Opioids I'm visiting a surgeon for pre-op exam, one where I will need painkillers-im on sub..

[THE_REAL_OBLIVION]

Hello,

How do I bring up that I am on suboxone to a surgeon when he decides I need surgery (and I do). I'm visiting him today (ugh, I'll need quite the facial shave) for pre-op exam. I was told at the ORT clinic that nothing but fentanyl would dislodge bupe, and i'd have to have a massive dose scripted, at least at first.

I don't want the surgeon to be well then you'll only have NSAIDs, it is a very painful area/problematic area, a nurse will come to my home everyday for 2-3 months to take care of the stitches and shit. The condition's called Pilonidal sinus...Warning, this is not a "how do i get opiates from doc" thread, it's a genuine question for somebody on suboxone to ask, since the shit makes it a nightmare to imagine getting hurt seriously, which surgery is kind of what happens at first...How honest do I have to be? Should I just mention I'm on Suboxone because my jaw specialist doctor retired in 2010 so I was left out cold (truth) and ignore the parts where I find a dilaudid and HM Contin connection and started IV'ing. I can just say being left out cold with a round-the-clock opiate treatment (CodeineContin 150mg every 12 hours with 2x60mg/30mg APAP Empracets (codeine/apap) when I would take the C-Contin. It might just sound like "you were just on codeine", yeah, but it was 320/440mg of codeine a day, I was feeling like shit + my painful jaw condition came back (one the doc decided was too risky to operate, so I'm stuck with it for life)...so I just went to an opiate detox clinic while I was shit out of luck? My ORT docs told me to be honest if I get hurt and that surgeons will adapt with the fentanyl no problem, maybe will contact them, but that's it. I wonder what they mean by honest though...

 

[f33lg00d]

Ive always worried about this, dont have any answers. Good luck.

 

[LilikoiMoon]

As someone who has worked in the medical/dental field for 18 years, I can advise you as a professional and an addict.

Are you willing to risk your sobriety after this surgery? If you decide not to tell the surgeon, you know the outcome will be back to square one on medications again, possibly developing another habit.

On the flip side, are you willing to deal with pain? Subs are not going to help with the pain, so can you cope?

You don't want any drug/anesthesia interactions, so make up your mind to start weaning off subs days prior to surgery, or tell the truth and stay on them.

Good luck!

 

[THE_REAL_OBLIVION]

Hmm...well the jaw issue believe it or not is kinda covered by bupe. It's not the greatest painkiller, but it works better than even my old codeine round-the-clock regimen.

I'm visiting the surgeon so he can look at this embarassing problem I got here called a pinodinal sinus, it used to be a pilonidal cyst, hell I had it for a decade+, but someday it decided to get infected and explode in a sea of disgusting foul smelling pus, and it created 2 small holes on the skin inside my buttcrack which eventually always get reinfected no matter how you keep that part of you clean and dry. So I need to get surgery. I'm going to call my ORT clinic before going to my appointment today to speak with them, they always to told me to call them if I was to get surgery, and they are aware of my issue, they allowed a doc to script me Supeudol (OxyIR) 20mg twice a day with my antibiotics when it first bursted and I couldn't sit or sleep at all (thank god my town has a doctor-comes-at-your-house service...it's hard to get them to come, you gotta pick up the phone and call non stop for 2 hours wishing you get through, and I did then, it's them who refered me to a surgeon as well.

Yes I am willing to get on fentanyl medium term (2-3 months for this thing to heal) then it'll be easier to go back on suboxone on a lower dose (I was shooting up 32 to 56mg of Dilaudid everyday when I snapped and went to the ORT clinic). I can even get Parafluorobutyrfentanyl in a spray from a place that's very well regarded in case I won't admit to the surgeon I am on Suboxone.

The point here is I never wanted any of this. I had medium to extreme pain in my left jaw/trigeminal nerves due to a freak accident in a music show. I was let down by my retiring maxilofacial doc, the ORT clinic is all aware of that, so they don't treat me like a mega junkie, I even have piss tests skipped since I'm such a compliant patient. Make no mistake, the ORT clinic wouldn't kick me out if I was to get on fentanyl after the surgery, it's their own advice.

I imagine I'll have to taper off slowly, maybe not completely, the subs, get surgery, then take fentanyl+subs, it's what they inferred when I was switched from methadone to suboxone a couple years ago.

 

[THE_REAL_OBLIVION]

Well,

turns out the surgeon tried to convince me, not to get surgery, right now anyway, and he will not, when he said that the fact I am overweight, even if not obese, is a factor in healing time, saying he's seen people having to lie on their stomach for 2 years before the wound closes correctly. My life's already a tiny bit fucked up enough without bedridding me, on a position I can't even get to sleep.

I'll get some of that BFTF maybe, in case another pus ball accumulates and explodes leaving me in extreme pain again, I won't have to deal with the well intentioned but ridiculous scripts of Oxycodone IR 20mg twice a day with antibiotics. The Oxycodone even when I took 80-100mg did absolutely nothing after 3 days of not taking suboxone...well no, it did kinda help for pain, but it then gave me headaches..... Next time, I'll admit to suboxone usage when I need help so I get some fentapops or something meanwhile.

I can't believe my 220lbs (supposed limit for my BMI : 196) makes a surgeon not want to operate. But when he said he's done 1000 surgeries for that pilonidal sinus issue, I stopped arguing and said ok, see you.

 

[serotonin2A]

For future reference, there are a few ways they can handle pain relief in this type of situation.

1) If the pain isn't severe, they could temporarily switch you to parenteral buprenorphine. It's not as strong as a full agonist bit it will provide some pain relief.

2) They can switch you over to a full agonist a few days before the surgery and try to stabilize you. Later they could transition you back to suboxone.

3) They could reduce your suboxone dose for a period of time before the surgery to reduce your tolerance.

4) They can give you high doses of fentanyl, sulfentanil, or remifentanil for the surgery.

5) Patients on suboxone can sometimes get adequate pain relief from continuous infusion of hydromorphine (as patient controlled analgesia). The last option takes close monitoring and the nursing staff really has to know what they are doing to find a dose and dosing schedule that will produce sufficient pain relief.

 

[THE_REAL_OBLIVION]

Thanks for the info. But the surgeon told me he didn't want to script me Fentanyl for as long as my wound would be open....what a sadist, unless he had been given talk by my ORT clinic that I do deserve Fentanyl, he might give people who get that script low oxycodone doses/some medium to high oral morphine or dilaudid /HM Contin doses, hell even CodeineContins 200mg. He was like, you wouldn't get painkillers after the surgery....WHAT.

For all its worth, I had given my name to 2 surgeons-containing clinics, when the other calls back, i'll visit them for a second opinion. Just imagine what sort of horrible pain would result from a pilonidal sinus removal surgery (and the surgery involved in taking them out, and the multiple months involved in the wound actually closing). I'll see what the other, female surgeon will have to say.

What is weird is he also told me, that if I had been smoking cigarettes with my current weight, he would have refused completely to operate on me...wat. Thankfully I stopped cigs 5 months ago now, but I was really pissed off when he told me I was too fat and there was very big risks if he did the surgery at the weight I am at. That, I did not dispute, he didn't understand my need for Fentanyl, which my ORT clinic told me, it's what I needed if injured badly or painful surgery. I can't think of a more painful surgery where they slice off the skin between your buttcrack, fill the sinus (basically a tunnel under my skin there that was accumulating hair falling from my back and ass since years. What's funny is that before it was a sinus, it was a cyst, that didn't hurt much, but I always felt some kind of bump there on my tailbone, once it hurt so badly I went to the ER.

It was like in 2000, and the then asian doctor (asians do not get pilonidal cysts/sinus at all, so he must have been confused as to what the hell that was), so I left the ER with a script for Empracets 30/300, just codeine and apap. Then 14 years later last november it exploded through another place creating a second hole, those 2 holes are what a pilonidal sinus is. The doc was ok, but didn't listen to me when I said I had two issues with the pilonidal sinus. He said you "2 issues in 15 years". NO, then it was a cyst. I've had the burst into disgusting malodorous pus incident and bad infection and another time where there seemed to be a ball forming under my skin near my buttcrack again, but thankfully it burst through the already existing 2 holes.

Everyday I keep this area very dry and clean, even after taking my regular daily shower, I do additional care for that part of my body. It's just that this is fucking frustrating, I had to yell at him that I'm on suboxone but that he wasn't dealing with a junkie (for the most part, true, if any stalker reads my jaw articulation and nerves issue, jk, but if somebody saw this, I was left out cold, and he understood that, I was relieved, and also, he knew the maxilofacial dental surgeon who bailed on me when retiring, so that helped.. But the "you're a fatty part" had me flying and swearing at him, it's the methadone that caused this, and i'm not kidding, it's what did it, switching to suboxone did the trick for my testosterone levels that the methadone were always killing (almost killing me in the process) but it didn't remove what they said was water-weight that methadone put in people. Fucking liars everywhere.

I'm gonna take some etiz and clonaz and relax because I'm about to burst a cap in frustration.

Thanks for the tips, previous poster, my ORT clinic seemed aware of all this, not this surgeon who was saying that I wouldn't be on a painkiller for as long as I had the wound...which is fucking sadistic. I'll keep you updated, monday I'm calling at the other surgeon place I said I had called but they hadn't called me back yet, this place took 4 months, both places told me to wait 3-5 months...we'll see.