My maternal grandmother was diagnosed with what is suspected to be a recurrence of BRCA. She has a h/o radical mastectomy of the left breast followed by chemotherapy and radiation, in 1981.
This new tumour was detected on a mammogram, bx'd and came back positive for CA. Since my grandmother has not received a nuc med scan (she's scheduled for one tomorrow, Monday), we're not 100% sure that this is a primary and not a met from some other primary. I just received the news today b/c my mother wanted to keep it from me over the holidays--my mother had BRCA in 1994, my grandmother in 1981.
So, here's the thing. My grandmother is 80 years old, a retired RN, relatively healthy except for severe arthritis (requiring a cane and/or walker), some thrombophlebitis and her prior bout with BRCA. She was a nurse in the days when doctors were God, and my biggest concern for her post-op--she's scheduled for a mastectomy of the right breast on Wednesday--is that she will be in pain, either from the surgery itself or from her arthritis, and won't ask for pain meds. Her hip pain is so bad after prolonged bed rest that she literally screams in the morning--but won't even take a Tylenol.
Her doctor is a old-school guy, and is of the don't ask/don't tell school of pain management. He doesn't ask, and she wouldn't tell.
So, I have a telephone call scheduled with him tomorrow (I have healthcare POA). My question is, what pain med would you recommend in the hospital after surgery? I was thinking PCA or other IV route--so that my grandmother wouldn't have to ask, it would just be there for her when she woke up in PACU. Alternatively, I am thinking about asking for a Fentanyl patch for her, for the same reason--no asking required for pain control.
My grandmother has already decided to forgo chemotherapy and radiation--it nearly killed her the first time around, and then she watched it nearly kill her daughter. She doesn't have any interest in doing it again. Any suggestions for palliative type care would be appreciated.
Also, if anyone is in the Cape Girardeau, MO area, that's where she is...and where I will be very soon, courtesy of United Airlines. The surgery is Wednesday, and I'll be leaving Tuesday for St. Louis and Cape Girardeau.
I need to toddle off and cry now...thanks in advance, everyone.