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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest suitable treatment for colon cancer & kidney disease

Hello Doctor,

My aunt is on at home hospice care going 5 months, she is 92 yrs old diagnosed with es colon cancer with mets to pancreas. She also has chronic kidney disease.

Current pain management-Morphine (Kadian 10mg)daily

Previously reduced to 5mg due to adverse effects of sleeplessnes/hallucinations/myoclonic twitching, however pain/anxiety/agitation returned.

Side effects were treated with lorazepam.

Hospice advised Haldol, however we did not want to give such a strong antipsychotic.

We are now back to 10mg, it does control the pain/anxiety/agitation.

Unfortunately the side effects have returned, only this time a little worse. She has been awake for almost 60 hours. Given 1mg Lorazepam yesterday at 4pm had no effect.

Doctor prescribed risperidone which was given 4 hours and she is still awake. She is bed bound. What are your thoughts on possibly switching to different pain management? At this point would there be any benefits or might a change be opening the door to possibly worse side effects? Any input would be appreciated. Thank you, Nat
Tue, 30 Jan 2018
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Oncologist 's  Response
Hi,

After hearing your history I would advise you to control her pain by Fentanyl 5 mg transdermal patch. Patients should apply it to intact, non-irritated, and non-irradiated skin on a flat surface such as the chest, back, flank, or upper arm. The site of Fentanyl application must be cleansed prior to application of the patch, do so with clear water.
Do not use soaps, oils, lotions, alcohol, or any other agents that might irritate the skin or alter its characteristics. Allow the skin to dry completely prior to patch application. Patients should apply the patch immediately upon removal from the sealed package.
The patch must not be altered (e.g., cut) in any way prior to application. It should not be used if the pouch seal is broken or if the patch is cut or damaged.
The transdermal system is pressed firmly in place with the palm of the hand for 30 seconds, making sure the contact is complete, especially around the edges. Each patch may be worn continuously for 72 hours. The next patch is applied to a different skin site after removal of the previous transdermal system. If problems with adhesion of the patch occur, the edges of the patch may be taped with first aid tape. If problems with adhesion persist, the patch may be overlaid with a transparent adhesive film dressing.

Regards,
Dr. Monish De
Oncologist
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Suggest suitable treatment for colon cancer & kidney disease

Hi, After hearing your history I would advise you to control her pain by Fentanyl 5 mg transdermal patch. Patients should apply it to intact, non-irritated, and non-irradiated skin on a flat surface such as the chest, back, flank, or upper arm. The site of Fentanyl application must be cleansed prior to application of the patch, do so with clear water. Do not use soaps, oils, lotions, alcohol, or any other agents that might irritate the skin or alter its characteristics. Allow the skin to dry completely prior to patch application. Patients should apply the patch immediately upon removal from the sealed package. The patch must not be altered (e.g., cut) in any way prior to application. It should not be used if the pouch seal is broken or if the patch is cut or damaged. The transdermal system is pressed firmly in place with the palm of the hand for 30 seconds, making sure the contact is complete, especially around the edges. Each patch may be worn continuously for 72 hours. The next patch is applied to a different skin site after removal of the previous transdermal system. If problems with adhesion of the patch occur, the edges of the patch may be taped with first aid tape. If problems with adhesion persist, the patch may be overlaid with a transparent adhesive film dressing. Regards, Dr. Monish De Oncologist