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Author: Subject: the lowdown on vicodan and morphine (pain mgmt.)
BajaBlanca
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[*] posted on 11-20-2015 at 04:26 PM
the lowdown on vicodan and morphine (pain mgmt.)


This information is from the O'Grady blog and it is really good to know here in Mexico:



Pain Management in Mexico

on November 20, 2015


As a result of the circumstances leading up to my recent spinal surgery, I got to find out first hand how advanced pain management works here in my adopted country of Mexico.

In the planning stages leading up to my abdominal surgery 6 months prior, I researched pain management options in Mexico, both on-line and during my in-person consultations with various doctors. I asked each of the potential surgeons if they prescribed narcotics—i.e. morphine, vicodin or their equivalent—for post surgery pain and recovery.

Each time I was answered with a vague, noncommittal “well, not exactly”, and that there is a “concern of addiction” with meds of that class, but that narcotic “type medications” would be available and sufficient for my procedure.

Hmmmmm…when I asked what the names of these meds were, I was told that a combination of paracetamol (tylenol), non-steroidal anti-inflammatories and other non-opiate “analgesics”, such as “ketoralaco”— which is used for light to moderate postoperative pain—would be used. I didn’t think that was going to cut it for major abdominal surgery.

This issue was significant enough to me that it had me seriously leaning towards returning to the States for the surgery, even though none of the other logistics of traveling there were convenient, affordable or logical.

I was disappointed and concerned to find out that opiate-type medication was not the norm for postoperative pain here in Mexico, let alone for other ailments qualifying for “advanced pain management”. I was having visions of waking up from the surgery in agonizing pain and suffering through the recovery. Having already been through two other abdominal surgeries in the States, I knew first hand the potential for significant pain and how important it was to moderate it and reduce it to aid in the healing process.

Some people would state, “oh, narcotics are available, you just have to find the right doctor”, never really quite understanding what that meant, where to go, who to ask for, and it certainly was never offered during the pre-surgery discussions.

Well now I know, now I have the information.

“Finding the right doctor” in my case, prior to my spinal surgery just 2 weeks ago, meant being personally escorted by my two physical therapy doctors—Dra. Rosario and Dra. Karla—straight to the office of Dr. Paulo Gonzaléz of Querétero. Dr. Paulo is an anaesthesiologist, angológo and paliativista—a doctor that specializes in the pain management of advanced conditions and is licensed to prescribe opiates, like morphine.

My first attempt at doing an MRI on my spine pre-surgery the Friday before my Tuesday surgery failed for I was not able to lie on my back for the required 45 minutes due to the excruciating pain AND the fact that I am very claustrophobic.

The MRI was rescheduled for that upcoming Monday under sedation. Dra. Rosario knew that the weekend ahead would be a long and literally unbearable one for me without some type of pain relief from the two discs that were severely compressing my nerves and rendering me semi-paralyzed.

We arrived at Dr. Paulo’s office and without further ado, my husband and all three of the doctors helped me up onto the treatment table. Dr. Paulo immediately got an IV concoction of morphine and some other goodies going through me and for the first time in a very long six days, I at last had a significant break from the pain. The tears flowed profusely.

Dr. Paulo monitored my vital signs throughout this whole process, asked me every few minutes how I was feeling, and adjusted the meds as needed. I think I was able to take my first full, deep breath since the discs went out.

He wrote me a prescription for a variety of medications including morphine to use while waiting for my Tuesday surgery and as needed for post-surgery pain. To get these prescriptions filled, we needed to go to a Farmacia Especializada (a specialty pharmacy), where my husband Frank needed to show his ID and fill out and sign all sorts of paperwork.

And so yes, narcotic-like pain management is available here in Mexico, it is just a matter of finding the right doctor and the right pharmacy.

And as it is said, experience is the best teacher and as a result of this very painful experience of having two of my vertebrae discs go out, I got to find out first-hand just how advanced pain management does work here in Mexico!

If you have any questions or need more clarification, feel free to leave me a note in the comment section below and I will get back to you ASAP.

Cheers,

∼Katie
.- See more at:

http://www.losogradysinmexico.com/pain-management-in-mexico/...




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[*] posted on 11-20-2015 at 05:21 PM


Thanks for going through the pain and for this report, Blanca.

Very Useful!!!




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[*] posted on 11-20-2015 at 07:32 PM


Katie,

I had my L5-S1 vertebrae fused 2 months ago up here in Boston, and my biggest problem was knowing how soon to get off of the opiates. Given the overdose problems here in New England, you would think they would be a bit less liberal with the meds. As it is, I weaned myself sooner than expected, and brought 120 tablets of Oxycodone back to the pharmacy. The medication was absolutely essential for the first 2 weeks after the surgery, but a huge obstacle after that. I'm glad to hear that you got relief after your surgery - I truly feel your pain!

Paul




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[*] posted on 11-21-2015 at 06:30 AM


Hi Paul,

I feel for you, believe me... The pain from a spinal injury is no walk in the park. Fusing wasn't an option for me and I have 2 silicone spacers in between L3 & L4 and L4 & L5.

The meds.....ahhh, yes, a double-edged sword indeed. I took the prescribed morphine the week before the surgery and then only 2 days post surgery as the side effects were so horrible for me. I opted to do the rest of the recovery without and although it has had its moments of significant pain, I am not dealing with the nasty side effects of the morphine. In fact, when I see my surgeon this Saturday I have a nice big bag of meds to donate.

I wish you all the best in your recovery.

Cheers,

Katie O'Grady




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[*] posted on 11-21-2015 at 07:15 AM


Katie,

Thank you for writing back! It's interesting how every diagnosis can be so different. I first injured my back nearly 30 years ago and went to great lengths to avoid surgery. Eventually there was nothing left of the L5/S1 disc, at which point even a chiropractor and a surgeon known for his use of microsurgery recommended fusion. Now the TSA will get a surprise every time they put me through the X-ray machine!

I hope your pain is manageable without the meds. I only had morphine in the hospital and it turned me into a zombie. Oxycodone and Oxycontin had me on the nods and had other side effects that were pretty hard to live with. I honestly don't know how anyone could become addicted to the stuff.

In any case, it's encouraging to hear that you were able to get a high level of surgical care in Mexico, although it seems that you had to do a significant amount of research to get it. In a way it's fortunate for me that my surgery took place now, a few years before retirement, but I'd be naive if I thought that my need for critical care was over, and that I'd always be in a part of the world with no shortage of doctors. Very sobering - in more ways than one!

I hope your recovery is speedy, and that you're back to 100% before you know it. You and your lovely family deserve the best.

Paul




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[*] posted on 11-21-2015 at 03:28 PM


I had my right knee replaced Sept.11th after an X ray indicated the knee was severaly damaged. I commented that them knee was not that much
of a bother to me however I have had a limp for years and the leg was bowed out slightly but my hips gave me problems. So the knee was replaced and my leg is now straight. However the pain in my hips is still with me and in fact has increased. X rays indicate I need to have my hip replaced.
I am being rebuilt!




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[*] posted on 11-21-2015 at 09:33 PM


You will be a bionic hipster.
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[*] posted on 11-21-2015 at 09:54 PM


Quote: Originally posted by bacquito  
I had my right knee replaced Sept.11th after an X ray indicated the knee was severaly damaged. I commented that them knee was not that much
of a bother to me however I have had a limp for years and the leg was bowed out slightly but my hips gave me problems. So the knee was replaced and my leg is now straight. However the pain in my hips is still with me and in fact has increased. X rays indicate I need to have my hip replaced.
I am being rebuilt!


....had my L knee done 40 days after you!

....as far as pain meds go,,a doctor described it all very well when he talked of there being 'layers' of pain meds,,,
Baseline is Tylenol's and equivalent,,,and stronger anti-inflammatories such as Naproxen(only once you've finished blood thinners!). These have a good baseline painblocker effect and are used alongside the other stronger layers,,but be aware whether the other meds also have Tylenol--you don't want to go above 3000mg/day.

. Immediately post surgery there's morphine and Oxy,,,I feel the same as above,,,got off them after 1/3 perscription,,,'nuff said.
. The 'mid-layer' is that of Tylenol 3's and equivalent...I really dislike T3's,,,but another similar strength one,,known as TRAMADOL seemed to be effective,,but left my head clear compared to anything else. Tramadol seemed to be something of a favorite at arthritis pain management classes.

. It would be interesting to hear an actual doctor's perspective,,,any 'round here? :rolleyes:

.

[Edited on 11-22-2015 by micah202]
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[*] posted on 11-22-2015 at 08:12 AM


wow....lots of input and Katie wrote for the first time! welcome to the playground.

Many years ago I had major surgery in the US and was told that morphine was the med given to be via IV and that I was to push the button anytime I felt pain enough to do so. Well, I was groggy after the surgery but was in a panic thinking that I could become "addicted" and stayed in pain most of the time.

Afterwards, I mentioned this to the doc and he said I shouldn't have worried - they control the amount so that there could never be an overdose or reach addictive levels.





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[*] posted on 11-22-2015 at 09:59 AM


Thanks for posting the report, Blanca. Great and useful thread.

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[*] posted on 11-23-2015 at 07:24 AM


I know,right? who knew there was a special doctor just for handing out the required strong pain medications.



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[*] posted on 11-23-2015 at 08:30 AM


Exactly Blanca,

In fact it was the Angólogo that instructed me to continue to take the morphine and the other meds he had prescribed me, post surgery. The surgeon was not on board with the morphine and only had me on some more mild pain relievers via my IV. I only opted to take the morphine 2 days post surgery but then stopped as the side effects for me were so horrible.

But yes, now I know how the system works, in part, and at least here in this region. I know many have had different experiences, but this was mine in 2 major surgeries here in Mexico. Believe me, had I known what I know now, I would have been better prepared for the abdominal surgery I had 6 months prior.

Live and learn....:)




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