsurgeon have never even prescribbed the level of meds your presently taking and the fact he wants you off is a pretty good indicator he wouldn't be happy with what he's going to have to prescribe to make a signicant difference in how you feel post op. 10 years ago, there was no such thing as 10 mg percs. Every surgery I ever had I was given 5 mg percs with instructions to take 1 or 2 every 4-6 hours. If your already taking the equivelant of 10times that amopunt, this doc may know he isn't going to be able to manage your pain and that your request will probabaly exceeed the limits of his comfort zone.

    Your options are find another surgeon, find one that is willing to let your PM continue to manage all pain meds or you may want to try to reduce you dose in preperation for surgery simply to make post op pain control easier on you and your doc..

    Unfortunately just beause we know they make a 30 mg oxycodone tablet that may very well work, doesn't mean every doc wants to be in the position of prescribing far more than he's ever prescribed in the past to people already taking more than they are comfotable with. That doesn't make him a bad surgeon, just one with an opinion about opiates and PM differn from yours and your PM doc. Bedside manner is nice, but I want the most talented surgeon working on my spine or what ever part of the body that needs surgery. Failed surgery but has a loose script pad doesn't make for a good surgical recomendation.

    Good luck and remember there is always another opinion out there.
    Dave

     
    Old 08-20-2008, 11:06 PM   #3
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    Re: Questions about having surgery while on Methadone.

    Hey Scrappin,

    It might be possible to ask your surgeon and your PM to co-manage your pre and post-op pain. My sister-in-law has had several surgeries over the past 6 or 7 years. She has her PM speak with the surgeon and set up a plan to have her post-op orders come from him, instead of the surgeon. All but one of the 4 or 5 surgeons she has gone to, have been perfectly fine with this arrangement. The 5th one didn't do the surgery. She found a different one. (Highly qualified, of course)

    Of course your PM and your surgeon would both have to be on board with this, but I don't think it could hurt to check into it. Hope this helps. Good luck with everything. CMP/MM

     
    Old 08-21-2008, 08:18 AM   #4
    forginon
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    Re: Questions about having surgery while on Methadone.

    My PM doc manages my pain when I'm hospitalized. Even when there's surgery.

    Shoreline already explained what the anesthesiologist needs to do to account for the methadone when calculating how much anesthetic it will take during surgery.

    I was on 80mg methadone daily and had two hospital stays, one with surgery and one without. Neither time did any of the docs even blink at the methadone. In the case of the non-surgical visit, the doc just added SA dilaudid IV to my regime and my pain was very well controlled. In the case of the surgical visit both my anesthesia and post-op pain management went very well, and I never had to change anything about my methadone dose.

    I wouldn't say this is lying on your doc's part, bit it clearly reflects his attitude towards opioids. I would change surgeons in a heartbeat, because this is a direct reflection on his attitude toward pain management, and he gets an "F" with me.

    The strange part is, it's the anesthesiologist that handles all your meds during surgery and can also be the one managing pain post-op. Your surgeon need not be involved at all.

    steve

     
    Old 08-25-2008, 06:20 PM   #5
    scrappinmaniac
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    Re: Questions about having surgery while on Methadone.

    Thanks for all your replies. All of you have confirmed exactly what I've been thinking for the last month. I'm going to fire my surgeon and find a new one and stop trying to wean myself off methadone because I can't stand being in pain like this.

    Thanks again for your replies. I appreciate them!

    May all of you truly be blessed .

    Take care,
    Scrappin'

     
    Old 08-26-2008, 12:06 PM   #6
    forginon
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    Re: Questions about having surgery while on Methadone.

    Scrappin'

    I truly admire you.

    It took guts to do what you did, and for what it's worth, IMHO you did the right thing. Maybe, just maybe this doc will at least think about why you left. One can hope...

    If I wrote more I'd just be gushing, I am so thrilled with what you've done. Good for you.

    Well done Scrappin'

    steve

     
    Old 08-26-2008, 12:37 PM   #7
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    Re: Questions about having surgery while on Methadone.

    Unfortunately your surgeon doesn't care that you need methadone so he isn't the right doc for you. It is the anesthesiologist that needs to know what exactly you are on so he/she knows what drug combination to use with you to during surgery. My husband was on extremely high pain meds and patches his last surgery and there was no problem the only problem we had is when he was sent to the floor and no one there knew what level of pain med to put him on to keep him out of serious pain so he suffered a great deal until they called the pain management team and then he got what he needed so if we ever have to do that again we will be sure that EVERYONE knows. We have discovered over the years that you are your own advocate because nurses/doctors are not use to dealing with patients with such high tolerance and needs. I can only suggest you get all your xrays or imagining pictures with reports and go to another surgeon that will work with you...your current surgeon is difficult not only before surgery but also he will be the one after surgery to order appropriate pain meds and it doesn't sound like he wants the added burden of Methadone which also involves that he keep better/special records for the Feds. Perhaps he has been in a lawsuit before over this issue ...you just never know why a doctor won't deal with some things but if you want this surgery you will have to see other surgeons for second/third opinion until you find the approp. doctor...Perhaps a teaching hospital they are more liberal. Good luck.

     
    Old 08-26-2008, 07:30 PM   #8
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    Re: Questions about having surgery while on Methadone.

    I'm confused about something Ann said in her post,

    "but also he will be the one after surgery to order appropriate pain meds and it doesn't sound like he wants the added burden of Methadone which also involves that he keep better/special records for the Feds."

    Why would the surgeon need to keep special records? I mean, methadone is dealt with the same way any other Schedule II drug is dealt with. Am I missing something? Memere (KathyMac)

     
    Old 08-26-2008, 11:08 PM   #9
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    Re: Questions about having surgery while on Methadone.

    Scrappin, I think you made the right choice. I am currently weaning off of Methadone and it is the worse thing that you could possibly go through. My pain on it was at an 8 now it is off the charts. I can not believe the stigma that is associated with this drug. It was a god send to me and now I can not find a doctor in this state to give it to me. So more power to you that you take your care in to your own hands. I wish you the best of luck in your search and that your pain is controlled pre and post op.


    Take care,
    Barbie

     
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