14th November 2005
Hi D Random, I have to agree with marcia, After 9 months she should be very well accomadated to any respirtory suppresive side effects from a steady dose of opiates. If she has had to steadily increase the dose it might make a little more sense if after her last increase this became a problem. But any chest surgery means using the chest muscles to breath. If that alone causes pain, an ordinary response would be to breath more shollow and prevent pain from taking deep breaths. This can put her at risk for respitory infection, not expelling phlegm "coughing would cause pain" so she tries to supress the cough which over time will deminish lung capacity. Does she have a respirtory therapist or still use one of the repirtory excercisers they give you post op.
There are other option like Long acting morphine, methadone, Duragesic patches "fentanyl", but Ultram is nowhere near the strength of Oxycodone. You also have to consider the need to slowly taper her off any pure opiate because after 9 months some physical dependence would be expected meaning she might experience some withdrawal symptoms should she they decrease her dosage too fast.
Please don't confuse a normal physiological response "dependence" with addiction. Adiction means a psychological reason to ABUSE medication/drugs/alcohol despite potential/actual harm. I can't imagine anyone that has had to use pain meds to manage pain for that length of time not developing some physical dependence. It doesn't mean she needs to go to rehab or be detoxed because they will treat her just like any drug addict that uses any drug recreationally.
Rehab is the wrong place for someone discontinuing pain meds after major surgery or a long recovery. A slow comfortable taper is just as effective because there are no psych issues to deal with, other than how to live the rest of your life with pain or disability if she's not completely cured by surgery.
She may need pain meds for the rest of her life and physical dependence is just one of the high prices we pay for trying to live a reasonably normal life with great adversity.
As Marcia said, without the complete HX it's hard to make a suggestion but she really needs to discus this problem and be evaluated by her doc for deminished lung capcity, infection or if shallow breathing is just a result of invasive chest surgery or an instinctive defense mechanism to prevent additional pain. She may need continued respirtory therapy, oxygen or PT to help increase her lung capacity.
It's easy to blame the drugs from a surgeons standpoint but what happens when you still have problems once the drugs are discontinued and you still have the pain and no means to manage it?
Good luck to you both, Dave
There are other option like Long acting morphine, methadone, Duragesic patches "fentanyl", but Ultram is nowhere near the strength of Oxycodone. You also have to consider the need to slowly taper her off any pure opiate because after 9 months some physical dependence would be expected meaning she might experience some withdrawal symptoms should she they decrease her dosage too fast.
Please don't confuse a normal physiological response "dependence" with addiction. Adiction means a psychological reason to ABUSE medication/drugs/alcohol despite potential/actual harm. I can't imagine anyone that has had to use pain meds to manage pain for that length of time not developing some physical dependence. It doesn't mean she needs to go to rehab or be detoxed because they will treat her just like any drug addict that uses any drug recreationally.
Rehab is the wrong place for someone discontinuing pain meds after major surgery or a long recovery. A slow comfortable taper is just as effective because there are no psych issues to deal with, other than how to live the rest of your life with pain or disability if she's not completely cured by surgery.
She may need pain meds for the rest of her life and physical dependence is just one of the high prices we pay for trying to live a reasonably normal life with great adversity.
As Marcia said, without the complete HX it's hard to make a suggestion but she really needs to discus this problem and be evaluated by her doc for deminished lung capcity, infection or if shallow breathing is just a result of invasive chest surgery or an instinctive defense mechanism to prevent additional pain. She may need continued respirtory therapy, oxygen or PT to help increase her lung capacity.
It's easy to blame the drugs from a surgeons standpoint but what happens when you still have problems once the drugs are discontinued and you still have the pain and no means to manage it?
Good luck to you both, Dave