Surgeon only gives Tylenol after surgery

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What kind of surgery is this?????????

An attempt to remedy the advanced trollitis OP apparently suffers from. Not urgent, apparently.

I’m so happy that OP didn’t feel the need to respond to you.

+1

[Anonymous]

Anonymous wrote:As a nurse, I've never worked with a surgeon or any physician for that matter, who only prescribes Tylenol for pain. What you need post-operatively depends on a lot of factors. This is a red flag in my opinion.

Yeah, like the actual level of pain, complications, etc. Asking for opiates at a consult is wild, and suggests drug-seeking behavior, regardless of the procedure in question. If the professional performing the procedure doesn't think it will be necessary, go with that. If they absolutely refuse if/when it is actually necessary, call your GP or another provider with whom you have a working relationship or go to an emergency room. A patient willing to bounce because they weren't guaranteed opiates before they were necessary is a massive red flag to the clinician.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What kind of surgery is this?????????

An attempt to remedy the advanced trollitis OP apparently suffers from. Not urgent, apparently.

I’m so happy that OP didn’t feel the need to respond to you.

You are OP, and you're sockpuppeting really hard at this point.

[Anonymous]

Anonymous wrote:

Anonymous wrote:As a nurse, I've never worked with a surgeon or any physician for that matter, who only prescribes Tylenol for pain. What you need post-operatively depends on a lot of factors. This is a red flag in my opinion.

Yeah, like the actual level of pain, complications, etc. Asking for opiates at a consult is wild, and suggests drug-seeking behavior, regardless of the procedure in question. If the professional performing the procedure doesn't think it will be necessary, go with that. If they absolutely refuse if/when it is actually necessary, call your GP or another provider with whom you have a working relationship or go to an emergency room. A patient willing to bounce because they weren't guaranteed opiates before they were necessary is a massive red flag to the clinician.

The time to discuss opioids is BEFORE the surgery. It is not drug seeking behavior. Going to the ER complaining of unbearable pain IS drug seeking behavior.

[Anonymous]

Anonymous wrote:

Anonymous wrote:As a nurse, I've never worked with a surgeon or any physician for that matter, who only prescribes Tylenol for pain. What you need post-operatively depends on a lot of factors. This is a red flag in my opinion.

Yeah, like the actual level of pain, complications, etc. Asking for opiates at a consult is wild, and suggests drug-seeking behavior, regardless of the procedure in question. If the professional performing the procedure doesn't think it will be necessary, go with that. If they absolutely refuse if/when it is actually necessary, call your GP or another provider with whom you have a working relationship or go to an emergency room. A patient willing to bounce because they weren't guaranteed opiates before they were necessary is a massive red flag to the clinician.

No GP in the United States is going to Rx opioid painkillers in the immediate aftermath of a surgery performed by someone else—and rightly so.

It is reasonable to find out in advance whether you are having surgery performed by someone who will use the full range of pain mitigation that they are legally authorized to provide, or by someone who categorically rules some of the most powerful out in advance.

I can’t tell from OP’s post whether that is what they inquired about, therefore none of the rest of us know what scenario we are arguing about.

Good vibes to all undergoing surgery—and all in, or contemplating, recovery from substance use disorders.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:As a nurse, I've never worked with a surgeon or any physician for that matter, who only prescribes Tylenol for pain. What you need post-operatively depends on a lot of factors. This is a red flag in my opinion.

Yeah, like the actual level of pain, complications, etc. Asking for opiates at a consult is wild, and suggests drug-seeking behavior, regardless of the procedure in question. If the professional performing the procedure doesn't think it will be necessary, go with that. If they absolutely refuse if/when it is actually necessary, call your GP or another provider with whom you have a working relationship or go to an emergency room. A patient willing to bounce because they weren't guaranteed opiates before they were necessary is a massive red flag to the clinician.

The time to discuss opioids is BEFORE the surgery. It is not drug seeking behavior. Going to the ER complaining of unbearable pain IS drug seeking behavior.

When your doctor says you're unlikely to need them and you ignore that and decide to shop for another doctor, you are drug-seeking.

post-surgical pain is either an emergency or it isn't.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:As a nurse, I've never worked with a surgeon or any physician for that matter, who only prescribes Tylenol for pain. What you need post-operatively depends on a lot of factors. This is a red flag in my opinion.

Yeah, like the actual level of pain, complications, etc. Asking for opiates at a consult is wild, and suggests drug-seeking behavior, regardless of the procedure in question. If the professional performing the procedure doesn't think it will be necessary, go with that. If they absolutely refuse if/when it is actually necessary, call your GP or another provider with whom you have a working relationship or go to an emergency room. A patient willing to bounce because they weren't guaranteed opiates before they were necessary is a massive red flag to the clinician.

No GP in the United States is going to Rx opioid painkillers in the immediate aftermath of a surgery performed by someone else—and rightly so.

It is reasonable to find out in advance whether you are having surgery performed by someone who will use the full range of pain mitigation that they are legally authorized to provide, or by someone who categorically rules some of the most powerful out in advance.

I can’t tell from OP’s post whether that is what they inquired about, therefore none of the rest of us know what scenario we are arguing about.

Good vibes to all undergoing surgery—and all in, or contemplating, recovery from substance use disorders.

I want a doctor to categorically rule out the most powerful narcotics in advance of procedures that don't require them. At most, I want them to say "if you encounter complications, call the 24-hour line and we'll take care of it." That's responsible. I don't want a pill-pusher (again), and I wish more people understood what they were risking taking these meds when they really don't have to. But some people can't even have that conversation without crashing out about meth for some reason.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:As a nurse, I've never worked with a surgeon or any physician for that matter, who only prescribes Tylenol for pain. What you need post-operatively depends on a lot of factors. This is a red flag in my opinion.

Yeah, like the actual level of pain, complications, etc. Asking for opiates at a consult is wild, and suggests drug-seeking behavior, regardless of the procedure in question. If the professional performing the procedure doesn't think it will be necessary, go with that. If they absolutely refuse if/when it is actually necessary, call your GP or another provider with whom you have a working relationship or go to an emergency room. A patient willing to bounce because they weren't guaranteed opiates before they were necessary is a massive red flag to the clinician.

The time to discuss opioids is BEFORE the surgery. It is not drug seeking behavior. Going to the ER complaining of unbearable pain IS drug seeking behavior.

When your doctor says you're unlikely to need them and you ignore that and decide to shop for another doctor, you are drug-seeking.

post-surgical pain is either an emergency or it isn't.

You are using unlikely like it means never. I don't think you know how to use that word.

[Anonymous]

Anonymous wrote:Without saying what surgery it is, it’s really hard to tell whether this is reasonable or not.

Exactly. A bone surgery? Something stronger. Many other things are managable with APAP

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:As a nurse, I've never worked with a surgeon or any physician for that matter, who only prescribes Tylenol for pain. What you need post-operatively depends on a lot of factors. This is a red flag in my opinion.

Yeah, like the actual level of pain, complications, etc. Asking for opiates at a consult is wild, and suggests drug-seeking behavior, regardless of the procedure in question. If the professional performing the procedure doesn't think it will be necessary, go with that. If they absolutely refuse if/when it is actually necessary, call your GP or another provider with whom you have a working relationship or go to an emergency room. A patient willing to bounce because they weren't guaranteed opiates before they were necessary is a massive red flag to the clinician.

The time to discuss opioids is BEFORE the surgery. It is not drug seeking behavior. Going to the ER complaining of unbearable pain IS drug seeking behavior.

When your doctor says you're unlikely to need them and you ignore that and decide to shop for another doctor, you are drug-seeking.

post-surgical pain is either an emergency or it isn't.

Post-surgical pain should not ever be an emergency. Having an emergency when you could have had timely pain management is a dumb, wasteful and expensive way to proceed through the health care system.

That doesn't mean one should look for a doc who will agree to prescribe opioids in advance or recommend them as standard of care. It does mean one should look for a doc who does not categorically rule them out.

It is totally unclear from OP's post which kind of doc this is.

[Anonymous]

Anonymous wrote:

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Anonymous wrote:

Anonymous wrote:

Anonymous wrote:With knee replacement surgery they tell you to get ahead of the pain.
My DH tried to skip the heavy duty pain meds and it was not pretty for a few days.

He definitely needed the stronger drugs.

This. I've had a lot of different surgeries, and my pain management needs have been quite different in each case. My ACL/MCL/meniscus repair was the worst, and I definitely needed the oxy for about 4 days post-op and multiple nights after that. My bilateral mastectomy wasn't too bad, and I was fine with gabapentin and tylenol/ibuprofen. They might have given me a vicodin or two while I was still in the hospital, but nothing to take home after I was released. Laparoscopic surgeries were trivial, and OTC meds were completely fine.

OP didn't tell us what the surgery is, so we have no idea whether the doctor is being reasonable with the pain meds or whether he's some sort of purist. I would run far from any orthopedic surgeon who thinks OTC meds are sufficient.

You think doctors don't know this? The fact that OP didn't say, and hasn't come back to clarify, strongly suggests they already know they're on some nonsense.

OP probably saw the people ganging up on her and accusing her of being addicted. It is a fact that some doctors are extremely rigid when it comes to pain management. Check out r/medicine and see the debates among physicians about this. Besides not knowing what the surgery entails, we also don't know whether OP has undergone any surgical procedures before.

OP was probably trolling, like most of the people who post here. Either that, or they wanted "support" and bounced when they got a perspective check instead.

The perspective that we should tough out surgical pain versus using an FDA-approved medication that is indicated for surgical site pain? There is zero reason to go back to biting sticks and rolling around in pain because of some junkie somewhere.

My body, my choice.

But you know this isn't what happens to patients after standard surgeries in Sweden, Germany, France, and the UK, right? What makes Americans react so very much more poorly to the same procedures?

What are your sources for this claim? From a quick review:

The US and Canada have much higher post-surgery use than Sweden, but the US and UK have seen a similar and substantial drop in opioid prescriptions. France has seen an uptick in prescription opioid use, and Germany still has opioids prescribed somewhat regularly as analgesics:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2749239

https://www.ofma.fr/wp-content/uploads/2018/09/Chenaf_et_al-2018-European_Journal_of_Pain-vf.pdf

https://www.mdpi.com/1660-4601/21/2/180

https://journals.sagepub.com/doi/abs/10.3233/JRS-220040

Sure. Same data as you. From your first link:

In this cohort study, more than 70% of surgical patients in the United States and Canada filled opioid prescriptions after 4 surgical procedures compared with only 11% in Sweden.

The exact same surgical procedures, but Swedes require 1/7 the opioid prescriptions post-op as Americans. Why is that?

Yes, the comparison with Sweden was noted in my reply.

You’ve also referred to Germany, France and the UK. The latter has similar stats to the US, as does Canada, which you’re notably excluding.

Germany and France also utilize prescription opioids, with the latter seeing an uptick, as noted in the respective link.

Do you have links to studies suggesting a large current disparity between the US use of prescription opioids post-surgery compared with the countries you mentioned other than Sweden?

I never said the rest of the world had a complete prohibition against opioids.

Sure, there's an "uptick," but there still is a broad difference. You are STILL avoiding the question -- why are they not needed elsewhere, but here we're presumably "writhing in pain and biting on sticks" like animals if we don't get them?

You’ve been making sweeping assertions that the US hands out prescription pain meds too easily compared to specific other countries. The research shows it’s not that clear or simple, and when asked to back up your claims for Germany, France, and the UK, you can’t/won’t.

Again, recent research shows Canada and the UK have similar usage to the US of prescription opioids—it also has noted that the US and UK have seen dramatic drops in those prescriptions in recent years. France has actually seen an uptick. Germany still dispenses them for severe chronic pain.

Sweden also has not legalized cannabis recreationally and only very strictly for medical use. Their alcoholism rates are also lower than those of the countries you specified. So, they appear more conservative regarding regulated substances overall, culturally and legally.

This is a poor topic to argue based on conjecture, because pain itself is so subjective.

The question itself is simple: why are Americans (and sure, Canadians) using so many more opioids post-operatively than are routinely used in other industrialized countries? And you are doing everything you can to avoid it.

Waiting for a link to data backing your conclusion that the US, Canada, and UK—who have similar Rx opioid usage—use “so many more opioids post-operatively” than “other industrialized countries.” Which countries other than Sweden would those be?

You already cited Sweden. Let's look at France. But let's also see if you really are willing to address the data, or if this was all diversion from answering the question.***

You haven’t provided a single citation supporting your assertion.

Here is a French link:

RESULTS
A total of 25 American patients (50%) consumed narcotics preoperatively vs 4 French patients (8%). Only 22% of Americans were opioid naïve. Postoperatively, all French patients had a narcotic-free prescription while all American patients were prescribed a significant amount of narcotics (617.04mg ± 345.16mg MED). One American patient returned to the emergency department for inadequate pain control while none of the French did. French patients were never prescribed steroids but had systematic nonsteroid inflammatory drugs while 41.4% of American patients were prescribed postoperative steroid tapers following a postoperative telephone call.

CONCLUSIONS
For identical surgeries, all American patients were prescribed postoperative narcotics while none of the French were. Cultural beliefs from both patients, physicians and the industry probably represent the most significant barrier against the implementation of a narcotic-free culture in our practice. Reducing narcotic prescriptions in our practice is not only feasible but also highly desirable.

The Spine Journal, Volume 19, Issue 9, Supplement, September 2019, Page S149
Differences between postoperative narcotic prescriptions in outpatient lumbar spine surgery between the United States and France
https://www.sciencedirect.com/science/article/abs/pii/S152994301930508X

***
So, once again: do you think people in Sweden and France are just left "writhing in pain and biting on sticks," or are they just superhuman uberpeople, or what? What is the difference?

[Anonymous]

PS: I'm a doc who has worked both in the US and outside of it. I'd never say there is no reason for opioid prescription post-operatively, but there is a marked difference. And I don't see patients writhing in pain or biting sticks elsewhere to get through it.

I myself have posted earlier in the thread about going home post-op from multiple open-heart surgeries (true open heart, with the sternum sawed open) on scheduled Tylenol and Ibuprofen. I'm not superhuman.

[Anonymous]

My wife just had a c section and alternated Tylenol and ibuprofen for maybe a week and was fine. Opioids are way over prescribed, even now.

If you wanted more you should have asked if you can alternate advil and Tylenol.

[Anonymous]

The hard but frank truth is that if you spin out with such exceedingly bad pain that you can't handle it with the recommended standard meds (for whatever procedure you had, as per the licensed provider who performed that procedure), then you should be reassessed by a medical provider. If it's the middle of the night, that means the ER.

If you are that much of an outlier, then more serious sequelae of surgery need to be ruled out, not covered over by sedating you with a narcotic.

[Anonymous]

Anonymous wrote:The hard but frank truth is that if you spin out with such exceedingly bad pain that you can't handle it with the recommended standard meds (for whatever procedure you had, as per the licensed provider who performed that procedure), then you should be reassessed by a medical provider. If it's the middle of the night, that means the ER.

If you are that much of an outlier, then more serious sequelae of surgery need to be ruled out, not covered over by sedating you with a narcotic.

Right. There are a lot of good reasons to not have the nods when you're recovering from surgical procedures that benefit from closer monitoring.