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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Power Vegan Meals – by Maya Sozer
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This book has inspired some of the recipes we’ve shared recently—we’ve invariably tweaked and in our opinion improved them, but the recipes are great as written too.
The recipes, of which there are 75, are all vegan, gluten-free, high protein, and high fiber. Some reviewers on Amazon have complained that the recipes are high-calorie, and they often are, but those calories are mostly from healthy fats, so we don’t think it’s a bad thing. Still, if you’re doing a strict calorie-controlled diet, this is probably not the one for you.
Another thing the recipes are is tasty without being unduly complicated, as well as being mostly free from obscure ingredients. This latter is a good thing not because obscure ingredients are inherently bad, but rather that it can be frustrating to read a recipe and find its star ingredient is a cup of perambulatory periannath that must be harvested from the west-facing slopes of Ithilien during a full moon, no substitutions.
The style and format is simple and clear with minimal overture, one recipe per double-page; picture on one side, recipe on the other; perfect for a kitchen reading-stand.
Bottom line: these recipes are for the most part very consistent with what we share here, and we recommend them, unless you’re looking for low-calorie options.
Click here to check out Power Vegan Meals, and power-up your vegan meals!
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Apple vs Pineapple – Which is Healthier?
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Our Verdict
When comparing apple to pineapple, we picked the pineapple.
Why?
An apple a day may keep the doctor away, but pineapples are heavier and armored and spiky and generally much more intimidating.
More seriously, apples are great but we say pineapples have the better nutritional and phytochemical properties overall:
In terms of macros, actually apples win this first round, albeit marginally; the two fruits are equal on carbs, while apple has a little more fiber and pineapple has a (very) little more protein. This makes the fiber content the deciding factor, so apples do win this one, even if by just 1g/100g difference.
When it comes to vitamins, however, apples have more of vitamins E and K, while pineapple has more of vitamins A, B1, B2, B3, B5, B6, B7, B9, C, and choline. The margins of difference are equally generous on both sides, so this is a clear and overwhelming win for pineapple (including 10x more vitamin C than apples, which are themselves considered a good source of vitamin C)
In the category of minerals, apples have slightly more phosphorus, and pineapple has a lot more calcium, copper, iron, magnesium, manganese, potassium, selenium, and zinc. Another easy win for pineapple.
Pineapples are not only also higher in polyphenols, but also contain bromelain, a powerful anti-inflammatory group of enzymes that are unique to pineapple—you can read about it in the link below!
Meanwhile, pineapple wins the day in our head-to-head here, but as ever when it comes to a plurality of healthy things, do enjoy either or both! Diversity is good.
Want to learn more?
You might like to read:
Bromelain vs Inflammation & Much More
Enjoy!
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Easing Election Stress & Anxiety
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
At the time of writing, the US is about to have a presidential election. Most of our readers are Americans, and in any case, what the US does tends to affect most of the world, so certainly many readers in other countries will be experiencing stress and anxiety about it too.
We’re a health science publication, not a political outlet, so we’ll refrain from commenting on any candidates or campaign policies, and we’d also like to be clear we are not urging you to any particular action politically—our focus today is simply about mental health.
First, CBT what can be CBT’d
Cognitive Behavioral Therapy (CBT) is far from a panacea, but it’s often a very good starting point. And when it seems the stakes are high, it’s easy to fall into such cognitive distortions as “crystal ball” and “catastrophization”, that is to say, predicting the future and feeling the impact of that (probably undesired version of the) future, and also feeling like it will be the end of the world.
Recognizing these processes and how they work, is the first step to managing our feelings about them.
Learn more: The Art of Being Unflappable (Tricks For Daily Life)
Next, DBT what can be DBT’d
A lot of CBT hinges on the assumption that our assumptions are incorrect. For example, that our friend does not secretly despise us, that our spouse is not about to leave us, that the symptoms we are experiencing are not cancer, and in this case, that the election outcome will not go badly, and if it does, the consequences will be less severe than imagined.
But… What if our concerns are, in fact, fully justified? Here’s where Dialectic Behavior Therapy (DBT) comes in, and with it, what therapists call “radical acceptance”.
In other words, we accept up front the idea that maybe it’s going to be terrible and that will truly suck, and then either:
- there’s nothing we can reasonably do about it now (so worrying just means you’ll suffer twice), or
- there is something we can reasonably do about it now (so we can go do that thing)
After doing the thing (if appropriate), defer processing the outcome of the election until after the election. There is no point in wasting energy to worry before then. In a broadly two-party system where things are usually close between those two largest parties, there’s something close to a 50% chance of an outcome that’s, at least, not the worst you feared.
Learn more: CBT, DBT, & Radical Acceptance
Lastly, empower yourself with Behavioral Activation (BA)
Whatever the outcome of any given election, the world will keep turning, and the individual battles about any given law or policy or such will continue to go on. That’s not to say an election won’t change things—it will—but there will always still be stuff to do on a grassroots level to make the world a better place, no matter what politician has been elected.
Being involved in doing things on a community level will not only help banish any feelings of despair (and if you got the election outcome you wanted, it’ll help you feel involved), but also, it can give you a sense of control, and can even form a part of the “ikigai” that is often talked about as one of the pillars of healthy longevity.
Learn more: What’s Your Ikigai?
And if you like videos, then enjoy this one (narrated by the ever soothing-voiced Alain de Botton):
Watch now: How To Escape From A Despairing Mood (4:46) ← it also has a text version if you prefer that
Take care!
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Pistachios vs Pecans – Which is Healthier?
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Our Verdict
When comparing pistachios to pecans, we picked the pistachios.
Why?
Firstly, the macronutrients: pistachios have twice as much protein and fiber. Pecans have more fat, though in both of these nuts the fats are healthy.
The category of vitamins is an easy win for pistachios, with a lot more of vitamins A, B1, B2, B3, B6, B9, C, and E. Especially the 8x vitamin A, 7x vitamin B6, 4x vitamin C, and 2x vitamin E, and as the percentages are good too, these aren’t small differences. Pecans, meanwhile, boast only a little more vitamin B5 (pantothenic acid, the one whose name means “it’s everywhere”, because that’s how easy it is to get it).
In terms of minerals, pistachios have more calcium, iron, phosphorus, potassium, and selenium, while pecans have more manganese and zinc. So, a fair win for pistachios on this one.
Adding up the three different kinds of win for pistachios means that *drumroll* pistachios win overall, and it’s not close.
As ever, do enjoy both though, because diversity is healthy!
Want to learn more?
You might like to read:
Take care!
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Rutin For Your Circulation & More
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Rutin is a bioflavonoid so potent it’s also been called “vitamin P”, and it’s found most abundantly in buckwheat, as well appearing in citrus and some stone fruits (apricots, plums, etc) as well as figs and apples—it’s also found in asparagus, and green and black tea.
So, what does it do?
Quite a lot: The Pharmacological Potential of Rutin
There’s much more there than we have room to cover here, but we’ll pick out a few salient properties to focus on.
First, a word of warning
A lot of the extant science for rutin is in non-human animals. Sometimes, what works for non-human animals doesn’t work for humans; we saw a clear example of this here:
Conjugated Linoleic Acid For Weight Loss?
…in which CLA worked for weight loss in mice, hamsters, chickens, and pigs, but stubbornly not humans.
The state of affairs with the science for rutin isn’t nearly that bad and there are human studies showing efficacy, and indeed, rutin is given to (human) patients with capillary fragility, varicose veins, bruising, or hemorrhoids, for example:
So, we’ll try to give you humans-only sources so far as we can today!
Improving blood flow
Rutin does improve various blood metrics, including various kinds of blood pressure (diastolic, systolic, mean arterial, pulse) and heart rate. At least, it did in humans with type 2 diabetes, and we may reasonably assume these results may be extrapolated to humans without type 2 (or any other) diabetes:
As you may gather from the title, it did also significantly improve serum antioxidant levels, and quality of life (which latter was categorized as: emotional limitations, energy and freshness, mental health, social performance, and general health).
We couldn’t find studies for cardioprotective effects in humans (and of course those couldn’t be RCTs, they’d have to be observational studies, because no ethics board allows inducing heart attacks in humans for the sake of science), but here’s a study using rats (with and without diabetes), showing proof of principle at least:
Anti-Alzheimer’s potential
As ever, a good general rule of thumb is “what’s good for the blood is good for the brain”, and that’s true in this case too.
The title says it all, here:
In case that is not clear: everything in that title after the word “inhibits” is bad for the brain and is implicated in Alzheimer’s disease pathogenesis and progression; in other words, rutin is good against all those bad, Alzheimer’s-favoring things.
Other neuroprotective activity
You may remember from the above-linked research that it helps protect against damage caused by Advanced Glycation End-products (AGEs) (the golden-brown stuff that appears as a result of dry-cooking proteins and fats); it also helps against damage caused by acrylamide (the golden-brown stuff that appears as a result of dry-cooking starches).
Note: in both cases “dry-cooking” includes cooking with oil; it simply means “without water”.
Again, this was a rat study, because no ethics board would have let the researchers fry human brains for science.
Want to try some?
As well as simply enjoying the fruits and vegetables that contain it, it is possible to take a rutin supplement.
We don’t sell it, but here for your convenience is an example product on Amazon 😎
Enjoy!
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When “Normal” Health Is Not What You Want
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝When going to sleep, I try to breathe through my nose (since everyone says that’s best). But when I wake I often find that I am breathing through my mouth. Is that normal, or should I have my nose checked out?❞
It is quite normal, but when it comes to health, “normal” does not always mean “optimal”.
- Good news: it is correctable!
- Bad news: it is correctable by what may be considered rather an extreme practice that comes with its own inconveniences and health risks.
Some people correct this by using medical tape to keep their mouth closed at night, ensuring nose-breathing. Advocates of this say that after using it for a while, nose-breathing in sleep will become automatic.
We know of no hard science to confirm this, and cannot even offer a personal anecdote on this one. Here are some pop-sci articles that do link to the (very few) studies that have been conducted:
- Mouth taping may be a trending sleep hack, but the science behind it is slim
- Mouth Taping for Sleep: Does it Work? And What are the Side Effects?
This writer’s personal approach is simply to do breathing exercises when going to sleep and first thing upon awakening, and settle for imperfection in this regard while asleep.
Meanwhile, take care!
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