Here I am following up on my, “The Queen and the Grape” series. Mom as a child (oldest of seven) contracted rheumatic fever which locked one of her heart valves at 10% open, which is the reason for moms dual heart valve replacement surgery, her COPD and caused a multitude of other medical issues one of which is, she is allergic to pretty much every pain medication as well as class of medication there in. This list includes, Dillaudid, Percocet, Microdantin, Ampicillin, Penicillin and as of her heart valve replacement just under two years ago the only medications they found she could take for pain was Tramadol and Morphine. So of course this surgery when asked if she had any allergies we responded, gave the 
reasons why not to use them and let them know what meds they used that seemed to work on her (see above two). This surgery went off with no problems, well at least not until after she woke up in recovery. Mom was exactly how she was when she had her first stroke, which only affected her speech and she was having some issues with her short term memory.
She was agitated, snippy, argumentative, mumbling excessively, twitching of her hands and her feet kept moving, short tempered, excessive sleeping, etc. When I first noticed this in the emergency room only hours after it happened, I explained to her nurse at the time of her previous stoke and if this could have been another stroke because of her behavior and if they had performed any CT-Scans to check, just in case. They did perform a CT-Scan, which he allowed me to review the test results and he informed me that the results were being sent up to neurology to have them confirm the findings. Not even 30 minutes later he was getting back to me confirming that neurology agreed with the ER doctors findings. If that’s the case, why then all the stroke symptoms? We started right away with the doctors at Sutter, Roseville expressing all our concerns and that we wondered if the Tramadol or the Morphine could cause them and if so that we would like them at least the Tramadol removed from her medication list. The event happened on Monday and the surgery took place mid-day on Tuesday, April 1st which is when we really noticed the change, which we think is due to the amount they gave her to get ready for the surgery. They suggested we wait and see what happens until Wednesday which will give her good pain relief for two days and then they will tapper her off them. The reasoning sounded good so I agreed with it, but right away when I walked in on Thursday morning the first item I questioned was, “Is she off the Tramadol?” Which I did not know should not be taken by elderly patients due to the kidneys have a harder time processing it out of their systems. After reviewing the nurses log’s it was determined that through the night all that mom was given for pain was, Extra Strength Tylenol.
Being off the Tramadol for going on 24 hours, had changed her not one bit. I understand that it takes a few days to a few weeks for some medications to work they way out of ones system and even more for someone who’s kidneys are only working at 50%, another side effect of the rheumatic fever. Once we were done trying mom with no Tramadol and there was no change in her behavior we started asking ourselves if it just may be the morphine? By this time (Friday) they were in the process of transferring her to a rehabilitation 
facility so we decided to just wait until we get there and on they in-take we’ll let them know, “No Morphine.” The transfer went smooth, using a gurney and transport van was the only way to go with mom because she can’t bend her knee yet. At ManorCare’s in-take we discussed with the in-house doctor the issues we had with the Tramadol and Morphine and explained that we already had her taken off the one with no change and that we would like to have the Morphine now discontinued. They were very nice and accepted that we knew what we were talking about so this was discounted once they received notice from mom’s surgeon that her felt it would be okay. This approval was received around 11:30 pm Friday night when her surgeon came out of the operating room and called ManorCare back.
On Saturday the effects were still present and hung around through Sunday morning but you could tell a major improvement in her attitude and behavior, which you could say was night and day. Even though she was not back to her normal self, I’ll take this mom over Friday’s mom any day. Now on Sunday she was about 90% back to herself. So I have to say, it looks like Tramadol and Morphine are now on mom’s “Allergic To” list or at minimum “Only Use One or the Other, Not Both and only in Small Doses,” list. All the other classes of pain medicine give mom all these side effects as well as either make her itch uncontrollably, break her out in hives or all three, which is really not pretty. We 
can now call her the, “The Woman Allergic to All Pain Meds.” This just goes to prove everyone needs an advocate in their corner at all times, who knows your caree better than you?
Richard (Kreisler)
PickYourPain@att.net
iCareTalk.net 