About 3 months ago Gary was put on a Fentanyl patch at 25 mcg, with liquid morphine available for breakthrough pain. When he needed the morphine often, Hospice then moved him to a subcutaneous Fentanyl pump, which allowed much better absorption with his weight loss, and also allowed for better dose management. They actually started him at 50mcg and it had the effect of lethargy and unresponsiveness, knocking him down each time the pump dosed him. They dropped it to 37.5mcg which worked well for the past couple months, then in the last 3 weeks Gary's pain his increased tremendously with the deterioration of his left arm and leg, so it's been stepped up to 47.5, then 60mcg. The pump also allows for "bolus" doses for breakthrough pain at 20mcg every 15 minutes as needed.
Medication adjustments, including pain meds, have put Gary through episodes of unresponsiveness and for the most part, he has returned from them, though not always up to his previous level. Any medication changes can cause drastic differences in mood, lucidity and appetite for Gary. Today, Hospice wanted to increase Gary from his 60mcg dose to 90. I pushed back for 75, so we can see how he responds to less, then step it up, rather than knock him down too hard too fast. In addition, the bolus doses were increased to 30mcg every 15 minutes.
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