Well Known Member
Using Cannabis Pre and Post-Surgery to Avoid Opiates: The Personal Journey of Nikki Lastreto (Owner of Swamy Select)
Nikki had a hip replacement following 20 years of pain. Pain that she been treating with cannabis. Her chosen hospital allowed her to use cannabis post-surgery as long as it was self-administered. When it's an operation that you'll end up in Intensive Care (i.e. heart surgery) this won't be an option. They're going to administer what they're used to. The medical staff is not permitted to administer or prescribe cannabis, because the Feds have it on Schedule One.
Her operation was full anesthesia. Three days in hospital. She'd requested no opiates post-surgery.
* Day 1 was incredibly nauseous. She reasoned it was from the anesthesia. After a full day of unsuccessful allopathic methods to settle the stomach she finally took cannabis drops (THC drops) at 10 PM. Nausea vanished immediately.
* Day 2, still nauseous, the staff is continuing to give her a cocktail of meds that her doctor had developed over the years to treat this recovery stage. He'd offered her the mix without opiates.
She'd been told there were anti-inflammatories in the cocktail, and she had a Tylenol drip going. Tylenol will activate the pain receptors in the brain the way THC will. She began taking light THC and CBD drops during the daytime. Her contention is that after you've lived with that kind of pain for so many years, this is nothing in comparison.
*** As a chronic pain patient you've already conditioned yourself to tolerate intense pain. There's no reason to believe that after the surgery you will suddenly forget how to overcome the discomfort of pain. This will pass, and there won't be the horrendous disruption you were living with that became so unbearable that you went through the operation. ***
At night she was taking Blue Dream drops from Hummingbird Lane. The high THC knocked her out and she slept like a log, excepting the times they came in to feed her the "cocktail". This was going on every four hours.
* Day 3, she's still nauseous, and because of that she can't eat. Now she's becoming anemic. She continued the THC and CBD drops.
Check out time is on day 3.
She went through this procedure with four other patients, none of whom were doing a cannabis regimen. They did PT as a group every day and she could overhear the conversations between the other patients and their surgeon. Oddly enough a couple of them were already asking the doctor to up their opiate dose, because they were feeling too much pain.
Since she's still feeling nauseous, more nauseous in fact, she called a physican friend and asked if she could explain to her why this was developing into such a difficult time. Her friend called the hospital and got the the list of medications in the "cocktail."
In that mix was Tramadol, a synthetic opiate. It has all the narcotic effect of an opiate, but a synthetic. Technically not an opiate. Slick, eh? This is a more common practice than we want to believe.
In questioning her doctor about the doses of opiates the other patients were taking and the length of their regimens, she learned they recommend weaning off after 4- 6 weeks.
What they're really saying in that 4-6 week regimen they lay out for their patients is that you'll be addicted to opiates.
Consider that approximately 40% of patients never get completely off the opioids.
There was also Gabapentin, at a high enough dose to halt seizures, supposedly to offset pain? Cannabis is more effective and far less dangerous.
As her friend explained it, the Tramadol was making her nauseous and the Gabapentin was spacing her out. Disturbed at being duped into taking opiates for three days, she stopped taking the cocktail, checked out and went to stay with a friend. By the second day withdrawal symptoms began as a consequence of stopping the "cocktail" cold turkey.
She lived through 12-14 hours of sheer hell, which has increased her compassion for others who are caught in the web the industry and our medical establishmeant wove. There are no regrets for having gone through the experience because she now understands the hell opiate addicts deal with.
When she contacted her doctor his response was "Well, you stopped cold turkey" to which she questioned "Why did you give it to me?" Something she had to work past. Moving on.....
After the withdrawal episode cannabis was her only pain med, and that's honestly all she needed. The pain before the operation was much worse than the pain after.
Her regimen included THC drops, with a lighter dose in the daytime for functionality and a higher dose at night for restful sleep. If she needed to be more clear-headed she took some CBD drops.
Nikki also used edibles at night when she wanted to assure a sound night's sleep, fairly strong edibles at that, taking small bites.
* Before you talk to your doctor get some edibles and some different tinctures that you can practice with. Find what works for you before you go to the medical team with the request to avoid opiates.
* If you're new to cannabis start at a very low dose and work your way up slowly and thoughtfully.
* Try CBD drops some night before you go to bed, when you're feeling pain. You may sleep better than you have in a while.
* Another night try some THC drops instead. You'll sleep better than with the CBD. It'll be a longer, more solid sleep.
* Topicals are miraculous for pain management. After the operation you won't need the topicals other than to heal the wound. An infused topical will help the wound close up and heal more quickly.
* Talk to friends, bud tenders, anyone who has experience that can help you in the search for what works for you.
If you're someone who's really afraid of the pain try CCO. Start with tiny doses. This is potent medicine and it will space you out or knock you out.
Nikki prepared a few gel caps with CCO before going to the hospital. They were simply a ball of CCO the size of a mustard seed loaded into a gel cap. She suggests one of those at night for sleep assistance.
We have the benefit of biobombs. I'd suggest 5:1 for those of you with a decent appreciation of euphoria. Not a dose to take lightly, but one both Cajun and I found to be enjoyable as a recreational experience.
Get some personal experience with cannabis ahead of the operation.
* Find your optimal therapeutic dose. What works before the operation will certainly work after to counter the pain of surgery. After all, it was managing the pain before you went in, because you dedicated yourself to finding your individual dose.
* Find a hospital that's ok with you dosing yourself and refusing opioids, because you can't lie about this. It's going to be in the try in front of you when you're dosing.
If you're in a legal state you have a better chance of finding a hospital open to this self-administered pain management regimen.
Nurses will be interested. The doctor may pretend that he's not noticing, but the nurses will engage you. They can't take it themselves because of their work restrictions, but many are already dosing family members.
* Overcome your fear. Your friends are going to tell you how crazy you are, so you'll have to be strong in your commitment, or keep it to yourself.
A common reaction is an enthusiastic "This is your chance to use opiates!" * sigh * It only took three days on Tramadol for her to experience half a day of frightening and painful withdrawal.
You'll need courage to
- do your homework and find your dose
- talk to your doctor about your wishes
- let your family members and friends who may be caring for you post-op in on your plans
- find a hospital open to your intent
- to just do it
Opiates slow everything down, including healing. Substituting cannabis results in faster healing devoid of the side effects commonly found with opiates.
A variety of ratios were used in the regimen:
* CBD dominant drops for daytime to relieve the pain but still be clearheaded. Her dose was 2 droppers full, approx. 20 mg.
This is not pure CBD oil. She uses full-plant extractions that'll have some THC. The cannabinoids work best in synergy.
* A 1:1 ratio is good for daytime when you're more uncomfortable for a CBD dominant.
* Night meds were stronger THC drops and edibles. Her THC dose was only one dropper full, approx. 10 mg, or 15 grams of an edible.
* THC drops at bedtime had been the regimen for years, so she already had them dialed in to her comfort zone.
Nikki mentioned noticing that when she uses THC drops for sleep and has to get up in the middle of the night she'll be smiling. Lol!
On her medical team's recommendation she'd discontinued any electrolytes pre and post-op. When she went into withdrawal she started adding in the electrolytes and had a banana, which raised her potassium levels. She was in tune enough with her body to know she needed to ignore her doctor's advice.
What did we learn here?
* Have a strong intent and some practice with cannabis as a pain management med before you talk to your doctor.
* Gain the support of whomever will be caring for you post-op.
* Find a hospital that will accommodate your wishes.
* Scrutinize your drug "cocktails". Doctors aren't always as ethical as we'd like. It's worth remembering that this opioid epidemic was directly caused by doctors writing prescriptions. Without that action, this horror doesn't exist. I've always found nurses to be more honest and forthcoming, even if they have to do it on the sly.
* Know your optimal therapeutic dose before the operation. Start incredibly low, lower than you may think is realistic, and titrate up slowly and thoughtfully.
Evidence suggests that for pain patients in particular it really matters that you don't overshoot the sweet spot with THC, and it's likely to be lower than you suspected. Pass it up and you run the risk of feeling the pain more. Humor me. Be thoughtful.
I suspect our population may have a higher dose threshold, but the warning still applies. Start low, go slow, and stop when you feel the pain relief you seek.
I'd recommend a 1:1 ratio to start, low THC, possibly around 5-10%. Toggle the cannabinoids upwards in your search for relief, always starting with an increase of CBD. In this way I believe you'll be more capable of finding that lower-dose sweet spot.
* Use a variety of options in ratios, dose concentrations, and administration methods to get the best pain management. You're an individual case. Find what works for you. Tinctures, topicals, capsules, lozenges, sprays, vaping, edibles - keep looking and experimenting until you're comfortable.
* Take along some heavy-duty sleep meds, some biobombs strong enough to overcome pain and let you sleep. A vaporizer will give immediate relief. Nothing beats inhalation for speed. The hospital may be resistant to a vape, so tinctures, edibles, and capsules feel like a good mix. Try to get permission for the vaporizer. You deserve instant relief.
* Keep your electrolytes in balance. Pay attention to the reality that the food you eat will either support or restrict your healing potential.
* Don't underestimate the value of a good topical. They can relieve pain in the body when applied to the palms or soles of the feet , and it'll offer relief anywhere else you can apply it. Just the action of massaging it into the skin supports the ECS.
* Daytime seems to go more smoothly with a CBD-dominant. If this doesn't work for you try a 1:1 THC:CBD chemovar (strain).
* Edibles or drops with 10-15 mg of THC at bedtime will help you sleep soundly so your body can heal. Good sleep makes it possible to have a good day.
My closing thoughts are to accept that your cells know the business of healing, and they're asking you to stay as joyful as possible in going through the healing stage. The closer your expression is to joy the faster you'll heal. THC helps reduce the tension created by pain so the healing signaling can be carried out without interference and keep you closer to joy. They didn't name anandamide "the bliss molecule" for nothing.
You can do this. We can help you get through the scary parts so you'll go into surgery confident that you can manage your pain with cannabis and get back to living without that constant companion.