My crazy cousin

[TerryJ2]

You know, when it rains, it pours.

After all that has happened lately, and especially since I spent over an hr at the dentist today being fitted for an appliance (aka having a woodworking clamp shoved over your face while a madman pumps caulking paste into your mouth), I thought I'd take myself out to lunch and read. Alone.
I had my foccaccia, my feta salad, my pinot grigio ... and then my cell ph rang.
It was my cousin in NYC. I've posted about her b4. I flew up there last yr, and the yr b4 to help her out. She refuses to go into a nursing home.

She is addicted to painkillers ... Oxycontin, Oxycodone, Fiorocet, you name it. She has a broken tailbone that never healed, and she broke her hip last spring and she signed herself out of the rehab ctr b4 she had finished with-therapy. Then she complained about the pain. And not being able to walk unassisted. Grr.

She calls, breathless, in tears, telling me how much she loves easy child, and be sure to tell her she loves her, and that there is $ in the will for me ... you can see where this is going.

She said she was checking into the hospital and didn't know if she would survive if they did surgery because she was so frail. A friend was taking her in.

The friend got on the phone and said, "She's a little confused. She's out of painkillers. She took them too fast." (No, really? What a shocker. ) "I'm going to the hospital to p/u her prescription, to see if I can get it one day early. She's not going to the hospital."

Cousin calls me back 4 X. Ea time is a repeat, except that I finally tell her thank you for the $ in your will, but you don't have a will. It was your husband's. You are intestate. The "will" you hand wrote will go to probate, and the state of NY will get half of everything."

"What?"

I've told her that b4. She didn't get it.

"Do you want me to fly up and help you with-a lawyer? I can help you create a real will, if you're serious about leaving me something."

"Well, I have to be a big girl. I am old and fragile and I have to do this. My tax man says I don't need a will if no one contests it."

Aaaargh.

It still goes to probate.

Anyway, I wasn't going to finish my wine, I only needed a sip. But by the time I had spoken to her (how many times?), I had finished the whole thing.

Don't be surprised is she gets the whole scrip filled and takes it all at once. She has been in a great deal of pain and may just do something drastic. It wouldn't surprise me.

Detach, detach, detach.

 

[bran155]

Boy, you need this as much as you need a hole in your head!!! I am so sorry that you have to deal with her drama.

Have some more wine!!!

 

[gcvmom]

BARTENDER! Another one for my friend Terry in honor of her wacky relatives!

Welcome to The Club, sweetheart!

(Am I sick to be laughing at this, or just plain crazy?)

P.S. Your lunch sounded yummy!

 

[ThreeShadows]

Terry, if she does want to leave you some money you will look bad if you help her write a will. I've just spent five years waging a legal battle against a woman who wrote a will for my mother in which she made herself the majority beneficiary.

 

[Hound dog]

If cousin is in chronic pain, why don't they prescribe her the pain patches? They'd probably work better for the pain too.

Wacky relatives can sure drive us bonkers.

Now, I haven't a clue.....other than the wine.....what on earth you had for lunch. But I hope you at least got to enjoy it.

 

[gcvmom]

DL, this is for you:

I had my foccaccia, my feta salad, my pinot grigio ... and then my cell ph rang.

 

[TerryJ2]

Don't you do Italian food, Daisylover?
Foccaccia is like a pizza with-no sauce. It's sprinkled with-herbs and spices and olive oil.

Yes, I wouldn't want to look bad, with-everything going to me. But I think she has it divided into equal amts between me and two neices. So that's not a problem.

We'll see. If she's out of pain tomorrow, she may change her mind and decide she's not going to die, after all.

I don't know why they don't give her pain patches. I do know that they do not want to increase her dosage, and are very concerned about her addiction and their potential liablity. Never mind that she's 80-something and it shouldn't matter at this point whether she's addicted. But the doctors have to watch their butts.

 

[tiredmommy]

Terry, sorry your lunch was ruined. You'll need to try again tomorrow for a peaceful and relaxing lunch, maybe at a spa with your cell turned off.

If it's any consolation my mother (that's Duckie's grandmother) left a drunken message on my home phone on inauguration day and failed to acknowledge her granddaughter's birthday. I called her very early Sunday morning (better hung over than drunk) and she still didn't ask about Duckie.

Somehow I think your cousin and my mother aren't exactly from the deep end of their respective gene pools.

 

[Marguerite]

Pain patches just may not work for her. If she's an addict, or if her pain is severe, or if she'salready habituated to a high dose, then patches are laughable.

Did oyu ever see the British TV series "Absolutely Fabulous"? Joanna Lumley's character of Patsy is a chain-smoking former model who turns up one day absolutely covered in nicotine patches. As Patsy lights up yet another cigarette she asks Edina (close friend) to help her take off the patches so she can find room to put more on. Edina says, "I don't know, darling, there seems to be some stuff coming out of your skin, onto the patches..."
Saffy, Edina's conservative daughter, leans across and says, "OMG, she's RECHARGING them!"

I do agree, with your cousin the doctors certainly do have to watch their rear ends. A doctor should not write prescriptions for osmeone they know to be an addict.

I once had a GP (standing in for my GP) accuse me of being an addict, despite my being under the ongoing supervision of a pain clinic. All I was asking for, was my regular monthly prescriptions according to what was already on my file as authorised. I'd heard bad things about this particular GP; a neighbour who was on long-term Valium had stormed out of the surgery, loudly proclaiming that he had called her an addict because she asked for a valium prescription, her first Valium script for 6 months.
Then it was my turn - I had authorisation to ask for 180 of my regular pain medications. It required special authorisation because the usual prescription was for 20 (which would hve lasted me 3 days).
The doctor first told me I was an addict, then offered to write me a prescription for 20!
In other words, "I won't write you up for what has alreayd been authorised by the pain clinic, but despite declaring you to be an addict, I will still feed your habit."

I am on long-term very strong pain medications. I know what will happen if I abuse this. Competent and responsible doctors would stop my supply, if I abused the trust placed in me by giving me the amount I need.

It is really easy for a doctor to work out that his patient is an addict, especially to strong medications that require a mountain of paperwork. However, I do know that this gets abused, that somedoctors simply don't care and will continue to be irresponsible. Also, the pharmacist who is dispensing the medications has a responsibilty to report possible abuse of the medication.

I was waiting for difficult child 3 after his drama class; difficult child 3 had gone to the shop to buy a burger. While I waited I noticed a couple of pill packets on the ground under a rubbish bin next to me. I picked them up and saw, from the pharmacy label, that they were for very strong opiate medications which had been dispensed that day. It was a form of morphine that I had once been on, so I recognised the packet. The dose was about double what I'd been on (which I remember at the time, was supposed to be a fairly high dose). One packet was these opiates, the other packet was a different form of long-acting morphine. Again, a very high dose. They had been dispensed that day, and the same doctor had prescribed these, for the same patient.
The packets were empty. Each foil had been emptied. I looked at the pharmacy name - the bin was right by the back door. So I gathered up the packets and marched in to the pharmacy and reported it. OK, there was achance that the pharmacist was in on whatever scam was going on, but what had happened was clear - the prescription shouldn't have been written at that high a dose without authorising paperwork from the pain clinic (which I know wouldn't condone this). The pharmacist could dispense it without knowing, but once alerted, ahd to call it in as possibly fradulent.
But at some point, a person had walked out of the pharmacy clutching a huge amount of prescribed pain medications, and then immediately removed the pills which could only have been to hand over (sell?) to someone else.

Nobody in genuine pain would do this - that was supposed to be a month's (large) supply. If you are the patient, you keep your medications in the packet with the prescription label which verifies you have a right to them. As soon as you remove the pills from the packet, your ownership of them becomes suspect. For all the pills to be removed, clearly within hours (or less) of dispensing, was a huge warning light to the pharmacist.

I don't know how it payed out, but what SHOULD have happened, is that patient's name whould have been flagged not only in the pharmacist's computer, but also eventually in the national data base, which should put the word out to hospitals, doctors and pain clinics, that this patient is able to give away such vital medication, and therefore doesn't have a right to it.
If, on the other hand, the patient was bullied out of her pain medications, someone genuinely in need should have gone to the police. Frankly, if it were me and they were my medications taken from me, I would have ended up in hospital. There is no way a genuinely needy patient could have stayed silent.

So although the system is set up to prevent this sort of abuse and reckless misuse of pain medications, there are unfortunately enough corrupt people out there who will abuse it and try to manipulate the system, to get their own way. And practitioners who enable this, despite knowing how very wrong it is.

Marg

 

[Hound dog]

Terry

My "Italian" menu consists of lasana, spagetti, and seafood alfredo via Olive Garden. And the latter I just discovered recently. lol Foccaccia sounds tastey though.

 

[rejectedmom]

I'm with TM on this one. A "do-over" is in order with the cell phone turned off! -RM

 

[TerryJ2]

ML, LOL!

Marg, LOL even more!

Now, for the serious stuff, how does one get off of pain medications when they're 82 yrs old and bed-bound? With breaks that haven't healed properly?
Isn't that cruel?

What should she do?

Meanwhile, I'm drinking tea and relaxing after a nice walk.

 

[Marguerite]

Terry, I was thinking about this in regards to myself, your post made me think about it again.

The trouble with strong paind medications, is that you can get addicted. And even if you don't, you can get habituated. I started taking pain medications because I was in pain. (duh) The trouble was, the pain wasn't going away quickly. When it became obvious that the pain was chronic, we had to shift into a different gear to manage it.

For short-term pain, you throw at it what it needs. You don't worry about long-term effects or problems because your main aim is to get pain relief fast and hang te consequences. But longer term you need a different approach. Your body responds differently to pain and even a mild pain that you could put up with in the short-term can be like water torture as the days, weeks and months wear on.

So in order to properly manage long-term pain, you should get yourself under the care of a pain specialist. Even though I'm young and not suffering from a terminal illness, I took myself to a palliative care clinic. It needed a referral from my GP but since it took the heat and responsibility off him for prescribing the strong medications I'd worked my way up to, he was happy to do it.

Now, when you begin taking opiates, it takes time to get ther dosage justright. In my case I was taking more than I needed and was finding it sedated me and gave me a bit of a buzz. Since I didn't like that feeling, I avoided taking the opiates unless the pain was really bad. However, after a few weeks the buzz effect was gone and I was no longer quite so sleepy.

Over time, either the pain has slowly got worse or the tolerance to opiates has increased, or both. As a result, the dose needed to knock the pain has increased. However, it has been important for me to never fully knock out the pain because to do so, it rapidly increases the rate of tolerance build-up. And the faster tolerance builds up, the faster you run out of medications and the sooner you get to that nasty point beyond which it is too dangerous to go; the point at which any further increase could be fatal.

So if you take opiates to deal with pain, and one day you wake up and the pain is gone, you should be able to stop the opiates without problem because you were'nt addicted. However, there can be some side effecgts (withdrawal) simply because your body has adapted to the opiates and stopping them means your body's adaptation swings back the other way. For example, opiates cause constipation. But if your body is used to them, then the constipation eases and things function normally. However, stop the opiates and your body's personal adjustment suddenly becomes obvious and you get diarrhoea. Only for a day or so (depending on what form you took the opiate in) but for someone with chronic pain, a bit of diarrhoea is no big deal.
When I was pregnant with difficult child 3, the pregnancy had the fringe benefit of greatly reducing my pain. As a result, I was able to stop all opaites for six months. However, as soon as he was born the pain was back. The dose I needed was almost as high as it had been six months earlier, it really hadn't done much for my tolerance levels.

However, if the person is in pain PLUS they're addicted, if they're taking the medications not only to knock out the pain entirely but to also enjoy a nice relax and snooze, then you have problems They will have a bigger problems with withdrawal, coupled with a return of pain.

An addict who is desperate for their next fix is bad enough; a person in pain who is anxious that they won't have enough medications to knock their pain to a tolerable level, is also pretty bad. Putthe two together and it's not pretty. Just as a heroin addict on the street will lie, cheat and steal to get their supply, a patient with chronic pain who has abused their medication will be even more anxious and frantic.

Getting off the medications - for an addict (such as a heroin addict on the streets) this only can work if they WANT to get off the heroin, and because they don't also have chronic pain. To get off heroin, the naltrexone route is the most effective. But they have to have the mindset and motivation to really work on this, because they go through the withdrawal process under sedation. After the sedation is finished, the patient then has to continue to stay off the opiates. It takes a lot longer than a few days to lose the high tolerance. After all, I didn't lose any tolerance in six months.

So for your cousin - unless her pain is now gone, you won't succeed. If there is another non-addicvtive pain medication that would suffice then you could try switching from one to the other. However, if such a medication existed, I'd be on it. There are other options she could try - TENS, acupuncture (which could promote healing also), a morphine pump that trickles analgesia into the spine - but if she's already abusing her pain medications, then chances are other methods would be doomed to fail.

If she's abusing her medications then a month's supply will be running out in much less than a month. So how is she getting more? Does she have several doctors prescribing, who don't know about each other? That wouldn't be possible here in Australia without multiple IDs which would be difficult to arrange.

What is needed is to make sure her doctor knows just how much she is taking, and to assess whether the dose is correct and whether there is anything else tat could be done to alleviate her pain more safely. Again, she would have to be cooperative. If she's taking medications primarily for the pain, then you would expect her to cooperate. But if she is getting a buzz out of it, she is likely to resist more controlled options.

At her age, it could be a case of shrugging your shoulders and letting her have what she wants.

If it's any consolation, opiates taken appropriately are probably the safest things she could be taking, in terms of long-term health issues. I know a lot of people find this hard to believe.

She's your cousin - if you can't get her to see a palliative care specialist, then you can't do anything more for her. Certainly you need to be careful to not get caught up in her manipulation (which is what it sounds like to me).

Marg

 

[TerryJ2]

Certainly you need to be careful to not get caught up in her manipulation (which is what it sounds like to me).

Yes, indeed.

On top of it, she is a retired actress. So it's like the Boy Who Cried Wolf. Her pain is real. But I never know when she's really THAT ill.

I did call 911 last yr when she fell, and she was in the hospital for quite a while, and then a therapy/retirement home. She refused the home care and told the Soc. wkr not to come over, then a mo later, complained that no one was helping her.
Grr.

She will not do acupuncture or massage or PT or Occupational Therapist (OT) because it means she has to get up, take a cab, and got to numerous appts. She is always late, and then complains when the staff cancels her appointment or charges her a no-show fee because, well, she showed up, even if she was an hr late!
She is bed-bound for the most part. Her own doing.
Still, her pain is real.
But so is her drama.

I fully expect to have to fly up and peel her out of bed after she's been dead a wk. I am steeling myself against the inevitable anger, and hope I can forgive her.

Meanwhile, she has a new pain-mgt dr who prescribes the exact same medications she's had for yrs, because he doesn't want to deal with-a neurotic old lady. All of her doctors have been like that. She is on her 5th dr in as many yrs. --not counting the specialists.

 

[TerryJ2]

P.S. If they would prescribe Xanax for her, it would cut back on her pain medications 50%, in my humble opinion.

 

[Shari]

Wow. No advice, just hugs.

Is there anything hospice could do? I realize she's not terminal, so probably not, but might be worth a call to ask if they can point you anywhere...

 

[TerryJ2]

She will cancel anything I arrange.
She still owes $300 to the last home svc I hired for her.
Thank you, though.
Did I mentiion she lost 2 more teeth? In front?

 

[Shari]

Then I think you have a good plan. Detach and prepare.