Four months ago I was in an auto accident and suffered a crush injury to my right (dominant) hand and forearm. I was pinned to the ground by a car. The two bones in my forearm had compound fractures that were repaired surgically. I also suffered from skin and tissue loss that required skin grafting from my palm to the underside of my wrist.

Following the accident and corrective surgeries I had no feeling in four of my fingers (my pinky finger was spared). Seven weeks after the accident the median nerve was released.

I have been in physical therapy since that time and have had only modest improvement in function, even less improvement with regard to pain and no recovery feeling in the fingers. My hand specialist shares little information with me with respect to the ultimate prognosis but what I have learned from the internet leads me to believe that I will be lucky to regain 25% of my wrist and hand function back because of the trauma to the median nerve.

What is most troublesome however, relates to the continuing pain. It randomly affects the bones in my fingers and palm, the very tight skin graft and the forearm muscles. In the past four months, I have been able to ratchet down the pain medications. I am now at a point where two 10 mg Norco tablets every four to six hours as needed controls my pain. I have experimented with popular over-the-counters (Motrin, Tylenol, Aleve, Aspirin, etc.) but none worked. I don’t want to be on the narcotic but it is the only thing controlling my pain at this point.

I understand today’s concerns over the misuse of prescription medications, but I resent my doctor for making me practically beg for a refill. I don’t use my medication inappropriately and I try not to take it if I can but sometimes the pain is just too severe. I believe the physician thinks I exaggerate the extent of my pain, although he has not said so.

These powerful drugs exist to alleviate pain and if the effects of my traumatic injury do not warrant their use, I can’t imagine what would. I am considering getting a second opinion, changing physicians or consulting a pain specialist. As a regular reader of your column I appreciate and value your advice.

DEAR READER:
Given the extent and severity of your injuries, narcotics are acceptable in this situation. You are only four months post-accident and I endorse your effort to regain function and eliminate your needs for prescription narcotics.

You have suffered serious injuries to the lower half of your arm and hand. I doubt that you will regain complete function; however, I cannot comment further because I am not an orthopedist. You need to know what the likelihood of recovery, both full and partial, is. You may also have to make changes to your lifestyle so that you can mentally prepare yourself if the outlook is grim.

If your physician is unwilling to talk to you about prognosis and less willing to provide proper medication, it is time to find a new physician who will be more compassionate and willing to explain your situation and the possible outcomes. If you are not ready to make a permanent switch, than a second opinion is an appropriate option.

Regardless of your physician choice, a pain specialist is an appropriate resource. These physicians specialize in ways to treat prolonged or chronic pain. Narcotics are often used as a last resort while alternative therapies such as acupressure or acupuncture, physical therapy and non-narcotic pain relievers (Ultracet, Mobic, etc.) are preferred.

The pain specialist cannot fix what is broken, but he or she can at least make it feel a whole lot better. You may wish to work with a pain clinic or specialist while awaiting an appointment with another orthopedic specialist for a second opinion.

To give you related information, I am sending you copies of my Health Reports “Managing Chronic Pain” and “Medical Specialists”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My wife is 80 years old and we have been married for more than 50 years. Until four years ago she was outgoing, energetic and of sound mind, body and spirit. Since then she has become a shell of her former self. I remember this change was precipitated by her no longer wanting to drive. She came to me, out of the blue and said she no longer felt comfortable driving and wanted to see a neurologist. My wife is a very guarded person and is not fond of going to the doctor so I surmised that she had been experiencing some type of problem. She was diagnosed as having dementia and placed on Aricept, Namenda and (despite telling him she wasn’t depressed) Zoloft. She has since been removed from these medications because they were not helping her. She was switched to Lexapro (for depression I don’t believe she has) and Ibuprofen liquid (for acute pain).

From that point on she began a rapid deterioration, physically, emotionally and mentally. She started complaining of acute pain that radiated from the back of her thighs throughout her lower extremities. I took her to a total of six neurologist and countless other specialists but none could find the cause of her pain. She had had a host of tests including MRIs and CT scans but all they showed was normal aging. She hasn’t had any strokes or other brain damage.

Six months after all this started, she became totally incapacitated. She is no longer able to walk, sit upright (without assistance), move her arms and legs, speak (she does mumble), chew food or feed herself, or perform any routine activities of daily living. Her food has to be pureed and fed to her. She is incontinent and cannot move of her own volition. She remains in whatever position she was last placed in and has to be moved manually. Her vital signs and appetite, however, are excellent.

It has been four very difficult and frustrating years. I love my wife dearly and it greatly pains me to see her like this. I believe that she understands what is being said to her but is unable to respond or express herself. On rare occasions she will say something clearly (often someone’s name or will callout) but then retreats back into silence. She is also very rigid. She keeps her arms and legs tight as if she is tense and resistant to being moved. I see this as her being fearful of what is going on around her so she is guarded and trying to protect herself.

I have exhausted all of my alternatives to finding help for my wife. Can you please assist me?

DEAR READER:
You wife appears to have advanced Alzheimer’s disease, a progressive and fatal neurological disorder. The first stages often include minor memory loss and language problems. As it progresses, memory loss becomes severe with the patient often failing to remember names of loved ones, time, location, and more. Eventually walking, sitting, eating, daily activities, and personal hygiene become impossible without assistance. Finally, speech and the ability to respond are lost, as is all voluntary movement. Muscles become rigid, incontinence occurs and swallowing will be impaired. The body remains intact and in generally good health but the brain and its associated functions fail.

Unfortunately, Alzheimer’s disease is incurable and the treatments available can only slow the progression. Your wife appears to be in the last stages and, in my opinion, is no longer a candidate for treatment. The best thing you can do for your wife at this point is to place her in an assisted living facility or hire 24-hour nursing care for her. You may wish to start her on comfort only care. You also state that you believe that she understands what is going on and is simply unable to respond. However, with Alzheimer’s this is not the case. Patients’ memory and cognitive abilities often decline so much that they simply do not remember where they are, who is around them, and what is happening from one minute to the next. The prognosis is very grim and I am very sorry for you and every other family that has to go through this difficult process. However, research is on going and many breakthroughs have been made. I believe it is only a matter of time before the mechanisms of this disease are better understand and we learn ways to effectively diagnose, treat and even cure this horrendous condition.

DEAR READER:
Ativan is used to treat anxiety disorders. It is also unavailable in 100 mg tablets. At that dosage she would have to be taking 50 of the highest dosage pills (2 mg) every day. I highly doubt this is the situation. Perhaps she is taking 1 mg daily. This is something that you need to clarify in case of an emergency. Knowing proper prescription names, dosages, etc. is vital. The same holds true for her Zoloft.

Zoloft is prescribed for panic disorders and as an anti-depressant. It is available in 25, 50, and 100 mg tablets. A general initial dose would be 25 mg per day for the first week, with graduation to 50 mg following that. Periodic evaluation by a physician would determine a necessity for an increase in dosage. Therefore, your mother could certainly be (and in my opinion, most likely is) overmedicated.

Side effects from the two medications are similar. These include confusion, agitation, drowsiness, dizziness, balance/coordination problems, weakness, nausea, and changes in appetite. Ativan carries the very serious side effect of seizures and Zoloft may (usually during initial treatment) worsen depression and increase thoughts of suicide or bodily harm. Also of interest is that Zoloft can adversely interact with Ativan.

I believe now is the time to sit down with your mother’s physician and psychiatrist to explain what is going on and express your concerns that she is being over medicated. If they are unwilling to listen, perhaps it is also time to find a new psychiatrist who will re-evaluate her and hopefully reduce her medications.

To give you related information, I am sending you copies of my Health Reports “Medical Specialists” and “Mental and Emotional Illness”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 (per report) to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).