What Did I Screw UP and get CTEPH? Pt. 4

I am ready to get to a few hypotheses of my own.  Why did I get CTEPH, the finale.  I welcome all readers to comment below, especially if you have ideas about this strange illness. My primary question: How Did I Mess Up My Body and Get CTEPH? Funny how Read more…

Visual hallucinations

Piecemeal posting while I am waiting for labs to be drawn. I always have been skeptical about the nature of visual hallucinations because I wondered how the brain could insert images while at the same time seeing the actual, non-hallucinatory background. Most hallucinations are auditory as you probably know. But Read more…

Repiratory Alkalosis and the Surgical Experience

I see I wrote a bit earlier this year. I do remember wanting to comment on ‘why fentanyl is so dangerous’ because I kept hearing on the news the damage was because of the ‘potency’. That’s probably related in that users do not know how much they are taking, but Read more…

The Other Opioid Crisis: Hospital Shortages Lead To Patient Pain, Medical Error

I came across this public-accesss story, and wanted to share the perspective: Pauline Bartolone, Kaiser Health News Even as opioids flood American communities and fuel widespread addiction, hospitals are facing a dangerous shortage of the powerful painkillers needed by patients in acute pain, according to doctors, pharmacists and a coalition Read more…

Ten Gripes of Buprenorphine Doctors

I recently gave a lecture to medical students about opioid dependence and medication assisted treatment using buprenorphine, methadone, or naltrexone. I was happy to see their interest in the topic, in contrast to the utter lack of interest in learning about buprenorphine shown by practicing physicians. In case someone from Read more…

Post-op Pain on Suboxone

Many patients on Suboxone or buprenorphine eventually require pain treatment, just like people who aren’t on buprenorphine products.  I’ve written about post-op pain control several times, but I continue to get emails from patients who haven’t seen my comments and who view an upcoming surgery with the same fear experienced Read more…

Opioid Analgesia Without Addiction

I don’t have pull with the addiction-related organizations out there.  I’m never been a joiner, and I tend to notice the problems caused by medical societies over the good things that they supposedly accomplish.    For example PROP, or ‘Physicians for Responsible Opioid Prescribing’, have a specific mission.  Once a Read more…

Suboxone Patient Needs Surgery, Refused Pain Control

First Posted 10/21/2013 I have received MANY messages over the years from patients on buprenorphine/naloxone (Suboxone) who required surgery, but whose doctors refused to provide post-op analgesia.  Those of you not on Suboxone– can you imagine having surgery, and being told that ‘it is too much hassle to give you Read more…

Taking Buprenorphine, Having Surgery

Originally Posted 8/12/2013 I will get to ‘Part II’, but today I talked with a patient about something that happens too often, that deserves to be pointed out.  The person was in the ER with an injury that resulted in tib/fib francture.  The ER doc provided no analgesia, in the Read more…

Post-Operative Pain in Suboxone Patients

Originally posted 12/19/2012 I’ve written about this topic a number of times, but I continue to receive emails from people on buprenorphine who describe inadequate pain control following surgery.  I have prepared a document for my own patients to provide to surgeons, dentists, and ER staff to be used in the case of injury or Read more…

Codeine Never Works for Me

Originally published 10/29/2012 The FDA recently released a Drug Safety Announcement about the use of codeine in young children after tonsillectomy/adenoidectomy surgery for obstructive sleep apnea.  I was somewhat surprised to see a safety announcement on a medication that has been in use for decades, but the release underscores our improved Read more…