Post-op pain & pills

[danjayh]

I'm finally home! In the hospital, they were giving me 2 vicodin every ~4 hours (which seemed like a lot to me), and that's what they prescribed me for home as well. That dosing works out to 6000 mg of acetaminophen/24 hours which is way over the recommended max dose, but it worked - I had very minimal pain. Today is my second day home (it's been ~1.3 weeks since my surgery, which was on the 22nd), and I decided to try cutting my does to 1 vicodin every 4 hours, mostly because I don't want to risk injuring my liver. Doing so resulted in rather intense pain around the site of the sternotomy and chest tubes. I've since upped it to 1 pill every 3 hours, which puts me at the maximum recommended daily acetaminophen dose (4000 mg) ... I'm honestly not quite sure why the hospital had me on anything higher than that. At this dose, the pain is still bad, but I'm functional (although I'm squirming in my chair and gritting my teeth as I write this).

My questions are these:

- What kind of pain have you guys had a week + 2 days after your surgeries? Bad enough that it distracts you from doing just about everything else?

- What were your pain relief dosages at this point in time? How long did you wait to cut back?

Thanks!

 

[normofthenorth]

I had an easy time post-op and stopped all the pain-killers ~3 days post-op, while I was still in the hospital.

I just had 3 dental implants (implant bases?) installed in my mouth two days ago, on Wednesday, and the directions were to take Extra Strength Ibuprofen (Advil) several times a day for maybe a week. I haven't taken anything at all since the 2 Extra Strength Advils they gave me just before they shot me full of novacaine, and there's virtually no swelling and no pain at all. (I'm mostly chewing on the other side, but that's what I've been doing since they initially extracted those teeth, pre-OHS.)

I scream like a little girl when somebody steps on my foot or bangs my (very tender!) shins, and I don't think I have a high pain threshold. I certainly hate being in pain. I think I just got lucky with my OHS, and with this dental surgery, too. My two Achilles tendon ruptures (both sides) were also both relatively painless (mostly discomfort from swelling), while others have suffered and used words like "childbirth". We're all different.

BTW, you seem to be using "vicodin" and "acetaminophen" interchangeably, which puzzles me. I thought Vicodin was a synthetic narcotic, and acetaminophen is the chemical-generic name for Tylenol, a non-narcotic OTC pain-killer. ??

 

[Debbrn]

As a nurse, we are not allowed to give more than 4000mg of acetaminophen per day.

As a patient after discharge I usually took 5 mg oxycodone 2-3 times per day and 650 mg acetaminophen 2-3 times a day, and ibuprofen 2-3 times a day. The narcotic and acetaminophen were in separate tablets so it was more difficult to take to much acetaminophen. After a week I was completely off the oxycodone.

Debbie

 

[Debbrn]

Vicodin is a combo medication with hydrocodone and acetaminophen. How many mgs of hydrocodone are in each of the tablets you are taking? Will they let you take ibuprofen at all?

Debbie

 

[Dray]

Hi Danjayh,

I had my AVR on June 1st with a full sternotomy. While I was in the hospital on the ICU floor I was on Dilaudid every 30 minutes. Once I was moved to the step down unit I was given a combination of Oxycodone and Tylenol every 6 hours. When I left the hospital on June 5th I had a prescription for 10mg of Oxycodone and the suggestion to purchase extra strength Tylenol. For the first couple of days I took the Oxycodone every 6 hours, but then only took it at night to help me sleep (I'm a stomach sleeper!)

At 10 days post-op I was feeling well enough to stop taking my pain killer during the day and just use 2 tablets of 500mg Tylenol in the morning. I was sore, but it really didn't bother me enough to prevent me from getting out and about - going to the park with my kids, going out to eat, etc. I just moved pretty slowly. Seatbelts were awful, I passed the chest belt behind my back.

Today, about 30 days post-op I rarely take the Oxycodone at all. I'll take some at night on the days I overdo my physical activity and start to become sore in my neck and back (which has really been the areas where I experienced the most pain). I'm still taking some Tylenol, but not every day.

Also, I was given a combination Tylenol/Oxycodone pill in the hospital that I could only take every 6 hours so I didn't overdose on the Tylenol. My nurse had the doctor split the prescription into two. One for Tylenol and the other for Oxycodone. This allowed me to take the Oxycodone every 4 hours (instead of 6 hours as before) to help with the pain and add Tylenol as needed every 6 hours. If your prescription is a combination like mine was originally, perhaps you could request they give you two prescriptions?

David

 

[malibu82]

hey there

i had bad pain for a month after surgery. then it got better, but even now, i have pain!

so to answer your question, i was doing 2 vicodin every 4 hours /24 hours a day. you have to stay ahead of your pain. i probably cut back a little after 1 month....i was never in so much pain i could not function or do anything without knowing about the pain.

i think you should go back to 2 every 4-6 hours!

 

[danjayh]

Vicodin is a combo medication with hydrocodone and acetaminophen. How many mgs of hydrocodone are in each of the tablets you are taking? Will they let you take ibuprofen at all?

Debbie

The tablets I am taking have 50mg (i think) of hydrocodone, and 500mg of acetaminophen (which is the component that I'm concerned about). Aside from those tablets, I am taking no other pain killers.

 

[Debbrn]

You should only take a total of 8 tablets a day because of the acetaminophen content. I think the hydrocodone content is 5 mg. 5 mg is not a big dose especially if you are not a small adult. If the doc allows adding ibuprofen seems to help a lot. Some docs do not use ibuprofen others do.

Debbie

 

[Lynlw]

The tablets I am taking have 50mg (i think) of hydrocodone, and 500mg of acetaminophen (which is the component that I'm concerned about). Aside from those tablets, I am taking no other pain killers.

I would probably call and ask about getting a different med or combo so you don't have to take so much acetaminophen to keep the pain under control. Hopefully you'll be able to taper down on the amount of meds you need soon.

 

[Greg a]

Not sure what type these guys take BUT.................

Not sure what type these guys take BUT.................

[video=youtube;y-PAhp9S6K0]http://www.youtube.com/watch?v=y-PAhp9S6K0[/video]​

 

[ken taylor]

I guess Im lucky, the only pain was in my back, on day three they took out the drain tubes and I did not take another pill after that and walking really did it. Now im going on day 39 my scar is healed and im walking 1 hour every morning. With my first OHS 6 years ago it was a lot worse. I can tell even my breast feeling is coming back. For me AVR has been easier than by pass, a lot easier. Every chance I get I will give Dr. Igor Gregoric THANKS. And it is for this family here on our forum also. If you are in need of surgery and close to Houston He is the BEST---REALLY!!!!!!!!!!

 

[Adrienne]

Very little real pain

Very little real pain

I relate to what normofthenorth said (maybe our Canadian winters anesthesize us:tongue2. I stopped taking anything for the pain on day 5 when I was released from the hospital. Naturally, when I sneezed, it hurt beyond belief, but not if I didn't forse anything. I also have had 3 dental implants, and that was not painful either. Also, like normofthenorth, I am usually a wimp about pain.

 

[ElectLive]

Well, I'm starting to feel like a wimp...very impressive.

I had somewhat the opposite experience of what's been mentioned. I have a very high pain threshold normally, but didn't even think about tapering (much less stopping) my pain meds until Week 2. But from Week 2 to Week 3, I tapered down to a complete stop. This is one area of my experience I was intentionally passive, though. I was told by nearly every doctor/nurse not to be a hero, the pain meds allow you to do everything you need to do to recover. I was already behind in walking by several days because they would not let me out of bed due to a temporary pacemaker, and that set back my intial recovery dramatically. Once walking, though, things followed a speedy progression.

Supposedly, pain is much higher in young patients (I was 35). There is a medical reason, I forget what it is, but in any case, there are exceptions too.

 

[Natina13]

I was not taking anything but tylenol...after the first 2 wks at home. I had a AVR and a Triple bypass and I found back pain, was the worse pain ,the first 2-3 days in the hospital. They gave me Fentanyl per IV in ICU. I am 11 wks post -op.......my pain is just the top of the sternum, nothing tylenol will not cover, but I can not sleep.... You can get around that dose limit of 4000mg of tylenol in 24 hr period.........Vicodin...comes in 10 mg/ 325. You get more of the narcotic to help your pain, less tylenol to worry about, as you only have to take 1 pill not 2.( Vicodin also comes in 10mg/650 )
Renee

 

[normofthenorth]

. . . I was told by nearly every doctor/nurse not to be a hero, the pain meds allow you to do everything you need to do to recover.

I got into interesting discussions with SEVERAL doctors and nurses about pain meds while I was still in the hospital, one of them along those lines. (Wait for it! ) My main ICU nurse was convinced I should be taking Morphine shots for several events. I said no a couple of times -- the first time was because they were getting me to "dangle" my legs over the side of the bed, stand up and sidle up to a different part of the bed and lie down again(!). I couldn't believe that it would be very painful despite her warnings, and it wasn't. I did let her bully me into the Morphine for the removal of something -- the drainage tubes, I think -- and I don't think that would have been painful without, either. But I did get weird visual disturbances from the Morphine for hours, which I tried (and mostly failed) to enjoy, like a psychedelic "trip".

When I went from CVICU to the ward, the nurses started coming around with paper cups of pills. One cup had Tylenols (ES?) and a narcotic (codeine?). I asked if I could skip the narcotic, and after some wonder and some discussion, they agreed.

Later, when one of the surgeons on my OR team came by on rounds, he asked a bunch of questions including one about pain. I said it was no problem, and the nurses immediately added that I'd even declined to take the narcotic pills. The surgeon said "That's fine, and if he doesn't need the Tylenol, he can skip those, too." I did skip them, too, from then on -- except I always kept one handy to see if it helped with my general inability to sleep more than 2 hours at a time.

I took one that night and one the following night, then stopped. I think part of my sleeplessness was post-op-cardiac-related, and part was from sleeping on linens that had sticky plastic sheets right under them. (At home I had no trouble sleeping in bed, but I still awoke every 2 or 3 hours for maybe a week.)

My biggest fight over meds was with the hospital's resident Cardiologist, and relates directly to the quote from ElectLive above. (Thanks for waiting!) She was a strong-willed bully by personality type, and I can dig in my heels with the best of them, so the stage was set for a battle. She REALLY wanted me to take all my pain meds (including the narcotic), and warned me that I would never use the Incentive Spirometer aggressively enough without them. I told her I thought I would, and I was afraid that I could do harm if I was drugged and "out of touch". (I have been known to "over-do"!) She left mad, but I didn't take the drugs. A day or two later, she asked me to demonstrate with the IS, and she had to agree that my lungs were doing very well, so that argument was over.

I'm sure she (and the quote above) was right for some patients, but I was pretty sure I knew myself much better than she did, and I'm glad I won that argument as my own "patient advocate".

BTW, I'm a wimp about SOME pain, and a hero about some other pain -- totally schizophrenic. If a pain surprises me, or if I think it might be a symptom of something serious, I'm a total wimp. If I know it's OK, and it's for my own good, like the IS, I usually WAY prefer to live through the pain than to have a needle (wimp shudder!:thumbd to deaden it! My fave examples are dental:
(1) I once convinced a dentist to grind down two front teeth to pointed cones (for a bridge) without any freezing. He was much more nervous than I was, but he did it. And I could tell when the roots were over-heating, and told him to back off and spray more water, so I think I came out ahead.
(2) After his successor pulled my WRONG wisdom tooth and refused to pull the RIGHT one (which was wobbly) because he wouldn't freeze me on both sides, I convinced him to pull it without freezing. I screamed like Hell for a second, but then it was over and I was (am) glad I'd done it. (He's probably still partly deaf in one ear, and we cleared his Waiting Room, so he may not be as glad as I am! )

But post-OHS, other than coughs and sneezes, and a bit of getting into and out of bed, I wasn't coping with pain without meds like a hero, it just was remarkably painless. Just lucky.

 

[ElectLive]

And in truth, pain tolerance and pain meds aside, everyone that goes through heart surgery deserves hero status.

The funny thing for me was, my post-pacemaker surgery (Day 4) pain was actually worse than the open heart surgery pain. I guess it was kind of like the late rounds in a boxing match. I’d taken all the punches the open heart had to give, then wham, the unexpected punch of pacemaker surgery hit me. It was one of those localized, annoying sort of pains, into the shoulder blade and could hardly move my arm on that side for a long time.

Back pain was the other tough one. It happened every night around 4 to 5 in the morning, after I'd been lying flat on my back for two 3 hour sleep shifts prior. I had that for weeks, could never fall back to sleep, and the interesting thing was, the pain meds didn’t seem to affect it at all.

The drain tubes. That was fun. Probably the creepiest feeling of my life. Not really pain, though, just disturbing. I told my wife it felt like they were taking something out with a corkscrew.