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Palliative treatment for BRAIN SRTOKE patient with bedsore.

Resolved Question:

Dear Doctor,
My father-in-law is aged 92 years.He had brain stroke 2 years old patientago and since then he is bed ridden.About 3 months ago he stopped taking food or fluids through mouth and hence a tube was inserted through nose and is fed through tube.He had developed bed sores. One neuro physician visits and takes care.Recently we have contacted one NGO organization in Hyderabad who specialize in pain and palliative care as he is complaining of pain.They have suggested some pain relieving patches/steroids.But our doctor says the patient may go in to coma and it will be very difficult to manage.

Kindly offer your comments on palliative care treatment and suggest how we should go further.



Category: Neurologist, Medical

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Category: Pediatric Neurologist
Dr. Sudhir Kumar is online now

Expert:  Dr. Sudhir Kumar replied 4 Days.

Thank you for posting your query.
I have noted the details of your father-in-law. I am pleased with the treatment approach taken by you and your family. He, at this old age, needs loving and compassionate care, and not high-end care in hospital. I applaud your efforts towards that.
Feeding can be continued via naso-gastric tube for a few months. However, we do not expect recovery in his swallowing function. So, a permanent method for feeding would be PEG (percutaneous endoscopic gastrostomy). This procedure involves making a small opening in stomach directly, to help in feeding. This procedure is done by gastro-enterologist.
He should be nursed in an alpha bed, to prevent bed sores. Also, his position on the bed should be changed frequently.
DVT stockings should be used in legs to prevent clotting of blood in leg veins.
For pain relief, medications such as amitriptyline or pregabalin may be used.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Patient replied :

Dear Doctor,
Thank you very much for your advise.I have a few more questions.
The pain and palliative care doctor has prescribed following patches/drugs for relieving the pain of the patient.
1.FEATANYL PATCH 25 Mg - Every 72 Hrs - 3 nos.
2.P.DIELOFENAE PATCH 100 Mg- Every Day
3.WHALYSLINE - 20 Mg -3 days; 10 Mg 3 days; 5 Mg 5 days
Our doctor says the patient may go into coma if we use patches/steroids mentioned above.
Please offer your comments.

Expert:  Dr. Sudhir Kumar replied 3 Days.

Thank you for getting back.
These medicines may cause drowsiness, however, coma is unlikely. In case of excessive drowsiness, the medicines may be stopped, and he would come back to normal in 1-2 days.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Dr. Sudhir Kumar
Category: Pediatric Neurologist
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
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