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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Top 5 Anti-Aging Exercises
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There are some exercises that get called such things as “The King of Exercises!”, but how well-earned is that title and could it be that actually a mix of the top few is best?
The Exercises
While you don’t have to do all 5, your body will thank you if you are able to:
- Plank: strengthens most of the body, and can reduce back pain while improving posture.
- Squats: another core-strengthening exercise, this time with an emphasis on the lower body, which makes for strong foundations (including strong ankles, knees, and hips). Improves circulation also, and what’s good for circulation is good for the organs, including the brain!
- Push-ups: promotes very functional strength and fitness; great for alternating with planks, as despite their similar appearance, they work the abs and back more, respectively.
- Lunges: these are great for lower body strength and stability, and doing these greatly reduces the risk of falling.
- Glute Bridges: this nicely rounds off one’s core strength, increasing stability and improving posture, as well as reducing lower back pain too.
If the benefits of these seem to overlap a little, it’s because they do! But each does some things that the others don’t, so put together, they make for a very well-balanced workout.
For advice on how to do each of them, plus more about the muscles being used and the benefits, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Take care!
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Gentler Hair Health Options
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Hair, Gently
We have previously talked about the medicinal options for combatting the thinning hair that comes with age especially for men, but also for a lot of women. You can read about those medicinal options here:
Hair-Loss Remedies, By Science
We also did a whole supplement spotlight research review for saw palmetto! You can read about how that might help you keep your hair present and correct, here:
One Man’s Saw Palmetto Is Another Woman’s Serenoa Repens
Today we’re going to talk options that are less “heavy guns”, and/but still very useful.
Supplementation
First, the obvious. Taking vitamins and minerals, especially biotin, can help a lot. This writer takes 10,000µg (that’s micrograms, not milligrams!) biotin gummies, similar to this example product on Amazon (except mine also has other vitamins and minerals in, but the exact product doesn’t seem to be available on Amazon).
When thinking “what vitamins and minerals help hair?”, honestly, it’s most of them. So, focus on the ones that count for the most (usually: biotin and zinc), and then cover your bases for the rest with good diet and additional supplementation if you wish.
Caffeine (topical)
It may feel silly, giving one’s hair a stimulant, but topical caffeine application really does work to stimulate hair growth. And not “just a little help”, either:
❝Specifically, 0.2% topical caffeine-based solutions are typically safe with very minimal adverse effects for long-term treatment of AGA, and they are not inferior to topical 5% minoxidil therapy❞
(AGA = Androgenic Alopecia)
Argan oil
As with coconut oil, argan oil is great on hair. It won’t do a thing to improve hair growth or decrease hair shedding, but it will help you hair stay moisturized and thus reduce breakage—thus, may not be relevant for everyone, but for those of us with hair long enough to brush, it’s important.
Bonus: get an argan oil based hair serum that also contains keratin (the protein used to make hair), as this helps strengthen the hair too.
Here’s an example product on Amazon
Silk pillowcases
Or a silk hair bonnet to sleep in! They both do the same thing, which is prevent damaging the hair in one’s sleep by reducing the friction that it may have when moving/turning against the pillow in one’s sleep.
- Pros of the bonnet: if you have lots of hair and a partner in bed with you, your hair need not be in their face, and you also won’t get it caught under you or them.
- Pros of the pillowcase: you don’t have to wear a bonnet
Both are also used widely by people without hair loss issues, but with easily damaged and/or tangled hair—Black people especially with 3C or tighter curls in particular often benefit from this. Other people whose hair is curly and/or gray also stand to gain a lot.
Here are Amazon example products of a silk pillowcase (it’s expensive, but worth it) and a silk bonnet, respectively
Want to read more?
You might like this article:
From straight to curly, thick to thin: here’s how hormones and chemotherapy can change your hair
Take care!
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End Your Carb Confusion – by Dr. Eric Westman & Amy Berger
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Carbs can indeed be confusing! We’ve written about it ourselves before, but there’s more to be said than fits in a single article, and sometimes a book is in order. This one is such a book.
The authors (an MD and a nutritionist) explain the ins and outs of carbohydrates of various kinds, insulin responses, and what that means for the body. They also then look at the partly-similar, partly-different processes that occur with the metabolism of fats of various kinds, and what that means for the body, too.
Ultimately they advocate for a simple and clear low-carb approach broadly consistent with keto diet macro principles, without getting too overly focused on “is this fruit/vegetable ok?” minutiae. This has the benefit of putting it well aside from the paleo diet, for example (which focuses more on pseudo-historical foods than it does on macros), and also makes it a lot easier on a practical level.
The style is very textbook-like, which makes for an easy read with plenty of information that should stick easily in most reader’s minds, rather than details getting lost in wall-of-text formatting. So, we approve of this.
There is not, by the way, a recipes section. It’s “here’s the information, now go forth and enjoy” and leaves us all to find/make our own recipes, rather than trying to guess our culinary preferences.
Bottom line: if you’d like an easy-to-read primer on understanding how carbs work, what it means for you, and what to do about it, then this is a fine book.
Click here to check out End Your Carb Confusion, and end your carb confusion!
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Zero Sugar / One Month – by Becky Gillaspy
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We’ve reviewed books about the evils of sugar before, so what makes this one different?
This one has a focus on helping the reader quit it. It assumes we already know the evils of sugar (though it does cover that too).
It looks at the mechanisms of sugar addiction (habits-based and physiological), and how to safely and painlessly cut through those to come out the other side, free from sugar.
The author gives a day-by-day plan, for not only eliminating sugar, but also adding and including things to fill the gap it leaves, keeping us sated, energized, and happy along the way.
In the category of subjective criticism, it does also assume we want to lose weight, which may not be the case for many readers. But that’s a by-the-by and doesn’t detract from the useful guide to quitting sugar, whatever one’s reasons.
Bottom line: if you would like to quit sugar but find it hard, this book thinks of everything and walks you by the hand, making it easy.
Click here to check out Zero Sugar / One Month, and reap the health benefits!
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How Useful Is Peppermint, Really?
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Peppermint For Digestion & Against Nausea
Peppermint is often enjoyed to aid digestion, and sometimes as a remedy for nausea, but what does the science say about these uses?
Peppermint and digestion
In short: it works! (but beware)
Most studies on peppermint and digestion, that have been conducted with humans, have been with regard to IBS, but its efficacy seems quite broad:
❝Peppermint oil is a natural product which affects physiology throughout the gastrointestinal tract, has been used successfully for several clinical disorders, and appears to have a good safety profile.❞
However, and this is important: if your digestive problem is GERD, then you may want to skip it:
❝The univariate logistic regression analysis showed the following risk factors: eating 1–2 meals per day (OR = 3.50, 95% CI: 1.75–6.98), everyday consumption of peppermint tea (OR = 2.00, 95% CI: 1.14–3.50), and eating one, big meal in the evening instead of dinner and supper (OR = 1.80, 95% CI: 1.05–3.11).
The multivariate analysis confirmed that frequent peppermint tea consumption was a risk factor (OR = 2.00, 95% CI: 1.08–3.70).❞
~ Dr. Jarosz & Dr. Taraszewska
Source: Risk factors for gastroesophageal reflux disease: the role of diet
Peppermint and nausea
Peppermint is also sometimes recommended as a nausea remedy. Does it work?
The answer is: maybe
The thing with nausea is it is a symptom with a lot of possible causes, so effectiveness of remedies may vary. But for example:
- Aromatherapy for treatment of postoperative nausea and vomiting ← no better than placebo
- The Effect of Combined Inhalation Aromatherapy with Lemon and Peppermint on Nausea and Vomiting of Pregnancy: A Double-Blind, Randomized Clinical Trial ← initially no better than placebo, then performed better on subsequent days
- The Effects of Peppermint Oil on Nausea, Vomiting and Retching in Cancer Patients Undergoing Chemotherapy: An Open Label Quasi-Randomized Controlled Pilot Study ← significant benefit immediately
Summary
Peppermint is useful against wide variety of gastrointestinal disorders, including IBS, but very definitely excluding GERD (in the case of GERD, it may make things worse)
Peppermint may help with nausea, depending on the cause.
Where can I get some?
Peppermint tea, and peppermint oil, you can probably find in your local supermarket (as well as fresh mint leaves, perhaps).
For the “heavy guns” that is peppermint essential oil, here’s an example product on Amazon for your convenience
Enjoy!
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The Hormone Therapy That Reduces Breast Cancer Risk & More
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The Hormone Balancing Act
We’ve written before about menopausal HRT:
What You Should Have Been Told About Menopause Beforehand
…and even specifically about the considerations when it comes to breast cancer risk:
Menopausal Hormone Replacement Therapy
this really does bear reading, by the way—scroll down to the bit about breast cancer risk, because it’s not a simple increased/decreased risk; it can go either way, and which way it goes will depend on various factors including your medical history and what HRT, if any, you are taking.
Hormone Modulating Therapy
Hormone modulating therapy, henceforth HMT, is something a little different.
Instead of replacing hormones, as hormone replacement therapy does, guess what hormone modulating therapy does instead? That’s right…
MHT can modulate hormones by various means, but the one we’re going to talk about today does it by blocking estrogen receptors,
Isn’t that the opposite of what we want?
You would think so, but since for many people with an increased breast cancer risk, the presence of estrogen increases that risk, which leaves menopausal (peri- or post) people in an unfortunate situation, having to choose between increased breast cancer risk (with estrogen), or osteoporosis and increased dementia risk, amongst other problems (without).
However, the key here (in fact, that’s a very good analogy) is in how the blocker works. Hormones and their receptors are like keys and locks, meaning that the wrong-shaped hormone won’t accidentally trigger it. And when the right-shaped hormone comes along, it gets activated and the message (in this case, “do estrogenic stuff here!” gets conveyed). A blocker is sufficiently similar to fit into the receptor, without being so similar as to otherwise act as the hormone.
In this case, it has been found that HMT blocking estrogen receptors was sufficient to alleviate the breast cancer risk, while also being associated with a 7% lower risk of developing Alzheimer’s disease or related dementias, with that risk reduction being even greater for some demographics depending on race and age. Black women in the 65–74 age bracket enjoyed a 24% relative risk reduction, with white women of the same age getting an 11% relative risk reduction. Black women enjoyed the same benefits after that age, whereas white women starting it at that age did not get the same benefits. The conclusion drawn from this is that it’s good to start this at 65 if relevant and practicable, especially if white, because the protective effect is strongest when gained aged 65–69.
Here’s a pop-science article that goes into the details more deeply than we have room for here:
Hormone therapy for breast cancer linked with lower dementia risk
And here’s the paper itself; we highly recommend reading at least the abstract, because it goes into the numbers in much more detail than we reasonably can here. It’s a huge cohort study of 18,808 women aged 65 years or older, so this is highly relevant data:
Want to learn more?
If you’d like a much deeper understanding of breast cancer risk management, including in the context of hormone therapy, you might like this excellent book that we reviewed recently:
The Smart Woman’s Guide to Breast Cancer – by Dr. Jenn Simmons
Take care!
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