TO THE EDITOR: I have intercourse ...

TO THE EDITOR: I have intercourse withed the article on the care of patients who are recovering from chemical colony in the November 15, 2003 issue of American Family Physician. (1) This important issue has received little attention in the general medical literature. The article provides an superior overview of the special factors united should consider when treating recovering human frames Many well-meaning physicians, unaware of these considerations, have unknowingly pushed a recovering body toward relapse by prescribing an avoidable mood-altering medication. The conclusions of relapse are often grave, including throw downed relationships, incarceration, and death. Understanding these issues and following the suggestions outlined on the authors can help physicians play an important part in preventing relapses.

In addition to the authors' highly deserving suggestions about the management of cough in commonalty recovering from chemical dependency, the use of albuterol inhalers should be considered. Albuterol inhalers are not disposition altering, and they effectively check cough associated with bronchitis. (2) In my experience, albuterol is level more effective for cough in recovering patients than it is in the general population. This is not surprising, because in the greatest degree recovering patients have smoking histories, and many have inhaled a wide variety of potential lung toxins (such as marijuana, cocaine, and toxins from homemade pipes made from aluminum cans).

The authors (1) discuss acute pain management, further the topic of postoperative pain be entitled tos additional attention. Following many surgical deeds patients have no choice if it be not that to use medications that have the highest potential for triggering relapse. Recovering patients generally be stirred trapped between accepting the use of these substances they have worked hard to avoid or suffering unnecessarily. Physicians should reassure the patient that many thousands of living bodys recovering from chemical dependence have undergone major surgery and remained in convalescence The patient should be encouraged to be as active as possible in convalescence efforts during the perioperative period (eg attending 12-step meetings, meditating).

Following surgery adequate pain relief should be provided; however, it is important not to overshoot the necessary dose because this will lead to avoidable euphoria. The physician should be attentive for objective signs of uncontroll pain (such as vital-sign changes, apprehension, difficulty moving) and unnecessarily high doses (such as the patient nodding without during conversation or being difficult to arouse). The patient may require substantially higher doses of medication than usual, and, especially in the early convalescence period, may have a real high tolerance. Because of cross-tolerance, this high tolerance may augment to substances the patient not at all abused.

In my experience, parenteral ketorolac (Toradol) is an effective adjunct that provides adequate relief while using earnestly lower doses of opiates. forward discharge, ongoing adequate pain relief should be provided, moreover the patient should be switched to non-mood-altering medications as pretty soon as possible. Patients should be instructed to adhere precisely to the scheduled dosing of mood-altering mix with drugss and may have someone otherwise keep the bottle and administer the medication. If the dosage is insufficient, the patient should contact the physician to discuss increasing the dose and/or oftenness Following these suggestions can help detain patients on course with their regaining following surgery and allay many of their concerns

REFERENCES

(1 Jone EM Knutson D Haines D belonging to all problems in patients recovering from chemical subject territory Am Fam Physician 2003;68:1971-8.

(2) Gonzales R Sande MA. Uncomplicated acute bronchitis. Ann Intern M 2000;133:981-91

EDITOR'S NOTE: This verbal expression was sent to the authors of "Common question s in Patients Recovering from Chemical Dependency" who declined to reply

ROBERT L HATCH, MD

University of Florida body of Medicine

Dept of Community Health and Family Medicine

1600 SW Archer Rd Room

G1-019 Gainsville, FL 32610

COPYRIGHT 2004 American Academy of Family Physicians

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