My dad has been going to a pain management clinic and has been taking Loracet 10s 3xs daily, and I/he think that he has developed a tolerance to this medication. So my question is should he ask for a higher doseage (or would that be too much tylenol) or a stronger or longer acting medicine... If so what types (name) would that be? Thanks in advance for any advice!
Hey JW, Unless there is a medical reason you must speak for your dad or you feel he's speaking and not being heard, If he's at a PM clinic they should know what's avauilable, how much tylenol is in each med he takes and have a treatment plan and a way of titrating, adjusting each patients medication based on response, previous exposure, type of pain and reporting.
They can't read his mind and it sounds strange for you to ask for oxycontin or any drug and be concerned about the small amount of apap he's taking if his docs aren't. He's well within safe limits, if his pain isn't being managed, go with him, listen and help him comunicate if he's minimalizing or not wanting to sound weak or something. Unless you're a doc or he's being poorly treated, the docs aren't really expecting the family to make drug suggestions. If he's having a bad reactiong , of course you involve yourself this soon, but anything more than "He doesn't seem to be responding as well" or "his level of pain seems greater at X and Y times" It seems kinda strange to have so little failth so soon.
I would continue to observe untill you feel you must intervene or take him elsewhere. Family that's too involved in a patient can make that patient a "problem patient." There are times it needs to be done and times it doesn't. I don't think I would be comfortable with a doc that didn't know the dangers of tylenol, but he's not taking too much unless he didn't disclose history or they didn't do any testing of their own. Most clinics do physicals and psych evals, at least the I went too.
My father asked me to ask for him because hes not very computer literate. He hasnt discussed it with his doc. yet (his appointment is next month) and didnt want to sound stupid when he went in to discuss it with him. He had heard a lot of people discussing people taking too much tylenol and wanted to know if that was going to be a factor or not. He just wanted to know if upping his doseage was going to be too much tylenol for one day or if there was a next level (stronger) medication he could take. I frequent these boards often and thought maybe someone here could help me. Im sorry if my post was confusing. I wouldnt consider myself "too involved" with his situations, just concerned.
Last edited by Justawondering; 01-27-2007 at 08:16 PM.
Reason: adding information
Hi JW, Sorry If you toojk my post in a diferent spirit than I intended. Of course I understand it's hard to see your dad in pain and there is nothing wrong with being involved in his treatment in the right ways.
I'm more of a tell it like it is kind of person. The intent of my comments were to say his docs are specialists in he field of PM, they come from Anesthesiology, physical medine and rehabilitation, neurology, Internal medecine, Pshychiatry etc. They are all specialist in their field and they know what the safe limits of apap are. You can ease you dads concerns by reminding him he's seeing docs with advanced specialties that know their meds, They know what's too much of one drug, the interactions they have with others and the next step in PM when they aren't reaching a target or goal in PM. They know they make hydro with lesser amounts of apap. They know their are pure forms of opiates and long acting ones. They know the WHO ladder of pain management.
You can ease your fathers concerns by telling him that 2000 mgs of apap a day is considered fine for chronic use and 4000 mgs for short term use. That info is out there because lay people over dose on OTC meds, I can't recall a single case where a doctor prescribed so much Vicodin that the apap damaged their liver. But people can certainly do it to themself when it's all they have to work with.
You can help if you relay information your dad isn't telling them, Like the meds aren't lasting as long and he needs to take additional meds like Motrin in between doses or more apap, or explain his pain in ways that will clue docs as to what the next satep should be.
It would be strange if you went in and said I think you need to switch my dads meds from Lortab or Loracet to Dilaudid or 30 mg roxicodone because he's concerned about the apap. It sounds like the meds you want around the house rather than the meds he needs to manage his pain. It's jumping from step C to step M. I'm not suggesting that's the case, but it does have the apeareance. Sometimes apearences can greatly harm his future with a doc or clinic if they feel someone is giving them excuses the docs are completely aware of to change a med to a specific drug.
Even with standards like the WHO ladder "world health org" docs still have their preferences and opinions. IF you notice a med keeps your dad from sleeping, you do need to be there to be sure he is talking about important issues like that. If you know it's been two weeks since a BM and he's not the type to complain, you need to pass along that info. As a lay people, we don't need to make specific med requests because if we or our loved ones haven't taken a med we have no idea how much more efective and what other side efects or drug interactions may be involved.
Every PM clinic I went through also had a Pharmacist on staff with advanced degrees, all were PhD's in Pharmacology and they were just as involved in individual treatment plans as the docs or the psychologist or anyone else involved in treatment.
We/you do need to make sure the docs have all the info they need to manage your fathers condition.They can't read minds, They can read expression, gate, apeareance, BP, pulse, sedation and many other aspects if he's in a clinic setting where you spend hours a day there learning to cope with the pain that even opiates can't manage.
I guess I can see a similarity between telling your comercial jet liner pilot to be sure he has his landing gear down upon aproach to telling a Anesthesiologist ,neurologist or any MD they need to watch his tylenol intake.To a doc it doesn'tmake snese to have that level of concern about apap at 3 pilsls a day as it would to be concred about untreated pain, the potential for abuse or addiction or the potential for other drug interactions with meds needed for life support like heart meds and BP meds. Once your with a Doc, the amount of apap worry shoud go out the door. There are greater things to worry about in PM, addiction, damage from procedures, Howmany nerve blocks or nerve ablation procedures has he had, Howmany surgeries, what's his cholesterol level if he'sliving a sedentary lifestyle are things t worry about, not the most basic things like is the apap safe.
If your dad was a heavy drinker heay have liver damage, and if he didn't relay that info, of course you should voice your concerns. Any other scenario that maybe you dad doesn't feel relevant, may be very relavant. From urinary retention "hard to pee" to frequency of BM when taking opiates. They need to know that kind of thing and if it becomes a prroblem, let them know before he's in the hosital with a kidney infection or an obstructed bowel.
We don't go to any other specialty with a list of meds we heard work and ask them to forget their way of doing things and pick something from the list of things we have heard of or read what other people thought of the med. When a family memeber starts to micro-manage every decision from the get go, they have no reason to think that's going to change. So we can accidentally have an effect on the way the person your concerned about is being treated.
Just safe yur concern and points of confrontation for when they are needed. "pick your bnattles" and the apap battle has already been fought. If you think your doc is so icompetant as not to know about the damgers of apap, how can someone be comfortable with that same docs knowl;edge of the most potent opiates available and invasice procedures used to relieve pan like nerve blocks, epidurals, nerve ablation. anything that involves a needle near the spine is much riskier than the amount of apap ahis doc is going to prescribe. But there are benefits to taking those risks,. juutst like there are bnbenfits in taking opiates despite the risks of addiction or the very least physical dependnece.
If you confront a doc on every choice and every part of a treatment plan, the doc may very well offer to turn the case over to you since you seem so informed about the subject. Unfortunately because addicts have used a sick spouse or a sick parent to get what they want, the family memebers actions can become a source of suspicion too. My intent was to just give you a heads up. What looks like concern for you family has been turned into something ugly by those more interested in dad or grandpa getting a scripot for the meds they want.
Reinforce that you dad is seeing specilists tha thave more than one trick up their sleeve and know that apap is dangerous at high doses. They know the next step is a stronger med or a longer lasting one with less apap. That is if this clinic believes in the use of long acting meds or stronger meds. If they don't use them on anyone, because they believe their other methds work, you can't expect them to make an exception for your father.
Sorry , I'm sure i'm over explaining again, but hopefully you get what I'm trying to say and understand why I'm saying it.
Good luck, Dave
Last edited by Shoreline; 01-28-2007 at 08:52 AM.
Reason: don't spell well at 6am.