Sunday, January 24, 2010
Dear Son Medical Update~Scopolamine Gel
Dear Son has been using the Scopolamine gel since we received it on Friday afternoon. I had paged the neurologist on Friday afternoon due to Dear Son's crying. He suggested a small dose of Risperdal Friday afternoon and at midnight. Between the gel and the Risperdal, Dear Son slept great. Friday night could not have been better. I went to bed at 12:30 p.m. and he didn't wake up until 4:30 a.m. Sometimes he gets hungry and likes his food started early so I started it around 5 a.m. I was up on and off after that with him for food, meds and to turn him over but generally he woke up happy, with a smile on his face and things seemed great. As a matter of fact, it was one of the his best days yet. He seemed like his old self.
On Saturday morning, I sat him up in the recliner again and he cried. For some reason, he can't seem to sit up more than ten to fifteen minutes before he starts crying out in severe pain. This is concerning to me since it's been going on for quite some time and we don't know why. I try placing pillows behind him to position him differently but nothing seems to work. He cries so much that he has a seizure. I end up using his VNS a few times and putting him back to bed. He is happy to lie down again.
After he left the hospital, I felt confident that the urinary retention was the problem for his pain and still do. At the hospital however, he never got out of the bed. They don't have a hoyer lift there and it's impossible to sit him up in the chair so we had no way to know that sitting was still a problem. I am concerned at to what would still be causing the pain-is it the bladder or is it pain from the pneumatosis? They say there should not be pain from that but I wonder. When I take him out of the recliner and put him back in his bed, he's happy.
While the gel seems to allow Dear Son to be pain free, since it's not causing urinary retention, I don't believe the gel is working at all. Dear Son's secretions have increased and he is choking on them which means that the Scopolamine gel is not drying up secretions like the patch did. The pharmacist said I could use up to .4 ml/day which I did on Saturday but it doesn't seem to have much effect. I am worried he will choke to death. In the meantime, I am trying to give it a few days to see if it will work. I have also started to track how much I am giving him. I was using it whenever he choked on Saturday but tried to decrease the amount since then using it only at night. My fear is that he will choke on his secretions when I am not in the room or he will choke at night when I fall asleep. He choked on his secretions last night when I went to bed and had a few episodes of apnea after some of the choking. It wasn't a great feeling. I worry he'll choke or aspirate on his saliva. I was also up a fair amount, every 90 minutes or so, could be more, I can't be sure, so it wasn't as good as it was Friday night, although I had not given him anymore Risperdal.
The actual medication is more like a foam than a gel. It's almost as if it the medication were "whipped". It seems to be mostly air to me. When I attempt to administer .1ml and put it on my gloved finger, .2 ml comes out. It's extremely difficult to get the exact amount out of the syringe. Also, when I try to pull back on the syringe, to pull .1 ml back into the syringe, it seems like it might have worked and yet when I go to adminster the next dose, sometimes nothing comes out at all so I wonder if anything was retracted at all. I am rubbing it on both wrists and sometimes on one wrist so I probably need to make another call to the pharmacist to make certain I am administering it correctly. I wonder how much remains on the rubber glove.
So at this point, I need to give it a few days to see how it goes. As with most medications, you really need to give it a week or two. Also, because he can't swallow or clear his airways, I'll have to be pretty careful. I get an awful feeling however, that something isn't quite right with this sitting. I would have expected that to improve somewhat but things haven't changed much where that is concerned.
In terms of the big picture, I am beginning to think that we are entering a "no-win" situation. We have to keep his airways clear. If the gel doesn't work, then perhaps the only option is surgical removal of two of the saliva glands. If Dear Son's two greatest risks are sedation and aspiration, then surgery would present a risk with the sedation. I don't know what other options there are, but I'll have to leave that to the physicians.
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