Volatile and increase

There came a point where dad had diarrhea a few times a day. We consulted the hospice nurse, who then suggested cutting down Lactul from 3x a day to 2x (morning and afternoon) and Senokot from 3x a day to once at night. Then he became constipated for a day. Reverted back and he had very soft lumpy poo a few times @@. However, we didn't change anything yet because it could just poo from the previous day when he constipated. He was alright that night. The cycle repeated the next few days i.e. constipation followed by diarrhea. All diarrhea occured between 11pm and 6am. So the hospice nurse advised us to change to her prescription whenever he has dirrhea during these hours and change back to the original prescription if constipated.

Next problem was his pain: his constant pain score increased from 3 to 6-7 and it at times spiked up to 9 (he cried and hitting his chest) and taking Oxynorm didn't help, neither did adding 2 tabs of paracetamol didn't help as advised by the hospice nurse. The nurse consulted the PCU specialist who then advised us to increase the Fentanyl patch dosage from 100mcg to 125mcg. The hospice nurse kindly gave us some 25 mcg patches to tie us over till the next PCU appointment. Seems to help to ease his leg pain because Oxynorm intake in the middle of night decreased from 3-4 times to 2 times an he was able to sleep (during day and night). However, he still experienced constant elevated pain score of 5-6 when he was awake.

After a few days, fortunately, it had gone down to 2-3 when awake and spiked up to score of 5-6. Oxynorm usually took an hour to be effectively, which was painfully long. Fortunately, he could sleep soundly.

Meanwhile the house called physiotherapist planned to use acupunture on dad. We were initially concerned because of what the TCM at Kepala Batas Hospital said. I spoke with her senior and he explained that:

• The hospital's TCM's aim was curative, not palliative. This gels with TCM's policy of not accepting metastatic cancer patient.
• The physiotherapist would be administering dry needling which only goes into muscle, to treat muscular skeletal pain. Acupunture's needles aim at meridian points and so affect nerves.

There was some happy progress with the physiotherapy sessions: with assistance, of course, he could sit up and took a few steps using the walker! Although it was the therapist's objective, most (maybe all!) of us were doubtful. To me, the process was beneficial as the exercises helped to move him around and therefore minimise muscular skeletal pain. I told dad that if he continues to improve, he should try to get a bath in the bathroom, and maybe later we can even bring him out for meals.