Thursday, March 13, 2014

Orally Disintegrating?

For the first time, only a few days ago, the Ondansetron tablet that I gave Pam, only worked 'minimally'. Whereas, the same tablets would give Pam almost instant relief from nausea, lately it's taken somewhat longer - but this time, the relief was very temporary.

I went to the pharmacy to find out what the next size dose-strength was and learnt it was 8mg (currently Pam is on 4mg). The pharmacist advised that rather than increasing the dose amount, consider a variation as to how it is delivered.

Pam currently has the 4mg tablet dissolved in water and delivered via her PEG tube into her jejunum (middle small intestine).  What the pharmacist was proposing was to make available dissolvable Ondansetron wafers which would be given to Pam under her tongue.  He explained that this would affect a quicker relief and possibly a more intense relief.

I asked Pam as to how she felt about dissolving a wafer in her mouth, but she thought it was potentially a GOOD idea, so I went to see Dr Bob to get a prescription for this new format.  When I picked it up, I noticed (with a smile) that the wording on the prescription was for “Ondansetron 4mg orally disintegrating tablets”, but what I got when I had it filled by the pharmacist was “ONDAZ-ZYDIS WAFER 4MG 10 (ONDANSETRON)”.  The pharmacist (Tim DeBoo) went to some trouble to explain how to remove the tablets from the packaging without disintegrating them.  (Whacko!  They still disintegrate and are indeed tablets, not wafers – even though what is printed on their box is exactly what’s in uppercase above.)

I am yet to find out what it’s like to actually do it, but I dare it’s just a matter of time.  I still have plenty of ordinary tablets and will continue to use them unless Pam’s nausea-needs demand something better.

Sunday, March 2, 2014

Keflex for one thing - or maybe two

Pam is once again producing an unusual amount of output from the remains of her rectum. Since the treatment for the adenocarcinoma (some years ago) the small bit left of her rectum was just 7 – 10cm, nevertheless it still digested its secretions and emitted them about once every 6 or 7 weeks.  These days it’s been once or twice a day causing me to seek our doctor’s advice.  He prescribed Keflex antibiotic – the same recently used for one of Pam’s bladder infections.

What has this to do with the subject heading?  Well at 5am today, Pam asked me to see if I could “push wee”.  Pam urinates via a suprapubic catheter into a leg-bag attached to her right thigh.  From there, whenever she is in bed, it further drains from the leg-gag to an overnight-bag – resting in a bucket hanging from her bottom bed rail.  Occasionally, the drainage to the overnight-bag doesn’t happen and Pam’s leg-bag fills giving uncomfortable back-pressure.  This prompted Pam’s request.  I was being asked to push urine from the leg-bag to the overnight-bag.

Here’s a picture of the hardware that Pam now wears. (Her head is to the left, feet to the right.) You can see the connected feed tube, the suprapubic catheter entry point and the two different-sized nozzles where it connects to the leg-bag. I use the folded tea-towel to keep all these connectors off Pam’s torso skin…

However, the leg-bag was draining satisfactorily, so what was discomforting Pam?  She even declared that she had been “weeing”; meaning urinating urethrally.  Anyway, I returned to my bed and wondered what was going on.  I eventually decided that although it was only about 4 weeks since I changed catheters, this one might be starting to “play up”.  So I got up, collected a 10ml syringe and a 50ml syringe, the later containing some tap-water and returned to Pam.

I used the 10ml syringe to see if the catheter holding-balloon was still inflated – it wasn’t.  So had the catheter begun to dislodge?  I wiggled it farther in (much to Pam’s chagrin) and re-inflated it.  I then used the larger syringe to inject some water up the catheter into Pam’s bladder, to ensure it (the catheter) was not blocked.  It wasn’t.

The small amount of urine collected in Pam’s panty-pad might have been because her catheter had just, very recently, dislodged – and I caught it in time.  All these things, the colostomy bags, the suprapubic catheter and the PEG-feed tube have to work ALL the time, but sadly, they don’t.  Anyway, it was tap-water that I injected into Pam's bladder - but the Keflex should look after THAT, as well.