As some of you are aware, my father in his second back-to-back rehab post hospitalization, the latter for 4 simultaneous infections. One of the conditions relates to his dysphagia. He's in a very good rehab center for the second time. I've been very pleased with the staff and consulting doctor. For the second time in this second rehab, I've met an NP with a rehab/physiatrist medical group, the same one I decided to boycott years ago after being told by one doctor somewhat bluntly that Dad is old, and he's going to have pain, and there's nothing to do but get used to it. I boycotted them as well after one of the doctors refused to script for TENS in PT I requested. I've had TENS therapy in PT; it works just as well if not better than anything for me in relieving pain.

In addition, I wrote on the intake papers that I won't allow any medical or personal information on me to be shared with any ACO. That caveat was neglected and an ACO contacted me. That did it. I don't return to or even consider a firm that can't follow basic instructions on privacy issues and release information to a for profit corporation making money off of my medical information and Medicare. Now, that firm is "treating" my father; it wasn't involved the first time, so this apparently is a new arrangement. Given that the therapists and the therapy director are top notch, I don't see what this firm is adding. This group is finding its way into what I considered a top notch rehab facility, and the NP is making decisions that I don't feel are either consistent with the facility's policy (nominal meds) or our own philosophy.

One of those decisions is to use a scopolamine patch on Dad's neck to decrease the secretions and/or counteract the thickness of the secretions and mucus. I did some quick research as soon as I got home and learned that scopolamine is countraindicated for someone who has glaucoma, which Dad does. It's unclear to me how she justifies this, given that that information was included in the Discharge Instructions from the hospital. So I called the evening shift nurse and asked her to hold the patch until I spoke with the rounding doctor.

I'm obviously unhappy about this, but also don't want to deprive Dad of something that might mitigate the effect of mucus in his dysphagia. But I'm still very uncomfortable with trying an entirely new treatment on a 99.5 year old man. So I'm wondering though if anyone else has any experience with the scopolamine patches for someone with dysphagia. Good, bad, reactions - I'm interested in it all.

Thanks for sharing your experiences.

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Another thing to do to help clear the mouth and throat of secretions is to roll the person on their side. This helps a lot.
Position a wedge at their back so they can not roll back. Place one leg over the other and bend the knee , this is more comfortable than having both legs on top of each other. Also prevents the pressure from one knee on the other leg.
Easiest way to figure out the best position is to lie on your side yourself, get comfortable then try to mimic the same positioning of each limb. (More difficult than it sounds.) I used a lot of pillows to cushion legs, arms, head, neck...
But to not hear that gurgle sound and when I finally saw him sleeping comfortably it was well worth the time it took to get him all tucked it.
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oh, GardenArtist, I'm so sorry; I well remember my dad's last fall, don't know what actually happened but he was so scraped; in many ways - and guess this is the peril of everything staying long distance - I wish could have been there to have prevented them going the cureall route and doing the wound therapy; it was so horribly painful for no good outcome, especially after he started turning black as well; so awful to see and contemplate, though he was on oxygen as well, but not really sure he did much desatting, but then, honestly, he wasn't doing much moving either; it took that hospital visit and that doctor, though, to even mention palliative care/hospice but that's where everything gets confusing; he was his assigned hospitalist but yet as long as we was in icu, which was another consequence of me not being there, he wasn't really in charge of dad's care, rather the icu docs were and the one - and I do love him dearly for how much he loved dad - just didn't want to let go; he still remembered him at his last visit when he was telling he was "fine, just fine"; took him a while to finally ask me how he'd really been doing since and come to accept he hadn't been the same person he'd last seen, to please just allow him to go; however, we did bring him home for that, but that may be a different situation for you - does his hospital have hospice there?
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I apologize for not answering earlier; things have changed quickly, and drastically, but I don't know if it's b/c of the patch. The NP's firm is off the case; I spoke with the DON and assistant, and reluctantly agreed to try the patch (recommended by the house doctor) b/c of the possible benefits.

However, Dad fell out of bed early Thurs. am. No one knows if the complications he's having now are from the fall or the patch. In the area he fell, it would be hard not to have hit either a chair or the oxygen concentrator.

Since Wed., he's now developed extreme weakness, more intense coughing, more sleeping, less eating, twitching of the extremities, deep throaty voice, and some abruptness with me. He can't stay awake for more than a few minutes.

The staff is concerned, as am I, and monitoring him closely. Labs and chest x-ray were ordered; doctor mentioned possibility of another bout of pneumonia.

Another ominous sign is that the stump of the former index finger (radial arm saw accident) has turned from purple on Wed. to black today. I asked about gangrene; nurse was unsure. Doctor said it could be from oxygen deprivation, another issue b/c even on 5 liters, he desats when he moves around.

He goes on Palliative Care tomorrow; some of the staff are already suggesting moving to Hospice Care. Either way, he unfortunately won't be coming home. (Stopped by his house tonight; what a strange sensation and sadness to know that he'll never return home.)

Doctor said perhaps a week, or less. I kind of expected that, but we'll see what the labs and x-ray show.

Thanks to everyone who answered. I will try to answer more individually, but things just changed so quickly, and I need to start making some arrangements. And I'm emotionally exhausted.
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Some of the side effects he had were disorientation, dry mouth,
confusion, hallucinations, difficulty urinating and rapid pulse. He is a very mild mannered dementia person in the late stages so these were not his norm and definitely not worth the benefit of the patch.
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like what kind of side effects?
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Bumping up
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They tried the patch on my friend whom I take care of in SN. He had every side effect in the book. I took it off the next day and refused to let them put another one on. All you can do is try it and if he has any side effects, take it off. Good luck!
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My husband had dysphagia. He didn't drool, though. We weren't offered any medicine to control dysphagia--I didn't know it could be controlled. He was just too weak. (Severe anemia and pneumonia and heart failure). The hospice nurse did say I should only offer him water in teaspoons at a time! That was so hard for both of us because his mouth was often dry and he loved drinking or sipping water. HOWEVER, he was too weak to swallow properly, so he would end up coughing a lot after he drank because the water went down the wrong way. I spoke to the nurse to ask her what was the risk of letting him drink. She said he would probably get pneumonia. We both agreed that was preferable to avoiding water. We chose quality of life over length of life. However, one suggestion did help. They advised thickening the water with a powder, "Thick-It." That worked like a charm. My husband could swallow pureed food or water the consistency of liquid jello. Maybe there are even physical exercises he could perform to improve his swallowing. I guess I'm advising to check into other methods of improving dysphagia besides scopolamine. Best wishes.
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Does your father have a hard time maintaining his ocular pressure? mother also has both glaucoma and these horrible thick secretions. Not sure if hers is from Her Parkinsons Meds or the disease itself. It is awful. Not just a light bothersome drool, its pretty bad. No one has ever suggested the scopolamine patch (yet) but we have been told it would be alright in the future since her pressures are consistantly low as long as that was checked during this type of treatment. ... Are they willing to do that? I doubt it.,
Since your Dad is so much older, I would worry too- Seems like they are so much more sensitive to drugs and side effects. Maybe they are thinking the comfort of those secretions is something they can control and seem to think it is more important than his pressures/vision at this point. Keep 'em on their toes. Remind them of his glaucoma. Seems like hospital and rehab stays are more work for us as caregivers!!!! I'm following this to see what happens! Also just curious- does your dad have Parkinsons? 
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When my Husband was on Hospice they prescribed Atropine 1% drops (orally) to help dry up secretions.
This is a common but off label use for Atropine.
I do not know if you could get a regular doctor to order it to see (no pun intended) if it works but if Hospice is involved they might be willing to order it.

I had, previous to the Atropine given him Benedryl.  He had always had allergies and the Benedryl worked well but it does make you sleepy and gives me a "foggy brain" I figured a foggy brain is the last thing a person with dementia needs so I discontinued the Benedryl and went with another allergy pill that was a "non drowsy" one but I do not think it did as good of a job drying up secretions.
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I can see why you'd be worried, given your previous experience with this organization.

How much longer is Dad likely to be at this rehab? Where will he go after that? I guess it would make a difference to me if he were leaving in a week or in a month.

My husband, Coy, was constantly drooling, clearing his throat, and spitting out fluid. He kept a plastic bowl spittoon with him constantly. This bothered him a lot. The hospice nurse suggested a "motion sickness patch" that had the side-effect of drying the mouth. She said it may actually cause too much dryness, but we could just stop it then. It don't know what this was, but from descriptions it was probably Scopolamine. We tried it. It worked a treat! Coy was much more comfortable without constantly spitting out fluid. Of course, he was on hospice and no one worried about possible withdrawal, or other side effects. If we noticed side effects, we'd stop. (Coy did have dysphagia, but I'm not sure the patch was suggested for that reason.)

My mother drooled a lot toward the end and I talked to the nursing home medical director about the possibility of trying such a patch for her. The director asked if the drooling was bothering my mother, or seeing it was bothering me. Well, she never seemed to notice. I guess it was more that it bothered me. She said they watch that the chin does not get sore, but otherwise they consider drooling a cosmetic problem. If it isn't bothering the patient they tend not to want to add another drug. I accepted that.

My suggestion is to try to keep your mind as open as you can, given your previous experience. Make a list of the questions you want to ask, and consider the answers carefully.

What I've read is not that scopolamine is necessarily contraindicated for someone who has glaucoma, but that it should be monitored carefully in that situation. I'd ask if the glaucoma has been taken into account, and why they think some risk there is justified by the dysphagia benefit. (Almost all treatment options are tradeoffs.)

Scopolamine is not a new treatment. Did you mean that it would be a new treatment for your dad? But if he has new symptoms or worsening symptoms, wouldn't you consider a well-established drug that is new to him?

The really disastrous thing you mention about this medical group is their disregard of your privacy rights. Did you report them? How did they defend themselves?

I borrowed a TENS unit from my son (who had it for therapy after an accident) and fully read the manual. I concluded that it would not be useful for the kind of pain I had. So, I think, denying someone a TENS unit could be a legitimate medical decision.

Poor patient communication is, unfortunately, fairly common.

But the privacy violation ... I can't think of any justification for that!

Try to establish a good relationship with this NP. You are both presumably working in your father's best interest. Don't make accusations, but do ask questions.
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