This discussion was created from comments split from: Thanksgiving aftermath - family feud.
To change the topic a little bit -
MIL is 94, cognitively all there but orthopedic-wise, struggling. She was addicted to pain pills and when she was in rehab for a fall last year, we got her weaned off of them. Now, she is experiencing terrible pain in her ankle, to the point where she is not able to stand. She has 24/7 care in home. I went to the orthopedist for my knee last week and asked him about whether or not we should bring MIL in for a check and possible ankle surgery. He said, she’s 94, just give her the darned pain pills… However, H’s Sis is a substance abuser. She lives with MIL and one of the reasons we weaned Mom was because SIL stole her pills. Clearly, pills are not a viable option but MIL’s pain is intractable. My question is whether or not anyone has any experience with the pain patches? I though that if we could put them on MIL every whatever, they’d be less likely to be stolen by SIL. I have heard that they last for 2 - 3 days, so we could leave one or two with the aides and keep the rest at our house to keep SIL from having access to them. We can’t evict SIL - we’ve done it twice at MIL’s request and each time, she invites her back. I am just not spending any more time or money on that.
Thanks all.
I’m sorry about your mother-in-law, @techmom99. My 90-year-old mom had knee replacement surgery a few months ago. It was successful, fortunately; before the surgery, she was in excruciating pain.
Fentanyl patches can be misappropriated and abused. There have been cases in which health-care employees removed the patches from patients’ bodies.
When my dog had surgery, he had a fentanyl patch. I was instructed to not touch the medicated side of the patch when I removed it and to not throw it in the garbage but to take it to a medication dropbox.
^^^^^ I wonder what that was that was filtered…
As do I!
@techmom99: Is it possible to move your mother in with you or another sibling and let your substance abuser SIL remain in Mom’s house? Otherwise Mom will always be in pain. And that’s not fair.
Ha ha. That’s weird. The filtered word is a common synonym for “disposal site for outdated and leftover medications” and also happens to be the name (when the first letter is capitalized) of a cloud-based storage system.
@rockvillemom I sympathize with you. My very elderly father passed away in January and he sounds a lot like your father. About 3 months before he died, at an appointment with his PCP it was clear that at-home hospice services were called for because his heart and kidneys were failing (he was a long-time diabetic). I can’t recall of the top of my head what the precipitating issue was that sent him to his PCP, but the doctor wisely presented it to my dad as, “I know you don’t want to return to the hospital so I’m going to have some nurses come to your house to take care of you.” He was mentally fuzzy by that point so he accepted that - but would likely have thrown a huge fit if he had to go back into the hospital to treat whatever it was. [My dad had spent many weeks on and off the preceeding couple of years hospitalized to deal with infections and he was miserable there, and made everyone who came in contact with him miserable as well].
There was no need to tell my dad that the nurses were hospice nurses - all he knew was that he was not going to go to the hospital and that’s what he wanted.
Just wanted to share that in case that point is approaching for your father and also in case you can arrange for any home healthcare visits for him, after consulting with his physician.
In my situation, my mom was/is of sound mind and body so she knew what was going on and it was a kindness to my dad not to spell it all out. He was comfortable and at home when he passed away.
Non-opioid drugs are ineffective for her? Some are mentioned in this trial: https://jamanetwork.com/journals/jama/fullarticle/2673971
Thank you to those who responded:
My MIL has tried acupuncture in the past for back pain and she believes in it. However, she is completely bed bound and I don’t know of any acupuncturists who make house calls. I am going to look into it, though. Her worst pain is in the ankle. The study that was posted dealt with knee and back pain. Since we weaned her from the opioids the last time, she has been taking acetaminophen. I bought her a bottle of 600 at Costco a couple of months ago and it’s just about gone. She pops three at a time. They take the edge off for a brief period of time but they don’t take the pain away. I actually got the idea for a Fentanyl patch from an episode of Law and Order: Criminal Intent. The killer took a patch from a comatose person, squeezed out the liquid and used it to poison someone else. I don’t intend to do that obviously, but the concept of the patch is attractive. MIL is completely cognitively aware and would know if her D was trying to take a patch off her body. Since they last for a day or two, we can give a couple to the day aide, who we trust, and allow her to take them home. In the alternative, H will have to stop by and apply or distribute a patch. The main box would stay at my house. I am not up on the CBD stuff. I understand opioids and how they function. I don’t understand the CBD. I also know how MIL reacts to opioids but have no clue how she’d react to CBD. She takes a zillion supplements and I am pretty sure there’s a B complex in there, though I am not as sure about the other ones mentioned. The doctor I spoke to, who I really liked and who I would recommend anyone to, said to just give her the narcotics and not worry about her getting addicted again at her age. He said to try very small doses.
You have all given me things to think about. I am not sure about the CBD in my state (NY). I know it’s legal but I am not sure if it’s available for ankle pain. My friend’s mom has it for stage 4 lung cancer. I don’t even know if you need a prescription or where I would go to get it or how to administer it. H is reluctant to try it as well and she’s his mother so he gets the final say, but I will look into the salve as that seems like the easiest to work with, for her.
Thank you all.
I wish she wasn’t in such pain. Her mind works so well but she is an invalid.
CBD can be made from the Hemp Plant and a Tree Bark and from part of a marijuana plant.
There is not even the possibility of a high from CBD. Gron chocolates are delicious and are from a tree bark. They can be ordered online. Topical CBD can be very helpful for a specific pain such as a tennis elbow.
The issue with edibles is they can take a long time–90 minutes to 4 hours to feel relief. They do help with pain and aching and help especially to sleep better. We have a couple of medical centers here that deal with pain and CBD treatment with Medical Doctors. The future for sure.
@techmom99 —It’s not hard to overdose on Tylenol. It can cause irreversible liver damage. She could try taking one ibuprofen and one Tylenol together and see if she doesn’t get a better effect. CBD oil is a good suggestion - it can be ordered online. No prescription needed.
@techmom99 Have you tried SalonPas patches? They’re over the counter. You can even get them in bulk at Costco. I used them when I broke my arm and was able to stay off the opioids with them.
Some health food stores carry CBD oil also.
My D and H use SalonPas as well for their varied aches and pains. They use the Costco-size box pretty quickly but no addiction worries.
Agree about potential irreversible liver damage from Tylenol.
Thanks again -
I have seen Salonpas at Costco and will check it out when I go next time. I have concerns about the liver issues, but her doctors have told me that at 94, she should just get the pain relief she needs. I like the idea of trying a Tylenol with a Motrin and will institute that the next time I go as I have to buy a bottle of Motrin.
The CBD just really makes me nervous. I am one of those people who disfavors legalization of pot and I have a really hard time believing that CBD isn’t addictive. I KNOW it’s not, but then I think that it really hasn’t been out there for all that long, so what are the long-term implications. I realize that, at 94, my MIL isn’t really dealing with extremely long term, but still. So, it’s really the lowest on my treatment options list. If she had cancer, G-d forbid, I would do it, but ankle pain just seems like overreacting to use CBD. I wish she could just have surgery but no doctor will agree to perform it since she has afib and mild CHF. She was depressed for a year after her last major surgery, which was a result of the anesthesia’s impact on the elderly.
Meanwhile, H just doesn’t even want to discuss it. I fear he will break down when she dies, they are so close.
At 94 who cares if she gets addicted. In my opinion make her as comfortable as possible. Don’t say only ankle pain if you don’t really know how badly it is hurting her.
One of the SalonPas types with lidocaine works fast for me. You can try these in a smaller amount from CVS. I haven’t ever bought a big box. You can ask a pharmacist if it interacts with anything.
I agree the concern about pain shouldn’t be less than the concern about addiction. This falls into knowing you did what you could. Pain can affect even thinking, we all know. Try it.
Adding. I’m med averse, I understand trying to avoid other issues. But it’s one thing to, say, avoid hormones after 60, then learn the bad effects of those. Or be judicious about opioids. Quite another to react slowly on ankle pain where she cant stand up. At 94.
And best pain mgt does come at onset, not hours after it’s flared.
My FIL, the same age are your MILused the patches. But he was stil in terrible arthritic pain and also took pain meds, especially to sleep. The patch is a good idea. But you may also need to figure out a way to have her back on pain meds and perhaps an ankle brace of some kind so she can at least stand up. Maybe get a safe that the in-home care folks (and you) have the combination to? It is not fair to your MIL to withhold medication that will allow her to at least get out of bed. So sorry she is in such pain.
CBD may be an option. My FIL tried the creams but claimed they did not help at all.
We also tried to have him do aquatherapy. I believe it helped while he was in the water, but he said it hurt worse when he got out (not sure that is possible). He was pretty reluctant to try new things.
If you Google, they take elderly pain seriously, but many articles bog down with the socio-behavioral talk. But capsaicin and lidocaine 5% patches are both discussed, the latter preferred because it doesn’t have the possible burning feel. And these can outlast the every 4 hours of an NSAID.
The cream may need to be applied every 4 hours.
As everyone knows opioides are notorious for constipation. Especially at 94 it is a concern.
I would worry less about addiction potential (except for the relative). Which makes the CBD oil even more attractive as a possible alternative.
I think it is irresponsible of a doctor to say Tylenol at high doses that may be ruining your liver is okay at 94 or any age.
I don’t know what strength pill she is taking however (just that she takes 3).
The maximum dose she should take is probably somewhere below 3 gm (3000mg) per day. The ibuprofen and tylenol taken together have a synergistic effect and works better than either alone.