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Author Topic: Starting Withdrawal from hydrocodone, HELP  (Read 4584 times)

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Offline KatieO

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Starting Withdrawal from hydrocodone, HELP
« on: June 12, 2006, 01:18:37 AM »
I have been on hydrocodone or methadone for many years. I used to take both, then just the methadone. When I stopped the methadone, first abruptly (ok, that was STUPID) and then gradually, I was very, very sick, even though it was a small-ish dose. Now I have been on hydrocodone again for years. I have to have stopped it completely one week before my July 5 surgery, so I have 2 1/2 weeks from now to go from 3 to 4 a day to a big zero. I know to do it gradually but there isn't much time. I know I can cut them in half so that spreads it out a little more but I am really scared. I don't want to get sick! I live alone. When I was withdrawing from the methadone, my boyfriend fed me tiny bits of scrambled egg, and kept getting me to drink. I can't ask him to be here extra because he needs to be here post op (he lives an hour away). If anyone has anything to suggest to ease this passage, or good stories, please share!
Thanks!!!
KatieO
5/98 twisting injury
10/98 ACL partial tear repair/ and RSD
10/01 ACL reconstruction w/allograft
7/03 LR
1/06 diagnosed with patella baja
7/5 open knee surgery for IPCS
Life shrinks or expands in proportion to one's courage...Anais Nin

Offline Heather M.

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Re: Starting Withdrawal from hydrocodone, HELP
« Reply #1 on: June 12, 2006, 01:33:38 AM »
Why do you have to be off the meds by your surgery date?  2.5 weeks is way too short to taper off of something you've been on for years.  What is the medical reason?  I've had surgery while I've been on pain management, there were no issues whatsoever--do you have a unique medical condition or something?

If you proceed with the withdrawal, the two main ways are tapering and substitution, or a combination of the two.  You say you take 3-4 pills, but what is the dosage of each pill?  If they are 3-4 5mg/325mg (tylenol) then you should be just fine, that is a very light dose.  3-4 10mg tablets is a bit more of a challenge, but still possible WITH ENOUGH TIME.

Tapering example:  You take 20mg of vicodin 4 times per day.  On the first day of your taper, take 12.5 to 15mg 4 times per day for a few days.  Then take 10mg 4 times a day for a few days.  Then 10mg three times per day for a few days.  Then 5-7.5 mgs 3x/day for a few days.  Then 5 mgs 3x/day for a few days.  Then 5mg 2x/day for a few days (this is usually one of the longer phases of the taper--when you are at half the former frequency (two times per day vs four times per day) and less than half the former dosage each time (5mg vs. 20mg).  Then 5mg once a day at night.  Then 2.5mgs once a day.  Then 2.5 mgs every other day, then phase it out entirely.

But this is just ONE example of a taper method.  There are literally countless variations.  You would do best seeing a doctor with experience in pain management.  And be sure to ask him/her why you have to go off before surgery--that just seems so strange, especially since you are going to be on major meds post-TTT because it is so painful.

I also don't want you to be all worried that this will be like going off Methadone!!  It won't.  Vicodin has a VERY short half-life.  Within 4 hours of taking a dose, half of that dose is out of your system already.  So it really is pretty easy to taper off...that's one of the reasons vicodin isn't a great pain med for long-term use--it has lots of tylenol in it, and with its short half life it's not every effective for chronic pain.

So anyway, if you are going more than 6-8 hours between Vicodin doses now, it should be fairly easy to taper off.  But each med has its own taper methods based on a detailed knowledge of pharmacology--so that's where the doctor comes in.  And if you are taking a relatively high dose each day (I don't think you are but am not sure) it is critical to taper carefully and in a supervised way, because you can get extremely sick doing it too quickly.  Personally, I think 2.5 weeks is an extremely short taper...maybe it will work because it is vicodin that you are taking and this has such a short half-life.  But it would all depend on how much you take and how often.  With that information, a doctor can help you come up with a sane and healthy and comfortable taper plan.  Look at clinics advertising pain management and addiction medicine--not that you are addicted at all, but these docs have TONS of experience working with tapering patients off of meds in a safe and comfortable way.

Heather

PS Buy a pill splitter at the pharmacy, it will save you a lot of grief.  And please discuss this again with your OS to understand the necessity of getting off your meds prior to a very painful surgery.  And if this is necessary, then get a doctor to help.  This is not a do-it-yourself kind of thing...you can get very, very sick, even to the point of rapid or racing heartbeat, BP problems, delerium and tremors....it can be very ugly, and it doesn't have to be!
« Last Edit: June 12, 2006, 01:37:42 AM by Heather M. »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline KatieO

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Re: Starting Withdrawal from hydrocodone, HELP
« Reply #2 on: June 12, 2006, 02:39:34 AM »
Heather, you are my angel. Thank you for all the advice and good reasoning. It is reassuring, and I had forgotten, that it doesn't stay in your system that long.
So more information: I had thought I might have a TTT but I am only having a release for infrapatellar contracture, with open incision. This is Dr. Fulkerson, so I have the best surgeon. So it isn't as big a surgery by any means as a TTT. I saw him last Wednesday and the surgery was scheduled for 4 weeks off, hence the tight time frame. It sounded like it was routine for him to require that you be off all pain meds for one week prior. I haven't started weaning because this has been a very demanding (painful) week. I do see my GP for my pre op on Tuesday so I will bring him all questions, and he can refer to Fulkerson if he needs to, or another pain specialist. He is good at asking for help if he doesn't know something.
I am currently taking 5-500mg, so I gather that means 5mg hydrocodone and then tylenol. As you say, a low dose. I take it 3 to 4 hours apart. I know I start getting a headache if I don't take it first thing in the morning.
I took 3 today. I do have a pill cutter. Such a wonderful cheap device! Assuming that I do indeed only have 2 weeks and 2 days.... I will talk to my doctor but I am wondering for myself (with your kind help!!!). What if, since morning is so important, I go, soon, to full pill in morning and half pills 3X day for the rest of the day. That would be going from 20 mg to 12.5 and hold there. Then maybe all half pills and three doses, so from 12.5 to 7.5. I don't know. I don't know that I should be playing doctor, as you say.
I also take Buspirone and Lorazepan at night but I don't think I need to stop those, too. I have to ask my doctor on Tuesday. It is startling to realize how many drugs are inbetted in my system!
Katie
5/98 twisting injury
10/98 ACL partial tear repair/ and RSD
10/01 ACL reconstruction w/allograft
7/03 LR
1/06 diagnosed with patella baja
7/5 open knee surgery for IPCS
Life shrinks or expands in proportion to one's courage...Anais Nin

Offline My Sister Sam

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Re: Starting Withdrawal from hydrocodone, HELP
« Reply #3 on: June 12, 2006, 02:44:26 AM »
The question I have is "Who has prescribed the hydrocodone to you for years"? Shouldn't you be having a discussion with this medical professional? Perhaps the doctor who has been providing the script should be aware of your plans to have surgery! It would be a wise thing to do, particularly if you are this concerned.

Liz

« Last Edit: June 12, 2006, 02:47:08 AM by My Sister Sam »
'70 Auto accident - Salter Harris IV fracture distal femoral epiphysis - R knee
'71 R - Bony Bar Resection femoral epiphysis
'78 L - Epiphysiodesis
'79 R - Distal Femoral Osteotomy/LR
'04 R - TTT/Medial Reefing 
'05 R - Trochleoplasty/Medial Reefing/TTT
'05 R - AIR/LOA
'07 R - TKA

Offline emphatic

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Re: Starting Withdrawal from hydrocodone, HELP
« Reply #4 on: June 12, 2006, 02:56:03 AM »
I'm curious about the requirement that you be off all pain meds for a week pre-op? Did someone give you a reason?

I'm imagining that the prescribing doctor gave you the pain meds because you're in pain. Is the pain magically going to go away for a week?

You certainly don't owe me any answers... I'm just curious and finding it odd. I hope you aren't expected to just suffer for a week.

Good luck with your procedure. I've read a few of your posts about your struggle to figure out what's going on and finally finding a good doctor, so I'm happy for you. I hope it goes really well!

Meg

Offline KatieO

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Re: Starting Withdrawal from hydrocodone, HELP
« Reply #5 on: June 12, 2006, 03:05:05 AM »
Can I tell you how much I appreciate everyone's caring and help??

Liz, it was my GP who initially prescribed the hydrocodone and that is who I am going to see for my pre op on Tuesday. He has been my family's GP for 18 years so he knows my whole family inside and out. That also means that he is a generalist, but he is smart enough to know when he is short of expertise and ask someone else.

Meg, Fulkerson's receptionist, in handing me forms and stuff, simply said that I had to be off all pain meds for a week, only allowed tylenol. It certainly sounds like this is going to be painful, starting with any less meds. I don't know if my GP can give me a stronger dose of Tylenol? Yes, I will bring him these questions, but Fulkerson's office seemed like this was just their protocol. I don't have enough experience (or memory?) of previous surgeries. Each surgery was a different time in my life and a different surgeon.

I am willing to do anything! Just a little chicken about it. My GP will certainly be helpful. He even administers hugs. He has cried enough times with me over the 8 years of knee stuff.
Katie
5/98 twisting injury
10/98 ACL partial tear repair/ and RSD
10/01 ACL reconstruction w/allograft
7/03 LR
1/06 diagnosed with patella baja
7/5 open knee surgery for IPCS
Life shrinks or expands in proportion to one's courage...Anais Nin

Offline Doc79316

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Re: Starting Withdrawal from hydrocodone, HELP
« Reply #6 on: June 12, 2006, 03:14:15 AM »
Hey Katie,

PLEASE take Heather's advice and speak to your doctor before you stop taking any meds. The reason I say this is because in the past I've had methadone prescribed along with subutex after trying to dump diamorphine. I stopped the diamorphine straight off and tried to go cold turkey with extremely drastic results. I ended up in hospital having to take methadone. After a while I did the same with that also and again ended up back in hospital. It wasn't that I was deliberately going against medical advice, I just didn't like the idea of being told I had to be weaned off these drugs. So I chose to do it myself! Both really stupid and really dangerous!

Anyway, the meds in total that I'm taking will have to be cut down gradually but there's no way I could do it in a little over 2 weeks. If you're expected to be "med free" for sugery, then what meds are you going to be given whilst in hospital and immediately after your procedure?

Also, you say you we told by a secretary to be off your meds. Are secretaries medically qualified in your part of the world? Here they're not - that's why they're not doctors. You need to get this sorted out sooner rather than later obviously and ask as many questions of both your own GP and Dr. Fulkerson. I'm sure between them they can give you some excellent answers and put you fears to rest completely. It's not OK to be worrying about your pain med regime whilst have the worry of forthcoming surgery also.

Take care,

Laura x
Left knee surgery
08/06/02-L/Release
13/08/03-Fulkerson TTT
05/06/05-Stabilisation & Medialisation/Tendon Transfer
13/01/06-Proximal Hamstring Superior Stabilisation
06/03/06-RSD/CRPS diagnosed
20/07/06 + 03/04/07-Excision of scar tissue
29/05/15-Arthroscopy
02/03/20-Left transfemoral amputation

Offline emphatic

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Re: Starting Withdrawal from hydrocodone, HELP
« Reply #7 on: June 12, 2006, 03:15:47 AM »
Since it was the receptionist who was apparently just informing you of the standard office protocol, if it were me, I'd certainly bring it up with the doctor and find out if there are exceptions --- does he have a reason for expecting you to spend a week in pain? Is it worth it, etc.?

From what you're saying, this is rather traumatic for you, and rather than taking it "as is" from a receptionist, it might be worth it to you to question it with the doctor and make sure you really need to go through this.... make sense?

Meg

Offline Heather M.

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Re: Starting Withdrawal from hydrocodone, HELP
« Reply #8 on: June 12, 2006, 05:49:46 AM »
Katie,

I agree with everyone else, it sounds like this was a casual comment based on office policy rather than a requirement that you go off pain management!  I tell you, though, I don't think it's a bad idea for you to be rid of vicodin in the long run...that is a lot of tylenol you are getting each day and the half-life is so short for this medication...there are other, better working and longer-lasting meds out there.

It sounds like you are at a very minimal dose--5mg at a time isn't much at all.  So you should do okay with your doctor's help if that is necessary.  The philosophy behind the tapers that I've been told (and I had to taper of two different meds--neurontin and toprol for BP) is to reduce dosage first, then frequency, then dosage again, then frequency.  The other method is substitution of another drug, but that probably isn't indicated in your case.  If it were, you'd probably switch to something like Tramadol/Ultram.

Be sure to speak up about things like comments the receptionist made...you have a special knee and the standard rules may not apply to you.  You are not taking vicodin for fun, you have a very painful condition.  And the surgery is going to be very painful, too.  Soft tissue release is no walk in the park, I'm afraid.  I've had broken bones feel better at four and eight weeks post op than my knee did after soft tissue release.  So just keep that in mind, though your case may be quite different.

Hang in there, you will begin to feel much better with all that scar tissue out of your knee.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline shade

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Re: Starting Withdrawal from hydrocodone, HELP
« Reply #9 on: June 12, 2006, 12:57:27 PM »
Katie O,

If you check through those forms you've been given you'll find a sheet of paper that tells you what to do.  It's the Welcome sheet and It states that you are NOT to take any herbal or diet meds two weeks prior to surgery. Then it says......  Please check with your physician regarding any prescription medications you may take.
All this stuff is handed out to each and every patient and it also states - if your have any special needs for your day of surgery, please inform your surgeon.....

So you have to discuss this stuff with your GP - the person prescribing the meds. 

I've found their info packets very informative - I've was even given a sheet with directions to the surgery center.  Most places do not go that extra mile......
//////////////////////////////////////////////////////////////////////////
This is why I hate seeing people using a surgeons name in their posts because other people can get the impression that something is wrong with a facility.  This is not the case with this facility, it is a first-rate facility.
A patient can call anytime and get answers to their questions - they are very obliging and go out of their way to help out.




« Last Edit: June 12, 2006, 01:25:40 PM by shade »
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline KatieO

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Re: Starting Withdrawal from hydrocodone, HELP
« Reply #10 on: June 12, 2006, 02:28:28 PM »
You are all the best!!!!!

Maybe I need to take a deep breath? Then another? Then write down everything to take to my GP tomorrow and sit tight until then. I am sure that a call to my surgeon's office will be needed, if not for the medications then for the brace I will need. I know they will fit it to me after surgery but I need to know the implications in terms of being able to drive or not. I have a Corolla, automatic, and it is my left leg, so these are all good things. But will I be able to physically get my braced leg into the driver's seat? I need to go to PT nearly every day. It is only a couple of miles from here but if I can't drive, I need to arrange rides, and that takes planning. Taxis are hard to find in this neck of the woods, though possible. Friends are nicer.

You have all been very helpful!!!
Hugs,
Katie
5/98 twisting injury
10/98 ACL partial tear repair/ and RSD
10/01 ACL reconstruction w/allograft
7/03 LR
1/06 diagnosed with patella baja
7/5 open knee surgery for IPCS
Life shrinks or expands in proportion to one's courage...Anais Nin

Offline jm121205

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Re: Starting Withdrawal from hydrocodone, HELP
« Reply #11 on: June 12, 2006, 05:07:44 PM »
Hey Katie:  I think the pain meds they are referring to are NSAIDS:  advil, aleve and asprin.  They have anti-coagulants in them and they don't want you on them before surgery.  You really should call Dr Fulkerson's office and have someone there clarify.  This might me easier than you think!! 

I am so happy to see you excited about this surgery!
11/1/05 clean patella fracture
12/12/15 shattered patella, emergency surgical repair
2/06 to 4/06 attempting to convince them something was not right
4/26/06 recheck with surgeon: original break not healing and wires from surgery broken
5/26/06 Second Surgery
8/16/06 no more brace

Offline KatieO

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Re: Starting Withdrawal from hydrocodone, HELP
« Reply #12 on: June 12, 2006, 05:32:53 PM »
Hi,
Yes, I am excited! I have been waiting for years for someone to know what was wrong and have a way to fix it. I accept the risk and just anticipate that this will WORK. I am trying to hold back on expectations for how well it will work but I do have to wonder. I want to be able to walk and stand and sit with minimal pain but will I DANCE????? Oh my.
The doctor's orders were clear that there are no pain meds for a week, but Tylenol is ok. Lots and lots of tylenol?? Anything is worth it. My GP is the sweetest guy on earth. It took a little effort for him to fit me in for a physical on such short notice but I knew he would. No time to waste!
Contra dancing, which is my love, my lost love, is very hot year round, but can be brutal hot in the summer. So I am thinking that when it starts to be a light frost at night, that is when I would like to be dancing again. I can dream!!!
Katie
5/98 twisting injury
10/98 ACL partial tear repair/ and RSD
10/01 ACL reconstruction w/allograft
7/03 LR
1/06 diagnosed with patella baja
7/5 open knee surgery for IPCS
Life shrinks or expands in proportion to one's courage...Anais Nin

knee deep in Goo

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Re: Starting Withdrawal from hydrocodone, HELP
« Reply #13 on: June 13, 2006, 02:53:26 AM »
I am thinkiing back to my presurgery days. I took vicodin once ..  three days prior to my surgery.  The surgeon said that was ok.  .. but you best ask Katie.  Why would the doctor allow you to be in pain for such a long time??
  I once called my doctor on a friday and asked him for medicine ... knowing i would see him on monday.. and he said .. that is along time to go in pain .friday to monday. . I was right to call him for pain medcine..  So he gave me  20 vicodin -  I cant say they work as well as percocet.  Found zero relief from it. 

Offline KatieO

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Re: Starting Withdrawal from hydrocodone, HELP
« Reply #14 on: June 13, 2006, 03:02:14 AM »
Hey,
I see my GP tomorrow and will see what he says. Vicoden is the same as hydrocodone. I am hoping he will prescribe something like percoset to get me through the next two weeks. I know I have to have one week without meds; that is the protocol of this OS and I will grin and bear it!! YOUCH. But I should be able to get something for the two weeks before then. Just taking fewer pills today wasn't fun. Not withdrawal stuff at all, just good old straight up pain. I am trying to limit my activities even more than usual and this is a good thing to do but not fun, and hard. Sigh...
Surgery soon!!!
Katie
5/98 twisting injury
10/98 ACL partial tear repair/ and RSD
10/01 ACL reconstruction w/allograft
7/03 LR
1/06 diagnosed with patella baja
7/5 open knee surgery for IPCS
Life shrinks or expands in proportion to one's courage...Anais Nin















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