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After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

nytimes.com

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Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#291

Post by Johnny555 »

refurb wrote: post #281
Johnny555 wrote: post #233

Earlier quoted context omitted.

My point is that the doctor said she she not only needed a week's worth of vicodin to manage the pain for recovery, but she'd likely need more. Yet she really only needed zero vicodin. Just like the person in the NYTimes article. But thanks for your illuminating anecdote of someone who had some procedure and ignored some medical advice and took something else than the something that was prescribed.

Why does it surprise you? The doctor is probably basing his/her advice off what they most commonly see. Are you saying your doctor should have known in advance your wife was an edge case with high pain tolerance?

Well no, I think her doctor is basing his/her advice on what he typically does, and what patients expect (see the original NYTimes article where the author was adamant that she needed stronger painkillers, but turns out she didn't).

The dangers of opioids are well known, and it turns out that the evidence for opioids being the best option to be routinely diagnosed is shaky. From the article I linked to:

The authors of the new trial, led by Andrew Chang of Albany Medical College in New York, note that common medical practice and guidelines, including those championed by the World Health Organization, suggest that opioids are simply more effective at treating acute pain than non-opioid medications—or combinations of them. Yet, the data backing that is shaky.

So maybe, more discretion on when and how many opioids are prescribed would be better for everyone.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#292

Post by seanmcdirmid »

vanderZwan wrote: post #167
jjeaff wrote: post #136

Earlier quoted context omitted.

I wonder if that doctor has ever had major surgery himself and been told not to use painkillers? Even if that is the case, pain seems to vary greatly in how it affects people. I would be very hesitant to tell someone that they should just let the pain "guide" them, because I have no idea what it is like for them.

> I wonder if that doctor has ever had major surgery himself and been told not to use painkillers? Since when is that a requirement for knowing what is best for your patients? The doctor is basing their judgement on current consensus within their field, which hopefully involves careful studies.

Empathy from the doctor is always nice, not just adherence to the current dogma that flips back and forth every decade or so.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#293

Post by jjcm »

sundvor wrote: post #223
dpflan wrote: post #67

This passage feels like it is premise of the article; the author eventually comes to terms with her tea-sipping and resting as recovery, and this doctor explains the reasoning behind the medical decision-making which is very clear (and mindful/thoughtful) I think. “To paraphrase him [German anesthesiologist], he said: ‘Pain is a part of life. We cannot eliminate it nor do we want to. The pain will guide you. You will…

The US mind programming of painkillers / drugs as an answer to everything is killing you by the thousands. I'm glad Australia is taking steps to avoid falling into the same pit. Sometimes, and at least on scale, a dose of HTFU can be much, much better.

On the flip side, Australia prescribes antibiotics like they're candy. I'm always amazed at how easy it is to get a flight of them here.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#294

Post by clwk »

jjeaff wrote: post #136
dpflan wrote: post #67

This passage feels like it is premise of the article; the author eventually comes to terms with her tea-sipping and resting as recovery, and this doctor explains the reasoning behind the medical decision-making which is very clear (and mindful/thoughtful) I think. “To paraphrase him [German anesthesiologist], he said: ‘Pain is a part of life. We cannot eliminate it nor do we want to. The pain will guide you. You will…

I wonder if that doctor has ever had major surgery himself and been told not to use painkillers? Even if that is the case, pain seems to vary greatly in how it affects people. I would be very hesitant to tell someone that they should just let the pain "guide" them, because I have no idea what it is like for them.

I have a very relevant anecdote:

My grandfather was an open-heart surgeon. In the days following surgery, he would always insist that his patients get up and take a short walk. They would not want to, but he insisted that this was an important and valuable part of recovery (in several dimension) and that they needed to push past resistance and force themselves to do it.

Later in life, he underwent a surgery requiring general anesthesia and found himself in the same position. He said, "If I had known it was like that, I would not have made them do it."

So I think the surgeon's personal experience of the situation is -- in fact -- highly relevant in practice, even if not in theory.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#295

Post by mratzloff »

kurthr wrote: post #236
dpflan wrote: post #143

Earlier quoted context omitted.

I agree that there is no "one-size-fits-all" medical solution, but perhaps having this base-line allows building up when discussed with one's doctor - the article does not discuss this post-operation re-negotiation of how to manage the pain. Perhaps some HNers have experience with a similar situation that they could share.

I have had my teeth filled by a dentist that didn't "believe" in novocaine. Luckily, he died before I had any significant issues, and I had a later dentist that did it correctly. If you are doubtful of the usefulness of pain management while receiving a filling, you can try it yourself. I'm perfectly understanding the concern for long term morpohine derivatives for treating post-surgical pain (although there are plen…

I have had my teeth filled by a dentist that didn't "believe" in novocaine.

I would have asked if he believed in repeat business—if so, give me the novocaine.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#296

Post by syshum »

rsynnott wrote: post #242
vinay427 wrote: post #78

Earlier quoted context omitted.

Not to mention, there are plenty of safer viable alternatives. Is ibuprofen or acetaminophen as effective at preventing pain as oxycodone for most people? Probably not, but they're good enough for most wisdom teeth extractions, a common operation that unfortunately results in many opioid addictions. I had some particularly difficult extractions so I took some ibuprofen for a few weeks to make eating manageable, but a…

Do dentists in the US actually give out opioid painkillers for wisdom teeth extraction?

10-12 years ago I would get small dose (5mg or less) Hydrocodone for an infected tooth or pre-root canal

Today it is just high dose ibuprofen, luckily I have pretty good dental insurance now (did not in my late teens and early 20s) so I do not need the dentist for anything more than cleanings but I do think my luck that I went through that pain back then instead of now, taking high does IB would not have let me sleep back in those days as I had to wait for the Antibiotics to kill the infection before they could remove or fill the tooth, that took anywhere from 2 to 7 days (had 2 infected teeth a couple years apart, I was hard on my teeth in youth, a lesson learned the hard way)

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#297

Post by underwater »

jjcm wrote: post #293
sundvor wrote: post #223

Earlier quoted context omitted.

The US mind programming of painkillers / drugs as an answer to everything is killing you by the thousands. I'm glad Australia is taking steps to avoid falling into the same pit. Sometimes, and at least on scale, a dose of HTFU can be much, much better.

On the flip side, Australia prescribes antibiotics like they're candy. I'm always amazed at how easy it is to get a flight of them here.

Compared to where? I found US doctors much more likely to prescribe them than Australian doctors.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#298

Post by syshum »

fastball wrote: post #288
syshum wrote: post #188

Earlier quoted context omitted.

Easy, once there is even a "baseline" of health services that becomes a platform to start restricting and taxing other things deemed to effect health. Things like smoking, Soft Drinks, high fat or high sugar foods, exercise mandates, and a variety of other public policies around "health" become justified because of public funding for healthcare. Now I am sure most people including you are going to agree with these pu…

Smoking is not illegal in most places, and realistically there is an argument that it should be (at least in public) because you don't have a right to expose other people to your habit. I don't know a single country that has socialized medicine that has illegalized high fat/sugar products or has mandated exercise. If you could point me towards instances where single payer healthcare is being used to outlaw/force such…

Of course they do not make it illegal, they have learned their lesson from prohibitionist policies on drugs, I can not image the horrors of human rights abuse and violence making candy illegal would bring

They do however regulate and tax to the extreme, For example, how many restaurants in socialized care nations have free refills on soda? How many places in socialized care nations can you buy candy by the pound with just normal sales tax..

>>at least in public

What the hell lets open up another can of worms... That would depend on how you define "public". See in recent years in the US there have been many laws passed the prohibit smoking in businesses that allow general consumer access, incorrectly called "public" businesses. I disagree with these laws as it should be up to the owners of the establishment if they want to allow or disallow smoking in their place of business. For example if a Bar wants to have smoking and you do not like smoking you are free to no go to that bar. However many people in the US believe it is their right to tell that business owner what his policy is, and they have a right to assert their dominance and their view on smoking upon others.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#299

Post by mcbits »

wallflower wrote: post #160
rascul wrote: post #125

Earlier quoted context omitted.

Could you elaborate on how there's no such thing as a former addict? I'm curious, as there are a couple substances I used to be addicted to but am not any longer.

Addiction is not just a chemical dependency. The context in which you use the substance matters. Your personality and past behavior matters. This friend, in particular, took partying to an extreme. Not one drink but twelve drinks and blackout situations. Not just drinks but drinking and drugs. A lot of people who do not know her history will innocently say something like "We're going to happy hour" or "Just have a dr…

That may be 100% true for her, but to say there is no such thing as a former addict, it would have to be true for everyone, which it isn't.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#300

Post by crx087 »

refurb wrote: post #290

"Time is a flat circle. Everything we have done or will do we will do over and over and over again- forever." For those of you who were around in the late 80's early 90's. Today's moral panic about opioids will give you a chuckle. Back in the 1980's opioids were the devil and many patients, even in hospice, had undertreated pain due to fear of addiction. In the 1990's it dawned on doctors that maybe they should be a…

In much of the conservative south, the stigma surrounding opioids never left, and economically underprivileged people have been suffering ever since.

Over the past decade, one of my longer-haired male family members has on separate occasions been forced to endure sizable fractures and even orthopedic debridement without analgesics.

The greatest irony is that tightened controls only seem to exacerbate substance abuse in communities with epidemic problems.

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