--Apple-Mail-383EF7E1-FC50-4DCE-9F7D-775EBCC1E949 Content-Type: text/html; charset=utf-8 Content-Transfer-Encoding: quoted-printable Hello Paul, I will revie= w all the medication instructions with the caregivers. Thank you. Best, Maria = Maria Licoudis RN Client Success Manag= er = 514-= 907-5065 TheKey.ca On J= ul 27, 2023, at 10:16 PM, Paul Teitelbaum <pt@alumni.upenn.edu> wrote:= =EF=BB= =BF Maria, Sorry. The last em= ail got messed up. Trying again here with the full message . . . . I need to update you on the p= roper administration of my mother=E2=80=99s medications based on discussions= I had this week with Dr. Piche and with the pharmacist a couple of weeks ag= o. Basically, if this is f= ollowed properly and as my mother stabilizes at home and her body becomes ac= customed to the new pain medications, eating and drinking more (which is goo= d) and her body increasingly tolerates the side effects, her constipation (a= nd diarrhea from the laxatives that over time should be needed less) should s= ubside. This is exactly what happened to her the last 2 times she was hospit= alized (in October for kidney blockage and in November or December for Sepsi= s): hospitalization and change of medications and food -> weakness, const= ipation, side effects at home -> adaptation to medications and stabilizat= ion And if the regi= men below is followed, she should not need any subcutaneous medications unti= l she=E2=80=99s really at the end, and that is the time when we would get an= LPN involved. The hospit= al was not expecting that my mother would need subcutaneous administration o= f medications at this time. The only reason they put in the butterfly and se= nt the bag of infusers home was as a precaution and just to have another way= to give meds if oral couldn=E2=80=99t be given. But my mother is taking ora= ls meds. Also, it was exp= lained to us on Tuesday by Dr. Piche that the only benefit the butterfly pro= vides is somewhat faster action - 45-50 minutes for the pills vs 15 minutes f= or the subcutaneous. Not really such a huge time savings particularly if the= oral meds are managed properly, and really no advantage for Ativan for anxi= ety as explained below. P= lease relay this to the caregivers. 1) Pain management: - In addition to the fentanyl patches (1.5 patches) which replaces the= 4.5 mg long acting Dilaudid because the hospital started to have some compl= iance issue with the pills as my