The Caregiver Chronicles

Sometime between darkness and dawn - while the caregivers sleep

I've developed a new philosophy . . . I only dread one day at a time.

Charlie Brown (Charles Schulz)

 

            Insomnia (photo: Cheryl Lindo Jones, flickr creative commons)

While I was sleeping last night things were going on at my parent's house that could have ended badly. That's the way it is with caregiving. Just when you think you can relax, something happens - or almost happens. What could have happened last night was that my mother could have fallen after taking an extra dose of Benadryl in the middle of the night. The other thing that could have happened was that my dad could have fallen when my mom talked him into going downstairs to get her that extra Benadryl. The final thing that could have happened was that the live-in caregiver (E.) could have quit in disgust because my mom and dad repeatedly ignore her advice and do things they shouldn't - usually when she's sleeping. 

My sister got a phone call from E. this morning at 6:30 a.m. (Central Time). My sister phoned me later in the morning to tell me what happened. My first thought was "oh, shit, just when things seemed to be going better." My mom fell and fractured her hip at a similar time in December - things had settled into a comfortable routine with E. and Mom hadn't had any medical crisis for several months. My sister and I were just heaving sighs of relief, when - Bang!- Mom fell and fractured her hip. What can we do to prevent such nasty surprises? Probably not much. The best we can hope for is to give Mom and Dad the information they need to make better choices. Will they make better choices? A 50-50 proposition, at best. 

                                          Benadryl (photo: Andrew Ronta, flickr creative commons)                                                

To get back to my mom and the Benadryl, Mom went to the ER a few mornings ago because she was having a panic attack and felt, in her words, "really, really bad." There apparently wasn't anything obviously wrong with her. Despite that, the doctor she saw recommended that she take Benadryl. Good idea? No, terrible idea. Benadryl is a poor choice for seniors. To add insult to injury, the doctor who recommended Benadryl was working in the Seniors' ER. Makes you wonder, doesn't it? Both my sister and I told Mom that Benadryl didn't seem like a good idea to take because it would make her drowsy and increase her risk of falling. We thought - silly us - that we had talked Mom into reducing her dose. Instead, sometime during the middle of the night, Mom woke up and demanded another Benadryl. 

 
Sometime after 11 p.m. and before 7 a.m. , Dad went down the stairs in the dark - or I suspect it was dark because he rarely turns on the hall light. He walked down the (dark) stairs, went into the kitchen and found a Benadryl and went back upstairs. Ironically, one of the main reasons for falls in the elderly is lack of sleep, so he was trying to get himself some sleep by giving Mom another Benadryl, which was increasing her own risk of falling. Sadly, Mom is more likely to get seriously injured in a fall than Dad, at least she's more likely to fracture a hip again. Aren't you worrying too much, you might ask. Maybe. However, when Mark Twain, or whoever it was, said, "I have spent most of my life worrying about things that never happened," they either didn't have aging parents or they were damned lucky. Many of the things my sister and I have worried about have happened, and things that it never occurred to us to worry about have happened too. 

What's the moral of this story? Choose one (or more).

• You can't trust aging parents with (or without) cognitive decline to go to the hospital alone.
• Many doctors seem woefully uninformed about what medicines seniors should be taking.
• Nurses are great. (It was the nurse who caught the problem and let my sister know about it.)
• It's challenging to relax and enjoy your own life while you're helping to care for aging parents. 
• You have to accept the fact that you can't always keep your aging parents safe. 
• Shit happens, especially in the middle of the night. 

These hard facts increase the stress load of caregivers. Here are some tips for coping with that stress.

I had been relaxed enough during the past two weeks to begin another blog called Digging Out to document the progress I was making in getting my life back on track. Today is my sister's anniversary. She and her husband have booked a table at a place that makes great martinis. They're still going, but it might not be as easy to relax as it was yesterday. Especially, after midnight, when E. will be in bed and who knows what my parents will be doing. 

  

Ways to Help You & Your Aging Parent(s) Stay Healthy: Walking

An early-morning walk is a  blessing for the whole day.

Henry David Thoreau 

 
                   After lunch stroll (photo: Robert Wallace, flickr creative commons)


Go for a walk

This is the first in a series of posts on ways to keep the loved ones you care for healthy, and ways to keep yourself, the caregiver, healthy. Each post will provide information on a topic and links related to the topic. I decided to start with walking because it's something I love and walking is also one of the best ways for people of all ages to stay healthy. Below are some great things about walking.

• Walking can be done just about anywhere
• Walking doesn't take any special equipment or training
• Walking helps control weight, reduces blood pressure, improves heart and lung function
• Walking improves memory
• Walking encourages safe communities 
• Walking reduces stress, anxiety, and depression 

Don't take my word for it though. There are many articles online, and printed books and articles, that reinforce this message. The links below were several I found and liked.

• Regular walking keeps seniors healthy and independent 
• Exercising helps the caregiver
• Walk safely 

 

                                    Two women on beach, photo: Whitney H., flickr creative commons

Research shows that there is something about walking outdoors that makes walking more beneficial. I think it's all the fresh air and the joy of feeling the earth under your feet. Whatever it is, this should be your first choice, if weather allows. Outdoors can be anywhere from a stroll down the sidewalk in front of your parent's house to walks in a nearby park or even a stroll on the beach. Anywhere that isn't inside a building and that's safe, will do. Of course, sometimes the weather isn't suitable to outdoor walking, but when it is seize the moment!  Below are links to more information on the importance of green walking. 

Walking in nature improves memory

Fresh air helps your brain

It's not just a walk in the park 

 

 What if your aging parent/spouse is afraid to go outside?

Today, I phoned my mother to wish her a happy Mother's Day. She wasn't in a good mood. I didn't discover why until my dad came in and began to complain loudly about the fact that Mom didn't come outside while he was putting in the annuals that he plants in the front yard every summer. "You know I'm not able to help," my mom whined. My dad didn't expect her to physically help, just to sit in a chair and watch and offer advice from time-to-time. "Well," my mom answered firmly, "you know I'm in pain," as if that settled the matter. Sadly, that's been how things have been for the past several years. Mom is very resistant to going outside to walk because she says she's in pain. She'll walk inside the house, doing "laps" in a circuit between the living room and dining room. The truth is, she's doesn't feel safe outside. This fear of going outside isn't completely rational, even though she's fallen before. For one thing, she wouldn't be alone: her strong and capable caregiver and my father would go with her. For another thing, she is just as likely to fall in the house as she is outside. Sadly, these facts aren't enough to persuade her. She's entrenched in her determination not to go for walks outside. Many other elderly people are in a similar situation, suffering from agoraphobia related to aging.  (above: Men out for a walk, photo: Heloise Lanteaume, flickr creative commons)

I hope your parent(s) are easier to motivate. To motivate yourself, take a look at the video clip below about a wonderful Health Walking program in England. Every community should have a program like this!

 

 

And then there were two - aging and sibling loss

Our brothers and sisters are there with us from the dawn of our personal stories to the inevitable dusk.

Susan Scarf Merrell

            My mother and her younger brothers and sister Vickie, circa 1950

My Aunt Vickie died last Friday morning, only two weeks after her 74th birthday. She had been sick with Parkinson's disease and asthma for a long time. Then, only days after her oldest sister died, she was diagnosed with colon cancer. She never got out of the hospital after surgery and, even though I knew she wasn't doing well, I didn't expect her to die so soon. In 2011, all of my mother's sisters were still alive. By April, 2012, she only had one sister left. I think that the picture above was taken the summer that my mom moved to Michigan for what turned out to be the rest of her life. Aunt Vickie is frowning and maybe even about to cry because her sisters were leaving her behind. 

When we were growing up, our family travelled to Kentucky every summer and usually stopped at Aunt Vickie's and Uncle Buddy's in Louisville. I had a lot of fun there and, even though my mom and Aunt Vickie were different in many ways, they never seemed to stop talking during our visits. They didn't even let things like bathroom breaks stop them. I can remember times when the two would be in the bathroom chattering away, while one or the other was using the toilet or attending to personal grooming. My Aunt Vickie was the more glamorous of the two. She loved looking pretty and never went anywhere without her "face" on. She loved to paint her fingernails and more than once painted mine too. When I talked to one of her daughters about two weeks before Aunt Vickie died, she told me that one of her girls had painted her mother's nails blue. I smiled because I could picture it so easily: Aunt Vickie in the hospital, so sick some days that she didn't even know where she was, and her granddaughter painting her fingernails. Blue too. I hope it was a bright shiny blue and that it made Aunt Vickie and everyone else smile. 

                                              The four sisters, circa 1990s 

I'm not sure when the four sisters were last together. The picture above may have been taken on that occasion. I don't know whether they were at the annual family reunion or a funeral. Sadly, as the sisters aged, their health made it harder for them to visit each other because Kathleen and Vickie lived in Kentucky and my mom and Eve lived in Michigan. That day in the lush Kentucky heat may have been their last time together.

The day Aunt Vickie died, I talked to my uncle David who told me that, "If we lived to be 100, it would still pass off fast." He sounded so sad about Aunt Vickie, and who can blame him. He was younger than her and had never known a world without her in it. My mother called early that morning too. I was in the bathroom and couldn't get to the phone and when I played the message back later, I heard my mom's distressed voice, calling to my dad. "I don't know," she was saying, "I don't know where she is; she doesn't pick up." I knew right away what must have happened and phoned back and, yes, Aunt Vickie was dead. No one could reach Aunt Eve. Her phone had been acting up and neither Mom nor my uncle could get through. I tried, ringing her home number first and then her cell phone. That's where I caught her:  grocery shopping. I hated to tell her while she was in public, but she knew anyway. "It's Vickie, isn't it?" she asked. Later, she told me that she cried after I hung up and a woman came to ask her if she was alright and told her that her father had just died of colon cancer and the two women hugged and cried together. No matter how many siblings you have - eleven like my mom or three like myself - when one of them dies it's hard not to feel sad about your dwindling family and the miles and years that stretch between you and the ones you first loved. (photo: Vickie and David, circa 1954)

Here are several places to read more about sibling loss:

Sibling Loss 

Sibling reconciliation in old age

Here are some books to check out:

• Family Ties and Old Age 
• Sisters: An Anthology
• Having Our Say

 

Like my Aunt Vickie, Levon Helm died in April and was laid to rest on April 27 in Woodstock, New York. That's why I chose this version of Angel Band, even though the trailer on the bottom of the video is a bit distracting.  

The kindness of strangers - my latest trip to the ER

Kindness is the golden chain by which society is bound together

Goethe

            Comfort (photo: Rosie O'Beime, flickr creative commons)

Last Saturday was a beautiful day. The cherry trees were blooming, the air was soft and warm, and the sun was shining. My husband and I had a pleasant, relaxing day and, around 5, I went upstairs to lie down. Around 6:30, the doorbell rang and I could hear my husband letting someone in and then the sound of a woman's voice. By the time I came downstairs whoever it was, was gone and my husband was standing in the kitchen cutting beets. "Who was at the door?" I asked. "I don't know," he answered. At first, I thought he was joking. Then I realized he meant it; he really didn't know who had been at the door. Only after I told him that I thought I heard a woman's voice, did he remember that the visitor was one of our best friends and her son: not a reassuring fact. 

 

It had been about three minutes since whoever it was had left and even though he looked perfectly normal standing there in the kitchen preparing dinner, something was very wrong: he had blanked out on the name of two people who had once been our next door neighbors and who we had known intimately for 8 years. I looked at him as he stood there chopping the beets and my heart lurched. At the end of an otherwise delightful day, we had a frightening surprise to deal with. We managed to eat dinner and then I searched Google. What I found, alarmed me. I picked up the phone and dialed 8-1-1 HealthLinkBC and talked to a nurse, who also talked to my husband. Based on what we told the nurse, she said it sounded as though it could be a TIA (Transient Ischemic Attack). A TIA can be a precursor to a "real" stroke and, at my husband's age (57) it is important to have it checked out. And that's why we spent the rest of the evening at Urgent Care. (Beets, photo: Kevin Wood, flicker creative commons)

Thankfully, it wasn't busy. A nurse, a 4th year medical student, then a more senior doctor checked my husband over, looking for neurological irregularities. They didn't find anything alarming, but after conferring with the vascular team at Vancouver General Hospital (VGH), the doctor told my husband to report to the ER at VGH the next morning at 11 for a CT scan. I wasn't happy because I had choir practice scheduled at the same time. My husband said he'd be fine, but I've had enough hospital experience to realize that even though he was probably right, I was unlikely to learn what the doctor told him, unless I was with him. 

              CT scan (WikiMedia Commons)

At VGH, all the examining rooms were full and my husband ended up on a bed in the hall. At first it was a bit annoying, but the human drama going on around us made up for it. An old woman, who appeared to be in her 80s, was lying on a bed, looking frightened. A doctor arrived minutes after we did and told her, and her caregiver, that she had three broken ribs. After some confusion on the old woman's part, the doctor gave her a Tylenol 3 and promised to check back. After the doctor left, her caregiver helped her drink juice from a straw and sat close to her, talking softly.

Meanwhile, an old couple, who we later learned were 93 (the man) and 96 (the woman), had been wheeled into the ER.  They had been at church and when he stood up, he couldn't maintain his balance. Someone helped to get him into a chair and then called 9-1-1.  A bit later, the man was taken into the examination room and the woman went to sit down by the Filipino caregiver, who comforted her. I asked if she'd like a cup of tea and volunteered to go get one from the vending machine. There wasn't any tea, so I bought her a cup of hot chocolate, which she sipped thankfully, as tears welled up in her eyes. When her husband came back,  the nurse got the woman a chair and placed it so she could see her husband's face and whenever he asked a question, she would gently answer him. Periodically, we could hear him asking, "Why am I in a bed? Am I in the hospital?" and each time, his wife answered patiently, as if it were the first time he had asked the question. 

And so the afternoon went. There was someone with a  gunshot wound down the hall, someone said, and a Chinese family passed through wheeling an old man in a bright red wheelchair, one of the women carrying a tray of coffee and donuts from Tim Horton's. Eventually, the doctor came to examine my husband and then he went for a CT scan. Meanwhile, I had made use of the waiting room's limited facilities, calling our son to let him know how things were going, buying myself some coffee, then chips. I got my husband a pillow and a granola bar. Much later, the doctor returned. "Your brain looks fine," he told my husband. However, he ordered another test that could be done at UBC hospital in the next week or 2. When we left, the old man and the elderly woman were waiting to be admitted. We hadn't found much out about what was wrong with my husband, but I left with the insight that, at least here in Canada, when nurses and doctors are overextended, everyone becomes a caregiver. 

Fear of Falling - how fear affects the health of aging women

We do not stop exercising because we grow old - we grow old because we stop exercising.

Dr. Kenneth Cooper 

 
                    Older woman with bicycle (photo: Paolo Margani, flickr creative commons)

My mother almost never exercises. That was understandable while her hip was healing. Now, she can walk with a walker and her orthopedic doctor has encouraged her to walk as much as she can and to do any exercises she gets from the physical therapist (PT) who is visiting her several times a week. My mother is only reluctantly cooperating. She will do the exercises when the PT is with her. She probably won't follow up when he isn't there. As far as walking, I think the extent of her walking is back and forth to the bathroom, which is 25 feet or so from her bed, and to the dining room for meals, about 50 feet from her bed. Outside walks, even when the weather is nice, aren't something my mom wants to do yet. 

It's a shame  because several years ago my mother was an active woman: she walked regularly, took aqua fitness classes, went to church, the local farmer's market, the library, and out to eat at least once a week. Those days are over. For one thing, she's less mobile and more frail. Mostly, however, she's afraid of falling and afraid of exercising. This isn't an irrational fear, but studies have shown that the fear of falling makes someone more likely to fall, not less likely. That's because of a cycle that starts with fear and ends with decreasing strength and fitness which can lead to more falls and more fear.  (The reason that I refer to women in the title of this post is that, not surprisingly, many more women than men are afraid of falling.)My sister and my mother's caregiver have already caught Mom three times since she's been home, just as she was about to fall. Not good! On the other hand, we need to respect our aging parent's/spouse's fear. Listen to them when they say they're afraid - just don't encourage them to give into their fear and sit most of the day. The more we sit and are afraid, the more afraid we will be. 

    Practicing Tai Chi in Beijing (photo: Wikimedia Commons)

It doesn't have to be that way.  Another study shows that: Exercising Prevents Falls. That's a nice way of saying, "Move it or lose it." However you say it, it's absolutely true. Here are some good exercises for aging people:

• Tai chi
• Yoga (particularly restorative yoga)
• Walking
• Swimming
• Feldenkrais
•  Qi gong
• Gardening

The main thing is to get your aging parent/partner up and moving. Sadly, this is easier said than done. Start gently. My mom, for example, will (or used to) walk laps around the house and for a while she would go out for a short walk every day, even if it was just down the driveway and back. As caregivers, we often have so much to do that we forget to take the time for exercising or give up too quickly when a parent or spouse refuses to cooperate. It's kind of like kids and broccoli: you can't just offer an unfamiliar vegetable to a child once. And if they don't like broccoli, try carrots; if they don't like walks, try gentle yoga. Sign up for a class together. Take them to the library or another location they enjoy, where they can walk as part of the visit. Enlist a friend or grandchild or even pay someone to walk with your parent. Whatever you do, don't give up. And, something I realize now, that if your aging parent/spouse is already exercising, make sure they continue. It's much easier to maintain an exercise regime than to restart one!  (granddaughter helping grandmother walk, photo: Rosie O'Beime, flicker creative commons)

 

Next time: How the built environment encourages or discourages exercising. 

 

Coming Home

There's nothing half so pleasant as coming home again.

Margaret E. Sangster 

                                            Cozy chair (flickr creative commons)

My mother came home today after over two months in a rehab center. It was a huge day for both her and my father and, as I write this, I hope they're asleep in their king-sized bed together. The bed had to be moved downstairs to the family room because, although my mother's hip fracture is healed, her orthopedic doctor would like her to use a walker for a few weeks and it wouldn't be safe going up the stairs to the bedroom with a walker. Walker or not, my parents are back under the same roof again. They're happy about it, my sister said when I talked to her today, and I'm glad to hear that, really glad.

I talked to my mom about 3 in the afternoon -her time - and she sounded as happy as I've heard her in a long time. She was sitting in her favorite chair reading, listening to Daniel O'Donnell, and digesting her home-cooked lunch. It doesn't get much better than that after you've been cooped up in half of a small room for several months, subsisting on institutional food, without a CD player or a radio. (My mom has never been much of a television watcher.) Now, Mom is at home with her own things around her and my dad and her caregiver and, for a few days, my sister by her side. Not bad. Not bad at all. As of the last report, she and Dad had watched Jeopardy and then got ready for bed. I am especially happy for Dad because he's been hearing my mom's voice some nights and wakes up and she isn't beside him in bed and he has even gotten up to look for her more than once."Oh well," I told him when he told me about it, "at least you haven't phoned 9-1-1 yet." (Two trees, photo: Tommy Huynh, flickr creative commons)

For now, my parents are getting along splendidly and Mom is being congenial to everybody and hasn't complained about pain or asked for more pain meds. The honeymoon won't last, but, for now, it's wonderful that Mom and Dad are enjoying being at home together. I try not to think about the fact that Mom hasn't spent more than two months at home during the past two years without some sort of medical crisis sending her to the hospital.  I try not to think about it and I fail because I'm human. However, even if I'm a bit worried, I can't help smiling because Mom's first day back home was a success. Other "transitions," as my sister calls them, haven't been so smooth. Now, I'm keeping my fingers crossed and hoping for the best. What else can I do? Besides, coming home is never so sweet, as when you're old and not in great health and all-too-aware that one day in the not-too-distant future you won't be coming home again. When you look at it that way, every day that my parents get to spend at home together is a precious one. By that measure, today was a true gift. (Mom and Dad, photo: Angela Wheelock)

Below, is a video clip of Daniel O'Donnell. I'm not a fan, but as my sister says, "Mom's a little stuck on that boy." 

 

Granny's on drugs - seniors and overmedication

 Medicine sometimes snatches away health, sometimes gives it.

Ovid 

                      Taking medication (photo: Baudouin, flickr creative commons)

People over the age of 65 are the largest consumers of prescription and nonprescription medications in the United States. Seniors in many parts of the world are similarly overmedicated. As of 2007, statistics showed that 30 percent of all prescription related deaths (in the U.S.) took place in elderly people and 20 percent of all hospital admissions for aging patients was related to medicine-related problems. This growing problem is referred to as overmedication and, within the medical community, as polypharmacy.

What is Polypharmacy?

Polypharmacy simply means when someone is prescribed more medications than are indicated by "good" medical practices and more than can be safely used. 

                Aging (photo: LHG Creative Photography, flickr creative commons)
 

Why are Elderly Patients More Likely to Be the "Victims" of Polypharmacy?

• Fewer clinical trials with older people
• The aging body metabolizes medications differently than younger people
• Elderly people have declines in liver and kidney function, which also changes the way the body metabolizes medications. 
• Seniors have more chronic health conditions and specialists may prescribe medication without being aware of all the medications a patient is on. 

What are some consequences of Polypharmacy?

• Drug reactions and side effects that send someone to the hospital or even cause death
• Falls related to dizziness, reduced muscle strength, and drowsiness
• Side effects, such as dizziness, dry mouth, depression, insomnia, nausea and diarrhea
• Changes in quality of life: elderly people who are taking too many prescriptions may no longer enjoy hobbies or  participate in regular activities. 
• Taking too many medications can be costly, depending upon the type of health care someone has (or doesn't have!)
• Younger family members or others may gain access to potentially addictive drugs such as Oxycontin.

How can you tell if your aging parent/spouse is being overmedicated?

•  Have you noticed changes in your loved one's behavior?
• Does your loved one still enjoy the things they used to enjoy?
• Has your loved one been falling more or had more than one significant fall recently?
• How many medications is your loved one taking regularly? (Some experts suggest that taking more than 6 medications at a time is enough to set off alarm bells.)
• Does any one doctor know all of the medications that your loved one is taking?

 What can you do?

The situation may seem overwhelming, but there are actually quite a few simple things that can make a big difference to your loved one's well-being. If you have the time, you can do further research and inform yourself with as much information as you have time to uncover. 

Here are a few places to get started:

• Find out what prescription and nonprescription medications your loved one is currently taking. (This may not be easy, but without finding out what medications they are taking, it will be impossible to proceed. If your loved one resists sharing this information, go slowly, gently repeat the request, and explain why it is so important to make sure they aren't taking medications that may be dangerous to their health.)
• Once you determine what medications your loved one is on, write them down on a list and copy the list: one list for you, one list for your loved one that they should keep in a convenient location to take to the doctor or hospital whenever they go.
• Buy your loved one a pill box and make sure they use it!  Better yet, help them fill the pill box and if you live with them, or nearby, make sure they take their medications on a regular schedule.

                  Pill box (photo: Kristen Beck, flickr creative commons)

• If your loved one's family doctor doesn't seem well informed or cooperative on the issue of overmedication, encourage your loved one to transfer to a geriatric physician or a family doctor (GP) who is informed about the issue of polypharmacy. 
• At least once a year, schedule a "brown bag appointment" with your loved one's doctor. This is exactly what it sounds like: help your loved one put all of their medications - prescription and nonprescription - into a bag (brown or otherwise) and take them to their doctor, so that the doctor will know exactly what medications they are on.
• Become informed. A good place to start is with the Beers Criteria (Medication List), a source developed by professionals that lists medications that are not recommended for seniors. 

For more on this important topic see:  (Over)medicating the Elderly or watch the video below. (It's long, but well worth watching.)

 

 

What's in your loved one's pill box - the dangers of opioids (narcotics)

Medicines are not meat to live by.

German proverb

            Pills (photo: Laura Gilmore, flickr)

The Overuse of Opioid (Narcotic) Pain Medicines

My son got out of the hospital last Wednesday. He had been there for acute appendictis and during the course of his stay he received three narcotic (opioid) pain medications: IV morphine, IV and oral hydromorphone (also known as Dilaudid), and Tylenol 3 (acetaminophine and codeine). He was sent home with a presciption for Lenoltec (No. 3), which he only took once or twice. There is no arguing that using opioid pain medications for acute pain is appropriate. What surprised me, was the variety and quantity of medication that the doctors prescribed. 

Few doctors or medical researchers argue with the use of opioid medication for acute pain and to provide relief for people with terminal cancer. However, the use of such drugs as Vicodin, Percocet, Tylenol 3, Oxycontin, Morphine, and others has been seriously questioned for the use of chronic pain. Most opioids are prescribed for chronic pain and this particularly true of seniors, many of whom have osteoarthritis or other chronic pain conditions.

What can caregivers do to keep their loved ones safe?

1.  Be aware of the many types of opioids (narcotics). (Following is a basic list)

Co-odamol (combines codeine and/or thebaine and acetaminophen or another analgesic)

• Tylenol 1, 2, 3, 4
• Emtec
• Percocet
• Vicodin
• Lenoltec
• Hydrocodone
• Panadeine
• Solpadol
• Atasol

Hydromorphone

• Palladone
• Dilaudid

Oxycodone (also known as OxyContin, aka "Hillbilly Heroin")

Meperidine

• Demerol

Morphine (oral and injected: many trade names)

See link for a more comprehensive list of opioid analgesics (narcotic pain medicines).  

2.  Be aware of the consequences of long-term opioid use

• Physical dependence or addiction
• Respiratory depression (increases risk for pneumonia)
• Unintentional overdose
• Falls and fractures
• Increased pain sensitivity
• Chronic constipation, risk of impacted bowel
• Chronic dry mouth

  Doctor writing prescription (photo: Via Tsuji, flickr)

3.  Observe how your loved one's doctor prescribes opioids

• Does the doctor prescribe opioids casually, without providing information?
• Does the doctor propose other methods of dealing with pain?
• Does the doctor talk about appropriate goals and risks before prescribing opioids?
• Does the doctor explain the risks of physical dependence and addiction?

For more on the responsible prescription of opioids visit Physicians for Responsible Opioid Prescribing, which has a wealth of materials on opioids. Awareness is an important step and can, hopefully, prevent future problems with pain medications. However, if you are afraid that your loved one is already physically dependent or addicted to such medications, proceed cautiously 

GETTING OFF OPIOIDS IS NOT A DIY PROCESS. NEVER ASK A LOVED ONE TO STOP TAKING OPIOID (NARCOTIC) MEDICATIONS ON THEIR OWN, CONSULT A DOCTOR OR QUALIFIED DRUG ADDICTIONS COUNSELLOR FIRST. 

The video below has an excellent discussion of the use of opioids (narcotics) for chronic pain.

  

 Next: polypharmacy  

 

 

 

A parent's worst nightmare - a dangerously sick child

. . . of all the hardships a person had to face none was more punishing than the simple act of waiting.

Khaled Hosseini 

                  Sick child (photo: Roberta Schonborg, flickr)

Our son, Brendan, turned 18 on March 14; on March 20th he got sick with what we thought was the flu. However, as the days passed, he didn't get better. Then on Thursday morning (March 22), he got up at 6 a.m. and came into our room to tell us that he felt really sick. We still thought that it was the flu and so we encouraged him to lie on the couch and watch television and drink gingerale. By afternoon, I began to realize that it was something unusual because he didn't want to eat and when he tried to eat part of a banana, he promptly threw it up. My husband and I talked about what was wrong and worried; however, since he quit throwing up and didn't seem to have a high temperature or severe pain, we still assumed it was the flu.

I'm a bit ashamed to admit that at 6:20 I left for choir. It was my first practice since the term had begun in late January and my first practice since returning to Vancouver. Choir - as usual - was great. However, while I was gone, my husband began doing Google searches and it began to look more and more like appendicitis. I don't know why we didn't think of it earlier. I guess we both expected more pain or a more dramatic fever. Meanwhile, Brendan tried to eat a popsicle and threw that up and his pain increased. The minute I walked in the door after choir we rushed to the hospital. It was 10 p.m. by then and Brendan was in a lot of pain and my husband and I were very worried.

At the ER, we didn't have to wait long before our son was seen. A nurse examined him, then a doctor, then he was taken for an ultrasound. However, I had so recently returned from America's bloated medical system, with its plethora of every type of medical technology imaginable, that the Vancouver General Hospital seemed frighteningly low-tech. Brendan was started on IV fluids and antibiotics. The diagnosis: appendicitis. Still, everything was maddeningly casual, not high-tech and urgent. There weren't even any white coats around and later a doctor told me, "you won't see many white coats at this hospital."

By now, it was 2 a.m. The hospital had taken on that eerie quality that empty places lit by fluorescent lights have, as though you and the other desperate people there are cut off from the rest of the planet.  I walked from one part of the ER to another, tried to read a magazine and failed, felt my son's forehead which was getting hotter, and held his hand. Eventually, my husband and I were too tired and worried to do anything but sit and reassure our son and worry. Time crept on and, eventually, Brendan was moved upstairs to the first available bed, which happened to be in the Spinal Unit. Everything was dark and it seemed like a ghost hospital. Two nurses  helped get Brendan into bed, but they couldn't tell us much about when he might have surgery. I was getting progressively more anxious and began to regret the fact that we lived in Canada (more on this later) and wished we were in the bustle of an American ER, with surgeons standing by to operate at any hour of the day or night. 

By the time Brendan finally got to surgery the following afternoon, I was beside myself with worry. Despite my worry, surgery went well, and during the past few days, we've settled into a routine of sitting with our son in the hospital, helping him with the multitude of small tasks hospital stays are filled with, and spelling each other off for sleep and meals. Brendan is slated to be released tomorrow. As soon as he's home, I'll return to this blog with fresh ideas to share. I'll also return to the series on seniors and medication with some new insights. Until then, time for bed. 

The Road to addiction is paved with pain - seniors and prescription drug addiction

 A sound mind in a sound body is a thing to be prayed for.

Juvenal 

Couple walking on beach 

The pain started in my mother's knee. It was a small thing, nothing to worry about. Mom was only in her mid-60s and she had always been healthy. Strong too. She wasn't overweight and walked and swam regularly. Unfortunately, my parents had the bad luck of living near two large hospitals, with two large orthopedic centers. Yes, bad luck, because when Mom went to see one of those orthopedic surgeons, he told her that the pain in her knee was being referred from her hip and he recommended surgery. If she had lived in England, where this brochure on osteoarthritis was produced, her family doctor would have recommended physical therapy or some other, more conservative, treatment. Surgery would have been far down the list of treatment choices. But Mom wasn't in England, she lived near a university community in the U.S. with many orthopedic surgeons. And so, in her mid-60s, my mother had her first joint replacement. Fifteen years later, my mother has had both hips, both knees, and both shoulders replaced. We used to call her the Bionic Woman, but we stopped because it quit being funny. We will probably never know which of these surgeries were essential. 

I sat by a rheumatologist on my latest flight home from Michigan and when I told him my mother's story he said, "Well, if you get sent to a surgeon, they'll want to operate," as though this were the most natural thing imaginable. He said he'd seen it happen many times in his own practice. It's like that old maxim, if you're a hammer, everything looks like a nail. There are lots of hammers walking around in the Ann Arbor area looking for "nails," my mother just happened to be one of them. It's not that her surgeries were necessarily a mistake - taken one at a time. It's just that one surgery lead to another and then another and along the way Mom's pain got worse, not better. Her last surgery took place in September 2011 to "correct" one of her hip implants.

My mom can't take NSAID's, like ibuprofen, because they irritate her stomach. And so when her arthritic pain and joint pain recurred after surgery, her former family doctor began to prescribe opiate pain medications, including both  Vicodin and  Percocet at different times. When Mom switched doctors, about two years ago, her Vicodin was stopped and her Percocet was tapered down to one or two pills a day and she was put on morphine. Not an ideal combination because when she fractured her hip last December at age 77, she had no "big guns" left to manage her pain. And, now, she is "withdrawing" from these increased doses so that she can safely go home, i.e. go home without too much cognitive and physical impairment related to opiate usage. It continues to be an up-and-down process, with Mom still complaining about withdrawal symptoms a week after the tapering began. 

Today, specialists in pain management are educating fellow doctors about the dangers of narcotic pain medications and patients are sharing stories similar to my mother's marathon quest for pain relief and battle with prescription drug addiction. The following video is well worth watching if you want to know more about this complicated and important topic. For more on this topic go to Physicians for Responsible Opioid Prescribing. 

  

 

How can you tell if your aging parent or spouse is abusing prescription drugs - either intentionally or unintentionally? This article on Prescription drug addiction provides information on what to look for. Next time: more on chronic pain and opiate addiction and alternatives to surgery and pain medication.