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Hello, to everyone!!! I am finally back.  I have really missed the website and interacting
with all of you.  First, I want to thank Dee and Ruth for keeping the website going while I was away. They deserve all the thanks and more.

My name is Deborah Shrira and I am the Creator of the website.  Last year I had to take a leave of absence to have two major back surgeries. Yes, I had two! You see I have Scoliosis & Fibrosis with my shoulders dropping down about 4 inches and a 75% curvature to my spine, this was causing my ribs to push in on my lungs causing excruciating pain and shortness of breath, I felt like I had no choice. It was either have the surgery or I would not have lived past another 6 months. I was taken into surgery on Tuesday the 26th of April, many hours later after the first stage of surgery was complete, the doctors had to place me in ICU where I was to remain the rest of the evening and the next day. Then came Thursday and back to surgery I went.  I was in such pain, I was glad to be put to sleep, if you know what I mean?  Once they finished with me I was returned  back to ICU. 

I was in agonizing pain ...and I needed my methadone, I kept praying they had ordered some intravenous methadone. I was on 320mg a day before the surgery and I'm sure many of you think it is a high dose but  I had been on methadone 19 years prior to my surgery.  I had met with the doctors, pharmacist and anestheologist before surgery and I felt I had educated them to the best of my ability concerning  methadone.  I informed them I could not miss a day without my methadone.   Now, I just prayed they had really heard me otherwise, I wasn't going to make it out of the hospital alive. 

I know many of you have experienced back surgeries and I am sure you can identify with the agonizing, relentless pain I was feeling. I was in such pain and when I asked them about my methadone I was told  they had already used all they had in stock and they had to make calls to locate some for me. Why do people wait until the last minute?  They had to have some flown in for me. The nurse kept telling me they had picked it up at the airport and they were on their way with police escorts. Can you believe this after I had spoke with them long before surgery to make sure they had it available.  I will never understand people for if they had done their job, I wouldn't have been  in the pain I was in. I lay there screaming and wanting to die if the methadone didn't soon arrive.  

It finally arrived and they pushed it 320mg through the IV bag. I could barely tell they had given me anything and this was not working for me. The doctor ordered Dilaudid 6-8mg every two hours if needed for pain. It wasn't helping me at all and I was just  about at the end of my rope. I had never hurt this bad before and I knew it was going to require more methadone. I was screaming at them to either give me more methadone or just shoot me ...  I could not handle it!!! I was totally serious, if my pain did not let us some, I really did want them to put me  out of my misery.              


Thank God for shift changes and nurses.   The third shift finally arrived and I was still causing everyone a lot of problems...my nurse came in to check on me and could tell I was in agonizing pain. Believe it or not, she wasn't pleased and assured me she would get my dose increased. She continued to call my surgeon, Dr. James until he returned her call. Most of the other nurses had called once and was much to afraid to question his orders.  She was different and when he did return her call... they argued and it all boiled down to the fact he didn't want to increase it because if anything went wrong then he would be responsible. She told him, she would take full responsibility if anything happened and she would go on record saying she increased it without his approval. I thank God for her and she did get in there and gave me as much as she could without stopping my heart. I was still in pain but she kept a watch on me and before it started running out she would start infusing the next dose.  She even ordered Ativan to be infused with the methadone to help my anxiety and at about 10 PM, she gave me my regular dose of Xanax.

I can tell you, I have been through many surgeries in my life  but to have two major surgeries in one week amost destroyed me.  It didn't help much either being on methadone for almost twenty years and believe me, I had not missed one day during those twenty years taking my methadone.  It didn't help either being on the high dose  I was on. Methadone is about the strongest medication you can take.  I found out no matter how much they gave me, they couldn't stop my pain totally. If you are not aware of this, no dopamine was being produced and when it is not being produced, you are much more sensitive to pain.  I remained in the hospital for two weeks before they allowed me to come home.  Believe me, I didn't feel like any visitors even though my Mother and sister had flown in to help me and of course, I had Dean Vereen, my partner and significant other. I must give him credit too because He raised as much trouble as the Nurse who obtained the higher doses of methadone for me.  He kept complaining at the nursing staff and trying to reach the doctor too. He really did give it his all and then some.

The going was still rough but my nurse would come in as much as she could to see how I was doing and give me encouragement.  I am not going to use her name as she asked me not to but I want to thank her for all she did for me. She did arrange another meeting with my significant other, anestheologist and the the Director of Pharmacy at the hospital. She wanted to make sure I was on a stable dose before they moved me out of ICU and into my own private room.  They all discussed it and it was decided  they would give me 300 mg three times daily and  the Ativan to be infused at a slow rate during the day.  The Ativan did help me considerably and they left orders if I needed more pain medication, I could have 6-8mg of Dilaudid every two hours.  I know some of you are thinking -how could I survive and take the amount I was taking but you must remember I had been on methadone for almost twenty years. The 320mg I was receiving from the Methadone Maintenance Treatment Center wasn't holding me 24 hours before I had the surgery.  I was more than pleased with what the team at Northside Hospital in Cummings, Georgia  was giving me now.  


Finally the day had arrived that I had been waiting for- I was going home.

My partner Dean arrived at the hospital to pick me up. Now, for those of you who don't already know, Dean himself is disabled and uses a wheelchair. I knew my going home would be difficult on him. Here I was, I had just had a very serious surgery and would require extensive care. How would we ever manage? Dean said he would take care of me and true to his word, he did. Once home, Dean somehow managed to help me dress, bathe, fix my meals and get me to and from the clinic and follow up doctor's appointments. Even when I didn't have the funds for my medication or whatever was needed he found a way.  How he was ever able to do it is beyond me.

About a week after my coming home we were able to get established with Coosa Valley Home Health Care located in Cartersville GA. The nurses from Coosa Valley came in twice a day to help with my personal care, dressing changes, and took care of the incisions which were located on my back, front side and side at the same time monitoring my vital signs and pain level.  Having been on methadone for almost 20 years how to handle my pain once home was something else that had to be addressed.  My regular dose of 320mg every morning had only been holding me until about 5 or 6pm in the evenings before surgery as I had been on that same dose for the last 3 years although I had tried to obtain an increase in my dose, I was told by the clinic that I was already on the highest dose of anyone attending my clinic. Thankfully my primary care provider Dr. Rudolph Tacoronti who is also the doctor from my methadone clinic had agreed to manage my pain medication once I was discharged from the hospital. I was given 320mg of methadone in the evening in addition to the regular morning dose of 320mg. I was also prescribed 4mg Dilaudid every 4 hours for breakthrough pain as needed. Again, I know this sounds like a lot of medication but when you think about how long I had already been taking methadone and combine that with all of the surgery I had just undergone, it really isn't. I am just grateful to have a doctor who cares enough and is knowledgeable in regards to methadone. Had it been any of the other doctors I had talked with before surgery I'm sure I would have been left in excruciating pain.  I hate to say this but a lot of doctors out there have the thought that if a patient is already taking methadone they don't need additional pain medication, that the methadone should take care of it. And that is not true.  This is why it is so important to discuss all of your options for pain management with all of your medical staff before any kind of surgery or procedure. Remember, be prepared, take notes and educate. I can't say that enough.

About 3-4 months into  my recovery from surgery, I believe  Dr. Tacoronti starting getting pressure from the State Methadone Authority the DEA and possibly the clinic to start reducing my dose, because he started looking for an alternative medication  to take the place of the evening methadone dose and breakthrough pain medication. At his suggestion, I agreed to try taking Nucynta 100mg to be taken every 8 hours as needed. I did so diligently knowing that I needed to try and see if I could reduce the dose of methadone because if an accident or medical emergency were to occur and I had to have surgery, I would be in a very bad situation again.

At first the Nucynta did reduce the pain somewhat but after a few months of taking it, I noticed some very unwanted side effects. I started having some unbelievable bad dreams. Nightmares actually. I was getting forgetful, dizzy, nausea and I started to have spells where I would just fall down. Some days I felt like I was losing my mind completely I would get so confused and I didn't like that feeling one bit.  I started reading up on Nucynta and others were describing the same side effects as the ones I was experiencing. After feeling the way I was when I was taking the Nucynta, I would never in good conscience recommend this medication to anyone. Please, if your doctor ever recommends that you take Nucynta, talk to them and do your research I would never want to see anyone go through what I went through while taking Nucynta.

Once I started to reduce my evening dose of methadone I started to experience withdrawal. I would start to shake, run a temperature of 102, hot and cold flashes and sometimes the withdrawal would be so bad that Dean would have to support me as I was not even able to hold my head up at times. I felt like I had gone backwards not forward. All of the way back to the first day of returning home from the hospital after surgery. Thank goodness for Dr. Tacoronti, once he saw what was going on with me and all of the withdrawal I was going through he made every effort to increase my evening dose back up to the original dose but it was a slow painful process. Even now several months later,  I am still not back to being the person I once was but I am trying. It is my dream to recover so that I can get back to work and get the new website completed.



Thank you

There are so many people that I have to thank and there are some extra special people that I want to especially thank.

Special thanks go out to Dr. Rudolph Tacoronti and his great staff for all of the great care I have received. Without their help in working together I could not have made it through this surgery. No words could ever express my gratitude to all of them.

GPA clinic in Doraville Ga. In my opinion and the opinion of many other patients, GPA is the best clinic in the state of Georgia. Nat Nwizu, the director and all of his staff have always shown great respect, compassion and caring equally for all patients.

I want to thank Dr. Steven James the surgeon who did my surgery. He and his staff have done a tremendous job.

Sincere thanks to the team at Northside Hospital and my extra special night nurse who gave that little bit of extra care during my stay.

Thank you Dean for all that you do and continue to do in taking care of me and at the same time answering the phone calls that come in from patients and professionals 24 hours a day 7 days week. Thank you also, for  having the patience needed to help teach me how to use a computer, I know I wasn't an easy student.

 Dee, my dear friend thank you for hanging in there, continuing to work while I haven't been able to.

And to Udi, I met Udi several years ago. He has been a great source of support and who's friendship I value tremendously.

The friendly staff of Aegis Medical Systems, located in Ca. Thank you for the help and support that all of you gave to me when I was adding the videos to this website. I can't thank you enough. The videos have been a great help to many people who view our site.

A Note

For anyone who might have any questions on the validity of the facts stated above in regards to my surgery or the administration of medication after surgery and during recovery, I have signed the necessary release of information forms with my primary care provider Dr. Rudolph Tacoronti. Those physicians or other professionals  who wish to obtain a copy of said records may make a written request to him and work out a reasonable fee for the copy of my records plus the cost of mailing. Please address all requests to:

Dr. Rudolph Tacoronti
Community Care MD
5019 Lavista Rd
Tucker, GA 30084



Suggested Reading

  • ·       The Science of Addiction: From Neurobiology to Treatment
  • ·       Addiction Essentials: The Go-To Guide for Clinicians and Patients

Both books are written by Dr. Carlton Erickson
Dr. Erickson has been truly supportive friend to both Dean and I. He is a highly respected professor of Pharmacology/Toxicology at the University of Texas at Austin. He has been studying addiction for the past 30 years and is the author of more than 260 peer-reviewed and professional publications, including his two sole authored books listed above.

  • Lowinson and Ruiz's comprehensive textbook titled: Substance Abuse 5th edition by, Pedro Ruiz and Eric Strain

All of the suggested reading material can be found on Amazon.com



The above Directors View was written by our founder Deborah Shrira in April of this year (2012).

Sadly, Deborah passed away on May 21,2012 from a blood clot in her lung. After much debate the staff of Medical Assisted Treatment of America Inc. decided to go ahead and publish the work that Deborah had work so hard to complete. Deborah wanted to reach out to our readers who have often asked the questions about Surgery and Medication Assisted Treatment. She wanted to share her experience with all of you so that you would know that it is possible to have surgery and receive the pain medications needed safely. She wanted to let doctors know not to be afraid to medicate their patients when needed, that being on mmt doesn't mean that you don't need pain medication but just the opposite.

Deborah worked tirelessly for years as an advocate for Medication Assisted Treatment to educate others about the disease of addiction, the various treatments available and reduce the stigma associated with patients who utilize medications to help them manage their addictions.

She will be missed by so many people. She had touched the lives of others in a way that could never be forgotten.

It is our goal to be able to keep this website along with our sister site, Suboxone Assisted Treatment operating so they may continue to help others. We would like to thank those of you who have donated in the past and encourage others to donate so that we may be able to realize our goal.

Won't you please donate today. It doesn't have to be much, as every little bit helps. Whether you donate $1, $5 or even $20. You can make a difference!

Remember- We are a 501(c)(3) Non-Profit Organization. All donations are tax deductible and kept confidential.

If you would like to donate please send your donations to:

Medical Assisted Treatment of America Inc.
Dean Vereen/Director of Finances
38 Winterwood Trail
Taylorsville, Georgia  30178

 Please help us so that we may continue to help you


Written by: Deborah Shrira, Founder                                                    April 2012

Updated and published by: Dee Black, Editor                                    June 2012









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