Question:
Student nurse needs help with your knowledge about pain medications
I am a student nurse graduating as an RN in May of this year. I am currently in a management clinical on a renal/oncology floor. I have been very touched by your stories of survival, and I have seen some problems on the unit where I am currently working. As part of my curriculum, I am required to write a paper based on a problem that I see. I have noticed that there are several bariatric patients that had surgery many years ago who are now on our floor for either kidney problems or cancer (something usually unrelated to having bariatric surgey). There are these new extended-release pain medications that doctors and nurses are being pushed to use on all patients in order to have continuous pain relief. I know from clinical experts that this medication cannot be absorped properly in patients who have had bariatric surgery, yet doctors are prescribing them and nurses are giving them!! Patients are not getting adequate pain relief and nobody is critically thinking that the medication goes out of their bodies before they have a chance to work! Help me help others by finding out WHAT YOU KNOW about these medications. Ms contin, oxycontin are a few. I want to know your experiences, or your knowledge about whether anybody has ever told you not to take them becasue they will not work!! Thanks so much-this paper could go on to get published and make a huge difference if it is good. Help me help you! — studentnurse (posted on February 23, 2006)
February 23, 2006
a friend died from oxycontin - my sister is fully addicted and I cant stand
what that medication does to her - its like she is on pure heroin....the
doctors that I have been to here in CA - rarely perscribe - but there in AZ
- its no problem - my sister is a mess and I blame that medication / Sonya
[email protected]
— Sonya Galindo
February 23, 2006
Right after they disconnected my pca machine, I began taking Tylenol with
codeine and it did the trick. I have not had to have anything stronger for
pain, although I do not suffer with menstral cramps that some women have.
The absorption or malabsorption varies from patient to patient and so
far, my thyroid meds have NOT had to be changed since my bloodwork is
coming out normal, so they are being absorbed just fine. Tyleno also works
for headaches, so it must be absorbed just fine, also.
I have avoided NSAIDS and understand that even though they may work
better for pain, they can cause ulcers and that most people are unaware of
the damage they can cause until long after it's established. In other
words, they take motrin because it doesnt bother them, but it may be
hurting them without them knowing it until it has to be treated.
— LauraA
February 23, 2006
Please email me privately at [email protected] and I will share my
experiences with chronic pain as I would rather not post it in a public
forum.
— georgiacarol
February 23, 2006
My surgeon told me that I could not take any drugs that are timed released.
Hope that helps you with your paper. I do know that I have liquid tylenol 3
with codine and before my surgery I could take 3 to 4 tylenol 3's and they
wouldn't do anything...now I take one dose of tylenol 3 with codine liquid
and it knocks me out LOL.
— HubbysBrat
February 23, 2006
Before surgery I took approx. 8 advils at a time for pain due to doctor's
not wanting to perscribe anything stronger or for only short periods of
time and then wanting me to come back for a doctor's visit and another
perscription more money in there pocket. When I go to the doctor I let
them know right off that I have had the surgery and what I can and cannot
take. I am very proactive about my health care and maybe these individuals
need to be advised to do the same and maybe they have not let anyone know
of their surgery status because they have forgot the rules this far out.
Those would be things that need to be addressed. Everyone should know that
doctor's spend a fraction of the amount of time with a patient and the
nurses hear more than the doctor does because of time issues. If a doctor
is unaware it needs to be documented in the patients history and chart in
case the doctor is unaware.
— 1968 Loser
February 23, 2006
I was prescribed Lortab due to pain from what was later discovered to be an
ulcer. I took this medication for 6 months, and at times would take 3 at a
time. (not good, I know) I never became addicted, honestly. :) About a
year later I was prescribed Oxycontin for a different pain. Even though
that pain killer scared me to death the first time I took it, I continued
to take it because I was in a lot of pain. I took it for about a week
before I noticed the addiction symptoms...craving it. I've never
experienced any sort of addiction and after taking Lortab for so long and
not getting addicted, couldn't believe how strongly the 'need' for
Oxycontin was. I quit taking it immediately. However, it did get rid of
the pain. :D That's my only experience.
— RebeccaP
February 23, 2006
these med have tracers, blood/urine tests for levels of the meds in the
system on the wls patients would be a clear indicator if they are being
absorbed or not.
— walter A.
February 23, 2006
PLease email me privatly also, as I have had a extreme battle with pain
medication and absorbtion also
[email protected]
— leahrobinson
February 23, 2006
Melissa,
Hi, i am a student aswell and a post -op gastric bypass patient as well.
You are a good observer. and it is good to know for myself and for the
future.
— evienicole
February 24, 2006
YOU ARE ABSOLUTELY RIGHT! Isn;t it horrible that people who are suffering
can;t get proper pain release because of 'marketing' by drug companies!
It's a farily standard instruction from any bariatric surgeon that you not
take time released medications, as you will not receive the full benefit.
I've been instructed that if I'm not sure about a medication, perhaps
because of it's size or delivery method, I should put it in a glass of
water and wait 10 minutes. If it's not fully dissolved, it't probably not
going to work fully/properly. If you look up the physiological changes
that are made to people during bariatric surgery (NOT lap band) you can
clearly see WHY they can not possible work. Our digestive (and therefore
absorption) process is radically altered. I was told by my PCP and my
surgeon that I should never accept time released medications from any
doctors and that I should always ask if there is a liquid or alternate form
of any pill available that I am perscribed. I was told by my surgeon that
most doctors don't take this into consideration, so I would need to be a
'smart consumer' and by my own advocate. Hope this helps you! Good luck
& congrats on spotting a problem that can easily be remedied, but also
is easily overlooked. This WILL make a difference to patients.
— LMCLILLY
February 24, 2006
Hi Melissa,
I too am a student and a mutliple baratric surgery survivior. I know
through my own experiences that pain meds are not as effective after
surgery...especially my last surgery to a gastric bypass. I noticed within
a few weeks that it took a higher dose than previous used prior to surgery.
I do know that also over time that the intestines do regain some of their
ability to absorb medications and food as they adjust to the malabsorption.
I am glad to see that someone is tackling this issue....good luck with your
paper!
Dawn
— dawn1234
February 24, 2006
If you can get any studies from the "cliical experts" that show
that post WLS (and that would include DS as well as RNY) do not absorb
extended release medications, I would really like to see them. The idea
that extended release meds gets repeated so often it becomes
"truth" but I have never seen any definative studies to prove
this.
Good luck with your career in nursing;I have been a nurse for 29 years!
I would also like some definative proof we post RNY people can
"never" take NSAIDs again. I am not talking anecdotal evidence
(in other words, "I took ibuprofen and I got a hole the size of a
Volkswagen in my stomach.", or "I know someone who knew someone
whose third cousin's hairdresser's daughter took Motrin and died.")
Now, many will say "my surgeon said....." and I would say,
"My surgeon said that it is possible to take NSAIDs after RNY."
(He is a professor and head of the department of endoscopic and
laparoscopic surgery at a major teaching hospital.)
— koogy
February 24, 2006
I will be quite honest I do take time release meds and I see absolutely no
difference in the effect whatsoever. I agree with what Susan said below.
— **willow**
February 25, 2006
There are pain medicines that are not absorbed through the GI tract. If
you have wls patients on your floor who aren't getting relief from oral
pain meds (or anyone, wls surgery or not, who is not getting relief from
oral meds), why don't they just switch people over to another route besides
oral?
If someone is in the hospital, why not give them IV morphine or IV
whatever..... or IM injections. There are lots of options.
Duragesic and Actiq are formulations of fentanyl and neither require the GI
tract for absorbtion. Duragesic is a patch that gets worn for three days
at a time. Actiq comes as a lozenge on a stick. You put it in your mouth
and the medicine is absorb by the mucus membrane.... the gums, tongue, and
cheek.
Good luck.
— mrsidknee
February 25, 2006
I have taken the same doseage of Vicodin for about 17 years now. While not
addicted, I am dependent on it for my chronic pain. I have found since my
GBS I don't absorb it nearly as well. I have even seen them whole in the
toilet, so it explained why I wasn't getting any relief. My experience
with it is now this: I cut them in half, and take them twice as often,
crushed. I sprinkle them on the back of my tongue...I'm not pain free by a
long shot, but this does even things out a bit for me. I figure this is
the best the doc will do for me....so I'm trying to make the most of it. I
tolerate a lot of pain, and go for the maximum relief on the minimum of
medication. I would not crush any extended release medications for obvious
reasons.
— Statuesque
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