Thursday, June 25, 2009
Caregiving when elderly patient is in pain
When I first entered the Duke Medical Clinic where I was treated by orthopedic surgeon Dr. Mark E. Easley, there was a sign in his office that stated "We do not want you to be in pain" and "Ask us how to help manage your pain." The year was 2002.
As the years have passed, attitudes about pain management at Duke Medical have dramatically changed. In fact, now secretaries, para-professionals and perhaps even physicians seem suspicious of patient's complaints of pain after a pre-determined, cookie-cutter length of time.
My dad is 76 years old and underwent an apparently complicated orthopedic surgery that required the placement of an external fixator on his left foot and lower leg. For the last two weeks, the orthopedic surgeons have tightened the screws with basic wrenches. They are "tweaking" the placement of the large bones.
My dad is trying to be compliant (a pleasant surprise for the surgeon - I am sure). Dad does exercises in chairs and actually (and even 24 days out from the surgery looks forward to physical therapy at the Duke Fitness Center.
But there is no way around the fact that dad is in pain. Dad's pain manifests itself with thrashing of his injured limb. And, as much as I try to keep dad's opposing leg covered, the thrashing is literally tearing up dad's right leg. He has a rather large sore that seems to be infected - caused in large part by the thrashing of an external fixator."
The orthopedic surgeon's office is insistent that my elderly dad must remain on pain medications that require re-dosing every 4-6 hours. That translates into my elderly dad not getting a fill not sleep (and me, as the caregiver also not getting a full night sleep).
The orthopedic paraprofessional suggested that my dad take Ambien. I reminded her that he does tend to sleep walk with other sleeping pills.
Last Fall, dad was scheduled for surgery at Duke. He "woke up" in the middle of the night and thought he was going to miss the surgery time. He could not find his car keys (there is a God) and so my 76 year old dad with a terrible foot infection started the walk to Duke University Hospital. That's a 40 minute drive. A town police officer woke me up with a bang at the front door. Now I know what parents of teenage children fear most. Dad was in a squad car explaining to officers and neighbors that he was having surgery later that day. True enough. He is not senile --- just sleep walking.
Anyway, there are many options for pain relief beyond the Medicare approved hydrcodones. There are patches, "additives" such as neurontin or antihistamine. There are also longer acting pain medications - 12 or 24 hours.
For the last two nights, dad has not had the longer acting pain killer and he wakes up in startled pain like clockwork - every four hours. I am beginning to feel like a fireman or a new parent. I am exhausted.
I yearn for the days when medical professionals worked with their patients. If my 76 year old dad is not sleeping well then how the heck can he be healing? It seems now that medical professionals are suspicious of patient's request for pain medications.
The patient is over sensitive because of pain and lack of sleep. Consequences:
(1) The patient begins to distrust that the medical professional even cares about the patient.
(2) Or worse, the sensitized patient may feel as though the physician's office does not believe the patient's complaints of pain.
I am not sure how or whether I will be able to get proper pain management for my elderly dad. But you can darn sure that I continue to try.
Dad is rapidly becoming physically and emotionally weak with 2 bad nights of sleep.
And this situation reminds me that under Obama Care, my dad would have never undergone the complicated orthopedic surgery. He is a cancer patient and elderly. Obama's federal medical board would consider my dad to be a waste of money.
The orthopedic surgeon, Dr. Mark E. Easley, has requested that I modify my blog as it relates to two orthopedic residents that cared for my dad while he was inpatient at Duke University Hopsital. Dr. Easley assures me that all of the residents in his program are "competent" doctors. To the extent that my primary concern is the failure of Duke University Hospital to institute regulations that require DUH hospitalists to contact, communicate, cooperate and, if necessary, coordinate with patients' current treating Duke Clinic physicians and surgeons, hammering on individual, inexperienced doctors is a distraction.
I agree that the blogs referring to those gentleman must be changed. But I am not getting sleep either as I have to be "on guard" to help dad during the night with his pain issues. I am exhausted and cannot wait until I can take an Ambien and get an effective sleep. Until then, dad (and not my sleep) is the priority.
I hear him on the "daddy monitor" -- gotta scoot. I am so proud of my dad. He is tough.