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PDF Editor FAQ
What is the remedy for a tooth ache?
A toothache can be severe and relentless. It usually requires a combination pain killer, such as what one would get after surgery.For severe tooth pain, I prescribe the combination drug of hydrocodone and acetaminophen- commonly known as Vicodin or Norco. It is taken 3–4 times a day. The maximum number of days is four. After four days one can quickly get physically addicted to it.Alternatives to Vicodin are to take 400 mg Ibuprofen, followed 2 hours later with 650 mg Tylenol. Then the cycle of alternating Ibuprofen and Tylenol is repeated on two hours intervals. This has proven to be very effective in treating dental pain. The drawback is that you have to keep taking two pills every two hours throughout the day.
Are doctors indifferent towards people's pain?
Are doctors indifferent towards people's pain?I have decided to place my answer below a comment I initially made on an existing answer by Habib here: Are doctors indifferent towards people's pain?My comment is first, the actual answer to the question is second. Thank you to those that asked me to post this as an answer. As a comment it struck a chord and I think it’s high time for a discussion on the subject1- Original Comment (made on Habib answer to this question)One of these days I will write an essay on addiction, opiates and doctor’s attitudes toward it. For now, I am just going to write a fraction of my experience and my thoughts on the matter.Yes, in the 90’s they were too [care]free in giving opioids out, and that did create a large part the heroin epidemic we are seeing now.However, the pendulum has swung all the way to the other side and that too is not pretty.A couple of years ago I was denied any opioid for my kidney stones, until I was given X-rays 12 hours later and they found a river rock lurking in my kidneys.It used to be that as soon as I showed up with kidney stones, I was immediately given something (I have had them at least 20 times from the late 80’s to about 3 years ago), but no more I guess.A pain patient today is assumed to be an addict until proven otherwise.I should suffer and convulse on the ground until hard proof is obtained because some (other) people abuse pain killers.And kidney stones always seem to happen on Friday nights when the ER is full to the brim.Of course, it is best for patients not to be addicted to anything, but addiction should not be treated as a moral failure or a weakness of spirit. Unfortunately too many doctors, treat it exactly that way.My wife has had various neck and back surgeries, alongside too many other illnesses to list, and she has been on Morphine Sulphate for over 10 years.When she started showing symptoms of an autonomic disorder too complex to explain here, it went undiagnosed because at the same time her old doctor retired and the new doctor went on a crusade to get her off opioids. She choose to ignore the very evident symptoms that something else was going terribly wrong, in favor of bringing her to “sobriety”.Those were the worst 3 months of our lives. We spent 5 nights a week awake dealing with her pain and this new syndrome’s symptoms.We waged a war on two fronts: on one I was advocating for my wife to get back on the pain regimen that had been working for her, on the other, I was trying to convince her Doctor that she was showing signs of Disautonomia. She ignored both.She was put on Suboxone at the time, which alleviated/eliminated the whitdrawl symptoms, but did nothing for her pain. It was sold to her as a pain management solution. It wasn’t.The opioid addiction went away, but the pain she suffered from, was back in play with a vengeance.(Edit: in the course of this experience, I discovered that Suboxone is administered by special doctors that have very shady deals with local hospitals and clinics. It is off topic for this post, but in our case there was a clear conflict of interest, the kind where Money and insurance fraud is involved).However, her doctors, including the pain clinic Docs, were completely disinterested in her pain (and my state of mind as well, incidentally. I slept maybe 3 hours per night and worked during the day, drove her to the ER twice a week (or more), waited around for hours, dealt with the bureaucracy, etc.).Then I started taking videos of how she spent her nights and I put it on youtube. That caught the attention of the higher ups and things started moving in the right direction.For some people addiction is a better option than the pain. Sure there are the John Wayne types that can grit their teeth and go on, but that’s not for everyone.If the choice is between sobriety and constant pain on one side and addiction that allows the patient to be functional on the other, I personally would take addiction. I most certainly take it for my wife.Now, because the autonomic disorder went undiagnosed (Ignored) for so long, it had progressed to a level that is pretty much incurable. We cannot know if that would have been the case with a prompt diagnosis, but if her doctors had not been so fucking sanctimonious about her morphine addiction and actually listened to our research on Disautonomia, to her complaints and to her symptoms and she ordered the tests we were begging for, maybe things wouldn’t be so bad now.Every morning now, I have to check if my wife is alive. Her breathing is so shallow in the morning, I often have to feel her pulse on her neck. Then I can make breakfast. The Cardiologist made it clear that one day he her heart may just stop beating. Just like that. She has been in heart failure since about 4 months after this whole detox thing happened.The stress alone did her in. In fact, while I couldn’t begin to quantify the damage they did to her with their anti-addiction crusade, she is objectively much worse now than she ever was before. Stress was and is a very big part of her illness and their actions were as stressful as anything she has ever experienced.She is back on morphine now, a lowered dose because fuck if I know. I guess she deserves to suffer a little bit for being such a weak person.By the way, during this ordeal, I was part of this surreal exchange after she was taken off suboxone:Doctor: “Mrs. Stradale, you have to understand you will never, ever again be on opioid medications and you’ll have to learn to manage your pain without them.”Then he proceeded to write her a prescription for Norco and another drug. As if we were idiots and could not google Norco and find out it is an opioid.I never understood what that was about and this was a pain Clinic doctor.For the record, Norco did not work and made her puke 3 times a day. Same with Vicodine. Both give her atrocious intestinal pains and stomach acidity (she also suffers from Barret’s Esophagus, a corrosion of the valve in the esophagus).Morphine has nothing of these side effects because it is free of Acetaminophen (Tylenol) to which she is, or has become, violently allergic to.Society and AddictionI have done a lot of research on opioid addiction. The current administration approach, continuing the war on drugs and criminalizing addicts, is simply a losing proposition.Portugal semi-liberalized opioid use some years ago. They are not sold in grocery stores, but they are available to those that need them so they can function.They discovered that use of opioid actually went down, not up as everyone feared.Part of it is that once you have to go to a drab government office to get your fix, much of the “magic” and “coolness” of doing Smack goes away.Part is that they offer real detox alternatives for those that take it for non-medical reasons.Frankly, even for people that take them without a medical reason, for “fun” or “recreationally”, if they have been doing it for long enough, sobriety is a daily struggle to a level where I wonder if a maintenance regimen would not be better.When the cheating addict is trying to pump the doctor for pain killers, is he/she not in pain? I would argue that he/she is in the 10 percentile of pain sufferers at that ER at that moment.Is she denied the drug on a medical or moral standing? Because the way I see it, it looks like a moral position, not a medical one. At least at that moment, in that clinic, refusing her what the body craves, means inflicting unnecessary pain on that person.I am a veteran of ER waiting rooms and I have seen plenty of people being treated like sub-human dirt because they were seeking opioids.Nurses treated them with contempt and outright hostility. Freely discussed their medical issues and their previous attempts to score in front of the other people in the room as if their privacy was not worthy. I have never seen anyone offer them treatment options or even just a caring word.There is definitely a “Us” and “Them” in many professions, including the medical one, but when it comes to addicts it is magnified to the point were medical personel don’t see the addict as worth of his or her humanity. They are just an insignificant annoyance.I think doctors and nurses perceive their pain as self inflicted and therefore not as worthy as that of a “real patient”.I make the argument they are real patients. That their pain is as real as anyone’s.Too many times my wife has been treated like a drug seeking addict. Too many times I have seen the sanctimony, lack of care and outright hostility. Most people on opioids are treated first as addicts and then as patients, even if they have ample proof they are not recreational users.(I have a kit in my car and one in my phone with all the documentation regarding her opioid use. Because she often needs what are called “breakthrough drugs” to get her out of her worse pain, when even morphine doesn’t work anymore.)Are they not suffering humans? Isn’t the obese fellow next in line just as guilty of eating cheeseburgers all his life? Should we withdraw care from him too? What about lung cancer patients?“You smoked all your life, no pain medicine for you” (which is pretty much what happened to my father in Italy, but that’s another story).My belief is that we need to stop the pendulum from swinging and review and rethink our attitude toward opioids, addiction, and how hospitals and doctors treat addicts.Right now, it is absolutely cruel and antithetical to ethical medicine, especially since doctors and pharma companies are not exactly innocent in all this.Do we rather have an army of addicts scouring the countryside for drugs and dying in dirty bathrooms with a needle in their arm or would it be better to take the approach Portugal did?I say decriminalize and destigmatization would be an improvement on the status quo and let’s stop with treating addiction at the same level as pedophelia or terrorism.Ask me what I think of sobriety the next time I get a kidney stone. I won’t be polite.In Portugal, Drug Use Is Treated As A Medical Issue, Not A Crime2- The answer:It is impossible to take a group as varied as doctors and give an answer that will cover every doctor out there.I have met a lot of doctors over the years. My wife has been ill for almost 30 years and I had a Liver Transplant (and all the complications that go with Liver Disease) almost 15 years ago.I have met wonderful, caring doctors and nurses, the majority, in fact, and I have met uncaring, cold, doctors that were completely devoid of empathy (and often not too good at their jobs either)Doctors may look “Indifferent” to pain, but if one thinks about it for a minute, should they empathize to the point of suffering as their patients suffer? We, as patients, need a professional that will do his/her best for our specific ailment. Medicine is not an easy profession and misdiagnosing a patient can lead to their death.When I screw up a line of code, at worse whatever I am programming will stop working. But I am not killing anyone.Doctors need to put up a barrier between them and their patient to better provide careThat doesn’t mean doctors should be uncaring automatons. Plenty of research has shown that part of the reason people go to Homeopathic doctors and other charlatans is because they spend “quality time” with their patients and they behave more emphatically.I think family doctors especially, but specialists as well, could learn a lot from these purveyors of fraudulent medicine. Their methods are flawed and can be dangerous when they preclude the use of real medicine against an illness but, by and large, their approach to patient care could teach Real Doctors™ a few things.I read more than one article where doctors that had recovered from a grave illness reported it had changed the way they practice medicine.In the case of pain, if the Pain Doctor caring for a patient has never experience the kind of pain a kidney stone can cause, they may never be able to properly empathize with the patient. It is a pain that is indescribable, like a toothache at the 10th potency.Of course it would be impractical to make every doctor suffer through every conceivable type of pain (or illness, loss of dignity, disempowerment, discomfort, etc.) to make them more empathetic, that would be impossible, not to mention unethical and impractical. But for some doctors I have dealt with, I am convinced that an hour walking (or rather laying in bed) in my wife’s shoes, experiencing her pain, her powerlessness and her loss of dignity, would have done wonders for their attitude.
Is it worth it to get your wisdom teeth removed? Could you get addicted to opioids after your removal due to the painkillers? One peer told me she was put on so much painkillers, fear that will lead to addiction. Experiences?
It all depends. My wisdom teeth were all impacted and likely would have resulted in damage to my second molars if they were left there for years. I had them extracted at age 19 by an oral surgeon and I was prescribed a short course of Norco (Vicodin). I’ll be honest, I took one Norco the afternoon after the surgery and I felt like I could do anything. That’s when my mom took the rest away. There is excellent research that ibuprofen is just as effective for pain relief after third molar extractions as opioids like Norco (which has hydrocodone AND acetaminophen). If you’re worried about effective pain relief, you can take acetaminophen (tylenol) together with ibuprofen and you will get excellent pain relief with no addiction potential.As for whether or not you should have your wisdom teeth extracted, you should have a consultation with an oral surgeon who can evaluate the risks and benefits of having them removed versus leaving them behind. I routinely recommend having them removed especially for patients that are younger. For older patients that have had them there for a long time without any problems, it is OK to leave them behind. But if I think there’s more than even a small chance they will cause problems in the future, I recommend extraction. And I would offer ibuprofen and acetaminophen for pain relief, not Norco.
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