Tissue removed from pulmonary arteries

Why Did I Get CTEPH? Pt 2: Now What?

After my diagnosis, my new pulmonologist said “if I was in your shoes. I’d get to San Diego”. That initiated a flurry of research about my illness and my options. I even went to Twitter and learned my account was suspended in 2018 for selling Rayban sunglasses. I don’t know 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…

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

I often receive emails from patients on buprenorphine (or Suboxone) who are preparing for surgery or other painful medical procedures. Ideally in such cases, the surgeon would have a discussion with the person prescribing buprenorphine, in order to coordinate the plan for treating postoperative pain. In practice such discussions don’t Read more…

Uncoupling of analgesia, tolerance, and euphoria from mu-agonists using buprenorphine

I presented this topic at the Atlanta meeting of ASAM a couple weeks ago.  There are too many slides, but the historical stuff was just too fascinating to leave out.  I wanted to demonstrate,  by lining it up on the side, how time has compressed the most critical discoveries to Read more…

Suboxone, Pregnancy, C-Section, and Surgery

A recent message from a reader: What would be the ideal care-plan for the pt taking 24mg/dayof Subutex who is going in for c section? I would like to show the response tomy OB, so if there is any way, please be specific as to any tapering or substituting of Read more…

I'm On Suboxone; Can I Have Surgery?

I recently resumed writing for the expert forum on addiction at MedHelp.Org. One result of writing for MedHelp is that I receive a number of e-mails from people with questions about specific issues related to buprenorphine. The most common questions are from people on buprenorphine undergoing surgery, asking about the Read more…

Medical bias against addiction

I haven’t gone anywhere in case you’re wondering… but I recently started writing a blog on Psych Central, called ‘an epidemic of addiction.’   Please add it to your reading list!  This is my favorite time of year and the time I am most likely going to be outdoors, so watch Read more…

Having Surgery: When to Stop Suboxone?

A question about Suboxone and Surgery: Hi-this is in reply to your message back to me. I am the girl who is soon to have surgery. You said that 3 days would be good to be off the suboxone, but you said the worst withdrawal takes about 3 days to Read more…

Surgery Preparations for a Suboxone Patient

The questions: I am having surgery and my doc was unaware of some things and I thought that you could confirm them for him?  Could you advise him to take me off the Suboxone 10-14 days prior to surgery?  I have been researching this religously and I have come to Read more…

Fentanyl patch for post-op pain, on Suboxone?

I’m in a bad mood tonight– squabbling with my 13-y-o daughter will do that to me– so I’m going to cheat and copy an e-mail that I recently sent to a reader.  She takes Suboxone and will be having surgery;  she did everything correctly, tapering her dose and then stopping Read more…