Started MMT Today

[Chip]

i see. yeah, get it done. i have that problem at bedtime.

[suboxstitute]

Wow - sucks about your parents; I totally misread them from your other post.  Well, at least your mom.      God.  She sounds really judgmental. 

[monkawat]

i see. yeah, get it done. i have that problem at bedtime.

For sure.

A lot of people said they needed meds post op but it was some weak ass shit like hydros which don't work 4 shit anyways. I don't want or need anything pain med wise to take home -my done and otc will be fine-but I'm worried about in-hospital pain before discharge.

Nurses on here or morfy- do you know if patients maintained on methadone are given any IV pain meds post op immediately after coming to the recovery wing? I know this shit will hurt then but probably won't be bad after that first day.

[Narkotikon]

I'm not an expert in the field by any means, but you're not on a blocking dose of methadone yet.  I can see them either giving you more methadone for the pain, or possibly giving you another opiate for the hospital stay.  I'm more inclined to think it'll be more methadone, b/c while your dose may not be fully blocking, it may still blunt the effects of other full agonists.  And I doubt any doctor is going to be okay with giving you higher doses of other opiates to compensate. 

I'm really sorry to hear that your relationship with your mother has always been rocky.  I admit, I misjudged her too based on your previous posts.  I always assumed you came from a really loving, non-judgemental, entirely supportive family.  It sucks b/c I think so many kids in those situations end up being negatively affected by it well into adulthood.  It's another form of child abuse / childhood trauma IMO. 

I won't go into details, but I can relate to your situation with your mother.  Mine is extremely morally conservative and judgmental too.  Not usually rational when it comes to core beliefs.  But honestly, things have gotten better between us over the past couple years.  Especially over this last year / year and a half.  We don't argue nearly as much.  Sure, we still have the occasional screaming match, but it's nowhere near the daily bitch-fest we once had. 

I'm just trying to say that things can always change.  I know it hurts feeling like your parent isn't supportive, but she may yet come around, at least to some extent.  Have you thought of taking your mother to the clinic, for a Q&A with the doctor?  I did that when I was in MMT.  My mother and one of my sisters were concerned, so I took them to one of my doctor appointments.  He alleviated a lot of their concerns.  Would she be willing to do that? 

[suboxstitute]

i see. yeah, get it done. i have that problem at bedtime.

For sure.

A lot of people said they needed meds post op but it was some weak ass shit like hydros which don't work 4 shit anyways. I don't want or need anything pain med wise to take home -my done and otc will be fine-but I'm worried about in-hospital pain before discharge.

Nurses on here or morfy- do you know if patients maintained on methadone are given any IV pain meds post op immediately after coming to the recovery wing? I know this shit will hurt then but probably won't be bad after that first day.

I've had two surgeries, one was back surgery when I was using a helluva lot and had a high tolerance and then a more minor surgery when on bupe... actually, three, since I had gallbladder surgery late in 2013 when I was clean-ish but still had a decent tolerance. 

Anyway... I was really worried about pain control in the hospital, like in the recovery room right after surgery especially. Not so much at home, since I figured I could take care of that one way or another. 

Each time, I told both the anesthesiologist & the surgeon that I had a HIGH TOLERANCE to pain meds and that I was concerned about immediate post-op pain. 

I didn't get into details; they seemed used to this and they "got it".   I didn't even tell them I was using or that I was on bupe for the one surgery.. altho' it was in my chart I suppose..  and I stopped taking them for a few days before... anyway, neither here nor there on that. 

Make sure to tell whoever is putting you under that you have a tolerance,the anesthesiologist has a LOT to do with pain control post-op, surprisingly, sometimes more than the surgeon.    They can give you something long-acting in your IV during surgery.   Anesthesiologists are all about pain control. 

I didn't have ANY trouble in the hospital w/pain control for any surgery when I was on stuff/had a tolly; in fact they tried different things (i.e. dilaudid didn't work so they tried morphine, etc.)   But I did tell them in advance about tolerance. 

HTH a little.

Now - post op might be a different matter but that's not what you're concerned about.  You'll probably be fine afterwards. 

[monkawat]

Thanks Nark/Suboxstitute.

I am having both a septoplasty and a turbinoplasty done at the same time. About 1-1.5 hours total which is great. My doc says she trusts her 2-3 anesthesiologists she uses. She only performs her surgeries at actual hospitals, not those BS outpatient surgical centers. Those places fucking suck. Plus a lot of em use nurse anesthetists (not happening- I will always happily pay for a board certified anesthesiologist for my surgeries- not worth the risk) and I don't play that game. Nurses here do not take offense please. I have simply worked with both as a surg. tech and would only allow a doctor to handle my anesthesia. With the amounts surgeries cost these days- there is no point IMO in cutting vital corners to shave a grand or so off your total bill.

She said she hand picks her anesth. docs and they're board certified and have all done general anesthesia and breathing tubes on people on methadone and other powerful long acting opioids with no problems. I'm a little freaked out about breathing tubes. I have had surgeries with it before but this time I am really freaked the fuck out. I know it is out before I wake up, but it still worries me.


I am gonna ask the anesth. if I can just have IV methadone only. I just want a shot or two immediately post op once I wake up if I'm in pain. Most people online say that's the most pain and by the 2nd or 3rd day they are only using motrin (only can use 800mg a day unfortunately bcuz of potential for bleeding risks- which sucks cuz ibuprofen is the shit for a lot of types of pain) A lot of videos of people post op on the day of and the 2-4 days after seem like a bunch of pussies (excuse my use of the term ladies). Having dealt with serious pain post op after having my entire glenohumeral joint reconstructed- I'm less worried about the pain then I probably should be. But then again, I was on dilaudid, morphine, and valium and maybe even fent during that time....so yeah.

But still- I want something given to me in the hospital when I wake up in pain. I don't wanna pay thousands of dollars for a surgery and have my pain go untreated. A lot of articles online (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892816/) say that it goes untreated for fear of inducing respiratory suppression or relapses. I hope that isn't the case. I will get a feel the day before when my anesth. doc calls me and I will switch to another one she has approved if I think he's gonna leave me in pain with it totally untreated post op.

[Narkotikon]

I realize opioid dependence and addiction are hot-topic issues these days, but I think doctors who knowingly and willingly let people suffer in pain (especially after a legit surgery) are unethical assholes.  They should be held accountable by the medical board IMO. 

I'm sure it happens all too often, but I don't see the harm in giving people pain meds IN the hospital.  It's a highly controlled environment, with staff dispensing the meds.  They can't knowingly foresee whether a person is going to relapse after being given pain meds.  And even if there were respiratory complication, you're in a freaking hospital!  That shit could be planned and accounted for. 

Now, for giving them pain meds to take at home, that's a little different.  But even in those situations, I still think everyone deserves adequate pain control, especially after surgery.  You simply shouldn't be allowed to perform a painful procedure on an opiate addict (or any addict, since they assume all addicts will use any drug, regardless of effect) and expect them to grin and bear it.  They should at least warrant pain control for the first few days home after a surgery. 

To leave a patient in pain is just barbaric IMO. 

Since the doctor said her anesthesiologists have performed on methadone patients before, I'm guessing you'll be in good hands.  It doesn't sound like they're inexperienced in this type of thing.  But, as you said, if you hear differently from them the day before during your phone call, definitely call the doctor back and demand another anesthesiologist.  I'd also tell the doctor your specific concerns, but that's just me.  I wouldn't want to risk it. 

Good luck, and hopefully you'll receive adequate pain control, especially in the hospital post-op. 

[LoneRanger7]

Hi Monk.  I had major surgery while on subs. I made sure everyone knew. The hospital called in a pain management doctor to work with me. Some of the nurses were real bitches about it, but that lady made sure I was ok, and didn't judge. Damn nurses tho, worse than fuckn pharmacists IMO. All I had to do though was page the pain doc and she'd help me out. I did ok, they controlled my pain. Then once I was out I just took care of things on my own. Sounds like you have a good doctor so I think you will be OK. Just have to advocate strongly for yourself and if the nurses are bitches about giving you your meds complain. I got one bitch in trouble bc she stood over me and basically told me to suck it up. I confronted her with the charge nurse in the room, she got TOLD and reassigned to another patient, which brought me joy because I am petty. Good luck!

[Sand and Water]

@LoneRanger--wow. Im sorry you had to deal with that. As an RN, it's my job to treat my patient holistically--it's most certainly not my role to judge a patients' perceptions of pain/etc. if I believe something is amiss and that for me to give a med is contraindicated, (could be warfarin, could be morphine; doesn't matter), I have a chain of command to follow in order to protect myself legally as well as ensuring the safety and continuity of care  of my patient.  Im glad you reported the nurse who told you to "suck it up".  SO not cool.

@Monk. I know how you feel about the breathing tube, Im the same way-- obviously they need access to an airway as they'll be working on your nose etc, but I hate the idea too!

As for pain control immediately post-OP, it doesn't sound like you'll have to worry. Typically, the anesthesiologist calls the shots (pardon the pun) right after due to the anesthetic and in consultation with your doctor, but you'll be monitored-- heart rate O2 sat etc, and usually your pain control will be tailored to what meds you're currently taking. Since you're NOT opioid naive, you'll likely receive prn IV short acting meds in doses w/your tolerance in mind, to keep you comfortable.  I hope everything goes smooth as silk and you're breathing easy soon!

[monkawat]

@LoneRanger--wow. Im sorry you had to deal with that. As an RN, it's my job to treat my patient holistically--it's most certainly not my role to judge a patients' perceptions of pain/etc. if I believe something is amiss and that for me to give a med is contraindicated, (could be warfarin, could be morphine; doesn't matter), I have a chain of command to follow in order to protect myself legally as well as ensuring the safety and continuity of care  of my patient.  Im glad you reported the nurse who told you to "suck it up".  SO not cool.

@Monk. I know how you feel about the breathing tube, Im the same way-- obviously they need access to an airway as they'll be working on your nose etc, but I hate the idea too!

As for pain control immediately post-OP, it doesn't sound like you'll have to worry. Typically, the anesthesiologist calls the shots (pardon the pun) right after due to the anesthetic and in consultation with your doctor, but you'll be monitored-- heart rate O2 sat etc, and usually your pain control will be tailored to what meds you're currently taking. Since you're NOT opioid naive, you'll likely receive prn IV short acting meds in doses w/your tolerance in mind, to keep you comfortable.  I hope everything goes smooth as silk and you're breathing easy soon!

Hey thanks S & W. I don't want any meds to take home. I have no problem using OTC meds and my normal methadone daily dose to control my pain after I get out of the hospital. I just don't wanna suffer when I wake up from the anesthesia, ya know? I was wondering- they can give you IV methadone, right? That might work really well for me if it is available in most hospitals.

If I can gut it out even then- I will- but if not- I'm hoping I get at least some help on their end.

--------------------------

BTW Y'all- As long as the doctor approves it, I will start getting a Saturday take-home as well as my normal Sunday one beginning next Friday!

[Griffin]

That is great news monk how long did you have to wait to get that first take out? How long until you get your next one? My clinic gives you Saturdays after 90 days of no missed doses, appointments, and clean UAs. You get phase 2 30 days after that and phase 3 60 days after phase 2. I'll get a take-home Wednesday as well as Saturday starting Nov. 1st. It makes a huge difference even though it is just one day.

 At my clinic Saturdays are the busiest because everyone gets a take home and they only have 3 hours for dosing instead of 6. It is nice to not have to go in early on Saturdays and deal with the longer waiting times. This is also the last month that I have to do a group session. If you are on daily's you have to do 2 groups and a counseling session a month. Phase 2 you have to do one group and one counseling session. After that you have to do either one group or one counseling session. I do the counseling session because my counselor is really cool and I get to pick the day and time I want to do it.

What are the requirements at your clinic for getting take outs and how often do you go up? When I hit the 6 month point I will only have to go Monday, Wednesday, and Friday. At 9 months its one week at a time and a year is 2 weeks at a time. I will be on phase 3 at christmas so I will only be doing 3 days a week. I have always wondered what the requirements were at different clinics. They just switched the policy for take outs here when it became free for medicaid patients. When I first started you weren't required to take any groups and could get your Saturday take home after 30 days.

[Narkotikon]

I think it's kinda fucked up that each clinic has its own rules regarding take-homes. 

When I was at the clinic, it was incredibly strict.  You had to go 90 days totally compliant (good UA's, counseling, no missed days, etc.) to get 1 take-home.  Another 90 days for 2, another 90 days for 3, etc.  You could get up to 28 days worth of take-homes, but that would take years. 

I couldn't even get one take-home, b/c I missed a day every 10 days or so.  At that point, I was also going home a lot.  So some days when I wanted to miss, I wasn't even in town.  I tried to get them to let me guest dose.  They said it would okay, but I highly doubt they even sent the paperwork.  I gave them like a month's notice, and all they kept saying was they never heard back from the clinic in Cincinnati. 

I hated that place, and I hated being on methadone.  Other people seem to do much better on it. 

[monkawat]

Little (actually big) update:

1) My wife lost her job. The new guy who bought her clinic a month ago laid EVERYONE off including the fucking dentist this week. I kept it private and attempted to downplay the situation on here for her privacy's sake (she reads all my posts about her/our living situation cuz she likes to get an idea of what's going on with me) until now because they first cut her to part time earlier but her last day was Monday..

2) I got a great raise because my mom (remember she is friends with the owner of the little family operated business I currently work at) called the owner and she bumped my title up to evening assistant manager. I now make around 1.5 times my old salary. I was making 10/hr as a normal employee and my mom explained that my wife lost her job and wants to switch to a full-time mom type lifestyle and get into a work-from-home type gig once she graduates this year. One call, a week of working there, and a family tie changed everything for the better...insane yet amazing. I'm still in total shock y'all........

I now make 16.70 an hour (effective Monday) and will work 35 hours a week, Tuesday-Saturday from 1-8pm. I can provide for us on my own now. I'll make around 32k a year before taxes. Not a lot to some people on here I'm sure- but it will work until I get graduated with my undergrad and get my master's in addiction counseling and go to work as a LCDC. My boss called me this AM and assured me I'll have a job here until I no longer wish to work there. This business makes superb profits daily and has no worries about going outta business. Plus, we are a very small operation with an amount of employees one can count on one hand so each of us are vitally needed.

3) I went up to 60mg today. I feel good. This may very well be my long term dose. I'm actually fairly sure that 60-65 is perfect ATM, for at least 3-4 months at least.

4) My mom is making relationship progress with me. She proved it by taking the initiative to call my boss and get me that raise since she and the owner are friends and were once pseudo-business partners too. She said if I have to be on MMT she hates it, but will accept it to maintain our relationship as best we can. She and I both know it won't be quite right, but we're making at least some progress y'all.

-------------------------------------------

So yeah, my wife doesn't have to work now until she gets her new bachelor's degree and can work in the field of graphic design that she's long dreamed about getting into. She only wants freelance work from home type gigs and I would love that for her because it's what SHE wants and that is all that matters to me. I'm so happy for her. She didn't care for her peers but her dentist was a great person. The dentist is moving out of state to open up their own clinic and I'm glad for them. They treated her right. They deserve it.

Anyhow- things are looking up again- my life is a real rollercoster lately. I still can't believe that in a matter of weeks the new owner of my wife's old dental office bumped her from full time, to part time, and then fired her. What a piece of shit...Whatever, it's all gonna work out and happened for a good reason IMO!

I'm so happy my mom was able to do that for me. Showed her heart is still in the right place. One phone call and my life situation just got 300 times better! I'm eternally grateful to her for this.

[suboxstitute]

Good for your mom!   Amazing what your wife has been through at work; crazy.  Can she pick up part-time, fill-in work in her current field until she has her new degree?  A friend of mine does that and makes a really good hourly wage.

[monkawat]

Good for your mom!   Amazing what your wife has been through at work; crazy.  Can she pick up part-time, fill-in work in her current field until she has her new degree?  A friend of mine does that and makes a really good hourly wage.

She really is tired of working to be honest. She wants to be a stay at home mom now. She'd do that if I lost this job- but I highly doubt that'll ever happen considering who my boss is and their relationship with my family.

She is excited to start freelance work from home only type work projects once she's degreed in the field of GD.

We are going from the 60k's to 30'sk but we've lived on less and I also get military related money for being disabled at a high service connected % plus I get combat related special compensation pay too. We'll be in the high 30s/low 40s with that added.

[suboxstitute]

Yeah it is surprising how little you can live on when you have to, especially when it is temporary.  I lost a really, really good job due to drug use etc. 8 years ago and I have never gotten anything comparable... and we're able to make it on a lot less, although my husband wishes it weren't so (he got used to my income).   I don't have my whole life ahead of me like you guys do, though, so I know you'll make it.