Additional arsenal
Unfortunately, the respite didn't last: dad's pain score increased to 3-4 when awake and spiked up to 6-7. Oxynorm breakthrough was 4-5 times a day, on top of the fixed 3 times daily.
His bedsores worsened, partly because he refused to get out of bed and sit on chair. He couldn't lie on his sides because of pain. The hospice nurse recommended Duoderm Hydrogel and Duoderm dressing (the latter's expensive!). Seem to help a little. My mum then used Agnesia hygiene care powder on those sores and thank goodness it helped him a lot because he was able to get back to his usual naps.
His bowel movement went overdrive at one point e.g. pooed 4 times in the morning and all were of normal quantity! This caused him pain because it hurt the open bedsores. He requested to stop the constipation for two days. I further suggested resuming them (Lactul x2, Senokot x1) if he doesn't poo by 2pm (maid said he would poo by then). Hospice nurse agreed to this plan.
Dad tried to kill himself using the cord of the bed's remote control but failed...because he called my mum over @@. My sister surmised that he was trying to get attention. His fightened maid wanted to quit but my sister managed to assure her that no one would blame her if he succeeded. I then spoke with him, saying that although I understood why he wanted to do that, I was concerned about the consequence of failure i.e. it could put him in a worse condition than now. Perhaps in even greater pain. As expected, he didn't want that. He then told his maid that it was just a joke (so lame hahaha) and that he wouldn't do it again.
On his appointment day with PCU, I was fortunate to consult Dr J, the kind and helpful specialist at Penang GH.
The next day, according to his maid and my mum, he appeared to be more drowsy than usual and slept much more. Accordingly, we reduced Gabapentin from 3x to 2x daily. Yet, the next day, he complained of sleeping all the time and so we told him we would reduce that to once daily.
Later, I read what Dr J wrote in the hospice nurse's medical record book: added methadone syrup and increased Fentanyl patch to 150mcg. "The rest the same." Yet the label on the Oxynorm (placed by GH's pharmacist) stated 2 pills of 10mg ie 20mg, which was an increase from 10mg. So I asked the hospice nurse to clarify with Dr J: turned out that it was supposed to be 10mg. She wanted us to have extra (make sense since took 4-5 as breakthrough i.e. total 7-8 a day).
Since we had been giving dad 20mg and now had to reduced Oxynorm back to 10mg, we revert back to Gabapentin 3x daily just to be on the safe side and then monitor his drowsiness. After a whole day on this, he said he felt very drowsy and his maid observed that he slept more than usual. So we decreased Gabapentin from 3x daily to 2x daily. The good news was that Oxynorm breakthrough was only once a day.
On her visit, Dr J recommended
His bedsores worsened, partly because he refused to get out of bed and sit on chair. He couldn't lie on his sides because of pain. The hospice nurse recommended Duoderm Hydrogel and Duoderm dressing (the latter's expensive!). Seem to help a little. My mum then used Agnesia hygiene care powder on those sores and thank goodness it helped him a lot because he was able to get back to his usual naps.
His bowel movement went overdrive at one point e.g. pooed 4 times in the morning and all were of normal quantity! This caused him pain because it hurt the open bedsores. He requested to stop the constipation for two days. I further suggested resuming them (Lactul x2, Senokot x1) if he doesn't poo by 2pm (maid said he would poo by then). Hospice nurse agreed to this plan.
Dad tried to kill himself using the cord of the bed's remote control but failed...because he called my mum over @@. My sister surmised that he was trying to get attention. His fightened maid wanted to quit but my sister managed to assure her that no one would blame her if he succeeded. I then spoke with him, saying that although I understood why he wanted to do that, I was concerned about the consequence of failure i.e. it could put him in a worse condition than now. Perhaps in even greater pain. As expected, he didn't want that. He then told his maid that it was just a joke (so lame hahaha) and that he wouldn't do it again.
On his appointment day with PCU, I was fortunate to consult Dr J, the kind and helpful specialist at Penang GH.
- Increased Fentanyl patch to 150mcg
- Increased Oxynorm to 20mg
- Added methadone syrup. If it causes extreme drowsiness, start cutting down Gabapentin frequency. Should help to cut down Oxynorm breakthrough
- If dad poo is watery and occurs a few times a day, cut down Lactul frequency. Ok to also stop constipation medicine for the day. Agree with me to restart them if he doesn't poo by 2pm
- The Agnesia powder is good for preventing the bedsores from bursting open i.e. use it when it's reddish
- Wants to meet me again in two weeks time to find out the effectiveness of this change in medicine
- Will try to to visit dad together with the hospice nurse
The next day, according to his maid and my mum, he appeared to be more drowsy than usual and slept much more. Accordingly, we reduced Gabapentin from 3x to 2x daily. Yet, the next day, he complained of sleeping all the time and so we told him we would reduce that to once daily.
Later, I read what Dr J wrote in the hospice nurse's medical record book: added methadone syrup and increased Fentanyl patch to 150mcg. "The rest the same." Yet the label on the Oxynorm (placed by GH's pharmacist) stated 2 pills of 10mg ie 20mg, which was an increase from 10mg. So I asked the hospice nurse to clarify with Dr J: turned out that it was supposed to be 10mg. She wanted us to have extra (make sense since took 4-5 as breakthrough i.e. total 7-8 a day).
Since we had been giving dad 20mg and now had to reduced Oxynorm back to 10mg, we revert back to Gabapentin 3x daily just to be on the safe side and then monitor his drowsiness. After a whole day on this, he said he felt very drowsy and his maid observed that he slept more than usual. So we decreased Gabapentin from 3x daily to 2x daily. The good news was that Oxynorm breakthrough was only once a day.
On her visit, Dr J recommended
- cutting the fixed Oxynorm from 3x daily to 2x daily. She agreed with the reduction in Gabapentin and further suggested reduce it to 1 tab after a week i.e. from 600mg to 300mg each intake.
- reducing Senokot to alternating day (we've already stopped it the night before but then the next day, the amount of poo was little).
- taking Oxynorm half an hour before physiotherapy.
- trying Capsaicin patch on the most painful area of dad's left leg. Unfortunately, the usual pharmacies didn't have that brand nor alternatives with exact same ingredients. Hence, we're trying Salonpass (it was sort of second choice by Dr J).
- Mucosolvan syrup to treat thick phlem on ad hoc basis.
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