Friday, October 10, 2008

Post-operative pain management

My medical partner and I are routinely aggravated by the following situation. Our patients are admitted for surgery, say a knee replacement or an appendectomy. They are released from the hospital on meds for pain with instructions to call us for follow-up and refills. We think the prescribing surgeon ought to stick with the program. Now I'm rethinking this strategy.

My friend E. who is now 2+ weeks post-op extensive abdominal surgery for cancer has been on high dose pain meds and anti-anxiety drugs. Her surgeon abruptly decreased the former and discontinued the latter two days ago, then added ibuprofen and Tylenol in place of the dropped narcotic doses. E. sailed through Thursday, feeling so wonderful that she went with her cousin up Trail Ridge Road, a spectacular mountain road which tops 11,000 feet in spots. The trip was a treat, but she began to feel shaky on the way home and had a full-blown panic attack early Friday morning. Queasy, breathless, and in pain, she called me over to help.

So what was going on? Was she queasy from pain, withdrawal, or ibuprofen? Was she anxious from a lack of anxiety meds, withdrawal from tranquilizers, increasing pain, or the fear that she'd have another panic attack? Was she in pain from doing too much too soon, undertreated post-operative healing, withdrawal cramps, or from ibuprofen-induced colitis? Or all of the above?

Perhaps a top-notch cancer surgeon, which I believe her oncologist to be, has no more business adjusting meds than an internist such as myself has performing cancer surgery.

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