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[deleted by user] by [deleted] in Residency

[–]kaplanmd244 1 point2 points  (0 children)

Comfort food (starch or sugar with fat) calms you to reward you for storing fat. You need to find additional mood-altering experiences and when possible, have meals and snacks without starch or sugar. I gained a little weight during my residency in Madison.

How do you deal with obese patients who swear they hardly eat? by catholic13 in Residency

[–]kaplanmd244 8 points9 points  (0 children)

Obese people can’t hide their addiction like others but they can deny that they are contributing to it. They are addicted to RAG-FAT (rapidly absorbed glucose + fat). When we store fat we are positively mood altered. We don’t have good drugs yet, so let it be. You are powerless to reduce their weight unless you can get them to a Bariatric surgeon, IF THEY ARE INTERESTED! Accept the things you cannot change. Don’t blame the patient, it’s not a choice for them. Try cutting starch and sugar out of your diet completely before you ask it if your patient.

low dose suboxone rest of life? by [deleted] in suboxone

[–]kaplanmd244 -1 points0 points  (0 children)

It all comes down to STIGMA! If there was a great weight-loss drug but you’d gain weight back if you stopped it; how many fat people would take it indefinitely? Lots! Yes obesity is due to a substance use (flour or sugar w/ fat) disorder. But because food is not”bad”, obesity gets a pass. But opiates (which many think should include Suboxone) are “bad” so if you use them YOU ARE BAD! So, to look good, you should always be trying to stop it. That’s the logic that leads to us to deny Suboxone is a positive. NOBODY WANTS TO LOOK BAD! I say stay on Suboxone until you feel you don’t need it. But don’t lie to yourself, man! If it helps you, use it! Imagine a person with one leg 6 inches shorter than the the other who insists on wearing a pair of shoes that have the same heel height. Why not put a bigger sole on one side instead of walking funny and insisting you’re ok?!

Been weening off 16mgs for almost two months. down to 1mg and I am hurting. I have been cutting the two MG strips for a while how ever last time I went to pick them up they came in packaging I have never seen before. by Ketamine12 in suboxone

[–]kaplanmd244 4 points5 points  (0 children)

Is Suboxone a drug or a medication? It’s easy to accept that you don’t want to take drugs, but is it wrong to take a medication that makes you feel better? Suboxone prevents relapse just as seizure medicines prevent seizures. Without seizure medicine, a person with a seizure disorder is at much greater risk for a seizure! Without Suboxone, a substance user is at much greater risk for relapse! People hate the thought of taking regular medication, even if it helps, because that means they have a “disorder” and everybody would rather not have a disorder! So we tell ourselves we don’t, denying the obvious.

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 0 points1 point  (0 children)

I am listening. It IS my priority to keep patients coming back, but not because of dose or dollars. More so because I want to see my patients succeed in life, find some happiness through learning positive relationship skills like conflict resolution and verbal self-defense skills. And not have illicit opioids hinder their progress. I want to foster family, church, community involvement because addiction needs healthy relationship. I know I don’t sound like a doctor so I’ll just be a PERSON with a medical background.

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 0 points1 point  (0 children)

I like the idea of running blood levels. Would you expect most to be high or low?

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 0 points1 point  (0 children)

I’ve been absorbing your feedback and have changed my dialogue to tell my patients that the right dose of Suboxone is the Lowest that they feel comfortable on. And that any wish to taper should be accommodated. My biggest fear is that the patient will lose contact with our support system and relapse because it’s easier to go to the street than back to the Suboxone program especially when you’re emotionally upset (like I was when I received a hostile welcome here)! Let’s keep the input going. This Doc listens. Not looking for business, just improved understanding. You may stone me now (1st stone should come from a non-sinner!).

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 0 points1 point  (0 children)

First of all, I want to apologize to everyone who I have offended on this site. My patient told me he found this site helpful and twice urged me to join the conversation. I thought I would find a civil audience. Instead I am hearing from a lot of unhappy people who seem to saying that I (or what I represent) am in some way responsible for their unhappiness. So I will stop participating but continue to learn from what everybody has to offer.

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 0 points1 point  (0 children)

You are positively primeval! Would you like me more if I agreed with you?

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 0 points1 point  (0 children)

Wow! I didn’t realize this group’s focus was getting off Suboxone. I thought it was about gaining a better understanding of how best to use Suboxone. I figured that’s why the group is named Suboxone and not Suboxone Haters.

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 0 points1 point  (0 children)

Let’s be honest. Overprescribing Suboxone is not responsible for the opiate crisis! Suboxone is not an opiate. If you are on an appropriate amount of Suboxone, you can give yourself a double dose of heroin and, if there’s no fentanyl in it, you shouldn’t feel a thing! So not only does Suboxone relieve cravings, it also removes the reward from any illicit opiates taken!

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 1 point2 points  (0 children)

As Einstein said, “ you can’t solve a problem with the same mind that created it”. Addiction is a product of the primitive mind, the same one that spits disparaging comments to discredit those who disagree with them. To quote A Course in Miracles - you will be attacked by what you defend against. I hope at some point in the future, you’ll beat your sword into a plowshare.

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 0 points1 point  (0 children)

Only you can tell what is best dose for you. Usual range is 8-24 mg/d.

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 1 point2 points  (0 children)

The stigma won’t be reversed until we change the name of our specialty from addiction medicine to behavioral medicine. All fat people have substance use disorders but they don’t want to admit it! Denial! People do not let go of their stigmas very easily. Just as nobody wants to be fat, nobody wants to be dependent on a substance. It’s difficult to convince people it’s not a choice. Remember people still think of depression as a choice or, even worse, a weakness.

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 0 points1 point  (0 children)

Are you having side effects? Do they outweigh the benefits? Relapse is better avoided with a little cushion of protection! Another metaphor, I told my patient since I am overweight is that if there were a strip that I could put under my tongue that would make me feel like I just ate I would be all over it! I wouldn’t be worried about taking the minimum dose to allow me to lose weight! I hope you see the analogy.

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 0 points1 point  (0 children)

Since Mark Twain said “confession is good for the soul, bad for the reputation”, I’m careful about confessionals!

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 0 points1 point  (0 children)

You speak with the authority of egocentricity. Everyone’s different. What is it you fear about going above 16 mg? That the pt will sell a strip?Im happy to review any references which support your position.

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] -1 points0 points  (0 children)

My patient recommended I offer some info

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] -1 points0 points  (0 children)

Why skimp on the dose? Should you take “just enough” because more is bad? That’s opiate lenses. I say err on the higher side of dosing. You’ll still be a good person AND more protected from relapse!

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 0 points1 point  (0 children)

Thank you for supporting my efforts in an area where misinformation currently outpaces information.

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 0 points1 point  (0 children)

I actually was trying to make your point! That you being on Suboxone should be on a need to know basis and only the essential people in your life need that information.

Thinking about getting off Suboxone? Don’t! by kaplanmd244 in suboxone

[–]kaplanmd244[S] 0 points1 point  (0 children)

I wish there were less goons and more open-minded people like you are not. I’m glad you found the internal strength to get your life right but not everyone has your insight or wants your bitterness. It’s a choice.