We haven\'t posted in quite awhile-Update on Bob

14 years 10 months ago #25831 by Patricia
Lorrie...i'm aware of a recall of fentanyl in Dec of 2008 and not sure of the status of it right now or if some of the old stuff is still out there?
Patches containing the prescription painkiller fentanyl have been recalled because of a flaw that could cause patients or caregivers to overdose on the potent drug inside. Sold in the United States under the brand name Duragesic by PriCara and generically by Sandoz Inc., the recall includes all 25-microgram-per-hour patches with expiration dates on or before December 2009. Some of the patches may have a cut in the lining of the internal reservoir where the drug is stored in gel form. If the fentanyl gel leaks into the drug's packaging, it could cause a patient or caregiver to come into direct contact with this powerful "opioid" drug. This could result in difficulty breathing and a potentially fatal overdose.

If this reservoir is cut, it can be seen when the foil pouch containing an individual patch is opened. Damaged patches should be flushed down the toilet and not handled. Skin that has been exposed to the gel should be thoroughly rinsed with water, but not washed with soap. (While the patches should be flushed down the toilet, you should keep the packaging and/or make a note the brand name, lot number, and expiration date of the defective patches). Please use extreme caution handling the packaging.

In December, the FDA put out its second warning in two years about the dangers of misusing the powerful drug.

The drug is intended for chronic pain in people used to narcotics, such as cancer patients, and can cause trouble breathing in people not used to this family of painkillers. Yet the FDA found cases where doctors prescribed it for headaches or post-surgical pain.
Pat.........

Please Log in or Create an account to join the conversation.

14 years 10 months ago #25829 by Julie
Good for you for speaking up Lorrie.
What dosage of Fentanyl is Bob getting. Dick was always on the every 3rd day schedule and they just upped the strength. What he would do was leave one patch on for for a day as it takes 12 to 18 hours to get into the blood stream the Dr. said.

Also they started to put Lidocaine patches on the area where it hurt. They were on 12 hours and off 12 hours. Dick said they helped and there is no effect on the bowel. Do your best to stay ahead of the constipation. It can sure make a person miserable.

How are you doing. I hope you are able to have some help taking care of Bob.
Julie

Volunteer Coordinator
ABLSC

Please Log in or Create an account to join the conversation.

14 years 10 months ago - 14 years 10 months ago #25828 by Patricia
Hi Lorrie....
I'm kind of glad your doctor added Gabapentin as they are not sure how it works exactly but it seems to block nerve pain...its used a lot with shingles patients and other neuropathic pain.
Gabapentin Capsules is used for:



Treating seizures associated with epilepsy. It may also be used for treating nerve pain associated with herpes zoster (shingles) infection (postherpetic neuralgia). It may also be used for other conditions as determined by your doctor.

Gabapentin Capsules is an anticonvulsant. The exact way that it works to prevent seizures and nerve pain is unknown

One thing not to mix with any of the drugs is grapefruit juice..just avoid it. Grapefruit juice can inhibit CYP450 3A4 and may theoretically increase the plasma concentrations of fentanyl. I've also been reading some new literature on orange juice and though its not mentioned yet it is popping up with other drugs.

Hopefully you can ease on the morphine as those fentanyl patches are really strong. The meds actually stay in your system for up to l7 hrs after removing a patch. Just watch him for any Central Nervous System problems...which i think from your description of him he's already had..the sluggishness, difficulty breathing.

I think your daughters observations were right on target. I remember when my father was in the hospital after heart bypass surgery gone bad (they opened him up 3 times in 4 days!!) he was on so many drugs he just wasn't my father anymore. He became surely, then just went into failure to thrive and their answer was to put more drugs into him. I didn't know if the pain was talking or the drugs? I wanted to baseline him to see what was actually going on. They wouldn't listen to me in the hospital, they fought me in Re-hab, and then he was sent to a pschiatric center where they threw more anti-psycotics into him, and finally transfered to a Alzheimers unit where i found a great doctor who agreed with me and finally we began to eliminate the drugs one by one. He still had short term memory loss but he was my father again and could now walk and carry on a conversation...long term memory no problem.....and all he needed for pain was an occasional tylenol. I was able to get him transfered out of the Alzheimers unit and into a lovely assisted living home. Anyway i realize this is not a cancer case but i have to wonder sometimes about the cycle of drug use and the dependence on them.
I truly hope the Gabapentin may provide some relief and block the right nerve pathways..........Pat

Please Log in or Create an account to join the conversation.

14 years 10 months ago #25825 by bobmac2
Hello All
Just want to give everyone a quick update on Bob. The pain was so bad that along with 'upping' the Fentanyl patch, they want it changed every 2 days instead of 3. They put him back on Morphine injections for breakthrough. It was awful watching this.....shuffling between the recliner chair & the bed was pretty much it for him.

Finally had the catheter taken out last Thurs. AM- YEAH, he could pee! He felt so much better with it out. Then we were off to see the pain DR. in Kitchener.I got angry & asked what the plan was going to be........were they going to just going to keep increasing the Morphine until he was unconcious????? Sometimes anger is the only way to get through to Dr.s- thye finally listened! He added Gavapentin, took him off the Morphine injections, increased the Morphine tabs to 4mg. every 2-4 hrs. We also met with a Radiation Dr. who hesitated as Bob's worst pain is in an area where it does not show Cancer. He will wait until the next CT scan to say whether or not radiation would help.

Anyhow, this new med. seems to really help (our daughter was asking them to try this for months), he is much more comfortable. We still change the Fentanyl every 2 days & he is taking the 4mg Morphine every few hours as needed & the Gavapentin 3 times daily. He is much more alert (thank goodness)- of course the constipation will rear it's ugly head again soon...............

Oh well, can't have everything can we?
That's it for now
Regards to all
Lorrie

Please Log in or Create an account to join the conversation.

14 years 11 months ago #25506 by Melodie
Lorrie,
Thanks for the update. I'm so sorry to hear Bob is in so much pain. I just can't bear the idea of anyone having to experience on going severe pain. I'll pray the medical folks find a better way to help ease that situation. Who knew you two would ever have matching catheters...and yes, living with one does suck...one never really fully understands until tied down with one. You are doing a great job, Lorrie, of holding it all together in spite of everything you have and continue to go through...you've come a long way since the beginning of this journey...as frustrating and difficult as it has all been, you've learned and grown in positive ways. You, Bob and family are in my daily prayers and thoughts. Hugs, Melodie

Melodie, Indy Pouch, U.W.Medical Center, Seattle, Dr. Paul H. Lange & Jonathan L. Wright

Please Log in or Create an account to join the conversation.

14 years 11 months ago #25495 by bobmac2
Thank you to everyone for your good wishes and replies.

Things are a little grim at the moment. Not only is Bob in agony with the pain in the back, but yesterday they had to put in a catheter as his bladder won't empty. The catheter keeps plugging, he has to flush it about every 4 hours as it's plugged with mucus & some blood clots(from inserting the catheter we think). They took him off the morphine injections & gave him a Fentynol patch, along with 2mg. morphine capsules for breakhrough. He has taken quite a few of those already as the pain is so bad. I'm so glad that the nurse is coming everyday- I do not have any medical knowledge & they reassure us. Unfortunately we seem to get at least 1 new nurse every week who has never been here so we need to go through the whole history each time- it's wearing but a small price to pay for their help. I joke that I'm going to make a recording that they can listen to, to learn his story.

He had a full body bone scan on Wed. & the Dr. he saw yesterday said that it looks like there is spine involvment but couldn't be totally sure because the bladder was so full when they did the test- (don't know why they didn't put the catheter in then but........)

On a lighter note
Bob & I have matching catheters. I had Prolapse & TVT surgery on Tues so had to come home with a catheter. I have to wear it until Wed. next week.So, I'm not much help to him as I can't lift anything over 5 lb. for the next 6 weeks. I never fully realized what my guy has gone through until I got my catheter- it sucks having this thing!!!


We don't know what is around the corner, each day seems to bring a new challenge. I am so thankful for our children who are here to help in any way they can, my very good friend who is looking after the building while I recover, and for my friends here who understand & let me vent.

Regards to all
Lorrie

Please Log in or Create an account to join the conversation.

Moderators: Cynthiaeddieksara.anne