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The Docs: Rethinking opioid use post-operation

September 11, 2019 at 9:54 a.m.


Q: I’m going to have a hysterectomy, and my doctor says that I’ll be taking pain pills for about a month. I don’t want to get hooked, but I don’t want to invite unwanted pain either. Are there any guidelines for what and how much pain medicine I should be taking and for how long? -- Andrea M., Omaha, Nebraska

A: Your pain management solutions will depend on what type of hysterectomy you have. A vaginal hysterectomy has a faster recovery time than an abdominal hysterectomy. So, before your operation, talk with your surgeon about how to handle pain issues, and keep him or her informed about how you’re feeling post-op. We also recommend getting a referral for a pain management specialist.

Tip: Ask your surgeon and pain management specialist if they know about a new evidence-based study from the Michigan Opioid Prescribing Engagement Network (Michigan-OPEN). Researchers there looked at surgery-related opioid use for 11 common operations at 72 hospitals and came up with some workable guidelines. What makes this study remarkable is that up to now, there haven’t been evidence-based guidelines for post-op opioid prescription!

The researchers determined that opioids were vastly overprescribed, plus they figured out how to reduce the need for opioids to manage post-op pain. They got great results from a combination of presurgery counseling so the patient (you) knows what to expect and alternate ways of managing pain that include relying on non-narcotic pain relievers (ask about aspirin and acetaminophen). Most amazing, even for in-study patients who were getting a reduced amount of post-op opioids, there was no spike in reported pain, and many only took half (or less) of what they were prescribed.

So discuss post-op pain management with your surgeon and pain management specialist and develop a program tailored for YOU that uses the amount of opioids you really need to repair and recover! Return any unused pills to your pharmacy (or use a mail-back program) so they’re not around to be misused.

Q: When I was 40, I could put on a few pounds over the winter and then work out a bit in the spring and summer and get back to my normal weight. Now I’m 55, and the extra 15 pounds I put on last year just won’t come off. What should I do? -- Barbara L., Pittsburgh

A: We hear this a lot, but don’t get discouraged.

Here’s the deal: After age 30, your metabolism slows down about 5% every 10 years. That might not sound like a lot, but it is enough, if you don’t counter it, to add weight.

Why does this happen? Your metabolism is generated by structures within your cells called mitochondria. They convert food into energy, and over time these engines slow down. Some actually die off. You also lose muscle mass over time (at the same rate of about 5% every 10 years after age 30), and that’s another reason you’re burning less fuel. The result? You have to work harder to burn the same number of calories.

Throw in a loss of sex hormones, and it’s time to commit to a more vigorous year-round fitness plan. Here’s how:

  1. Start by getting enough sleep. Chronic fatigue makes it twice as hard to work out more.

  2. Stay away from the Five Food Felons: added sugars and syrups, trans and saturated fats (in processed foods and meats), and any grain that isn’t 100% whole.

  3. Work on physical agility, aerobics and balance. Check out Denise Austin’s 5-minute stretch at Do it daily in the morning. Aim for 10,000 steps daily or the equivalent.

  4. Now you’re ready to build muscle. Each pound of muscle you add not only increases your body’s fat-burning potential, but it also helps protect you from future bone loss. Using your body weight and stretch bands for resistance exercises builds muscle, stamina and endurance. Check out “Beginner Resistance Workouts” also on Sharecare’s website.


(Mehmet Oz, M.D. is host of "The Dr. Oz Show," and Mike Roizen, M.D. is chief wellness officer and chair of Wellness Institute at Cleveland Clinic. Email your questions to Dr. Oz and Dr. Roizen at youdocsdaily(at sign) Distributed by King Features Syndicate, Inc.)


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