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#177695 02-22-2014 09:31 PM
Joined: Oct 2012
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missyp Offline OP
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My husband is awaiting a mandibulectomy in a week and a half. His pain has gotten steadily worse and the Dr. presribed a fentinoly patch and it wasn't working so the on call Dr. said he could use the lortab as needed for break through pain. Any advice is much appreciated to keep the pain at bay until surgery day


Caregiver to husband 53 SCC stage 3 soft palate 2011 Rad, recurrence tongue stage 4 2012 induction chemo, partial glossectomy surgery, cancer back left rad neck dissection 2013, more chemo, allergic to erbitux, cancer back 2014 floor of mouth and jaw, mandibulectomy scheduled 3/5/2014
missyp #177700 02-22-2014 11:08 PM
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I don't know what his dose is but I would mention to the doctor. If the fentanyl isn't working, I doubt the lortab will work. This is just my opinion and the doctor needs to address it.


SCC Stage IV, BOT, T2N2bM0
Cisplatin/5FU x 3, 40 days radiation
Diagnosis 07/21/03 tx completed 10/08/03
Post Radiation Lower Motor Neuron Syndrome 3/08.
Cervical Spinal Stenosis 01/11
Cervical Myelitis 09/12
Thoracic Paraplegia 10/12
Dysautonomia 11/12
Hospice care 09/12-01/13.
COPD 01/14
Intermittent CHF 6/15
Feeding tube NPO 03/16
VFI 12/2016
ORN 12/2017
Cardiac Event 06/2018
Bilateral VFI 01/2021
Thoracotomy Bilobectomy 01/2022
Bilateral VFI 05/2022
Total Laryngectomy 01/2023
missyp #177705 02-23-2014 07:54 AM
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Administrator, Director of Patient Support Services
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The fentanyl patch will take about 24 hours to work. Follow the directions EXACTLY! No long hot showers or baths. never EVER bend, cut, tear, or rip the patch. These things can cause the patch to release all the meds in a short period of time causing major issues.

Fentanyl is the strongest pain med there is. If it isnt working the dose can be increased, call the doc. If your husband is in severe pain I would guess he should be on about 75mg. I would also guess that he started on 25mg or maybe 50mg. This medicine needs the step up and step down approach.

Ive used the fentanyl patch and have gone from 25 which did nothing for me to 50 which helped for a while. It steadily increased as my pain did and for about 10 days I topped out at 150mg of fentanyl. This quickly went down to 50mg during about the next 6 weeks.

Lortab is a good breakthru medicine and its very commonly used. Plus it comes in liquid form which is easy to take. There are other pain meds available if this one doesnt help. First get the fentanyl at thew right dosage then the lortab should work great.

Keep at it! Its not beneficial at all for a patient to hurt. The pain your husband has, Ive been thru and it can be unbearable when it gets flared up. You are being a wonderful advocate for your husband! Keep up the good work smile


Christine
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07
-65 lbs in 2 mo, no caregvr
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo xtended hospital stay, ICU & burn unit
PICC line IV antibx 8 mo
10/4/10, 2/14/11 reconst surg
OC 3x in 3 years
very happy to be alive smile
missyp #177742 02-24-2014 07:21 PM
Joined: Oct 2012
Posts: 41
missyp Offline OP
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he's on 50 mg of fentanyl and now he has the lortab for break through pain. He was having the most pain on Sat. which is when he first used the patch, so I think it took that amount of time to release and get into his blood stream. He's much better now being able to use both. Thanks for the advice.


Caregiver to husband 53 SCC stage 3 soft palate 2011 Rad, recurrence tongue stage 4 2012 induction chemo, partial glossectomy surgery, cancer back left rad neck dissection 2013, more chemo, allergic to erbitux, cancer back 2014 floor of mouth and jaw, mandibulectomy scheduled 3/5/2014
missyp #177746 02-24-2014 07:48 PM
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Thats great! Glad to hear the patch is working and your husbands pain is being controlled. It does take a while to begin to work. Just make certain you put it in a new place every time its changed. Also change it right on time every 72 hours (if thats the one he was given). I used to mark my calendar to remember the time and date I should put on a new patch.


Christine
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07
-65 lbs in 2 mo, no caregvr
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo xtended hospital stay, ICU & burn unit
PICC line IV antibx 8 mo
10/4/10, 2/14/11 reconst surg
OC 3x in 3 years
very happy to be alive smile
missyp #177766 02-25-2014 05:30 AM
Joined: Jul 2012
Posts: 3,267
Likes: 1
Patient Advocate (old timer, 2000 posts)
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I used to put the date on the patch itself, and showered when it was the date to be changed. It's easy to lose tract of the time. Good luck.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs







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