May 242012

Elderly are more susceptible to infections than most people and as a result often end up on antibiotics. While all medications have the potential to cause reactions, antibiotics seem to be the culprits more often than most.

The trouble is we do not know how you will react until you take the medication. While the list of possible side effects for all antibiotics are often long, there are five that are most commonly seen: nausea, vomiting, diarrhea, rash, and secondary yeast infection.

The problem for your elderly parents is they are more susceptible to yeast infections than younger people. Prevent the yeast infection by eating yogurt or drinking buttermilk every day or taking probiotics works sometimes. If that does not work, there are over the counter preparations ladies can try. Read the package instructions and follow them. If those do not work, have the doctor prescribe Diflucan. Usually, but not always, one pill will take care of the problem. So if you know that Sulfa gives mama a bad yeast infection go ahead and ask the doctor to order something for her. Or she may choose to order a different antibiotic.

But what about your father? He can get a yeast infection too. Yeast infections can occur in your mouth and are quite painful. When yeast infections occur in the mouth it usually called thrush. Thrush is associated with babies but people who wear dentures, are on long-term steroid therapy or have a weakened immune system have a harder time fighting it off. There are prescription medications available to relieve the discomfort and treat the yeast.

If your parent experiences any of the other common side effects, nausea, vomiting and diarrhea, depending on the severity and the antibiotic, the physician may decide to treat the symptoms and continue the antibiotic. Always check with your doctor before stopping a medication unless the reaction is severe.

If your parent has any trouble breathing or starts to swell, especially in the face, give them some Benadryl if they can swallow and call 911. They could be going into anaphylactic shock and every second counts.

While a reaction can occur at any time, usually the chances are greatest after the second dose of medication. Stay nearby for the first hour after giving a new medication for the first couple of doses.

Please do not ever give your elderly parent leftover antibiotics unless their doctor has given you instructions that it is okay because of a chronic, ongoing infection. Some medications and antibiotics do not play well together. Antibiotics are often specific to what classification or type of organism they treat. Cultures are done to determine what exactly will kill off the bacteria. Giving a person an antibiotic that is not strong enough to kill the infectious organism can lead to a more virulent drug-resistant strain.

Some antibiotics have to be monitored via blood work to ensure they are at therapeutic levels without being toxic. These types of antibiotics are usually given IV and can often be given at home. IV antibiotics get into the blood stream immediately and go to work faster. IV antibiotics are much stronger than those taken orally. They also have side effects and because of the speed with which those side effects can hit, make sure you know which ones to look for before the nurse hangs the antibiotic so that you know what to watch for.

Remember to check with the pharmacist about what to do if you miss a dose. This is more important with antibiotics than some other medications. And ensure your elderly parent takes all of the antibiotic until gone. Just because they feel better does not mean they are well. If you parent is started on an antibiotic and you do not see improvement within 48 hours, let you healthcare provider know.

May 142012

When I first started working in homecare my primary area was the drug district of the county. Crack was just coming onto the drug scene and the dealers would literally hold the bags of crack out hawking the price when I drove by. Once they learned that I was a nurse and in the area only to do a job they began watching out for me. But that is another story. I am telling you this so you will understand why Mrs. Boone and the director picked me to be their information source.

Mrs. Boone was a nurse who had come out of retirement when her husband retired. She was an older woman who always wore a skirt and did not work on Tuesdays because that was when her Bible study group met. She was the kind of person who never had to tell you she was a Christian and never judged anyone who was not. We all liked and respected her.

One morning as I arrived at work the director opened her office door and motioned me to enter. Sitting inside was Mrs. Boone. Before I could even say good morning, Mrs. Boone asked me, “Do you know where I can buy some pot?” My mouth literally hung open and I could not utter a single word. Mrs. Boone and the director both laughed at my reaction and I know it took me a full minute before I could say a word. That was the last question I expected!

Mrs. Boone usually volunteered to take on the most challenging of patients, one of whom was a young mother dieing of breast cancer. The mom was not handling the morphine well, could not eat and was always nauseated. Mrs. Boone had talked with the doctor and they had tried everything they knew. But the idea that Mrs. Boone would even consider recommending marijuana much less purchasing it herself was completely beyond my comprehension.

I told her to talk to the lady’s teenage daughter. She would know where to get it and if she got caught, the worst she would get would be a slap on the wrist. No way was I gonna buy it and I knew Mrs. Boone was not sneaky enough. I assumed she followed my advice because when I asked her later, the patient had acquired the pot and was doing well with it.

Our director was a former hospice nurse and she had seen how well marijuana worked for some people. It helps reduce pain, stimulates the appetite and lowers nausea. It also can produce a feeling of euphoria and help to combat depression. (I have to admit that I get somewhat amused at the literature that lists a feeling of euphoria as a side effect as if that is a bad thing.)

I once took care of a quadriplegic who saved the Valium his doctor gave him to control his severe muscle spasms for when he could not obtain pot. He claimed the pot worked better and he was concerned about becoming addicted to the Valium. And in all honesty, after I had seen the severity of his muscle spasms and how quickly the pot worked I only requested he not smoke it while I was there. AIDS patients, those with multiple sclerosis, sufferers of depression, people with Chron’s disease and whole list of other illnesses claim to be helped by smoking pot.

It is not legal to use marijuana for medicinal purposes in my state but that does not stop healthcare professionals from quietly recommending it to some patients. We look the other way when a patient tells us that they smoke pot because we understand that for some people, it really is a viable treatment option. We just do not admit that out loud.

Like any medication there is not guarantee that marijuana will help and is not without potential side effects such as paranoia, short-term memory impairment, difficulty learning, loss of coordination, increased heart rate or the exacerbation of an already existing lung condition. And of course the previously mentioned euphoria. Most of these, however, only last a short while.

Unfortunately, our current political climate is not conducive to scientific testing of pot and its usefulness, so most evidence is anecdotal. It may be just producing a placebo effect for those who claim it helps them. However, there is some research available and a website that offers a more balanced look at the use of medical marijuana.

Just remember, it is not legal for medical use in all states. If you live in a state where it is legal for medicinal purposes, you must have a prescription and most other states will not honor it. Also, it is still a federal offense no matter where you live.

May 122012

As I said in Part I, chronic pain serves no purpose. But what exactly is chronic pain? Chronic pain is defined as pain lasting 6 months after the body has healed. There are many causes of chronic pain including nerve damage, certain diseases, bone pain, muscle spasms, and circulatory problems; just to name a few.

Pain is measured as mild, moderate or severe by the World Health Organization. Healthcare professionals will often ask you to rate your pain on a scale from one to ten, with ten being excruciating and one almost no pain. They may have you point to a face on the pain scale that represents how you feel. With acute pain there are often physical signs such as elevated pulse and blood pressure. This is not always the case with chronic pain which sometimes leads sufferers to be labeled as malingering or drug seekers.

As a society we are very judgmental about chronic pain sufferers. We tend to judge them as lazy, attention seeking or drug-seeking. Many people will suffer rather than deal with the judgment they receive when they seek help. We are so busy judging we forget there are other things that will also help alleviate pain.

Though I started out this series on a rant about using narcotics, they are a last choice and should be used as little as possible while still maintaining a high quality of life. Narcotics are not without side effects including nausea, vomiting, constipation, confusion, hallucinations, and increase risk for falls to name a few. A lot of times the elderly will avoid taking narcotis because of the side effects.

With that in mind, there are other alternatives that should be explored as part of your elderly parents pain management regime such as: physical therapy, chiropractor treatments, nerve blocks, Lidoderm patches, heat, cold, massage, acupuncture, meditation, exercise etc. should all be considered in addition to medication. Anti-inflammatories and non-opioid analgesics such as tramadol are also good alternatives. But when none of those works, please, let us give our parents the drugs!

As I said in Part I of this dissertation on pain, if you or a loved one has chronic pain find a doctor who specializes in the management of pain. They have ideas and treatments that your medical doctor has not heard about. I am not going to tell you they can alleviate the pain completely, but how different would life be if the pain level dropped from a nine to a five? For my mom, it is a huge improvement in her quality of life.

The really sad part of all this is those who can not tell us they hurt. In those who have dementia or confusion it is often difficult to tell if they are in pain. In the third article in this series we will look at a pain scale designed especially for those patients and I will give you some references that I think you will find useful.

In the meantime, here are some organizations that deal with chronic pain and have information that you may find helpful:

American Chronic Pain Association Make sure you look at the 2011 Guide to Pain Management and Treatment and Using Opioids Safely

American Pain Foundation

American Pain Society

May 112012

Pain management in the United States is terrible! This is especially true of the elderly and it is a pet peeve of mine so please forgive me if I go off on a rant. I have fought this battle for more than one patient and my own mother and I find it frustrating that I am still fighting it in this day and time.

I do not know if healthcare professionals realize how severe chronic pain can be or if it is fear of reprisal from our current anti-drug environment but it is past time for people to come into the twenty-first century and take advantage of the resources available to them. With the knowledge and the medications available to us there is no reason for people to suffer in pain. To do so is not only unethical in my opinion but cruel.

Pain is often called the fifth vital sign and I really wish that professional caregivers would check it at least as often as they do the other vital signs. While acute pain serves to tell us something is wrong and prevent further injury, chronic pain serves no purpose and can have severe consequences. A person living with chronic pain is often depressed and even suicidal. Their quality of life is lower, they lose strength due to lack of activity and normal activities become harder.

When in pain, the surrounding musculature tightens, exacerbating the pain. To make matters worse, as the pain goes on the nerve fibers get even better at transmitting the painful impulses and the brain signals the pain intensity up trying to get your attention. The result is that even though the pain might not be any worse your pain level is! It quickly turns into a vicious cycle.

While the goal of acute pain is to alleviate it, this is seldom possible with chronic pain. The best you can hope for is to control it. This means it needs to be treated just like any other chronic condition such as diabetes or hypertension with diet, exercise and daily medication. Unfortunately this is not what happens.
Some doctors are reluctant to use powerful pain medications known as opioids (also known as narcotics) to treat pain even when non-opioid medications have not worked. As one doctor told me; the more you take, the more you need. My response was, “So?” Elderly people in particular are leery of using narcotics because of either the side-effects or fear of addiction. We fought for years to get past this same mentality for cancer patients but we have made very little progress for those suffering from chronic pain.

Even doctors are afraid of making an elderly person addicted. Really? The ignorance on this subject is amazing in part fostered by our government anti-drug campaign. (That is the subject I will address in the future). The truth of the matter is that if you are in real pain you will not become addicted to pain medication. That is as silly as my grandma not wanting to use her oxygen for fear of becoming addicted to oxygen.

Am I comparing pain medication with oxygen as necessary for life? If you are in chronic pain, then yes I am. When you live in pain your body is in constant stress, producing chemicals that literally damage your heart as well as the rest of your body, not to mention the mental and psychological toll. I said it before and I will say it again, there is no benefit to chronic pain. It can in fact lead to an early death.

In their defense doctors live in fear of investigation if they prescribe too many narcotics and I do understand that. Even if they do not get fined or lose their license, their reputation is affected as well as the time, aggravation and financial strain of defending themselves.

As a society we have decided it is more important to prevent a drug-seeker from getting their fix than to alleviate the pain and suffering of someone whose only relief comes from narcotics. Because of our backwards priorities, we are letting good people suffer.

If your elderly parent is suffering from chronic pain, be an advocate for them. Talk with their doctor and if you do not get the results you want, get a referral to a pain specialist. Medication is not the only answer but it is one that needs to be included.

Next up, some things to try before you try narcotics.

May 102012

Elderly Parents: Taking Expired Medications

Thanks to Scott Bell for his question about medications from overseas and off the internet. It is time you know another little truth about your medications.

Medications come with expiration dates by law. Before I give a medication I am supposed to check the expiration date. What happens to medications that are expired? Do we just trash them? Not at my house!

While there are a few exceptions, most expiration dates are arbitrary. They mean nothing. Ask you pharmacist what they do with expired medications. They are sent back to the company who might repackage them first, maybe not, and ship them to other countries such as India and Mexico. When you order medications from the internet, chances are you are getting something that “expired” and could not be sold in the US.

I have worked with doctors who go on medical mission trips to other countries. We saved expired medications and medical products for them to take with them. Some countries have limits on how long the medications they bring in can be out of date, others do not. For most things, the dates do not matter.

Some medications are good for quite a while others start to loose their potentcy and a very few will actually change chemically over time.

Here are some guidelines:

Never, ever, use expired medications on your eyes. It just is not worth the risk. Once a bottle of drops or ointment have been opened there is an increase in the risk of the medication becoming contaminated and causing a severe eye infection which could lead to blindness. After 60 days, you should throw it out.

Nitroglycerine degrades rapidly. Throw it out 6 months after opening, irregardless of the expiration date. (Make sure you have a new bottle first.) If I am taking something for chest pain, I want it at full strength. Even the nitropaste and patches should be within the expiration time.

Antibiotics – check with your pharmacist. Realize that the expiration date on the bottle the pharmacist fills is one year from the date that the prescription was filled, however the original bottle the medications came in could have a much longer exiration date and probably does. Some antibiotics can loose potentcy over time also, so please check with your doctor or pharmacist first.

Insulin – It too will start to loose potentcy after the bottle is opened. The recomendation is to throw it out 28 days after opening it. Some insulins are more stable than others. Talk with your doctor or pharmacist but as a general rule, I would change bottles once a month.

Narcotics – Most are good for a long time after the expiration date. However, do you know that if you are caught with a bottle of narcotics that are out of date, even if the prescription was written for you, you could be charged with illegal possession?

Before you give that “pain” medication to your neighbor that hurt their back, realize that is prescribing without a license and if they have a reaction you could be charged. It has happened. Actually, this is true of any medication but because narcotics are controlled the charge has more “teeth”.

We had an unfortunate incident in which a nurse hurt her back, it was the weekend and a relative gave her some of her prescription analgesic, a very mild one. (We’ve all done this, self-medicate). Then the relative got mad at her, called the cops and said she stole the medication. Even though there were witnesses to the verbal consent to take the medication, the nurse was arrested and her license to practice suspended. The legal and financial requirements to straighten it all out were too much and she decided it was easier to not fight it and gave up her nursing license. Now she has a record. Be very careful about who you “borrow” medication from.