![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by SandyWeb on April 21, 2007, at 12:54:57
I know that Dilaudid isn't a psych med, but I have a question about it if anyone knows the answer. My 15-year old daughter just had major jaw surgery (broke both jaws, moved bones around to line up teeth, surgically cut out all 4 of her wisdom teeth, placed a few titanium plates into her gums to keep the bones together, and wired her jaw shut for 6+ weeks). While she was in the hospital for about 5 days, she was always on morphine plus a whole host of other meds.
She is home with me now, and instead of morphine she is taking Dilaudid 4mls (liquid, of course) every 4 hours for at least a month....along with another narcotic and other meds. The surgeon said they would give her a refill of the Dilaudid if she needs more because this wasn't a simple jaw surgery and she's going to be in pain for awhile.
My question: Do you think she will become physically addicted to the narcotic when she comes off it in a month or two? I don't believe she will psychologically addicted simply because it relieves most of her pain and she's not getting high off it. But will she have to be weaned? I would hate for her to go through withdrawal symptoms after all the other pain she's been through.
Thanks so much.
God bless,
Sandy
Posted by Phillipa on April 21, 2007, at 22:33:17
In reply to Dilaudid, posted by SandyWeb on April 21, 2007, at 12:54:57
Sandy hi sounds like a long time for a pain med like dilaudid did you discuss this fear of withdrawal with the doc? Can he deescalate the doses or change to something weaker as the pain lessens? Love Phillipa
Posted by crenshaw387 on April 21, 2007, at 23:06:55
In reply to Re: Dilaudid » SandyWeb, posted by Phillipa on April 21, 2007, at 22:33:17
i have used dilaudid a lot it is very addictive if overused but when used to control actual pain and not used when not needed it is a very effective medication... i actually found it to have far less side effects than equivalent doses of oxycodone and fentanyl.
Posted by SandyWeb on April 23, 2007, at 10:30:38
In reply to Re: Dilaudid, posted by crenshaw387 on April 21, 2007, at 23:06:55
Thanks for the responses. My 15-year old daughter still has pain 24/7 on the Dilaudid, but it is so much more gentle on her tummy than the morphine was. Morphine made her nauseaus, no matter what dose or how much Gravol they gave with it. We know never to have her put on Morphine again if there's a need for a strong pain med. *smile*
I have tried different variations on her dosing (from 4-6 hours and lowest to highest dose). She is even allowed to take it every 2 hours for break-through pain, but I've only done that once. I just don't want to have her on it all the time. We have finally gotten to the point where she can MOST of the time wait 5 hours for her dosing now, but it's still at the highest dose. It doesn't make her high or "weird"....just tired (which is good because sleep is beneficial to healing). Although, I have to admit that she has the funkiest dreams now! I call them her "drug dreams", and told her to enjoy them while she has them. She probably won't ever dream like that again. Lol. Tomorrow will be one week since her surgery, and I do see changes towards improvement....but we still have a long ways to go.
The next plan I have is to get her to 6 hours between dosing (plus she has other meds, so she's not relying solely on the Dilaudid), but that hasn't worked out yet. Once we're stable at 6 hours, then I'll start trying to slowly reduce the amount I give her. I'm sure we'll be getting refills, but once those run out, she may just be put on Codeine (which I find very mild). At some point, she'll be going back to her classes in Grade 9, and we can't have her falling asleep at her desk! Lol. Her teachers have been SO supportive of her ordeal. She had two girlfriends visit her in the hospital and when they realized that it was their friend laying in that bed, they both said, "Holy crap!". LOL.
Now I just have to get more fluids in her since she can't open her mouth. Tough! She won't touch the chocolate Ensure, and I bought 11 CASES of it!!! I think she will get hungry enough, as time passes, that she'll find she wants to try it. Yogart and ice cream are too thick, even when thinned out with milk. But we're still only in Week One. I think she's doing very well, but it's pretty darn scary at times....especially for a mum with anxiety issues. But I've been, amazingly enough, handling this quite well! I guess because it's dealing with my daughter and not with myself.
Thanks again for your responses, and sorry for rambling on. It helps to just type things out and know that someone is reading it.
God bless,
Sandy
Posted by kelv on April 23, 2007, at 16:21:27
In reply to Dilaudid, posted by SandyWeb on April 21, 2007, at 12:54:57
> I know that Dilaudid isn't a psych med, but I have a question about it if anyone knows the answer. My 15-year old daughter just had major jaw surgery (broke both jaws, moved bones around to line up teeth, surgically cut out all 4 of her wisdom teeth, placed a few titanium plates into her gums to keep the bones together, and wired her jaw shut for 6+ weeks). While she was in the hospital for about 5 days, she was always on morphine plus a whole host of other meds.
>
> She is home with me now, and instead of morphine she is taking Dilaudid 4mls (liquid, of course) every 4 hours for at least a month....along with another narcotic and other meds. The surgeon said they would give her a refill of the Dilaudid if she needs more because this wasn't a simple jaw surgery and she's going to be in pain for awhile.
>
> My question: Do you think she will become physically addicted to the narcotic when she comes off it in a month or two? I don't believe she will psychologically addicted simply because it relieves most of her pain and she's not getting high off it. But will she have to be weaned? I would hate for her to go through withdrawal symptoms after all the other pain she's been through.
>
> Thanks so much.
>
> God bless,
> SandyWhat is Dilaudid?
is it like Morphine?, as long as she's not in pain.
Posted by harry_in_philly on April 23, 2007, at 18:19:42
In reply to Re: Dilaudid » SandyWeb, posted by kelv on April 23, 2007, at 16:21:27
Dilaudid is hydromorphone...chemical relative to morphine...is much stronger. Can be very addictive.
Once her pain begins to subside consider switching to Tramadol (ultram) or perhaps Darvocet or Talwin.
Posted by wishingstar on April 25, 2007, at 8:31:11
In reply to Dilaudid, posted by SandyWeb on April 21, 2007, at 12:54:57
Hi Sandy,
I didnt read the thread, but I just saw your post and wanted to comment. I had the same surgery when I was about 16 as well.. even down to the wisdom teeth and jaw wired shut bit. I was lucky and never had a tremendous amount of pain from it.. I dont think I ever took more than tylonel once I was out of the hospital.. but I dont imagine that response is typical. If you have any questions about the process - healing, eating, etc - please dont hesitate to send me a message! That's realy why I posted. Looking back, there are a lot of things I wondered myself.. and didnt figure out until the end.
Hope your daughter is feeling better soon. I'm sure she'll be glad she did it eventually... I swore I never would be, but looking back now, I am glad. Good luck!
Posted by SandyWeb on April 26, 2007, at 12:50:13
In reply to Re: Dilaudid » SandyWeb, posted by wishingstar on April 25, 2007, at 8:31:11
Thanks for your response, Wishingstar. I've been getting a lot of messages from people who have been through some of the same procedures as my daughter, and it's GREAT to be educated!!!!
She is doing a lot better than in the hospital or even at home for the first few days. We are now down to 3 mls of Dilaudid every 5-6 hours, but she's still not comfortable (who would be??). Did you have your jawbone cracking in places and the feeling that teeth were going to fall out? That seems to be the scariest thing for her right now. She DID have one choking session, but it was only water so I knew she would be alright. But she couldn't really breathe and she couldn't even get rid of the water in her mouth. It was scary for BOTH of us. And, of course, she cried and cried after that....which didn't help her nose one bit! Lol.
You were only on Tylenol (with Codeine probably)?? Wow. You're a real Super Hero!! Lol. Your pain tolerance must be extremely high. I bet you don't take a headache pill very often. *smile*
Thanks for your post. I appreciate getting all the first-hand information I can. She sees her surgeon again next Wednesday (May 2nd), so we'll know how things are progressing at that point.
By the way, did you use a prescription oral rinse called Perichlor (chlorhexidine gluc)? Since she can't brush the inside of her mouth, she is supposed to rinse twice a day with this stuff. She says it makes her legs feel like they're floating beneath her body?!?! I thought it was just a mouth wash?? Just wondering if you had the same experience?
God bless,
Sandy
Posted by SandyWeb on April 26, 2007, at 12:59:52
In reply to Dilaudid, posted by SandyWeb on April 21, 2007, at 12:54:57
Thanks, everyone, for all your responses regarding my questions concerning Dilaudid. I had no idea it was such a big, bad drug. That being said, it has really helped with her pain control....even though it never took it completely away.
We are now down to 3 mls every 5-6 hours. For a couple of days we were only taking 2 mls every 5 hours, but she now wants 3 mls instead. Other nerves are starting to wake up in her face, and she's experiencing different types of pains in different places. Ugh. But it's just a matter of time. Even her neck and upper chest are bruised. But a lot of the swelling on her face has gone down, although anyone seeing her for the first time would definately notice the swelling and bruising. But I remember what she looked like a week ago! *smile*
Thanks for all your help. I appreciate it!
God bless,
Sandy
Posted by crenshaw387 on April 27, 2007, at 23:19:24
In reply to Re: Dilaudid, posted by SandyWeb on April 23, 2007, at 10:30:38
dilaudid is a short acting opioid... it only lasts 3-4 hours for me at any dose.... instead of trying to go longer between doses it would be more advisable to instead use a smaller dose but dont spread them farther apart... that is when pain breaks through and then more is needed to get rid of it. also this way will further decreace you daughters chance of haveing any withdrawal symptoms because her body will recognize a smaller dose as cutting back instead of getting a large dose less often, causing a lot of ups and downs...
Posted by crenshaw387 on April 27, 2007, at 23:28:30
In reply to Re: Dilaudid » SandyWeb, posted by kelv on April 23, 2007, at 16:21:27
> > I know that Dilaudid isn't a psych med, but I have a question about it if anyone knows the answer. My 15-year old daughter just had major jaw surgery (broke both jaws, moved bones around to line up teeth, surgically cut out all 4 of her wisdom teeth, placed a few titanium plates into her gums to keep the bones together, and wired her jaw shut for 6+ weeks). While she was in the hospital for about 5 days, she was always on morphine plus a whole host of other meds.
> >
> > She is home with me now, and instead of morphine she is taking Dilaudid 4mls (liquid, of course) every 4 hours for at least a month....along with another narcotic and other meds. The surgeon said they would give her a refill of the Dilaudid if she needs more because this wasn't a simple jaw surgery and she's going to be in pain for awhile.
> >
> > My question: Do you think she will become physically addicted to the narcotic when she comes off it in a month or two? I don't believe she will psychologically addicted simply because it relieves most of her pain and she's not getting high off it. But will she have to be weaned? I would hate for her to go through withdrawal symptoms after all the other pain she's been through.
> >
> > Thanks so much.
> >
> > God bless,
> > Sandy
>
> What is Dilaudid?
>
> is it like Morphine?, as long as she's not in pain.dilaudid is hydromorphone. it is a VERY potent, short acting, semi-synthetic opioid analgesic.
approximate dosage conversions are
8mg hydromorphone = 60mg morphine = 30mg oxycodone
Posted by SandyWeb on April 28, 2007, at 15:32:46
In reply to Re: Dilaudid, posted by crenshaw387 on April 27, 2007, at 23:19:24
Hi crenshaw,
Thanks for the info. With the new prescription we got from the doctor, he had changed the dosing to 2 mls every 6 hours!! That's rather rough on my 15-year old. She's still in lots of pain, and she's more than ready for her dose when it's time. But if I give the 2 mls ever 4 hours (which would be kinder to her), we will run out before she's out of pain. The nurse even said that she could take it every 2 hours, but it all comes down to a matter of quantity.
We see the doctor again on Wednesday for a follow-up, and I'll find out what the plan is from here. Maybe he'll be putting her on Codeine, but I always found that med to be rather mild. My daughter CRIES if left too long without a dose. We'll explain all this to the doc. It does seem more humane to keep her at every 4 hours, but to keep the dosing at 2 mls. I hate putting her through any "up and down" periods, but she simply can't run out. OTC wouldn't even touch this!
I'll let you know how the appointment goes. I know they just don't want to get her addicted, but there's no way she could when she's in this much pain....only as the pain resides more (which it *is* getting a bit better) do we have to be concerned with the effects feeling pleasureable rather than just a relief.
Thanks for your help.
God bless,
Sandy
Posted by SandyWeb on April 28, 2007, at 15:39:55
In reply to Re: Dilaudid, posted by crenshaw387 on April 27, 2007, at 23:28:30
Crenshaw wrote:
> dilaudid is hydromorphone. it is a VERY potent, short acting, semi-synthetic opioid analgesic.
>
> approximate dosage conversions are
> 8mg hydromorphone = 60mg morphine = 30mg oxycodone
-------------------------------
My daughter had problems with just plain morphine. It made her extremely nauseas. She was on a continuous drip in the hospital, and always had to take Gravol with it....which didn't really help at all.Dilaudid is so much more gentle on her tummy. Since she can only take liquids due to her jaw being wired shut, I mix the Dilaudid in with a small amount of Tylenol. We also coat her tummy with a chocolate milk to help with any sicky feelings it might cause. So far, she has done fine on it.....although she has NEVER been pain free. Break-through pain? She's never been pain-free except for when she's asleep, poor thing.
Do you happen to know why morphine would be more severe on the tummy than Dilaudid?
God bless,
Sandy
Posted by wishingstar on April 29, 2007, at 11:52:04
In reply to Re: Dilaudid » wishingstar, posted by SandyWeb on April 26, 2007, at 12:50:13
Sorry for taking a few days to respond... I always forget when I've posted on this board because I dont do it often. :)
I'm glad she's starting to do better. I cant say I ever experienced the feeling that my teeth were going to fall out, or the cracking. I had an acrylic plate attached to the bottom side of my top teeth for all 6 weeks (along with being wired shut) that basically held my jaw in line like a retainer.. so perhaps that cut down on some of that. Does she have anythnig like that?
I had a similar moment to her water experience in the hospital.. except it wasnt triggered by anything. I just started feeling like I was choking and couldnt breathe. It was very scary. I think not being able to open your mouth really creates a lot of anxiety. I'm glad shes okay.
Once I got out of the hospital, I believe it was just regular tylonel I was taking actually. It's odd because I dont have an unusually high pain tolerance most of the time, but my jaw was just never all that painful. They were pumping me full of morphine in the hospital and I was trying to refuse it because I just didnt need it. I got some pretty nasty swelling.. but I'm not sure I got so lucky regarding the pain!
I did have a percription mouthwash, but I dont remember the name of it. If I remember correctly, I think it was a light green or bluish color, and I used it several times a day. I think it worked well. I also bought a water pic and used that occasionally after the first 2 weeks maybe, and it helped me feel a little more clean. I guess it has some pretty strong things in it since its being used as the only oral hygeine thing for 6 weeks, during a time where cleanliness is obviously important, so I'd guess she's just getting other effects (the floating feeling) from something in it. I dont think I ever felt that, but again.. it was about 8 years ago so I could be wrong.
In the first few weeks after my surgery, I lost 10-15lbs (putting me at around 85-90lbs probably) and getting enough calories was a real problem. They almost rehospitalized me just for that! How have you and your daughter been doing with eating? By the end of the six weeks, I think I'd actually put pizza in the blender once. You can add milk and blend anything... :) But I know my first 2-3 weeks were pure liquid only, which is how I lost so much weight. I'd recommend milkshakes made with ensure or cream (yum!).. potato soup (blended smooth, of course) made with cream instead of milk.. I also ate a lot of oatmeal blended with milk to make it a thin puree.. and later on, mac and cheese blended with milk. I believe that was the first thing I ate after several weeks of only juice, and it was the best thing I'd ever tasted in my life! My mother also took me to lunch at Baskin Robbins (one of those "real" ice cream places) a few times and I'd have an extra large milkshake thinned out, while she had dessert. Anwyay, rambling.
Good luck!
Posted by SandyWeb on April 29, 2007, at 13:28:00
In reply to Re: Dilaudid » SandyWeb, posted by wishingstar on April 29, 2007, at 11:52:04
Hi wishingstar,
Don't worry about taking awhile to get back to me. We don't all check the forms every day. *smile* But thanks for the response.
My daughter has braces, so the wires were connected through those. That's probably why she didn't have the acrylic plate like you did.
Yes, I can't imagine what it's like to be choking on something as stupid as water....but not being able to open your mouth and spit out the excess water in your mouth. She was gagging and coughing with her eyes running, and then she just stopped and swallowed the rest of the water in her mouth and coughed a bit more. And then she cried a lot. That really scared her. She just had a stitch come out last night, and it came out on the INSIDE of her mouth. She was terrified to swallow it after the water incident. So she worked for a VERY long time trying to pass that stitch through some spot between her teeth. She finally got it out. Poor girl.
My daughter had a lot of work done. The x-rays are amazing. Both jaws were broken, and it looks like someone took a pair of scissors and just cut straight down through the jawbone on each side of her chin....separating the bone....and the same on the upper jaw but with much more "stuff" happening up there. The separated bones are now held together with titanium plates, but that's only at the very top. The rest of the bone, all the way through, is not joined at all. I guess it will take awhile for the bones to "fuse" back together? They also shortened her upper lip, and there are tons of inside stitches all around her nose, and then the titantium plates for the upper jaw right below all that. And then there are little plates and stitches back further in her mouth, plus she had the wisdom teeth cut out. I can't imagine being able to handle that kind of pain on just Tylenol, but the surgeon did say that it wasn't a normal jaw breaking. They really did a lot of work in there. One thing I'm concerned about, though. She says that she can feel the tip of one of the titanium plates in the upper jaw sticking outside of the gum! How can that be unless it shifted? It shouldn't be sticking out, even just a little, right??
Yes, it sounds like you had the same prescription oral rinse that we have. She says it doesn't make her legs feel like they're floating anymore. So weird because she didn't even swallow the stuff! Lol. I guess it tastes pretty awful!
I have a feeling she will lose a lot of weight because she is hardly drinking anything. And there is not ANY space ANYWHERE to get soft foods in her mouth. She is getting headaches from her jaws clenching together so tightly, and there is nothing she can do about it. She's been drinking Instant Breakfasts, Yops, hot chocolate, chocolate milk. I have a ton of apple juice and cases of Ensure, but she won't touch those. I'll have to get her some other type of juice. And I tried softening up some ice cream and adding whole milk, but even the little globs of hardened ice cream in the drink caused her trouble. I just hope she doesn't have to be rehospitalized!
Anyways, she has Dilaudid (which I mix with grape Tylenol) for pain, Naproxen for inflammation and pain, pseudoephedrine for her stuffy nose, a nasal spray to clear her nostrils if she bleeds again, the oral rinse, and Gravol for nausea. And do you realize that one of the least expensive meds on that list is the Dilaudid???? Seems unreal!
Thanks for writing back.
God bless,
Sandy
Posted by crenshaw387 on April 30, 2007, at 16:59:02
In reply to Re: Dilaudid » crenshaw387, posted by SandyWeb on April 28, 2007, at 15:32:46
another thing to consider is a low dose perhaps 12.5 or 25 ug/hr fentanyl patch.... they are applied once ever 3 days and provide round the clock pain relief without constant dosing... a 12.5 microgram patch would be about equivalent to her current dilaudid dose for pain. also stomach upset and other side effects are very low.
Posted by SandyWeb on May 1, 2007, at 13:56:35
In reply to Re: Dilaudid, posted by crenshaw387 on April 30, 2007, at 16:59:02
> another thing to consider is a low dose perhaps 12.5 or 25 ug/hr fentanyl patch.... they are applied once ever 3 days and provide round the clock pain relief without constant dosing... a 12.5 microgram patch would be about equivalent to her current dilaudid dose for pain. also stomach upset and other side effects are very low. <
---------------------------
Thanks for that idea, Crenshaw!Yes, my daughter's dose is VERY low now...but she still definately needs something. The poor girl was pulling her sheets up around her face this morning and accidently punched herself in the jaw. Can you imagine? OUCH. According to the x-rays, the jaw is not even connected together anymore except by the titanium plates on the top holding it in place. I'm assuming the bone grows back together over time. And she has at least 4 spots on both jaws that are completely cut through like that. And plenty of other painful incisions and such to recuperate from. But I felt so bad for her when she was crying this morning because of her hand slipping on the sheets. And there was nothing I could do other than get a hot pack for her to place on her jaw.
I think the patch is a great idea because I've been wondering about when she returns to school. I don't feel comfortable with her taking a bottle of Dilaudid to a High School each day. What if someone got ahold of it somehow?? But the patch would work great because she wouldn't have to take any meds to school with her at all, and she wouldn't have to mention to any of the kids about the patch (maybe warn the teachers, though, in case she gets sleepy from time to time).
She has another appointment with the surgeon tomorrow afternoon. I'll see what he thinks about the patch. Hey, and anything's better than having to drink yucky tasting medicines every day!!!!
Thanks again for the advice!
God bless,
Sandy
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.