I’ve been given opioids after surgery to take at home. What do I need to know?
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Opioids are commonly prescribed when you’re discharged from hospital after surgery to help manage pain at home.
These strong painkillers may have unwanted side effects or harms, such as constipation, drowsiness or the risk of dependence.
However, there are steps you can take to minimise those harms and use opioids more safely as you recover from surgery.
Which types of opioids are most common?
The most commonly prescribed opioids after surgery in Australia are oxycodone (brand names include Endone, OxyNorm) and tapentadol (Palexia).
In fact, about half of new oxycodone prescriptions in Australia occur after a recent hospital visit.
Most commonly, people will be given immediate-release opioids for their pain. These are quick-acting and are used to manage short-term pain.
Because they work quickly, their dose can be easily adjusted to manage current pain levels. Your doctor will provide instructions on how to adjust the dosage based on your pain levels.
Then there are slow-release opioids, which are specially formulated to slowly release the dose over about half to a full day. These may have “sustained-release”, “controlled-release” or “extended-release” on the box.
Slow-release formulations are primarily used for chronic or long-term pain. The slow-release form means the medicine does not have to be taken as often. However, it takes longer to have an effect compared with immediate-release, so it is not commonly used after surgery.
Controlling your pain after surgery is important. This allows you get up and start moving sooner, and recover faster. Moving around sooner after surgery prevents muscle wasting and harms associated with immobility, such as bed sores and blood clots.
Everyone’s pain levels and needs for pain medicines are different. Pain levels also decrease as your surgical wound heals, so you may need to take less of your medicine as you recover.
But there are also risks
As mentioned above, side effects of opioids include constipation and feeling drowsy or nauseous. The drowsiness can also make you more likely to fall over.
Opioids prescribed to manage pain at home after surgery are usually prescribed for short-term use.
But up to one in ten Australians still take them up to four months after surgery. One study found people didn’t know how to safely stop taking opioids.
Such long-term opioid use may lead to dependence and overdose. It can also reduce the medicine’s effectiveness. That’s because your body becomes used to the opioid and needs more of it to have the same effect.
Dependency and side effects are also more common with slow-release opioids than immediate-release opioids. This is because people are usually on slow-release opioids for longer.
Then there are concerns about “leftover” opioids. One study found 40% of participants were prescribed more than twice the amount they needed.
This results in unused opioids at home, which can be dangerous to the person and their family. Storing leftover opioids at home increases the risk of taking too much, sharing with others inappropriately, and using without doctor supervision.
How to mimimise the risks
Before using opioids, speak to your doctor or pharmacist about using over-the-counter pain medicines such as paracetamol or anti-inflammatories such as ibuprofen (for example, Nurofen, Brufen) or diclofenac (for example, Voltaren, Fenac).
These can be quite effective at controlling pain and will lessen your need for opioids. They can often be used instead of opioids, but in some cases a combination of both is needed.
Other techniques to manage pain include physiotherapy, exercise, heat packs or ice packs. Speak to your doctor or pharmacist to discuss which techniques would benefit you the most.
However, if you do need opioids, there are some ways to make sure you use them safely and effectively:
- ask for immediate-release rather than slow-release opioids to lower your risk of side effects
- do not drink alcohol or take sleeping tablets while on opioids. This can increase any drowsiness, and lead to reduced alertness and slower breathing
- as you may be at higher risk of falls, remove trip hazards from your home and make sure you can safely get up off the sofa or bed and to the bathroom or kitchen
- before starting opioids, have a plan in place with your doctor or pharmacist about how and when to stop taking them. Opioids after surgery are ideally taken at the lowest possible dose for the shortest length of time.
If you’re concerned about side effects
If you are concerned about side effects while taking opioids, speak to your pharmacist or doctor. Side effects include:
- constipation – your pharmacist will be able to give you lifestyle advice and recommend laxatives
- drowsiness – do not drive or operate heavy machinery. If you’re trying to stay awake during the day, but keep falling asleep, your dose may be too high and you should contact your doctor
- weakness and slowed breathing – this may be a sign of a more serious side effect such as respiratory depression which requires medical attention. Contact your doctor immediately.
If you’re having trouble stopping opioids
Talk to your doctor or pharmacist if you’re having trouble stopping opioids. They can give you alternatives to manage the pain and provide advice on gradually lowering your dose.
You may experience withdrawal effects, such as agitation, anxiety and insomnia, but your doctor and pharmacist can help you manage these.
How about leftover opioids?
After you have finished using opioids, take any leftovers to your local pharmacy to dispose of them safely, free of charge.
Do not share opioids with others and keep them away from others in the house who do not need them, as opioids can cause unintended harms if not used under the supervision of a medical professional. This could include accidental ingestion by children.
For more information, speak to your pharmacist or doctor. Choosing Wisely Australia also has free online information about managing pain and opioid medicines.
Katelyn Jauregui, PhD Candidate and Clinical Pharmacist, School of Pharmacy, Faculty of Medicine and Health, University of Sydney; Asad Patanwala, Professor, Sydney School of Pharmacy, University of Sydney; Jonathan Penm, Senior lecturer, School of Pharmacy, University of Sydney, and Shania Liu, Postdoctoral Research Fellow, Faculty of Medicine and Dentistry, University of Alberta
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Healthy Longevity As A Lifestyle Choice
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7 Keys To Healthy Longevity
This is Dr. Luigi Fontana. He’s a research professor of Geriatrics & Nutritional Science, and co-director of the Longevity Research Program at Washington University in St. Louis.
What does he want us to know?
He has a many-fold approach to healthy longevity, most of which may not be news to you, but you might want to prioritize some things:
Consider caloric restriction with optimal nutrition (CRON)
This is about reducing the metabolic load on your body, which frees up bodily resources for keeping yourself young.
Keeping your body young and healthy is your body’s favorite thing to do, but it can’t do that if it never gets a chance because of all the urgent metabolic tasks you’re giving it.
If CRON isn’t your thing (isn’t practicable for you, causes undue suffering, etc) then intermittent fasting is a great CR mimetic, and he recommends that too. See also:
- Is Cutting Calories The Key To Healthy Long Life?
- Fasting Without Crashing? We Sort The Science From The Hype
Keep your waistline small
Whichever approach you prefer to use to look after your metabolic health, keeping your waistline down is much more important for health than BMI.
Specifically, he recommends keeping it:
- under 31.5” for women
- under 37” for men
The disparity here is because of hormonal differences that influence both metabolism and fat distribution.
Exercise as part of your lifestyle
For Dr. Fontana, he loves mountain-biking (this writer could never!) and weight-lifting (also not my thing). But what’s key is not the specifics, but what’s going on:
- Some kind of frequent movement
- Some kind of high-intensity interval training
- Some kind of resistance training
Frequent movement because our bodies are evolved to be moving more often than not:
The Doctor Who Wants Us To Exercise Less, & Move More
High-Intensity Interval Training because unlike most forms of exercise (which slow metabolism afterwards to compensate), it boosts metabolism for up to 2 hours after training:
How To Do HIIT (Without Wrecking Your Body)
Resistance training because strength (of muscles and bones) matters too:
Resistance Is Useful! (Especially As We Get Older)
Writer’s examples:
So while I don’t care for mountain-biking or weight-lifting, what I do is:
1) movement: walk (briskly!) everywhere and also use a standing desk
2) HIIT: 2-minute bursts of hindu squats and/or exercise bike sprints
3) resistance: pilates and other calisthenicsModeration is not key
Dr. Fontana advises that we do not smoke, and that we do not drink alcohol, for example. He also notes that just as the only healthy amount of alcohol is zero, less ultra-processed food is always better than more.
Maybe you don’t want to abstain completely, but mindful wilful consumption of something unhealthy is preferable to believing “moderate consumption is good for the health” and an unhealthy habit develops!
Greens and beans
Shocking absolutely nobody, Dr. Fontana advocates for (what has been the most evidence-based gold standard of healthy-aging diets for quite some years now) the Mediterranean diet.
See also: Four Ways To Upgrade The Mediterranean Diet ← this is about tweaking the Mediterranean diet per personal area of focus, e.g. anti-inflammatory bonus, best for gut, heart healthiest, and most neuroprotective.
Take it easy
Dr. Fontana advises us (again, with a wealth of evidence) Mindfulness-Based Stress Reduction, and to get good sleep.
Not shocked?
To quote the good doctor,
❝There are no shortcuts. No magic pills or expensive procedures can replace the beneficial effects of a healthy diet, exercise, mindfulness, or a regenerating night’s sleep.❞
Always a good reminder!
Want to know more?
You might enjoy his book “The Path to Longevity: How to Reach 100 with the Health and Stamina of a 40-Year-Old”, which we reviewed previously
You might also like this video of his, about changing the conversation from “chronic disease” to “chronic health”:
Want to watch it, but not right now? Bookmark it for later
Take care!
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Running: Getting Started – by Jeff Galloway
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Superficially, running is surely one of the easiest sports to get into, for most people. You put one foot in front of the other, repeat, and pick up the pace.
However, many people do not succeed. They head out of the door (perhaps on January the first), push themselves a little, experience runner’s high, think “this is great”, and the next day wake up with some minor aches and no motivation. This book is here to help you bypass that stage.
Jeff Galloway has quite a series of books, but the others seem derivative of this one. So, what makes this one special?
It’s quite comprehensive; it covers (as the title promises) getting started, setting yourself up for success, finding what level your ability is at safely rather than guessing and overdoing it, and building up from there.
He also talks about what kit you’ll want; this isn’t just about shoes, but even “what to wear when the weather’s not good” and so forth; he additionally shares advice about diet, exercise on non-running days, body maintenance (stretching and strengthening), troubleshooting aches and pains, and running well into one’s later years.
Bottom line: if you’d like to take up running but it seems intimidating (perhaps for reasons you can’t quite pin down), this book will take care of all those things, and indeed get you “up and running”.
Click here to check out Running: Getting Started, and get started!
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Tasty Hot-Or-Cold Soup
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Full of fiber as well as vitamins and minerals, this versatile “serve it hot or cold” soup is great whatever the weather—give it a try!
You will need
- 1 quart low-sodium vegetable stock—ideally you made this yourself from vegetable offcuts you kept in the freezer until you had enough to boil in a big pan, but failing that, a large supermarket will generally be able to sell you low-sodium stock cubes.
- 2 medium potatoes, peeled and diced
- 2 leeks, chopped
- 2 stalks celery, chopped
- 1 large onion, diced
- 1 large carrot, diced, or equivalent small carrots, sliced
- 1 zucchini, diced
- 1 red bell pepper, diced
- 1 tsp rosemary
- 1 tsp thyme
- ¼ bulb garlic, minced
- 1 small piece (equivalent of a teaspoon) ginger, minced
- 1 tsp red chili flakes
- 1 tsp black pepper, coarse ground
- ½ tsp turmeric
- Extra virgin olive oil, for frying
- Optional: ½ tsp MSG or 1 tsp low-sodium salt
About the MSG/salt: there should be enough sodium already from the stock and potatoes, but in case there’s not (since not all stock and potatoes are made equal), you might want to keep this on standby.
Method
(we suggest you read everything at least once before doing anything)
1) Heat some oil in a sauté pan, and add the diced onion, frying until it begins to soften.
2) Add the ginger, potato, carrot, and leek, and stir for about 5 minutes. The hard vegetables won’t be fully cooked yet; that’s fine.
3) Add the zucchini, red pepper, celery, and garlic, and stir for another 2–3 minutes.
4) Add the remaining ingredients; seasonings first, then vegetable stock, and let it simmer for about 15 minutes.
5) Check the potatoes are fully softened, and if they are, it’s ready to serve if you want it hot. Alternatively, let it cool, chill it in the fridge, and enjoy it cold:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Eat More (Of This) For Lower Blood Pressure
- Our Top 5 Spices: How Much Is Enough For Benefits? ← 5/5 in our recipe today!
- Monosodium Glutamate: Sinless Flavor-Enhancer Or Terrible Health Risk?
Take care!
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Green Paneer Flatbreads
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These are versatile little snacks that can be eaten alone or served as part of a buffet; great for warm summer nights!
You will need
- 1 lb block of paneer (you can also use our plant-based high-protein paneer recipe)
- 7 oz unsweetened yogurt (your choice what kind; plant-based is fine; live cultured is best)
- 1 tomato, thinly sliced
- ½ red onion, thinly sliced
- 2 oz spinach leaves
- 1 tbsp lime juice
- 1 tsp red chili powder
- 4 wholewheat flatbreads
And then the marinade:
- 3 oz spinach
- ½ bulb garlic
- 1 tsp cumin seeds
- 1 tsp coriander seeds
- 1 tsp chili flakes
- ½ tsp MSG or 1 tsp low-sodium salt (MSG being the preferable and healthier option)
- 2 tbsp extra virgin olive oil
- Juice of ½ lime
Method
(we suggest you read everything at least once before doing anything)
1) Blend the marinade ingredients in a blender.
2) Cut the paneer into long cuboid chapes (similar to fish fingers) and put them in a bowl. Pour ⅔ of the marinade over them, and gently mix to coat evenly.
3) Heat a ridged griddle pan, and when hot, add the paneer and cook for 1–2 minutes each side without stirring, jiggling, or doing anything other than turning once per uncooked side.
4) Combine the onion, tomato, spinach leaves, lime choice, and chili powder to make the salad.
5) Add the remaining marinade to the yogurt to make a green dip.
6) Toast your flatbreads under the grill.
5) Assemble, putting the paneer and salad with a spoonful of the dip on the flatbread, and serve:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- High-Protein Plant-Based Paneer
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- Our Top 5 Spices: How Much Is Enough For Benefits?
- Monosodium Glutamate: Sinless Flavor-Enhancer Or Terrible Health Risk?
Take care!
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Do You Believe In Magic? – by Dr. Paul Offit
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Here at 10almonds, we like to examine and present the science wherever it leads, so this book was an interesting read.
Dr. Offit, himself a much-decorated vaccine research scientist, and longtime enemy of the anti-vax crowd, takes aim at alternative therapies in general, looking at what does work (and how), and what doesn’t (and what harm it can cause).
The style of the book is largely polemic in tone, but there’s lots of well-qualified information and stats in here too. And certainly, if there are alternative therapies you’ve left unquestioned, this book will probably prompt questions, at the very least.
And science, of course, is about asking questions, and shouldn’t be afraid of such! Open-minded skepticism is a key starting point, while being unafraid to actually reach a conclusion of “this is probably [not] so”, when and if that’s where the evidence brings us. Then, question again when and if new evidence comes along.
To that end, Dr. Offit does an enthusiastic job of looking for answers, and presenting what he finds.
If the book has downsides, they are primarily twofold:
- He is a little quick to dismiss the benefits of a good healthy diet, supplemented or otherwise.
- His keenness here seems to step from a desire to ensure people don’t skip life-saving medical treatments in the hope that their diet will cure their cancer (or liver disease, or be it what it may), but in doing so, he throws out a lot of actually good science.
- He—strangely—lumps menopausal HRT in with alternative therapies, and does the exact same kind of anti-science scaremongering that he rails against in the rest of the book.
- In his defence, this book was published ten years ago, and he may have been influenced by a stack of headlines at the time, and a popular celebrity endorsement of HRT, which likely put him off it.
Bottom line: there’s something here to annoy everyone—which makes for stimulating reading.
Click here to check out Do You Believe In Magic, and expand your knowledge!
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- He is a little quick to dismiss the benefits of a good healthy diet, supplemented or otherwise.
Could my glasses be making my eyesight worse?
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So, you got your eyesight tested and found out you need your first pair of glasses. Or you found out you need a stronger pair than the ones you have. You put them on and everything looks crystal clear. But after a few weeks things look blurrier without them than they did before your eye test. What’s going on?
Some people start to wear spectacles for the first time and perceive their vision is “bad” when they take their glasses off. They incorrectly interpret this as the glasses making their vision worse. Fear of this might make them less likely to wear their glasses.
But what they are noticing is how much better the world appears through the glasses. They become less tolerant of a blurry world when they remove them.
Here are some other things you might notice about eyesight and wearing glasses.
Lazy eyes?
Some people sense an increasing reliance on glasses and wonder if their eyes have become “lazy”.
Our eyes work in much the same way as an auto-focus camera. A flexible lens inside each eye is controlled by muscles that let us focus on objects in the distance (such as a footy scoreboard) by relaxing the muscle to flatten the lens. When the muscle contracts it makes the lens steeper and more powerful to see things that are much closer to us (such as a text message).
From the age of about 40, the lens in our eye progressively hardens and loses its ability to change shape. Gradually, we lose our capacity to focus on near objects. This is called “presbyopia” and at the moment there are no treatments for this lens hardening.
Optometrists correct this with prescription glasses that take the load of your natural lens. The lenses allow you to see those up-close images clearly by providing extra refractive power.
Once we are used to seeing clearly, our tolerance for blurry vision will be lower and we will reach for the glasses to see well again.
The wrong glasses?
Wearing old glasses, the wrong prescription (or even someone else’s glasses) won’t allow you to see as well as possible for day-to-day tasks. It could also cause eyestrain and headaches.
Incorrectly prescribed or dispensed prescription glasses can lead to vision impairment in children as their visual system is still in development.
But it is more common for kids to develop long-term vision problems as a result of not wearing glasses when they need them.
By the time children are about 10–12 years of age, wearing incorrect spectacles is less likely to cause their eyes to become lazy or damage vision in the long term, but it is likely to result in blurry or uncomfortable vision during daily wear.
Registered optometrists in Australia are trained to assess refractive error (whether the eye focuses light into the retina) as well as the different aspects of ocular function (including how the eyes work together, change focus, move around to see objects). All of these help us see clearly and comfortably.
Younger children with progressive vision impairments may need more frequent eye tests. Shutterstock What about dirty glasses?
Dirty or scratched glasses can give you the impression your vision is worse than it actually is. Just like a window, the dirtier your glasses are, the more difficult it is to see clearly through them. Cleaning glasses regularly with a microfibre lens cloth will help.
While dirty glasses are not commonly associated with eye infections, some research suggests dirty glasses can harbour bacteria with the remote but theoretical potential to cause eye infection.
To ensure best possible vision, people who wear prescription glasses every day should clean their lenses at least every morning and twice a day where required. Cleaning frames with alcohol wipes can reduce bacterial contamination by 96% – but care should be taken as alcohol can damage some frames, depending on what they are made of.
When should I get my eyes checked?
Regular eye exams, starting just before school age, are important for ocular health. Most prescriptions for corrective glasses expire within two years and contact lens prescriptions often expire after a year. So you’ll need an eye check for a new pair every year or so.
Kids with ocular conditions such as progressive myopia (short-sightedness), strabismus (poor eye alignment), or amblyopia (reduced vision in one eye) will need checks at least every year, but likely more often. Likewise, people over 65 or who have known eye conditions, such as glaucoma, will be recommended more frequent checks.
Eye checks can detect broader health issues. Shutterstock An online prescription estimator is no substitute for a full eye examination. If you have a valid prescription then you can order glasses online, but you miss out on the ability to check the fit of the frame or to have them adjusted properly. This is particularly important for multifocal lenses where even a millimetre or two of misalignment can cause uncomfortable or blurry vision.
Conditions such as diabetes or high blood pressure, can affect the eyes so regular eye checks can also help flag broader health issues. The vast majority of eye conditions can be treated if caught early, highlighting the importance of regular preventative care.
James Andrew Armitage, Professor of Optometry and Course Director, Deakin University and Nick Hockley, Lecturer in Optometric Clinical Skills, Director Deakin Collaborative Eye Care Clinic, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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