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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8 Signs Of Iodine Deficiency You Might Not Expect
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Health Coach Kait (BSc Nutrition & Exercise) is a certified health and nutrition coach, and today she’s here to talk about iodine—which is important for many of our body functions, from thyroid hormone production to metabolic regulation to heart rate management, as well as more superficial-but-important-too things like our skin and hair.
Kait’s hitlist
Here’s what she recommends we look out for:
- Swollen neck: even a slightly swollen neck might indicate low iodine levels (this is because that’s where the thyroid glands are)
- Hair loss: iodine is needed for healthy hair growth, so a deficiency can lead to hair loss / thinning hair
- Dry and flaky skin: with iodine’s role in our homeostatic system not being covered, our skin can dry out as a result
- Feeling cold all the time: because of iodine’s temperature-regulating activities
- Slow heart rate: A metabolic slump due to iodine deficiency can slow down the heart rate, leading to fatigue and weakness (and worse, if it persists)
- Brain fog: trouble focusing can be a symptom of the same metabolic slump
- Fatigue: this is again more or less the same thing, but she said eight signs, so we’re giving you the eight!
- Irregular period (if you normally have such, of course): because iodine affects reproductive hormones too, an imbalance can disrupt menstrual cycles.
For more on each of these, as well as how to get more iodine in your diet, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Further reading
You might also like to read:
- A Fresh Take On Hypothyroidism
- Foods For Managing Hypothyroidism (incl. Hashimoto’s)
- Eat To Beat Hyperthyroidism!
Take care!
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ADHD… As An Adult?
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ADHD—not just for kids!
Consider the following:
- If a kid has consistent problems paying attention, it’s easy and common to say “Aha, ADHD!”
- If a young adult has consistent problems paying attention, it’s easy and common to say “Aha, a disinterested ne’er-do-well!”
- If an older adult has consistent problems paying attention, it’s easy and common to say “Aha, a senior moment!”
Yet, if we recognize that ADHD is fundamentally a brain difference in children (and we do; there are physiological characteristics that we can test), and we can recognize that as people get older our brains typically have less neuroplasticity (ability to change) than when we are younger rather than less, then… Surely, there are just as many adults with ADHD as kids!
After all, that rather goes with the linear nature of time and the progressive nature of getting older.
So why do kids get diagnoses so much more often than adults?
Parents—and schools—can find children’s ADHD challenging, and it’s their problem, so they look for an explanation, and ADHD isn’t too difficult to find as a diagnosis.
Meanwhile, adults with ADHD have usually developed coping mechanisms, have learned to mask and/or compensate for their symptoms, and we expect adults to manage their own problems, so nobody’s rushing to find an explanation on their behalf.
Additionally, the stigma of neurodivergence—especially something popularly associated with children—isn’t something that many adults will want for themselves.
But, if you have an ADHD brain, then recognizing that (even if just privately to yourself) can open the door to much better management of your symptoms… and your life.
So what does ADHD look like in adults?
ADHD involves a spread of symptoms, and not everyone will have them all, or have them in the same magnitude. However, very commonly most noticeable traits include:
- Lack of focus (ease of distraction)
- Conversely: high focus (on the wrong things)
- To illustrate: someone with ADHD might set out to quickly tidy the sock drawer, and end up Marie Kondo-ing their entire wardrobe… when they were supposed to doing something else
- Conversely: high focus (on the wrong things)
- Poor time management (especially: tendency to procrastinate)
- Forgetfulness (of various kinds—for example, forgetting information, and forgetting to do things)
Want To Take A Quick Test? Click Here ← this one is reputable, and free. No sign in required; the test is right there.
Wait, where’s the hyperactivity in this Attention Deficit Hyperactivity Disorder?
It’s often not there. ADHD is simply badly-named. This stems from how a lot of mental health issues are considered by society in terms of how much they affect (and are observable by) other people. Since ADHD was originally noticed in children (in fact being originally called “Hyperkinetic Reaction of Childhood”), it ended up being something like:
“Oh, your brain has an inconvenient relationship with dopamine and you are driven to try to correct that by shifting attention from boring things to stimulating things? You might have trouble-sitting-still disorder”
Hmm, this sounds like me (or my loved one); what to do now at the age of __?
Some things to consider:
- If you don’t want medication (there are pros and cons, beyond the scope of today’s article), you might consider an official diagnosis not worth pursuing. That’s fine if so, because…
- More important than whether or not you meet certain diagnostic criteria, is whether or not the strategies recommended for it might help you.
- Whether or not you talk to other people about it is entirely up to you. Maybe it’s a stigma you’d rather avoid… Or maybe it’ll help those around you to better understand and support you.
- Either way, you might want to learn more about ADHD in adults. Today’s article was about recognizing it—we’ll write more about managing it another time!
In the meantime… We recommended a great book about this a couple of weeks ago; you might want to check it out:
Click here to see our review of “The Silent Struggle: Taking Charge of ADHD in Adults”!
Note: the review is at the bottom of that page. You’ll need to scroll past the video (which is also about ADHD) without getting distracted by it and forgetting you were there to see about the book. So:
- Click the above link
- Scroll straight to the review!
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Green Tea Allergies and Capsules
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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
❝Hey Sheila – As always, your articles are superb !! So, I have a topic that I’d love you guys to discuss: green tea. I used to try + drink it years ago but I always got an allergic reaction to it. So the question I’d like answered is: Will I still get the same allergic reaction if I take the capsules ? Also, because it’s caffeinated, will taking it interfere with iron pills, other vitamins + meds ? I read that the health benefits of the decaffeinated tea/capsules are not as great as the caffeinated. Any info would be greatly appreciated !! Thanks much !!❞
Hi! I’m not Sheila, but I’ll answer this one in the first person as I’ve had a similar issue:
I found long ago that taking any kind of tea (not herbal infusions, but true teas, e.g. green tea, black tea, red tea, etc) on an empty stomach made me want to throw up. The feeling would subside within about half an hour, but I learned it was far better to circumvent it by just not taking tea on an empty stomach.
However! I take an l-theanine supplement when I wake up, to complement my morning coffee, and have never had a problem with that. Of course, my physiology is not your physiology, and this “shouldn’t” be happening to either of us in the first place, so it’s not something there’s a lot of scientific literature about, and we just have to figure out what works for us.
This last Monday I wrote (inspired in part by your query) about l-theanine supplementation, and how it doesn’t require caffeine to unlock its benefits after all, by the way. So that’s that part in order.
I can’t speak for interactions with your other supplements or medications without knowing what they are, but I’m not aware of any known issue, beyond that l-theanine will tend to give a gentler curve to the expression of some neurotransmitters. So, if for example you’re talking anything that affects that (e.g. antidepressants, antipsychotics, ADHD meds, sleepy/wakefulness meds, etc) then checking with your doctor is best.
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Fermenting Everything – by Andy Hamilton
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This is not justanother pickling book! This is, instead, what it says on the front cover, “fermenting everything”.
Ok, maybe not literally everything, but every kind of thing that can reasonably be fermented, and it’s probably a lot more things than you might think.
From habanero chutney to lacto-lemonade, aioli to kombucha, Ukrainian fermented tomatoes to kvass. We could go on, but we’d soon run out of space. You get the idea. If it’s a fermented product (food, drink, condiment) and you’ve heard of it, there’s probably a recipe in here.
All in all, this is a great way to get in your gut-healthy daily dose of fermented products!
He does also talk safety, and troubleshooting too. And so long as you have a collection of big jars and a fairly normally-furnished kitchen, you shouldn’t need any more special equipment than that, unless you decide to you your fermentation skills for making beer (which does need some extra equipment, and he offers advice on that—our advice as a health science publication is “don’t drink beer”, though).
Bottom line: with this in hand, you can create a lot of amazing foods/drinks/condiments that are not only delicious, but also great for gut health.
Click here to check out Fermenting Everything, and widen your culinary horizons!
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What Most People Don’t Know About HIV
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What To Know About HIV This World AIDS Day
Yesterday, we asked you to engage in a hypothetical thought experiment with us, and putting aside for a moment any reason you might feel the scenario wouldn’t apply for you, asked:
❝You have unprotected sex with someone who, afterwards, conversationally mentions their HIV+ status. Do you…❞
…and got the above-depicted, below-described, set of responses. Of those who responded…
- Just over 60% said “rush to hospital; maybe a treatment is available”
- Just under 20% said “ask them what meds they’re taking (and perhaps whether they’d like a snack)”
- Just over 10% said “despair; life is over”
- Two people said “do the most rigorous washing down there you’ve ever done in your life”
So, what does science say about it?
First, a quick note on terms
- HIV is the Human Immunodeficiency Virus. It does what it says on the tin; it gives humans immunodeficiency. Like many viruses that have become epidemic in humans, it started off in animals (called SIV, because there was no “H” involved yet), which were then eaten by humans, passing the virus to us when it one day mutated to allow that.
- It’s technically two viruses, but that’s beyond the scope of today’s article; for our purposes they are the same. HIV-1 is more virulent and infectious than HIV-2, and is the kind more commonly found in most of the world.
- AIDS is Acquired Immunodeficiency Syndrome, and again, is what it sounds like. When a person is infected with HIV, then without treatment, they will often develop AIDS.
- Technically AIDS itself doesn’t kill people; it just renders people near-defenseless to opportunistic infections (and immune-related diseases such as cancer), since one no longer has a properly working immune system. Common causes of death in AIDS patients include cancer, influenza, pneumonia, and tuberculosis.
People who contract HIV will usually develop AIDS if untreated. Untreated life expectancy is about 11 years.
HIV/AIDS are only a problem for gay people: True or False?
False, unequivocally. Anyone can get HIV and develop AIDS.
The reason it’s more associated with gay men, aside from homophobia, is that since penetrative sex is more likely to pass it on…
- If a man penetrates a woman and passes on HIV, that woman will probably not go on to penetrate someone else
- If a man penetrates a man and passes on HIV, that man could go on to penetrate someone else—and so on
- This means that without any difference in safety practices or promiscuity, it’s going to spread more between men on average, by simple mathematics.
- This is why “men who have sex with men” is the generally-designated higher-risk category.
There is medication to cure HIV/AIDS: True or False?
False (though there have been individual case studies of gene treatments that may have cured people—time will tell).
But! There are medications that can prevent HIV from being a life-threatening problem:
- PrEP (Pre-Exposure Prophylaxis) is a medication that one can take in advance of potential exposure to HIV, to guard against it.
- This is a common choice for people aren’t sure about their partners’ statuses, or people working in risky environments.
- PEP (Post-Exposure Prophylaxis) is a medication that one can take after potential exposure to HIV, to “nip it in the bud”.
- Those of you who were rushing to hospital in our poll, this is what you’re rushing there for.
- ARVs (Anti-RetroVirals) are a class of medications (there are different options; we don’t have room to distinguish them) that reduce an HIV+ person’s viral load to undetectable levels.
- Those of you who were asking what meds your partner was taking, these will be those meds. Also, most of them are to be taken in the morning with food, so that’s what the snack was for.
If someone is HIV+, the risk of transmission in unprotected sex is high: True or False?
True or False, with false being the far more likely. It depends on their medications, and this is why you were asking. If someone is on ARVs and their viral load is undetectable (as is usual once someone has been on ARVs for 6 months), they cannot transmit HIV to you.
U=U is not a fancy new emoticon, it means “undetectable = untransmittable”, which is a mathematically true statement in the case of HIV viral loads.
See: NIH | HIV Undetectable=Untransmittable (U=U)
If you’re thinking “still sounds risky to me”, then consider this:
You are safer having unprotected sex with someone who is HIV+ and on ARVs with an undetectable viral load, than you are with someone you are merely assuming is HIV- (perhaps you assume it because “surely this polite blushing young virgin of a straight man won’t give me cooties” etc)
Note that even your monogamous partner of many decades could accidentally contract HIV due to blood contamination in a hospital or an accident at work etc, so it’s good practice to also get tested after things that involve getting stabbed with needles, cut in a risky environment, etc.
If you’re concerned about potential stigma associated with HIV testing, you can get kits online:
CDC | How do I find an HIV self-test?
(these are usually fingerprick blood tests, and you can either see the results yourself at home immediately, or send it in for analysis, depending on the kit)
If I get HIV, I will get AIDS and die: True or False?
False, assuming you get treatment promptly and keep taking it. So those of you who were at “despair; life is over” can breathe a sigh of relief now.
However, if you get HIV, it does mean you will have to take those meds every day for the rest of your (no reason it shouldn’t be long and happy) life.
So, HIV is definitely still something to avoid, because it’s not great to have to take a life-saving medication every day. For a little insight as to what that might be like:
HIV.gov | Taking HIV Medication Every Day: Tips & Challenges
(as you’ll see there, there are also longer-lasting injections available instead of daily pulls, but those are much less widely available)
Summary
Some quick take-away notes-in-a-nutshell:
- Getting HIV may have been a death sentence in the 1980s, but nowadays it’s been relegated to the level of “serious inconvenience”.
- Happily, it is very preventable, with PrEP, PEP, and viral loads so low that they can’t transmit HIV, thanks to ARVs.
- Washing will not help, by the way. Safe sex will, though!
- As will celibacy and/or monogamy in seroconcordant relationships, e.g. you both have the same (known! That means actually tested recently! Not just assumed!) HIV status.
- If you do get it, it is very manageable with ARVs, but prevention is better than treatment
- There is no certain cure—yet. Some people (small number of case studies) may have been cured already with gene therapy, but we can’t know for sure yet.
Want to know more? Check out:
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Thinking about cosmetic surgery? New standards will force providers to tell you the risks and consider if you’re actually suitable
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People considering cosmetic surgery – such as a breast augmentation, liposuction or face lift – should have extra protection following the release this week of new safety and quality standards for providers, from small day-clinics through to larger medical organisations.
The new standards cover issues including how these surgeries are advertised, psychological assessments before surgery, the need for people to be informed of risks associated with the procedure, and the type of care people can expect during and afterwards. The idea is for uniform standards across Australia.
The move is part of sweeping reforms of the cosmetic surgery industry and the regulation of medical practitioners, including who is allowed to call themselves a surgeon.
It is heartening to see these reforms, but some may say they should have come much sooner for what’s considered a highly unregulated area of medicine.
Why do people want cosmetic surgery?
Australians spent an estimated A$473 million on cosmetic surgery procedures in 2023.
The major reason people want cosmetic surgery relates to concerns about their body image. Comments from their partners, friends or family about their appearance is another reason.
The way cosmetic surgery is portrayed on social media is also a factor. It’s often portrayed as an “easy” and “accessible” fix for concerns about someone’s appearance. So such aesthetic procedures have become far more normalised.
The use of “before” and “after” images online is also a powerful influence. Some people may think their appearance is worse than the “before” photo and so they think cosmetic intervention is even more necessary.
People don’t always get the results they expect
Most people are satisfied with their surgical outcomes and feel better about the body part that was previously concerning them.
However, people have often paid a sizeable sum of money for these surgeries and sometimes experienced considerable pain as they recover. So a positive evaluation may be needed to justify these experiences.
People who are likely to be unhappy with their results are those with unrealistic expectations for the outcomes, including the recovery period. This can occur if people are not provided with sufficient information throughout the surgical process, but particularly before making their final decision to proceed.
What’s changing?
According to the new standards, services need to ensure their own advertising is not misleading, does not create unreasonable expectations of benefits, does not use patient testimonials, and doesn’t offer any gifts or inducements.
For some clinics, this will mean very little change as they were not using these approaches anyway, but for others this may mean quite a shift in their advertising strategy.
It will likely be a major challenge for clinics to monitor all of their patient communication to ensure they adhere to the standards.
It is also not quite clear how the advertising standards will be monitored, given the expanse of the internet.
What about the mental health assessment?
The new standards say clinics must have processes to ensure the assessment of a patient’s general health, including psychological health, and that information from a patient’s referring doctor be used “where available”.
According to the guidelines from the Medical Board of Australia, which the standards are said to complement, all patients must have a referral, “preferably from their usual general practitioner or if that is not possible, from another general practitioner or other specialist medical practitioner”.
While this is a step in the right direction, we may be relying on medical professionals who may not specialise in assessing body image concerns and related mental health conditions. They may also have had very little prior contact with the patient to make their clinical impressions.
So these doctors need further training to ensure they can perform assessments efficiently and effectively. People considering surgery may also not be forthcoming with these practitioners, and may view them as “gatekeepers” to surgery they really want to have.
Ideally, mental health assessments should be performed by health professionals who are extensively trained in the area. They also know what other areas should be explored with the patient, such as the potential impact of trauma on body image concerns.
Of course, there are not enough mental health professionals, particularly psychologists, to conduct these assessments so there is no easy solution.
Ultimately, this area of health would likely benefit from a standard multidisciplinary approach where all health professionals involved (such as the cosmetic surgeon, general practitioner, dermatologist, psychologist) work together with the patient to come up with a plan to best address their bodily concerns.
In this way, patients would likely not view any of the health professionals as “gatekeepers” but rather members of their treating team.
If you’re considering cosmetic surgery
The Australian Commission on Safety and Quality in Health Care, which developed the new standards, recommended taking these four steps if you’re considering cosmetic surgery:
have an independent physical and mental health assessment before you commit to cosmetic surgery
make an informed decision knowing the risks
choose your practitioner, knowing their training and qualifications
discuss your care after your operation and where you can go for support.
My ultimate hope is people safely receive the care to help them best overcome their bodily concerns whether it be medical, psychological or a combination.
Gemma Sharp, Associate Professor, NHMRC Emerging Leadership Fellow & Senior Clinical Psychologist, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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