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Re: Avinza - Detox

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Phil,

You bring up a good question that I did not think to ask. I just assumed

that he wanted me to lower my medication prior to surgery so that it did not

interfere with the anesthesiologist. I'm starting to wonder if you're

correct - why would I put my body through the stress prior to major surgery.

Anyway - I think I'm going to stay where I'm at. I got down to 60 mg and I

take hydro every 4 hours. That should be good enough. I'm also going to

ask for a Pain Management Specialist to be present after my surgery so that

I get proper pain control. One of my fears is that they will give me the

same amount of morphine they would others, and we both know that with my

tolerance - that will not begin to cover the pain. Since I'll have a six

inch incision and staples, I don't want to the having to argue with the

doctors and nurses that I need more pain control.

Thanks for your info Phil - I appreciate it.

-Jeff

Phil wrote: <snipped>

> I don't know how you'll feel (remember, I'm just another patient, I'm

> not a doctor) but I do suggest that you not just drop from 60 to 30.

> Although you've gone down by 30 mg before, this is now a bigger

> percentage decrease (50%) than before (33%).

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~:{[sungoddess]}:~ wrote:

> For true withdrawl to start, one must stop

> all opiods....if one is still taking hydro there would be barely

> any withdrawl or none at all.

Correct. Most (but not all) opioids are pretty much interchangeable, and

I think this is true for morphine and hydrocodone.

> I thought her doc said to cut down and not to quit Avinza...am i

> wrong? It is very dagerous just to stop taking a medication

> like that.

The textbooks all say that rapid opioid withdrawal, while extremely

uncomfortable, is generally not life-threatening. Sudden withdrawal from

other depressant drugs, such as alcohol, benzodiazepines and

barbiturates, can be much more dangerous because seizures can result.

It's best done in a hospital by switching to Valium and slowly tapering.

Opioid withdrawal can still be dangerous if the person has a weak heart,

as the sympathetic nervous system goes into hyperdrive and pours

adrenaline into the blood. The non-opioid blood pressure drug clonidine

can suppress this rebound.

> I hope my doctor does the Tappering things when it comes time to

> stop taking my Vicodin hp 10/660. If he does just stop me some

> day, say when i am recovered...

Whether it's life-threatening or not, forcing any patient with a

significant opioid dependence to simply stop without treatment would in

my opinion constitute serious malpractice.

Phil

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dee fry wrote:

> hey how much pain tablets dose it take to have withdrawl

I am really not an expert on this. You might try searching for

" addiction medicine " or similar words on Google. All I know from both

reading and personal experience is that physical opioid dependence

develops pretty rapidly with even normal doses taken for a few days.

Although I'd had surgery before, the first time I really experienced

opioid withdrawal was after my first foot surgery in 1999. The pain

level dropped fairly suddenly about a month later, so I cut way back on

the painkillers. That night I just couldn't get to sleep. At first I

couldn't figure it out! I took a small dose to test my theory, and then

I knew. I guess the pain from my previous surgeries had decreased much

more gradually for me to notice.

Anyway, that's how I learned to not just stop suddenly.

I've read that you can trigger noticeable withdrawal by giving just a

*single* dose of morphine to a non-dependent person and then giving an

opioid antagonist (blocker) like Narcan. So opioid dependence appears

with the very first dose, though it's normally masked by the natural

taper as your body metabolizes it.

Phil

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Jeff wrote:

> Phil - I'm going to s Hopkins because I've been everywhere else in

> Pennsylvania. All the good Dr.'s have left here because of malpractice

> insurance. Hopkins is my last choice. I have an appointment on the 29th to

> discuss my surgery. I will bring these concerns up during that visit.

s Hopkins is a good place. It's in my home town, btw. I just can't

imagine you should have a problem getting good pain control after your

surgery. Unlike chronic, non-cancer pain, opioids for post-operative

pain have *never* been controversial so I can't imagine that you won't

get whatever you need. Good luck.

Phil

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