Major Surgery & Problems with Painkillers

[TheFDA]

Alright, so, I'm going to try & make a long story & complicated situation much shorter & more manageable here...

A week ago, I had a really major surgery... During the consultation before the surgery my surgeon actually said to me in no uncertain terms that this surgery was definitely considered a major surgery & would without question be significantly more painful than the surgery I'd had in the past [for which that same surgeon was also the primary surgeon for]. He also promised me that no matter how much pain I was in they'd be able to treat it with painkillers, & wouldn't hesitate to do whatever it took to make me as comfortable & as pain-free as possible.
However, the consultation the day before the surgery they only gave me Tylenol #3 to treat the "incredibly severe" most surgery pain. This of course really made me wonder, but, it's not like I was going to back out of the surgery because of that.

So, they definitely weren't lying about the surgery being incredibly painful. In the hour or two after the surgery they treated my pain fine, & gave me injections of Fentanyl (sp?) as much & as frequently as I needed. After an hour or two, though, they said I couldn't stay on the IVs & had to leave the hospital & go to the hotel that's connected to the hospital by a walkway or something. Apparently during the surgery they gave me localized anaethesea that helped keep my pain level tolerable for the first two or so hours I was off IVs. After three or four hours of being off the IVs, though, I was in AGONIZING, AGONIZING pain. The Tylenol with Codeine that they gave me didn't do anything, & for hours I was in so much pain I couldn't even walk [& the surgery was nowhere near my legs!], in so much pain I could barely move, & couldn't stop screaming & crying because of how much agony I was in. My father was taking care of me, & after over an hour he finally got the head surgeon to prescribe me 50mg Demerol pills.

50mg Demerol pills were the strongest thing they ever gave me. & those didn't do ANYTHING at ALL for the pain, either. I spent days in absolute hell. & they kept saying that no stronger painkillers existed than Demerol... That that was the STRONGEST thing that they had that they could give me...

Does anyone know why on earth surgeons would say that? There's no truth to it whatsoever, right? Did the hospital just do wrong by me or what?

 

[MadWolfZX]

Of course they lied. I have no idea why they would fabricate such a story and claim Demerol was the best thing they had.

Do you have a history of drug abuse that the surgeon/doctors know about? That's about the only reason I could think of them making such a claim, but even then, it sounds like what they did amounts to very unethical behavior, maybe you even have a possible lawsuit against them for purposely making you suffer. I would contact a lawyer or two and ask them about the merit of a lawsuit. No one should be allowed to impose such physical suffering on another individual purposely, regardless of their 'title'.

Now, let me make it clear, I am strongly against frivolous lawsuits. But your case sounds like a very important matter, if you are accurately describing the incident. An example should be made of this doctor to show other doctors this is simply not excusable!

Chris

Alright, so, I'm going to try & make a long story & complicated situation much shorter & more manageable here...

A week ago, I had a really major surgery... During the consultation before the surgery my surgeon actually said to me in no uncertain terms that this surgery was definitely considered a major surgery & would without question be significantly more painful than the surgery I'd had in the past [for which that same surgeon was also the primary surgeon for]. He also promised me that no matter how much pain I was in they'd be able to treat it with painkillers, & wouldn't hesitate to do whatever it took to make me as comfortable & as pain-free as possible.
However, the consultation the day before the surgery they only gave me Tylenol #3 to treat the "incredibly severe" most surgery pain. This of course really made me wonder, but, it's not like I was going to back out of the surgery because of that.

So, they definitely weren't lying about the surgery being incredibly painful. In the hour or two after the surgery they treated my pain fine, & gave me injections of Fentanyl (sp?) as much & as frequently as I needed. After an hour or two, though, they said I couldn't stay on the IVs & had to leave the hospital & go to the hotel that's connected to the hospital by a walkway or something. Apparently during the surgery they gave me localized anaethesea that helped keep my pain level tolerable for the first two or so hours I was off IVs. After three or four hours of being off the IVs, though, I was in AGONIZING, AGONIZING pain. The Tylenol with Codeine that they gave me didn't do anything, & for hours I was in so much pain I couldn't even walk [& the surgery was nowhere near my legs!], in so much pain I could barely move, & couldn't stop screaming & crying because of how much agony I was in. My father was taking care of me, & after over an hour he finally got the head surgeon to prescribe me 50mg Demerol pills.

50mg Demerol pills were the strongest thing they ever gave me. & those didn't do ANYTHING at ALL for the pain, either. I spent days in absolute hell. & they kept saying that no stronger painkillers existed than Demerol... That that was the STRONGEST thing that they had that they could give me...

Does anyone know why on earth surgeons would say that? There's no truth to it whatsoever, right? Did the hospital just do wrong by me or what?

 

[BIGsherm7272]

Hmm doesn't make sense why they wouldn't treat your pain adequately.......I had gall-bladder surgery (which wasn't really that painful), and I was treated with 4mg of IV dilaudid every 3 hours for the whole week I was in the hospital......they even knew about my past addiction to opiates and that I was on suboxone.......and when I left they sent me home with 30 10/325 percocets.

 

[Lolie]

They probably have a policy about what pain-killers they prescribe for use in the hotel part and which can be used in the hospital proper. They'd certainly have a policy about which drugs can be given by hospital staff and which can be self-administered by a patient still nominally under their care.

I guess this is one of the problems inherent in the model of using hotels as an extension of the hospital and rapid discharge from the acute care setting. It's absolutely worth making a formal complaint about your experience to both your surgeon and the hospital administration, but pain relief seems to be an issue in which there is often conflict between patient expectations and what's actually delivered.

 

[TheFDA]

They probably have a policy about what pain-killers they prescribe for use in the hotel part and which can be used in the hospital proper. They'd certainly have a policy about which drugs can be given by hospital staff and which can be self-administered by a patient still nominally under their care.

I guess this is one of the problems inherent in the model of using hotels as an extension of the hospital and rapid discharge from the acute care setting. It's absolutely worth making a formal complaint about your experience to both your surgeon and the hospital administration, but pain relief seems to be an issue in which there is often conflict between patient expectations and what's actually delivered.

Thank you SO much for your response! The more I think about it, the more I feel that this HAS to have been what was going on. I mean, it would totally explain the comment about "Demerol being the strongest painkiller they could give me"; they probably meant it was the strongest painkiller that could be prescribed under their hospital's policy for "hotel/home pain management" or whatever.

... Wow, suddenly it all makes sense, & seems notably less irritating! lol. (Although, make no mistake, it's irritating nonetheless!)

Of course I'm going to have to find a way to make certain that this all IS a valid explination for what caused the circumstances in question & whatnot; but, assuming it turns out to be, I think I'll definitely take your advice & still make a formal complaint against the hospital regarding it.

Thanks again for your insight; it helped a ton!

 

[BIGsherm7272]

I'm sure the hospital sends patients home with vicodins and percocets, so I doubt that demerol is the strongest opioid they can give you to take home. If they would have tried to send me home with demerol after being on 4mg of IV dilaudid for a whole week, I would've raised hell. That wouldn't have even helped that much with the dilaudid withdrawals, let alone help with pain.

 

[Lolie]

Thank you SO much for your response! The more I think about it, the more I feel that this HAS to have been what was going on. I mean, it would totally explain the comment about "Demerol being the strongest painkiller they could give me"; they probably meant it was the strongest painkiller that could be prescribed under their hospital's policy for "hotel/home pain management" or whatever.

... Wow, suddenly it all makes sense, & seems notably less irritating! lol. (Although, make no mistake, it's irritating nonetheless!)

Of course I'm going to have to find a way to make certain that this all IS a valid explination for what caused the circumstances in question & whatnot; but, assuming it turns out to be, I think I'll definitely take your advice & still make a formal complaint against the hospital regarding it.

Thanks again for your insight; it helped a ton!

Policies can vary radically from one hospital to the next. The hospital nearest me does not allow any drugs other than morphine and nitrous in its birth centre and doesn't allow walking epidurals in its labour and delivery ward. Doctors whose patients want more options need to send them to a different hospital. Doctors practising within a hospital environment are to some extent constrained by the policies of each particular hospital at which they practise - which are heavily influenced by insurance considerations.

Rapid discharge is the norm here and I can't even remember the last time I can recall someone being sent home with anything stronger than tramadol (which is about equivalent to pethidine in effectiveness) for post-surgical pain. The expectation here is that the patient will see their GP for any ongoing pain issues during the interval between discharge and follow up with their specialist.

For what it's worth, pethidine (Demerol) was the standard drug given in hospitals for pain relief both IV and IM for decades as morphine regarded as too dangerous. Thank goodness that attitude has changed.

 

[BIGsherm7272]

Policies can vary radically from one hospital to the next. The hospital nearest me does not allow any drugs other than morphine and nitrous in its birth centre and doesn't allow walking epidurals in its labour and delivery ward. Doctors whose patients want more options need to send them to a different hospital. Doctors practising within a hospital environment are to some extent constrained by the policies of each particular hospital at which they practise - which are heavily influenced by insurance considerations.

Rapid discharge is the norm here and I can't even remember the last time I can recall someone being sent home with anything stronger than tramadol (which is about equivalent to pethidine in effectiveness) for post-surgical pain. The expectation here is that the patient will see their GP for any ongoing pain issues during the interval between discharge and follow up with their specialist.

For what it's worth, pethidine (Demerol) was the standard drug given in hospitals for pain relief both IV and IM for decades as morphine regarded as too dangerous. Thank goodness that attitude has changed.

That is funny because demerol has more severe side effects than morphine and is generally regarded as more dangerous, especially in regard to its neurological side effects. Demerol actually mainly agonizes the kappa receptor, not the mu receptor like most conventional opioids do.

 

[Lolie]

That is funny because demerol has more severe side effects than morphine and is generally regarded as more dangerous, especially in regard to its neurological side effects. Demerol actually has much more action on the kappa receptor than the mu receptor (hence why people can go into delirium on it).

I'm not sure that was well known going back a decade or two. It's now regarded as totally unsuitable for long-term use because of its neurotoxicity but it's really not all that long ago that morphine was regarded as evil and to be used only in extreme cases.

Bear in mind that a lot of replacement drugs have proven to be less effective, as addictive or more dangerous than their predecessors and that the original drugs tend to find favour again once that happens.

 

[phatass]

do they know if you have a history of drug abuse...? I allways make sure before i get surgery (twice in my life i think) what painnkillers i'm going to get after... i've never had very painful surguries, so tramadol/codeine/dextropropoxyphene and once morphine did the trick... but i have no idea why they would have you on IV fent for a couple of hours and then switch you to codeine... it's outrageous....

i'm sorry to hear you had to go through that pain, nobody deserves that... whether you're a drug abuser shouldn't even come into the picture...

hope you're better now

 

[K'd-OUT-in-AZ]

Thy should have prescribed you something stronger with less side effects like oxycodone. Roxicodone or something like that. That seems to have become the standard for treating moderately severe to severe pain. Maybe they believe that Demerol is more powerful than oxycodone formulations. I highly doubt that they would have sent you out with Fentanyl though if that is what you were expecting. Also, not all hospitals "prescribe" Morphine anymore, as it has become a narcotic prescribed more for chronic pain (MSContin).