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View Full Version : What meds did they make you stop before and/or after surgery?



Back-out
06-20-2010, 12:16 AM
All this talk of surgically hastened menopause, plus other discussions has made me wonder about the question in the thread title.

Also, having just had the long dreaded myelogram* makes me wonder all the more. Stopping all NSAIDs and sleeping med, left me in pain and very tired, until I was allowed to go back on. That meant two days before and one afterwards, and my trusty sleeping med is a tiny dose of Seroquel at bedime PRN. Even just 25 mg though, and they said "no".

So looking ahead, I'm wondering what meds they want to you stop at every stage and for how long with the surgery. I'm not looking forward to the long three months without NSAIDS as that will just guarantee I'm that much more hooked on opiates (a serious problem in the past). Also I figure I'll be pretty much discombobulated for a week or so beforehand thanks to no NSAIDs then too. (I depend on them and am trying to avoid opiates as much as possible).

The business of no estrogen (I take HRT) is a new one. I'd hate to have hot flashes etc for the first time after this monster surgery!

Especially, if they too want a discontination of Seroquel for any amount of time. Sleep is important!

And perhaps there are others on the forbidden list, too! Maybe someone has such a list to post (I've seen some whopping long lists for myelograms!)

************************************************** ************************************************** ******

*Some good news, BTW. The myelogram itself was a breeze contrary to my fears - well, relatively anyhow, There were only a few almost unfelt needles and NO headache.

However, all this as entirely a function of the radiologists' expertise. They told me there was only ONE potential opening to inject in my entire (degenerated) lumbar spine - a tiny little hole like a swervy underwater channel. Lots of murmuring told me it was to be quite a challenge, and I braced myself.

But they made it! So that's off my mind :) Now to get the results...Thanks to this site, I brought films of my spine to help them if my lumbar spine proved difficult, so even though the procedure was fluoroscopically guided, I think you all may have spared me a lot of pain, thanks to that advice (don't remember whom to credit).

They DID lose my X-rays somewhere before discharge, but who's counting? :D

jrnyc
06-20-2010, 12:37 AM
i was told i could take bio- identical hormones throughout...and warned to not stop them by my hormone doctor in CA......nor would i want to...though how to remember them while zonked out i dont know...but am not worried about it...
i'd expect that anything that thins the blood or could cause bleeding would be stopped just prior...that is required even for cataract surgery, which involves one day (plus two weeks of certain restrictions as well)....
accepting the surgery means accepting the limitations required...i didnt get in to details with my surgeon as i havent set a date...til that time, i wont worry...

i cannot believe how many things you worry about...without a date set for surgery! i am not saying this to try to insult you...just to say that the kind of worrying it sounds like you do......well, i cant even imagine sleeping...:rolleyes:

jess

Back-out
06-20-2010, 12:56 AM
It's called "planning" jess. Hey, I may not even have a helper afterward, unlike you with a spouse and maybe others to look after you!

jrnyc
06-20-2010, 01:01 AM
in my opinion, i think it is waaaaay beyond planning..and no, i will have no others to take care of me...and possibly not hubby either...
i think if you go in with a list of these questions, the first surgeon you see could knock off the answers for you, whether you ended up having surgery with that doctor or not..the rules about what you can do/take before surgery are the same, regardless of doctor...actually, i think all surgeries may have the same rules...due to danger of bleeding with any kind of surgery...
sooo..there could be a few days of ...mild to severe pain...for many scoli patients prior to surgery...but i believe there are some pain meds without aspirin that are allowed...

jess

kennedy
06-20-2010, 01:03 AM
I just took norco after surgery

Confusedmom
06-22-2010, 04:48 PM
Hi Amanda,

Why is a myelogram?

Also, I hear you on figuring out this stuff ahead of time! I've been wondering about Lexapro--antidepressant, or in my case anti-anxiety med. I cannot contemplate stopping it before surgery, as that will make my anxiety skyrocket just when it will be skyrocketing naturally!

I thought I read in one of the scoli books that you need to stop Nsaids maybe a couple of months (??!) before surgery. Check that out. But you definitely can continue Tylenol and other types of pain meds.

Evelyn

Back-out
06-22-2010, 05:59 PM
Hi Amanda,

Why is a myelogram?

Also, I hear you on figuring out this stuff ahead of time! I've been wondering about Lexapro--antidepressant, or in my case anti-anxiety med. I cannot contemplate stopping it before surgery, as that will make my anxiety skyrocket just when it will be skyrocketing naturally!

I thought I read in one of the scoli books that you need to stop Nsaids maybe a couple of months (??!) before surgery. Check that out. But you definitely can continue Tylenol and other types of pain meds.

Evelyn
H, Evelyn!

Thanks for understanding. Hard to figure not grasping the difficulties of stopping medications on which we depend - and being able to brace ourselves mentally for the outcome, at least to the extent possible!

Depending on their requirements, it's looking like I may be plunged into menopausal symptoms because of having to discontinue HRT (Hormone Replacement Therapy) - and my body thermostat is already wonky! Means I put on and take off socks throughout the night, even in the summertime and I gather sock putting on is one of the hardest things to do after a long fusion! :eek:

God help me, if surgical recovery coincides with having out and out hot flashes (ETCETERA)! My OBGYN specialist (very good and well-read), has managed to spare me them thus far! Not that avoiding hot flashes is why I wanted to start and continue HRT from peri-menopause on. That FWIW is based on the most up to date research on which she was way ahead of the curve (as witness recent NYTImes article, detailing the medical rationale - very strong, as long as it's started early).

And if on top of that, I am forced to do without my tried and true sleep med (for all it's hangover effects, the only one that works), all I can say in this format is :eek: :eek: :eek:

The bit about discontinuing NSAIDS is old (bad) news - though, I admit I hadn't heard about stopping them so far in advance. Whatever, the time frame, it will be very hard for me as they not only help tremendously, they are my only alternative to opiates and I really, really want to minimize using opiates, especially before the surgery (=The Surgery).

Like many - especially those who like me, have had difficult experiences with opiate tolerance and discontinuation in the past - I am dreading the forced addiction to opiate pain meds (followed by withdrawal)l as much or more than the surgery itself! Among other side effects, it is VERY depressing!

That goes double or more, if I have to contend with this alone! The last time I had to go off (a year ago). I fell repeatedly, leading to my breaking several ribs! Extreme insomnia (the primary bad side effect of withdrawal for me), will do that to you, and I wasn't even in much pain! Worst of all, is that falling after a long fusion is simply not allowed, as we all know.

So it all adds up! Hot flashes, socks, insomnia, depression and isolation --- very scary, non-trivial and all too reality-based. Anyone dependent on meds to combat anxiety and/or depression will certainly also want to know how long (if at all) they will need to discontinue them.

I know they were on the no-no list prior to the CT myelogram, but that was only three days in all. A very LONG three days, though, if one needs these meds to feel OK, and especially considering they need to be titrated up or down rather than stopped or started cold turkey. That makes the total withdrawal experience potentially longer.

Back-out
06-22-2010, 06:01 PM
You asked about a CT myelogram at a good time since the results were in today's mail. They inject a radio-opaque dye into your spinal fluid at the lumbar area (thecal sac to be precise) - much like a lumbar puncture, I think. This injection is fluoroscopically guided. Afterward, a CT scan is done on whatever portion of the spine has been indicated for the study.

The two generate a lengthy report of the health of your spinal column as far as the fluid extends. Not sure which part contributes to the information.

At any rate, my report indicated vertebra by vertebra, what was going in in terms of degenerative disease, disk herniation, spurring and stenosis. It also reported on (haha) scoliosis. That - "gross findings" (gross, all right!) - was perhaps the only weak part of the study, as they said I had "severe scoliosis" in a "C curve" while I have always been said to have an "S curve". Furthermore, they also didn't report on the degrees of curvature. But then I hadn't expected any report on the structure. My understanding was that this procedure would indicate where there were nerve impingements which could explain or predict areas of pain. For me (if I go forward with the surgery), this would help the surgeon in addressing my spine's needs at the time he operates.

Hope this was clear. Others may understand (and be able to explain) the procedure much better . All I know is, I was VERY relieved not to get the dreaded "spinal headache" afterward, and that I was also relieved only to have to go off my regular meds for three days. Matter of difference here - the NYC spinal surgeon who ordered it, told me I'd need to be off NSAIDs for a full week beforehand. So did the neurosurgical P.A. I spoke with yesterday abt a different issue. So it appears I was just (very) lucky. It seems bleeding from the dye injection, can lead to bleeding in the thecal sac - and that can cause paralysis! :eek:.

I did notice that both when the IV was put in for the myelogram and when blood was drawn yesterday, I really spurted so I guess my blood's been quite anti-coagulated by thinning meds. I certainly won't try to cut corners before the Big Spinal surgery, seeing anti-clotting in action. Yuck. After all, I have "only one spinal cord to give for my body", and besides as a long-time reader here, I know that extreme blood loss is one of the risks of this surgery! Boring to use the same emoticon, but it's all we have here, so :eek:

It so happens. I lost almost 1/2 my total blood volume during and after my first childbirth simply because no one bothered to tell me to avoid aspirin in the third trimester. Figuring it was all that was safe (haha), I really tanked up. Still remember the near-fatal drip-drip under my gurney many hours after delivery!

jrnyc
06-22-2010, 06:44 PM
i was told i only have to avoid meds containing aspirin/aspirin like products (and blood thinners) for cataract surgery..nothing else...and the opthalmologist said she sees all surgeries as having the same rules for meds that must be stopped prior...for her surgery it is 4 days to one week prior...

Ev...i have had 2 surgeons tell me they would not have a problem with any patient on bio-identical hormones...also told same for thyroid meds, as well as any antidepressants...if you look the topic up on the internet, there are some doctors who worry about the consequences of stopping meds (aside from the forbidden ones that cause bleeding) versus consequences of taking them!

i think if a patient really wants the surgery, they put up with the requirements...i have meds i take that i would hate to have to stop taking...but i will if i decide to have the surgery...no point in going ahead with it and sabotaging myself! there could be enough possibilities of complications without me adding to it! :rolleyes:

Amanda...i dont know how common "forced addiction" is after surgery...everyone is different as to pain tolerance, meds needed, kind of pain meds that work for their pain...perhaps a pain management doctor could help...

jess

Back-out
06-22-2010, 11:00 PM
For the CT myelogram, they also wanted all antidepressants and pschotropics stopped before and afterward because there is thinking that in conjunction with the spinal puncture, seizures may be induced.

Don't know how much this might extend to a scoliosis fusion but since a dural tear is commonplace, it seems to me (if the myelogram ban was valid) that this would be the cautious approach to any surgery on or near the cord. I can hardly think of anything worse after the surgery than having a seizure! :eek:

Of course, one "puts up" with the restrictions, but one sure as hell works around them as much as possible - including anticipation and planning! For me, that means getting things done before the med bans takes effect and doing whatever I can to duplicate the needs the meds meet (exercise for depression/anxiety, for example; light management and sleep hygiene for insomnia).

jrnyc
06-22-2010, 11:48 PM
on internet, Spine Institute of NY (Dr Neuwirth) has a list of meds to be stopped before surgery...and for how long...
on the list, i noticed oral hormones and HRT...but not bio-identical...especially since most bio-identical are creams, not oral...
my hormone doc also told me she can make sure all of her patients who are having surgery receive all their hormones in cream form for the duration of surgery...she said no surgeon has ever told her that it was a problem...

meds are one of my lesser concerns about the entire experience...

jess

Confusedmom
06-23-2010, 09:15 PM
Jess,
Thanks for the reference! Here's the list from Dr. Neuwirth:

MEDICATIONS TO DISCONTINUE BEFORE SURGERY

Please do not take any of the following medications for at least seven (7) days prior to surgery. If you have spinal fusion surgery, you will NOT be able to take NSAIDS or medications containing aspirin for about 3 months (until your doctor tells you that your fusion appears solid).

•Non-Steroidal Anti-Inflammatory Drugs (NSAID’s)
Advil Celebrex Ketoprofen Oruvail
Aleve Daypro Lodine Toradol
Anaprox Diclofenac Mobic Relafen
Ansaid Feldene Motrin Vicoprofen
Arthrotec Ibuprofen Naprosyn Voltaren
Bextra Indocin Naproxen

•Medications containing Aspirin:
Alka-Seltzer Bufferin Fiorinal
Anacin Darvon Compound Pepto-Bismol
Asprin Ecotrin Percodan
Bayer Arthritis Excedrin

•Estrogen Products
All oral contraceptives hormone replacement therapy

•Anticoagulants and Antithrombotics: (You will need to consult your physician regarding plans for stopping these medications.)
Aggrenox Halfprin Persantine
Coumadin Heparin Plavix
Ecotrin Lovenox Ticlid
Fragmin Orgaran

•MAO Inhibitors:
Nardil (Phenelzine) Parnate (Tranylcypromine)

•Herbal Medications and Supplements:
Vitamin E
(14 days before) Garlic Lovaza Valerian
Multivitamins
(containing Vit.E) Ginkgo Biloba Ma Huang
Echinacea Ginseng Saw Pilmetto
Fish Oil Kava St. John’s Wort

•The following medications MAY be taken prior to surgery: (This list of medications to discontinue is not complete. Other medications may contain these products as well. Please check with your physician if you are taking other medications.)
Acetaminophen (Tylenol) Duragesic MS Contin Roxanol
Darvocet Fioricet MSIR Tylenol + Codeine
Darvon Lorcet Oxycontin, oxycodone Tylenol
Dilaudid Lortab Percocet Vicodin (Hydrocodone