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    Old 08-26-2011, 11:24 AM   #1
    rockdove
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    Elderly father unable to eat with severe spinal pain, nausea

    Dear all

    A month ago my elderly father aged 83 had a great escalation in his back pain to the point of being unable to move in the slightest without excruciating pain and was hospitalized and put on pain medication (Fentanyl patch 25 mcg) and Dilaudid up to every 4 hours as needed, among others).

    MRIs and Xrays have given us a conclusion of "multiple disc problems" -- I've been told Spinal stenosis, spinal osteoarhritis with fusions, and herniated discs at different times by different doctors.

    Additionally, he has always had a difficult stomach, feeling nauseous and unable to eat at times, and only a limited variety of foods -- and would take antacids and Pepcid regularly.

    He has declined surgery for the condition, thinking it is too painful and difficult at his age, so the only option was to send him to a rehabilitation center to try to work with the pain. He spent a week or so in the program, and began to look better and move better, but gave up, because he just feels too miserable. He then refused medications because he figured they were aggravating his stomach even more.

    Unfortunately now for the past few days he can no longer eat, but drink only water, and has refused any further tests, feeding tube, etc and is confined to the bed. He is getting weaker and weaker.

    Doctor said the Dilaudid, or the pain itself that may have constricted his stomach. And truly, he does sound like there is stuff coming back up in his mouth. Doctor removed Dilaudid upped the Fentanyl to 50 mcg upon informing her.

    My father won't take anything in pill form so I wonder if there are some good anti nausea medication by injection that can make a big impact.

    I also wonder (since my father vomited after receiving a morphine injection) if opiods like Fentanyl itself are contributing to this inability to tolerate food. Fentanyl is the only medication he's on now.

    Any reply is greatly appreciated. This is an urgent situation.

    UPDATE: Now the Fentanyl has been increased again to 75 mcg upon my asking. I wonder if we have we been not getting good pain management or is this level appropriate after a month of beginning opiods.

    Last edited by rockdove; 08-26-2011 at 10:12 PM.

     
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    Old 08-27-2011, 01:02 AM   #2
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    Re: Elderly father unable to eat with severe spinal pain, nausea

    Hi, I'm sorry to hear about your dad. It is so nice of you to come here to try and help him. About the anti-nausia medication, I believe there are some that can be given by IV, but I don't know the names. Because your dad took ant-acids regularly to be able to eat, you could tell his doctor this and explain this is why he isn't able to and I am sure his doctor would be able to help. Also, I have not had the meds your dad is on, but lack of appetite may be a side effect, being thirsty may be one, or stomache problems. I would ask the doc if these are side effects, and if they are, tell the doc your dad needs to eat, and can't. If he could eat, and get some strength back, he may want to consider therapy again. I know water therapy is very gentle yet feels very good when it comes to pain. You are weightless in water, so it's very relaxing. Hopefully they have this therapy available. Also, some pain meds cause a person to want to sleep and feel lethargic all the time. This may be why your dad doesn't want to do anything. Ask your dad how he feels on the medicine, and what else can be done to help him. He is lucky to have you to be so concerned and want to help him. Good luck to you and your dad, I hope the med helps him and he can then eat and start feeling better.

     
    Old 08-27-2011, 06:49 AM   #3
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    Re: Elderly father unable to eat with severe spinal pain, nausea

    He says nothing should be done to help him . He has given up. But more than that, he says he has "decided" that he wont suffer any more. He says they could give him a dozen pain patches and there would still be pain.

    I have a strong feeling that the pain management in the hospital was poor since they gave my father Dilaudid which may have nauseated him, instead of increasing the dose of the baseline pain drug Fentanyl. I was worried instead that it would be too much, too soon for him, being naive to any opioids. I didn't think he would give in so soon.

    We missed a window of opportunity at the beginning of his treatment. For example, He has not even tried cortisone injections into the spine. We had the great misfortune of being taken to our closest hospital.

    The question I need to get an answer to is if it is possible for severe back pain to be reduced to minor pain with drugs alone.

    Last edited by rockdove; 08-27-2011 at 06:56 AM.

     
    Old 08-27-2011, 07:50 AM   #4
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    Re: Elderly father unable to eat with severe spinal pain, nausea

    Without knowing specifically what is causing your father's pain, it is hard for any of us to try to answer your question. Given his age and what you mention, it would appear his problems are degenerative in nature, whether it is herniated discs, stenosis, etc. Usually with these conditions, there is spinal nerve compression, which accounts for the pain. Opioids do not have a very good ability to help with nerve pain. They mostly just make people not care so much that they are in pain.

    Is your dad's pain mostly in his back or is it a "sciatic" type pain that runs down his buttock or leg? Is it an on-going pain or is it worse when he is standing or sitting? Are there times when it goes away, or is it with him 24-7?

    Dilaudid can be a nasty drug. It makes some people very nauseated or sick to their stomachs. It can also cause confusion and hallucinations, in severe cases making the patient seem "out of his mind." I recently went through this with my elderly aunt who was hospitalized. It was very frightening for her and for me. It also can take away the appetite.

    I personally have no experience with the patches. A friend that uses them does OK except when the dosage is increased. Then she has side effects.
    According to the PDR, "Fentanyl's major side effects (more than 10% of patients) include [B]diarrhea, nausea, constipation,[/B] dry mouth, somnolence, confusion, asthenia (weakness), and sweating and, less frequently (3 to 10% of patients),[B] abdominal pain[/B], headache, fatigue, anorexia and weight loss, dizziness, nervousness, hallucinations, anxiety, depression, flu-like symptoms, dyspepsia (indigestion), dyspnea (shortness of breath), hypoventilation, apnea, and urinary retention. Fentanyl use has also been associated with aphasia."

    So, to me, it sounds like the patches may be just as bad as dilaudid.

    Last edited by teteri66; 08-27-2011 at 07:52 AM.

     
    Old 08-27-2011, 08:16 AM   #5
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    Re: Elderly father unable to eat with severe spinal pain, nausea

    The pain is there 24/7 that he feels mostly when he attempts to move in any way. It does not run down the leg; it stays in the back. Now reading what you say maybe it was a bad idea to to have the Fentanyl dose raised.

    It sounds right when you say the meds dont really take away the pain... I noticed that at the beginning he appeared sedated with the drugs but still in a lot of pain. That was contrary to my understanding of pain drugs. I should have posted here sooner.

    Maybe he ought to remove all patches and take Vicodin instead (now prescribed).. but he refuses any pills.

    Last edited by rockdove; 08-27-2011 at 08:21 AM.

     
    Old 08-27-2011, 08:51 AM   #6
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    Re: Elderly father unable to eat with severe spinal pain, nausea

    Vicodin might be more tolerable but it wouldn't help the pain much more than the other opioids he has tried.

    Do you know that the pain is coming from the spine? Have they ruled out anything stemming from the internal organs? I was just wondering since you mentioned he had always had a touchy stomach, etc.

    Do you know if the pain is in the lumbar area or is it up higher? With stenosis, there is usually leg pain that is somewhat relieved when the patient bends forward slightly. I had very bad stenosis and I can assure you there was no drug that touched it.

    I should not have said that opioids made "no difference". They do kind of "numb" you all over, but you still have the specific nerve pain, if that makes sense.

    I assume your father has had MRIs of the spine and perhaps internal organs. If he had agreed to surgery, do you know what type of surgery was suggested?

     
    Old 08-27-2011, 05:20 PM   #7
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    Re: Elderly father unable to eat with severe spinal pain, nausea

    Somehow stenosis diagnosis got confused at the hospital. The orthopedic dr only said "osteoarthritis", recommended surgery, but did not say what type (he's not a spine surgeon).

    Unfortunately, because of medical privacy laws I am not allowed to look at the papers directly.

    The very urgent question is whether the nausea arises more from the pain or from the medication. If the medication is causing it, I wonder if the Fentanyl patches should be discontinued entirely and what the withdrawal would be after a month of use.

    My father may well have another problem but refused a CT in the hospital, as well as other tests.

    The Dr is not here on the weekends.

    Last edited by rockdove; 08-27-2011 at 05:23 PM.

     
    Old 08-27-2011, 07:25 PM   #8
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    Re: Elderly father unable to eat with severe spinal pain, nausea

    Do you think you can get your father to see a spine specialist, either an orthopedic spine surgeon or neurosurgeon?

    You would probably need to cut back on the fentanyl slowly, and not stop it abruptly. I think it less likely that the pain is making him so sick to his stomach, and that the drugs are the likely cause.

     
    Old 08-27-2011, 07:33 PM   #9
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    Re: Elderly father unable to eat with severe spinal pain, nausea

    He is refusing any more tests or medications other than Fentanyl patch. As i said, he has given up. And I have a feeling now that the drugs have built up in his system, if he tapers off now, the nausea symptoms may not resolve before he dies of starvation.

    Last edited by rockdove; 08-27-2011 at 07:33 PM.

     
    Old 08-27-2011, 09:45 PM   #10
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    Re: Elderly father unable to eat with severe spinal pain, nausea

    Was he this discouraged before the last trip to the hospital? I hope it isn't the pain meds that are depressing him so much. I'm a little surprised there isn't something else wrong that is causing so much pain that it would make him give up. If it is pain from stenosis, that surgery to make more room for the nerves isn't a bad surgery, as back surgeries go.

    I know you are desperate to help him and I'm sorry I don't have any great suggestions for you. I did just spend the past five months out with my 89-year old aunt, who first had a stroke that caused right-side paralysis, and then a mass in her colon was detected and she had surgery for colon cancer, so I am quite familiar with how some of these high-powered pain meds can effect an elderly person. My aunt was hallucinating on morphine and was very sick to her stomach. She got off all pain meds as quickly as possible after her surgery and it all cleared up.

     
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    Old 08-27-2011, 11:30 PM   #11
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    Re: Elderly father unable to eat with severe spinal pain, nausea

    One injection that helped me immensely when I had to go to the ER a few times was toridal. It has always been a huge help to me. I could barely move or walk from the terrible pain and my low back was swollen, ( arthritis ). By the next day, I was doing fine again. Oh, and this does not affect a persons head at all, does not make you tired, out of it, nothing. Maybe this would work for your dad. I believe there are different ways for this to be administered.

     
    Old 09-10-2011, 09:01 PM   #12
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    Re: Elderly father unable to eat with severe spinal pain, nausea

    Yes he has definitely has a history of depression and is evident now and I find it impossible to encourage him.

    After talking to him today I understand that he is not eating by choice. It's awful for someone to be in front of you, deteriorating, and be unable to help. He simply wants to be done with the pain and be done with old age and its problems in general, as soon as possible.

    Is there not any medication that can take very intense back pain down significantly rather than just dull it or sedate the patient? Only this could have the hope of restoring some morale in someone who has given up.

     
    Old 09-10-2011, 09:36 PM   #13
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    Re: Elderly father unable to eat with severe spinal pain, nausea

    Aren't his doctors aware of what's going on? If there is a medication, I would think they would know about it and would be willing to give it to your dad, if he'd be willing to take it.

     
    Old 09-26-2011, 10:12 PM   #14
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    Re: Elderly father unable to eat with severe spinal pain, nausea

    As I said, my father won't take any pills by mouth. No other liquids besides tea/water. I'm not sure how much is nausea, how much originates from the pain or is just loss of appetite. We really cannot tell either way if he won't do an endoscopy, but I tend to think it may be his decision not to eat due to the intolerable circumstances.

    Every day I see him alive it still seems like there is a tiny bit of hope but when I speak to him there is no possible means to enter a meaningful discussion on the subject, only to irritate him.

    I continue to wonder, Where did we go wrong and how can we get back to that decision point? I honestly did not see this coming..or I would have been there at each moment. I thought he was going to give the rehabilitation a try as a conservative treatment, first, then consider the injections or surgery. I could not really anticipate that his life could end over back pain. Other than this he seems relatively healthy for his age. Yes, the pain is excruciating and debilitating. However, assuming no greater illness is present, can giving up be legitimate if he hasn't really tried any more aggressive treatment, giving himself at least a chance? This isn't end-stage cancer or Alzheimer's, this is osteoarthritis and yes, depression.

    It probably has something to do with his outlook on the future as an 83 year old. What can he expect (his return) if he goes through difficult treatments (investment)? More bodily problems associated with advanced age, including possibly dementia, and maybe he feels now is a good point to stop and avoid getting in any deeper.

    OTOH, My grandfather at age 90 decided he didn't want to suffer any more and had an operation to remove a cancerous tumor. His thinking is more present-minded, his logic being that the worst thing that could happen was that he died, which would happen anyway without surgery. Though he had a more straightforward operation - cutting into soft tissue. Not fighting intangible pain. Maybe the deciding factor for my father was that the doctor could not guarantee that the pain would go away with surgery.

    Last edited by rockdove; 09-27-2011 at 12:19 AM.

     
    Old 09-26-2011, 11:48 PM   #15
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    Re: Elderly father unable to eat with severe spinal pain, nausea

    People older than your dad have spine surgery all the time. My mother-in-law had a one-level fusion at L4-L5 about the same time I had mine! And she did just fine. Yes, she has some aches and pains but she is 91 (had the surgery when she was 87). But she travels back and forth visiting her children around the country, and enjoys her life. Who knows why your father didn't get a more positive message concerning what could be done. Perhaps the doctor was no good at explaining things, or your father didn't like him, etc.

    It definitely sounds like he has made up his mind that he doesn't care to live like this.

    I would think if the drugs make him ill, could they bypass that reaction by giving him the meds in an injection?

    I am really sorry you all are going through this and wish I had some concrete suggestions for you....

     
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