Oxycodone and seniors

[tbm3fan]

Even me, who is around my father at least three times a week, was unaware of how much oxycodone my father was taking. I knew he had a prescription from a doctor for some back pain but not aware of how much hew was using.

Three weeks ago he had what seemed to be a TIA which cause temporary speech and vision problems. Late at night and he didn't call 911, go to the hospital or call me. His doctor later gave him the riot act for not doing that. On Wednesday, the 18th, I went over to his place to have lunch with him as it was his 92nd birthday.

All was fine. Then I called Saturday morning so I could stop by with the information I had to pre-arrange burial with the Veterans Administration when the time comes. Only I get him in the hospital as he had another TIA Friday morning. I have my son with me and he tells me not to come by because of that.

Then comes the late night call I have always dreaded. Marsha, his second wife calls at 12:30 am as the neurologist wants to talk to me. It seems he is having a third TIA and this one is not going away. It is now at the 2 hour mark and if TPA is used it must be within 3 hours. The doctor wants me to give the clearance for using the drug. Marsha is confused and technically they are no longer married for financial reasons. The drawback with the drug is that there is a 6-7% of hemorrhage because it is a powerful anti-coagulant. At 92 it is more like 15% and it would be a death sentence.

The doctor gives me the particulars, he answers my questions and I tell him to go ahead and roll the dice. I know my father is no fan of being incapacitated by a stroke. I then immediately head to the hospital and get there at 1:00 am just as they start the line in ICU. The RNs already know about me and what I do so they where all very nice and allowed me in while all of us monitored his vitals. He was strapped down as he had become combative and I tried to keep him down and calm. Finally he sort of dozed off although the RN has to wake him up every 30 minutes to ask name, check movement of extremities and measure pupil size. I left at 5:00 am in a cloudy daze now.

My sister wakes me at 11:00 this morning as she drove the 100 miles from her place. Tell her I will be down. Just talked to her and the third CAT scan has shown no bleeding in the brain. Once again he became quite combative and his speech was a little better. One could hear him asking Marsha if she brought it. It was oxycodone. He was taking 40mg/day which will lead to addiction. Now the question is he undergoing withdrawal right now in the hospital. Now the doctor wonders if he truly had a stroke. Oh great after having made that decision earlier. Doctor says it was the right course knowing what we knew.

He was just given 10mg of oxycodone by the doctor while under the hospital's oversight. My niece, an RN who deals with seniors, says she sees this all the time herself. Seniors get addicted quickly and then have these combative symptoms when withdrawn among who knows what else. So now I am off to the hospital, 20 minutes away, to see how things are in person. One big take away from all this, for everyone actually, is how evil oxycodone can be when one does not maintain tight control over it's use by the patient. It does have it's uses but with that comes it's dangers as a double edged sword.

 

[stubs300]

I don't know what a TIA or a TPA is either?

 

[Big_John]

I don't know what a TIA or a TPA is either?

TIA="mini stroke"
TPA=Med that dissolves blood clots

 

[1978 NYB]

I was in the hospital 3 times during the last 6 months for 4-6 weeks at a time. I was in for a number of heart and kidney issues but I also had severe open wounds on my legs. I was getting morphine injections every 4 hours to manage the pain. The pain relief was almost immediate but would last about 3 hours. About 2 weeks before I got out of the hospital they transitioned me from morphine to oxycotin. The oxycotin would take a lot longer to kick in but would stop the pain for about 4 hours. A few weeks after I got home I started to ween myself off of the oxycotin because of the addictive properties. The doctors offered to keep me on it for as long,as I wanted. About a month later I flushed the remaining stockpile. It' a great help for legitimate pain but too easy to get addicted to.

 

[Fratzog]

What I saw with my mother as her condition deteriorated (heart ailment) the net benefit of the medication (different) became negligible to the point medical staff were only trying to make her comfortable. My thoughts and best wishes are with you.

 

[Rapidtrans777]

I glad to hear your dad has made it through. Our son has been through the oxycodone gamut. A car accident led to a pain med prescription, which led to an addiction, job loss, and then rehab. He has been sober over 2 years now. Big pharma has spent millions in DC, I don't expect much will be done to curtail overprescribing.

 

[Wollfen]

Oxycodone is a derivative of opium and is similar to heroin in some ways. It is why drugs like this are leading to many issues in drug taking, addiction etc. It also causes constipation too which makes for its own set of issues. My wife was on it for a month after her car accident and yeah it was not good. Glad to hear you are getting things monitored correctly now though.

 

[Rapidtrans777]

While addiction is a serious problem a little humor doesn't hurt.

 

[live4theking]

Man, I'm so sorry to hear about this situation with your father. I'll be praying for you.

 

[tbm3fan]

Back from the hospital. Father was resting comfortably and his vital signs of heart rate, respiration and BP I could see were normal when I saw the monitor walking into his room. He came into the hospital on Friday through Emergency and brought to the general floor. He came with nothing. By the time of this second supposed TIA it was Saturday night. I heard from my sister that he had been asking before hand if Marsha had brought it. Brought it was the Oxy to the hospital. So it is quite possible the agitation that increased through the night was early withdrawal symptoms and that complicated the picture.

Interestingly when I was there at night their computer system was rebooting for the hospital. They needed to chart by paper. Some nurses had never charted by paper and were unfamiliar with doing so. Others were fine as I am with paper. Consequently there was no access to a complete patient history. Whether this played into the scenario regarding who knew the what, where, and when of the Oxy usage is hard to say. Even if it was charted I don't think the doctors had an idea how much Oxy was being used. The 40mg amount tends to be a typical dose for a hospice patient near the end of life. At that point who cares what the dosage is as long as the patient has subjective relief from pain. I do know his early usage was two 5mg a day but has obviously gone up. Told the nurses this is a good example of a careful and thorough case history as patients sometimes withhold or lie.

So the 10mg administered to him had set in and he was resting as well as can be expected. He does had fairly bad back pain and benefited from an air mattress placed under him. He could move toes and fingers as requested and could recite his name. I'm not sure he recognized me or not. He was to have a final CAT scan at 1900 hours to check for bleeding. Tomorrow an ECG is scheduled and then a possible spinal tap. The cause of his aphasia (loss of speech) is still unknown. In hindsight not a TIA as one cannot have a TIA that affects speech and sight at the same time. Seizure? Reason for ECG. Spinal tap? Because of a cloudy area seen on the MRI and this is looking for cancer cells.

Luckily, for me, my bet on the TPA didn't come back and bite me in the ***. In hindsight was probably not needed. Had I been called earlier in the evening at the very beginning I could have gotten down in 20 minutes and talked with the doctor as doctor to doctor which yields a different conversation. The nurses knew somehow and the conversation was on the professional level and they listened to my opinion. If all goes well, as in calm and stable, he will be moved back to the general floors. He will be on Oxy but I need to have a discussion concerning the amount and type. The only thing left is determining the cause of his aphasia. He does have two benign meinigomas on the right side of his frontal cortex but speech is on the left side.

 

[tbm3fan]

I was in the hospital 3 times during the last 6 months for 4-6 weeks at a time. I was in for a number of heart and kidney issues but I also had severe open wounds on my legs. I was getting morphine injections every 4 hours to manage the pain. The pain relief was almost immediate but would last about 3 hours. About 2 weeks before I got out of the hospital they transitioned me from morphine to oxycotin. The oxycotin would take a lot longer to kick in but would stop the pain for about 4 hours. A few weeks after I got home I started to ween myself off of the oxycotin because of the addictive properties. The doctors offered to keep me on it for as long,as I wanted. About a month later I flushed the remaining stockpile. It' a great help for legitimate pain but too easy to get addicted to.

The last nurse I talked to today was telling me of her experience with Nortab. When in her early 20's, before becoming a nurse, she had her tonsils removed and the doctor said she could have bad pain. Why the hell he said bad pain I don't know as it was a huge mistake. That sets the stage for what the patient expects right or wrong. Then he prescribed a tricyclic antidepressant. What!? Nonetheless, whatever she took it was for five days, rather than waiting to see what would happen, and 24 fours after her last dose she started to have shakes and wanted to crawl out of her skin. She had withdrawal after five days. Alcohol abusers usually get it in three days. I told her I had my tonsils out in 1959 using ether and my pain med was all the chocolate ice cream I could eat. So I mentioned that maybe she could have handled it without the Nortab as I did as a five year old and you know kids.

I understand the need for pain meds. I know if you are experiencing mild to moderate pain for the first time you should be started on Step 1 drugs like aspirin, acetaminophen, ibuprofen, Celebrex and the like. If mild to moderate and step 1 didn't work before then move to weak opiods like Tylenol with Codeine, Percocet, Percodan, Vicodin or Morphine. Now if it is severe initial pain that won't respond to step 1 or 2 then you need to move to the stronger opiods. One can stay on step 1 drugs, but stop step 2 drugs, and use a low dose of a step 3 drug like Oxy, and slightly higher doses of Codeine or Morphine. Somewhere along the line if it is temporary pain the person has to withdraw from the medication in order to know if the pain is gone. Once the mental and physical process sets in, on people who aren't at the end of life, you are playing with fire.

So Bob were these open wounds due to diabetes? On a scale of 1-5 where would the pain level be? I saw someone last week in a nursing home whose right leg was quite swollen. She said she was a bit uncomfortable and then she showed me a 6"x4" open wound on her calf. My aide almost fainted.

 

[1978 NYB]

The doctor asked me on a level of 1 to 10 where was I. I was a solid 9 or even 10 at peak times. The open wounds were from cellulitis due to heart and kidney disease. My wounds were from my toes to my knees. Some were 8"x8". They would heal a little than a new one would start or an old one would open up again. I battled that for 6 months and going to Wound Care at the hospital twice a week when I was released from the hospital.

I posted a couple of pictures but decided to delete them. I thought a little too graphic for public viewing on a car forum.

 

[1978 NYB]

I perform compression therapy with a machine on my legs twice a day for an hour every day at home.

 

[Fury440]

I feel bad for your dad, but I can understand how he got into trouble. Modern medical prescribes far too many pills.

My mother hated hospitals, doctors and anything that even smelt medicinal, her cure for all ailments was grin and bare it! My dad had the same affliction and I can only assume he was trained my mom. So as a kid our home was interesting when anyone was sick or injured. To see a doctor required major sickness. I don't remember any of us kids ever visiting a hospital.

One amusing event when I was an early teen, I was building a boat and had the side rail tied with a rope to draw the nose to the front of the keel. The keel was hard wood and really didn't want to accept the 3" screws I was trying to drive in without pilot holes. Got most screws about half way in before stripping the heads so I stood back to ponder the problem when the rope broke, the boards sprung apart and I ended up with a screw stuck head first in my shin. I hobbled home and asked mom for help. The first thing out of her mouth, "You better not get blood on my rugs!" Then she yanked the screw out, poured mercurochrome into the hole, stuck a band-aide on it and told me to be more careful. That was it, not even an aspirin for the pain. We learned at an early age to ignore things that didn't leak and for anything else to steer clear of the rugs.

 

[tbm3fan]

So after that first event early Sunday morning my father went home on Wednesday. On Friday he started to lose his ability to speak again and was taken to the hospital at 8:30pm. I was at the Emergency Room at 9:00pm and they were checking him out to see if he was having another stroke. I didn't think he was as the previous CAT scans showed nothing in the speech region. They took him down for another CAT scan and while there I voiced my opinion to the on call doctor.

Around 11:30pm the scan results are in and there isn't anything going on in that region again. My father was getting upset that they couldn't get their act together and felt he needed the TPA again. I knew that wouldn't happen so soon after the first one. I left at midnight and he spent all day Saturday sleeping. Better by Sunday but his very bad left side temporal headache was back. Oxy and tylenol would take care of it. Once again I talked to the nurse about getting a sed rate done to see if any inflammatory cells in his blood. She later called me and said it was normal. Then told her a biopsy would be next on the list but his Plavix would argue against that.

What I have been thinking for a month now was that he had temporal arteritis Temporal Arteritis: Symptoms, Diagnosis, and Treatment
He would bring it up and I did once and got the opinion that the tests didn't show it. I thought what the hell, If the tests don't show it just try the treatment and see what happens. I have done that with ocular conditions and guess what the people got better. I don't have the ability to prescribe prednisone orally but only topically for the eyes.

So yesterday a pain doctor visits him and my father brings up the side of his head again. That doctor calls in a rheumatologist and my father passes on what I have been saying. This guy says the tests show nothing but then goes the next step would be to experiment and treat!!! Bingo! He gets prednisone and 5 hours later all the pain is gone. Double bingo! So he is now home and is on 40mg of prednisone every day. No pain today and his eye sight is clearing up in the good eye. This stalling could have easily led to some very serious complications as temporal arteritis can kill you. I should have been an MD as all it seems is that many want to test rather than take a chance on treating for fear of being sued.

 

[azblackhemi]

I am currently being treated for Temperal Arteritis. It took multiple doctors 4 months to diagnose. In their defence it very rare for a male my age to have it. Anyway just like your dad hours after my first dose of predisone my symptoms were gone. Now I'm just fighting the side effects of the predisone . Now I'm being slowly weaned off the predisone due to the serious risks associated with long term steroid use. They should start your dad on Actemera in addition to the predisone because it's a safer long term option. My treatment will last 1-2 years. From what I experienced until they do a biopsy of the Temperal artery they can't make a definite diagnosis. Hope everything goes well for you dad.

 

[tbm3fan]

He is currently on a 1 month trial at which point it will be re-evaluated.

You're right in that Temporal Arteritis can be hard to a definite diagnosis. Similar is multiple sclerosis and myasthenia gravis. However, if some one walks into my office complaining of a strong temporal headache that is sensitive to touch. May or may not have nausea and may or may not have jaw pain on chewing I can't discount it. For me the primary reason is your vision and how quickly you could lose it. Second would be the possible effect on your life as some cases require the emergency room.

The first test is sedimentation rate which is not fool proof. As a result you need an actual biopsy of the temporal artery. The issue here is now you are waiting on lab results and you may not have the time. Similar to someone showing up with a infectious corneal ulcer. I can't know if it is gram positive or gram negative bacteria without doing a culture. That then takes 3-4 days to nail down the bug. Problem is you will lose your cornea in 2-3 days so waiting is not an option. Therefore you treat aggressively right away and the same here with temporal arteritis. This is a very easy and safe thing to do here since the effect can be noticed in hours while the immediate side effects are none.

 

[azblackhemi]

In my case as soon as it was suspected they put me on the predisone and then scheduled the biopsy. Then after it was confirmed the Actemera was prescribed. Can't wait to be off of the steroids .

 

[commando1]

However, if some one walks into my office complaining of a strong temporal headache that is sensitive to touch.

So help me with my TMJ. 24/7 of agonizing pain.
NO! I refuse to wear a mouth piece, I already have to endure a CPAP. Enough crap already.

 

[commando1]

Can't wait to be off of the steroids .

POISON over the long term.
And it makes you Fat!