Sunday, December 23, 2012

Jefferson Regional Drug Switch Trib Review Article and Implications

Reporter Luis Fabregas penned a terrific article in today's Tribune Review titled, "Answers on drug switch elude family."   In the article concerning Jefferson Regional's drug switch debacle, he focused on one of the patient's whom I am honored to represent, John Kolesar.  The story was told through his daughter and local City of Pittsburgh Police Officer, Nicole Kolesar.  What is not fully disclosed in the article is the extent to which all of the other patients I represent experienced the same crippling pain.  Each family I have spoken to has described the same eerily similar symptoms- indescribable pain that prompted each patient to exclaim that they would rather die than continue to struggle with the pain accompanied by an almost delirious state of mind.

Amazingly, we, the general public, have little appreciation for the detrimental physical and mental effects of  prolonged untreated pain.  Carolyn Middleton, BSc, RGN, a clinical nurse specialist, has put together a wonderful resource to help better understand the all encompassing damage caused by prolonged, untreated pain.  In her article "Understanding the physiological effects of unrelieved pain" she goes through a detailed explanation of how unrelieved changes the way our bodies operate.  Here are a couple of excerpts that I found particularly alarming:

"The cardiovascular system responds to the stress of unrelieved pain by increasing sympathetic nervous system activity which, in turn, increases heart rate, blood pressure and peripheral vascular resistance. As the workload and stress of the heart increase, owing to hypertension and tachycardia, the oxygen consumption of the myocardium also increases. When oxygen consumption is greater than oxygen supply, myocardial ischaemia and, potentially, myocardial infarction, occur."

"Unrelieved pain can result in a patient limiting the movement of the thoracic and abdominal muscles in a bid to reduce pain. This may cause some degree of respiratory dysfunction with secretions and sputum being retained because of a reluctance to cough. Atelectasis and pneumonia may follow (Macintyre and Ready, 2001). This pulmonary dysfunction, caused by painful excursion of the diaphragmatic muscles of the chest wall, is also associated with a reduction in vital lung capacity, increased inspiratory and expiratory pressures and reduced alveolar ventilation. The resulting hypoxia can cause cardiac complications, disorientation and confusion and delayed wound healing (Wood, 2003)."

This means that prolonged unrelieved pain can contribute to patients developing cardiovascular complications like heart attack and pulmonary disfunction contributing to life-threatening pneumonia.  Disturbingly, we know that a couple of people that passed away in the midst of the Jefferson Regional drug diversion fiasco developed pulmonary disfunction.  It is too early to know whether the drug diversion played any role in contributing to patient death but it is certainly something that will be explored.  I will write more about this in future posts.

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