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I'm going to get a nurse fired--my blood pressure must be through the roof
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<blockquote data-quote="Marguerite" data-source="post: 474146" data-attributes="member: 1991"><p>I know just how anxious a person can get when pain medications are not available when you feel you need them. I much prefer being able to self-medicate even in hospital. I've been on strong opiate pain medications for ages (decades). The dose does increase over time even if the pain does not, because your body gets accustomed to the medications and it takes more to have the same effect. I have fought every increase but my pain specialist has been supportive and realises my dose increase is not related to addiction.</p><p></p><p>WHat has worked for me, has been to never try to eliminate the pain entirely. If you do, your body habituates faster. But in dementia, it is hard to remember that a certain amount of pain has to be tolerated. On top of tat, the anxiety over whether you will be permitted your medications when you desperately need them, will make things worse.</p><p></p><p>She threw up when told she could not have more medications? That is anxiety ramping up and I wonder if it is not also related to past experience. It is easy to tell someone with dementia that they've already had their medications, when they have not. And if your body is used to that dosage and you don't get it, the pain ramps up incredibly. If for any reason my medications are not on board (if I have a gastric bug for example, or migraine with vomiting) I've needed to go to hospital for an injection.</p><p></p><p>I realise that what I describe can sound like addiction, but it is also what you get when there is severe pain. My pain medication dose has been high and over the years doctors have tried to get me off them. I've tried to get off them. But first deal with the pain.</p><p>However, for reasons I cannot explain, a year ago I noticed my pain levels had reduced a little so I reduced my dose. Since then I have brought my opiate dose such a long way back that I think soon I could even be off these medications entirely. I no longer have withdrawal problems if I am late taking these medications, I just get pain. But the pain is far more tolerable and controllable. i wish I knew why so I could bottle it.</p><p></p><p>My point is - on opiate medications, too many health professionals see it as bad when in fact it can often be the best option. They also carry on about addiction even where the patient is taking the medications exactly according to prescription. </p><p></p><p>These medications can very easily be abused. That should be far less likely in hospital. It would also be easier, I suspect, for someone with dementia to develop an addiction problem simply because they forget why they have pain and want the pain totally gone. That ramps up the opiate dosage perhaps faster than is healthy, and of course more and more is needed when you do that.</p><p></p><p>However, patients with dementia are also very vulnerable to unscrupulous hospital staff who themselves are abusing patient medication. </p><p></p><p>A trick I have used which S could try if she is a frequent enough visitor - I used to be in such pain that I would take two strong pain pills (paracetamol plus codeine) with a cup of hot coffee. The idea was, the hot coffee would speed up my body's uptake of the medications and give me a faster relief from pain. What also happened, however, was a conditioned response. The taste of coffee was associated with pain relief and I could actually use this to reduce my medication levels. I could drink a cup of coffee with half the medication dose and still get pain relief. The trick is, to have something you associate every time with medication. The same thing. it doesn't have to be a cup of coffee but something with a strong smell or taste is recommended because that plugs in to the brain at the most basic level.</p><p></p><p>I think you handled this well. I wouldn't have too many staff members in your sights or you will just seem to be adversarial. Instead, deal with the issues rather than the people. If there is drug abuse going on with the staff, dealing with the issues will still bring the deeper problems to light.</p><p></p><p>Another point to make to the staff - this is a chronic situation, not an acute one. When a patient has surgery, they are often on strong medications. Over the next few days they are eased off the stronger medications and onto something more innocuous for longer-term. You get staff telling you to wait a little longer, or take these two pills instead of the injection. I remember feeling very resentful when I was told this after kidney surgery when I was 20, but with hindsight they were doing the right thing. But conversely, when I needed my regular pain medications after difficult child 3 was born, and the nursing staff tried the "wean her off" routine despite doctors having ordered my medications to be ongoing, I knew they were doing it wrong. It was just that most of their patients, if not all, were acute. I was chronic. And the nursing staff were responding out of habit.</p><p></p><p>Marg</p></blockquote><p></p>
[QUOTE="Marguerite, post: 474146, member: 1991"] I know just how anxious a person can get when pain medications are not available when you feel you need them. I much prefer being able to self-medicate even in hospital. I've been on strong opiate pain medications for ages (decades). The dose does increase over time even if the pain does not, because your body gets accustomed to the medications and it takes more to have the same effect. I have fought every increase but my pain specialist has been supportive and realises my dose increase is not related to addiction. WHat has worked for me, has been to never try to eliminate the pain entirely. If you do, your body habituates faster. But in dementia, it is hard to remember that a certain amount of pain has to be tolerated. On top of tat, the anxiety over whether you will be permitted your medications when you desperately need them, will make things worse. She threw up when told she could not have more medications? That is anxiety ramping up and I wonder if it is not also related to past experience. It is easy to tell someone with dementia that they've already had their medications, when they have not. And if your body is used to that dosage and you don't get it, the pain ramps up incredibly. If for any reason my medications are not on board (if I have a gastric bug for example, or migraine with vomiting) I've needed to go to hospital for an injection. I realise that what I describe can sound like addiction, but it is also what you get when there is severe pain. My pain medication dose has been high and over the years doctors have tried to get me off them. I've tried to get off them. But first deal with the pain. However, for reasons I cannot explain, a year ago I noticed my pain levels had reduced a little so I reduced my dose. Since then I have brought my opiate dose such a long way back that I think soon I could even be off these medications entirely. I no longer have withdrawal problems if I am late taking these medications, I just get pain. But the pain is far more tolerable and controllable. i wish I knew why so I could bottle it. My point is - on opiate medications, too many health professionals see it as bad when in fact it can often be the best option. They also carry on about addiction even where the patient is taking the medications exactly according to prescription. These medications can very easily be abused. That should be far less likely in hospital. It would also be easier, I suspect, for someone with dementia to develop an addiction problem simply because they forget why they have pain and want the pain totally gone. That ramps up the opiate dosage perhaps faster than is healthy, and of course more and more is needed when you do that. However, patients with dementia are also very vulnerable to unscrupulous hospital staff who themselves are abusing patient medication. A trick I have used which S could try if she is a frequent enough visitor - I used to be in such pain that I would take two strong pain pills (paracetamol plus codeine) with a cup of hot coffee. The idea was, the hot coffee would speed up my body's uptake of the medications and give me a faster relief from pain. What also happened, however, was a conditioned response. The taste of coffee was associated with pain relief and I could actually use this to reduce my medication levels. I could drink a cup of coffee with half the medication dose and still get pain relief. The trick is, to have something you associate every time with medication. The same thing. it doesn't have to be a cup of coffee but something with a strong smell or taste is recommended because that plugs in to the brain at the most basic level. I think you handled this well. I wouldn't have too many staff members in your sights or you will just seem to be adversarial. Instead, deal with the issues rather than the people. If there is drug abuse going on with the staff, dealing with the issues will still bring the deeper problems to light. Another point to make to the staff - this is a chronic situation, not an acute one. When a patient has surgery, they are often on strong medications. Over the next few days they are eased off the stronger medications and onto something more innocuous for longer-term. You get staff telling you to wait a little longer, or take these two pills instead of the injection. I remember feeling very resentful when I was told this after kidney surgery when I was 20, but with hindsight they were doing the right thing. But conversely, when I needed my regular pain medications after difficult child 3 was born, and the nursing staff tried the "wean her off" routine despite doctors having ordered my medications to be ongoing, I knew they were doing it wrong. It was just that most of their patients, if not all, were acute. I was chronic. And the nursing staff were responding out of habit. Marg [/QUOTE]
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I'm going to get a nurse fired--my blood pressure must be through the roof
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