Interesting observation to share

Cosmic

DW 59 years was diagnosed 13-14 yrs ago with AD. Advancement is slow but in late stage 6 about now. The past few weeks she has had chronic pain in her lower back and down her legs, spinal stenosis and osteoarthritis pinching nerves. Had to go to our local ER last Sunday and after 7 hours, tests, drugs etc. they said if she could not walk without assistance they would admit her to the hospital. Final desperate move was to give her an extremely high dose of oxycodone and that did the trick. Here's the interesting part. she usually gets very "loopy" with opioids, this time she didn't and the past few days she has been taking the oxy "as needed" until surgery is scheduled. Her speech has improved, no more word salad, she can hold a short conversation, is very much aware of surroundings and can dress herself, tie her shoes and other things that just totally confused her before.

Maybe just wishful thinking but wondering if there is a connection between the opioid and other brain function. something that cleared away the fog somewhat.

Opins?

May flowers

That is interesting - do you think it was the pain reliever or the pain relief?

We had many times where a course of antibiotics or pain relief (for unrelated issues) gave my FIL days (and sometimes weeks) of clarity. I don’t know if it was the meds, but I suspected in our case that the freedom of pain allowed him to concentrate on conversation and cognition.

For us, one med in particular turned back the clock for almost a year (at least cognitively, not so much so physically). Despite this reprieve, he continued downhill, just not as quickly. It seemed that way anyway.

mommyandme (m&m)

I think May flowers is onto something… Pain and discomfort can definitely add to our LOs disorientation.  What I’ve heard to be true is when there is real pain the opiod targets the pain receptors in the brain and leaves a patient’s cognition alone.  Even constipation discomfort can send a dementia patient off the rails and only when their issues are resolved will they come back to baseline.  Could this be your moms actual baseline?

M1

Cosmic, my partner has severe congenital scoliosis and has had five different spinal surgeries.  she has been on opioids for years with great success--her pain docs called her the poster child for how to do it right--and the opioids have never affected her congitive abilities one way or the other, that I can tell.

But spinal surgery is very, very difficult.  I would ask a lot of questions before committing your DW to it if she's late stage 6.  If she can get relief with medication without surgery, perhaps that's an acceptable alternative?  Tough call.  

harshedbuzz

Cosmic-

I am going to pile on M1's sentiment.

Spinal surgery is not something to which I would subject a PWD past stage 5. Especially in the context of such a good response to pain management. In your shoes, I would be looking for the top pain management specialist in the area to make a plan for managing oxycontin responsibly while managing the constipation side effects. Spinal surgery is a last resort. It doesn't always offer relief even when successful. You can expect a drop in cognition-- which could be permanent-- associated with hospitalization, anesthesia and transfer to sub-acute rehab. 

HB

JDancer

Some spinal surgeries have a very brief recovery and can provide great relief. Are they planning a laminectomy? It can relieve pressure, pain and numbness in most cases.

Cosmic

Yes. They are talking about an outpatient procedure. What I understand it's removal of whatever interferes with the nerves. Pardon the description, I'm not well versed on these types of things

Monday is a consultation for options. I live near a city where medical care is top notch and our PCP and specialists have great communication. 

Several years past over time she had both knees and both shoulders replaced and that is when we found her intolerance to opioids. Things have changed since then.

Every day of extreme pain and tears is heart wrenching, and she keeps muttering "God help me". Nothing I can do but give more pain meds.

JDancer

Sounds like they will be removing a small piece of bone. Much simpler than many spine surgeries. It's called a laminectomy if the bone removed is the lamina, which is a part of the vertabrae. You might ask if it can be done without general anesthesia.

Iris L.

Ask how much post-op rehabilitation will be needed.  Can she learn to use a walker?

Iris L.

Cosmic

She's already using a walker for the past week or so since the pain was really bad.

Things at home are set up, high profile toilets, power adjustable bed with massage, power lift recliner chairs. I spoil her. Installing a large walk-in shower at the moment, should be finished by Monday. My plans are to keep her home as long as possible. It's a full time job as you all know. Cooking, laundry, cleaning, shopping, managing meds, etc. Certainly not what was planned for the retirement years.