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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What I Wish People Knew About Dementia – by Dr. Wendy Mitchell
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We hear a lot from doctors who work with dementia patients; sometimes we hear from carers too. In this case, the author spent 20 years working for the NHS, before being diagnosed with young-onset dementia, at the age of 58. Like many health industry workers who got a life-changing diagnosis, she quickly found it wasn’t fun being on the other side of things, and vowed to spend her time researching, and raising awareness about, dementia.
Many people assume that once a person has dementia, they’re basically “gone before they’re gone”, which can rapidly become a self-fulfilling prophecy as that person finds themself isolated and—though this word isn’t usually used—objectified. Talked over, viewed (and treated) more as a problem than a person. Cared for hopefully, but again, often more as a patient than a person. If doctors struggle to find the time for the human side of things with most patients most of the time, this is only accentuated when someone needs more time and patience than average.
Instead, Dr. Mitchell—an honorary doctorate, by the way, awarded for her research—writes about what it’s actually like to be a human with dementia. Everything from her senses, how she eats, the experience of eating in care homes, the process of boiling an egg… To relationships, how care changes them, to the challenges of living alone. And communication, confusion, criticism, the language used by professionals, or how things are misrepresented in popular media. She also talks about the shifting sense of self, and brings it all together with gritty optimism.
The style is deeply personal, yet lucid and clear. While dementia is most strongly associated with memory loss and communication problems, this hasn’t affected her ability to write well (7 years into her diagnosis, in case you were wondering).
Bottom line: if you’d like to read a first-person view of dementia, then this is an excellent opportunity to understand it from the view of, as the subtitle goes, someone who knows.
Click here to check out What I Wish People Knew About Dementia, and then know those things!
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Do CBD Gummies Work?
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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
❝I take CBD gummies. I don’t know if they are worth buying. Can you find a study on the effectiveness of gummies❞
If you take them, and you’re not sure whether they’re worth it, then it sounds like you’re not getting any observable benefit from them?
If so, that would seem to answer your question, since presumably the reason that you are taking them is for relaxation and/or pain relief, so if you’re not getting the results you want, then no, they are not worth it.
However! CBD gummies are an incredibly diverse and not-well-studied product, so far, given the relative novelty of their legality. By diverse we mean, they’re not well-standardized.
In other words: the CBD gummies you get could be completely unlike CBD gummies from a different source.
CBD itself (i.e. in forms other than just gummies, and mostly as oil) has been studied somewhat better, and we did a main feature on it here:
And while we’re at it:
Cannabis Myths vs Reality ← This one is about cannabis products in general, and includes discussion of THC content and effects, which might not be so relevant to you, but may to some readers.
Companies selling CBD and CBD gummies may make bold claims that are not yet backed by science, so if you are buying them for those reasons, you might want to be aware:
Selling cannabidiol products in Canada: a framing analysis of advertising claims by online retailers
One thing that we would add is that even though CBD is generally recognized as safe, it is possible to overdose on CBD gummies, so do watch your limits:
A Case of Toxicity from Cannabidiol Gummy Ingestion
Take care!
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Superfood Broccoli Pesto
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Cruciferous vegetables have many health benefits of their own (especially: a lot of anticancer benefits). But, it can be hard to include them in every day’s menu, so this is just one more way that’ll broaden your options! It’s delicious mixed into pasta, or served as a dip, or even on toast.
You will need
- 4 cups small broccoli florets
- 1 cup fresh basil leaves
- ½ cup pine nuts
- ¼ bulb garlic
- 3 tbsp extra virgin olive oil
- 2 tbsp nutritional yeast
- 1 tbsp lemon juice
- 2 tsp black pepper, coarse ground
- 1 tsp red pepper flakes
- ½ tsp MSG or 1 tsp low-sodium salt
Method
(we suggest you read everything at least once before doing anything)
1) Steam the broccoli for 3–5 minutes. Allow to cool.
2) Blend the pine nuts, garlic, lemon juice, and nutritional yeast.
3) Add the broccoli, basil, olive oil, black pepper, red pepper, and MSG or salt, and blend in the food processor again until well-combined.
4) Serve:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Broccoli vs Cauliflower – Which is Healthier?
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- Herbs for (Evidence-Based) Health & Healing ← Basil features here! It’s easy to think that medicinal herbs have to be some kind of arcane obscurity, but it’s often not so.
- Our Top 5 Spices: How Much Is Enough For Benefits? ← Black pepper, red pepper, and garlic all feature here
- All About Olive Oil: Is “Extra Virgin” Worth It?
- Monosodium Glutamate: Sinless Flavor-Enhancer Or Terrible Health Risk?
Take care!
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Thinner Leaner Stronger – by Michael Matthews
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First, the elephant in the training room: this book does assume that you want to be thinner, leaner, and stronger. This is the companion book, written for women, to “Bigger, Stronger, Leaner”, which was written for men. Statistically, these assumptions are reasonable, even if the generalizations are imperfect. Also, this reviewer has a gripe with anything selling “thinner”. Leaner was already sufficient, and “stronger” is the key element here, so “thinner” is just marketing, and marketing something that’s often not unhealthy, to sell a book that’s actually full of good advice for building a healthy body.
In other words: don’t judge a book by the cover, however eyeroll-worthy it may be.
The book is broadly aimed at middle-aged readers, but boasts equal worth for young and old alike. If there’s something Matthews knows how to do well in his writing, it’s hedging his bets.
As for what’s in the book: it’s diet and exercise advice, aimed at long-term implementation (i.e. not a crash course, but a lifestyle change), for maximum body composition change results while not doing anything silly (like many extreme short-term courses do) and not compromising other aspects of one’s health, while also not taking up an inordinate amount of time.
The dietary advice is sensible, broadly consistent with what we’d advise here, and/but if you want to maximise your body composition change results, you’re going to need a pocket calculator (or be better than this writer is at mental arithmetic).
The exercise advice is detailed, and a lot more specific than “lift things”; there are programs of specifically how many sets and reps and so forth, and when to increase the weights and when not to.
A strength of this book is that it explains why all those numbers are what they are, instead of just expecting the reader to take on faith that the best for a given exercise is (for example) 3 sets of 8–10 reps of 70–75% of one’s single-rep max for that exercise. Because without the explanation, those numbers would seem very arbitrary indeed, and that wouldn’t help anyone stick with the program. And so on, for any advice he gives.
The style is… A little flashy for this reader’s taste, a little salesy (and yes he does try to upsell to his personal coaching, but really, anything you need is in the book already), but when it comes down to it, all that gym-boy bravado doesn’t take away from the fact his advice is sound and helpful.
Bottom line: if you would like your body to be the three things mentioned in the title, this book can certainly help you get there.
Click here to check out Thinner Leaner Stronger, and become thinner, leaner, stronger!
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Healthy Habits for Managing & Reversing Prediabetes – by Dr. Marie Feldman
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The book doesn’t assume prior knowledge, and does explain the science of diabetes, prediabetes, the terms and the symptoms, what’s going on inside, etc—before getting onto the main meat of the book, the tips.
The promised 100 tips are varied in their application; they range from diet and exercise, to matters of sleep, stress, and even love.
There are bonus tips too! For example, an appendix covers “tips for healthier eating out” (i.e. in restaurants etc) and a grocery list to ensure your pantry is good for defending you against prediabetes.
The writing style is very accessible pop-science; this isn’t like reading some dry academic paper—though it does cite its sources for claims, which we always love to see.
Bottom line: if you’d like to proof yourself against prediabetes, and are looking for “small things that add up” habits to get into to achieve that, this book is an excellent first choice.
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The S.T.E.P.S. To A Healthier Heart
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Stepping Into Better Heart Health
This is Dr. Jennifer H. Mieres, FACC, FAHA, MASNC. she’s an award-winning (we counted 9 major awards) professor of cardiology, and a leading advocate for women’s heart health. This latter she’s done via >70 scientific publications, >100 research presentations at national and international conferences, 3 books so far, and 4 documentaries, including the Emmy-nominated “A Woman’s Heart”.
What does she want us to know?
A lot of her work is a top-down approach, working to revolutionize the field of cardiology in its application, to result in far fewer deaths annually. Which is fascinating, but unless you’re well-placed in that industry, not something too actionable as an individual (if you are well-placed in that industry, do look her up, of course).
For the rest of us…
Dr. Mieres’ S.T.E.P.S. to good heart health
She wants us to do the following things:
1) Stock your kitchen with heart health in mind
This is tied to the third item in the list of course, but it’s a critical step not to be overlooked. It’s all very well to know “eat more fiber; eat less red meat” and so forth, but if you go to your kitchen and what’s there is not conducive to heart health, you’re just going to do the best with what’s available.
Instead, actually buy foods that are high in fiber, and preferably, foods that you like. Not a fan of beans? Don’t buy them. Love pasta? Go wholegrain. Like leafy greens in principle, but they don’t go with what you cook? Look up some recipes, and then buy them.
Love a beef steak? Well we won’t lie to you, that is not good for your heart, but make it a rare option—so to speak—and enjoy it mindfully (see also: mindful eating) once in a blue moon for a special occasion, rather than “I don’t know what to cook tonight, so sizzle sizzle I guess”.
Meal planning goes a long way for this one! And if meal-planning sounds like an overwhelming project to take on, then consider trying one of the many healthy-eating meal kit services that will deliver ingredients (and their recipes) to your door—opting for a plants-forward plan, and the rest should fall into place.
2) Take control of your activity
Choose to move! Rather than focusing on what you can’t do (let’s say, those 5am runs, or your regularly-scheduled, irregularly attended, gym sessions), focus on what you can do, and do it.
See also: No-Exercise Exercise!
3) Eat for a healthier heart
This means following through on what you did on the first step, and keeping it that way. Buying fresh fruit and veg is great, but you also have to actually eat it. Do not let the perishables perish!
For you too, dear reader, are perishable (and would presumably like to avoid perishing).
This item in the list may seem flippant, but actually this is about habit-forming, and without it, the whole plan will grind to a halt a few days after your first heart-health-focused shopping trip.
See also: Where Nutrition Meets Habits!
4) Partner with your doctor, family, and friends
Good relationships, both professional and personal, count for a lot. Draw up a plan with your doctor; don’t just guess at when to get this or that checked—or what to do about it if the numbers aren’t to your liking.
Partnership with your doctor goes both ways, incidentally. Read up, have opinions, discuss them! Doing so will ultimately result in better care than just going in blind and coming out with a recommendation you don’t understand and just trust (but soon forget, because you didn’t understand).
And as for family and friends, this is partly about social factors—we tend to influence, and be influenced by, those around us. It can be tricky to be on a health kick if your partner wants take-out every night, so some manner of getting everyone on the same page is important, be it by compromise or, in an ideal world, gradually trending towards better health. But any such changes must come from a place of genuine understanding and volition, otherwise at best they won’t stick, and at worst they’ll actively create a pushback.
Same goes for exercise as for diet—exercising together is a good way to boost commitment, especially if it’s something fun (dance classes are a fine example that many couples enjoy, for example).
5) Sleep more, stress less, savor life
These things matter a lot! Many people focus on cutting down salt or saturated fat, and that can be good if otherwise consumed to excess, but for most people they’re not the most decisive factors:
Hypertension: Factors Far More Relevant Than Salt ← sleep features here!
Stress is also a huge one, and let’s put it this way: people more often have heart attacks during a moment of excessive emotional stress—not during a moment when they had a bit too much butter on their toast.
It’s not even just that acute stress is the trigger, it’s that chronic stress is a contributory factor that erodes the body’s ability to handle the acute stress.
Changing this may seem “easier said than done” because often the stressors are external (e.g. work pressure, financial worries, caring for a sick relative, relationship troubles, major life change, etc), but it is possible to find peace even in the chaos of life:
Want to know more from Dr. Mieres?
You might like this book of hers, which goes into each of the above items in much more depth than we have room to here:
Heart Smarter for Women: Six Weeks to a Healthier Heart – by Dr. Jennifer Mieres
Enjoy!
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