Please help. Just found this on my dad's back.

[sprigatito]

My dad's partner died of cancer a few days ago, he and I were with her when she died, and I've brought him home with me until the funeral (and probably permanently). He's got Alzheimer's and his partner was his carer. He's been looking pained and twisting his shoulder, he said it's just a spot, but I made him show me his back and found this. It looks just like the squamous cell carcinoma he's had removed before, only it's enormous. He's lost weight and is pale and more vague and breathless than usual, but I thought it was just grief

This is really fucking bad, isn't it? He survived stage 4 lymphoma in 2017 and has a heart condition. I have a doctor calling me back from 111, but should I just take him to A&E?

A low dose of codeine might help, but if he's having breathing difficulties they might not want to give that. Voltarol is a NSAID like ibuprofen, but more potent, so I don't think they'll give that instead of ibuprofen. There will be something they can give though so don't let them fob you off.

They prescribed him codeine phosphate in A&E, but then I got a phone call from the consultant saying not to give it to him because of his kidney disease which has taken a sudden turn for the worse, it showed up in the recent blood tests (egfr is 34). He also has an abdominal aortic aneurysm.

I kind of hate to say this, but given his dementia and general state of health, and possible prognosis, I wouldn't worry about which pain killers to give him.

Just give him whatever keeps him pain free.

This is terrible, he needs analgesia and tbh ive no idea why the Dr would say don't give codeine but then didn't offer an alternative. I believe codeine can be used cautiously with renal impairment.

I know you've been back and forth but ring the GPs Mon get a proper wound review and don't leave without a prescription for strong painkillers. Good luck. Honestly his aftercare has been seriously lacking.

Oh sorry, I forgot you mentioned that before. It does depend on the dose though. Some opioids are relatively safe for patients with CKD. The lower the better obviously and for as short a period of time as possible. Ask about tramadol.

Ask for a low does (15mg) codeine at a reduced frequently.

I'd also ask for his renal function to be repeated along with a full blood count.

I agree that keeping him comfortable is more important than anything else. Poor guy. That absolutely sucks.

OP do you think he needs to be admitted to hospital?

He sounds fragile and in a lot of pain.

I can’t believe the NHS can’t help more.

When are you next talking to a doctor and also getting chest x-ray.

So sorry for all of this that you’re going through. It’s so very hard I know 💔

I'd love him to be admitted if it meant he would get pain relief, good nutrition, restful sleep and a bit of TLC, but I think the chances of that are quite slim unfortunately (every HCP we deal with is brilliant, but the conditions for them and for patients are just terrible).

He's actually booked in to have the stitches out tomorrow but I'm going to cancel that, as the A&E team in Stoke said to phone the dermatologist here and try to get him seen tomorrow. I did manage to confirm last week that the urgent referral for chest x ray had gone through, I was hoping to come home to an appointment letter for that but it's not here yet. He has an ECG on Thursday, then a GP appointment in 3 weeks to talk about the repeat blood tests and hopefully the histology on the tumour will be back by then as well. He also needs the other lesion on his face removed, and a biopsy on the smaller one on his back.

'I did manage to confirm last week that the urgent referral for chest x ray had gone through'

May be different where you are but here once a cxr has been requested it is up to us to ring our local dep and book an appointment . As I say may be different but I'd hate for you to be waiting for a letter if someone hasn't told you to ring and book.

Oh god, really?! I was definitely told to wait for a letter, but it's entirely possible I've been given duff information again. Thanks Janiie, I'll ring and chase that up tomorrow.

Different GPs do it differently I just know my df was waiting for a letter to be told snippily that it was up to him to ring his local xray so you never know. Tbh if you did ring directly they might slot you in. I just pitch up at ours and they do it there and then if not busy. Not recommending that obviously with your df's current problems.

Sadly, although this sounds like a good idea, I am quite sure that the NHS is no longer capable of this.

Even in the 1970s, when I trained as a nurse, dealing with pain, and giving good nursing care was starting to be a bit hit and miss.

Nowadays, the NHS is just not able to support elderly people who need rest and care, and pain relief.

The best team to help someone like the OP's father would either be palliative care, or hospice nurses and doctors.

This gentleman's care is not "joined up" in any sense. There are various hospital doctors, the GP, the practice nurse......... and none of them communicate properly with the others.

This might be a hard read but it's well worth getting in touch with your local hospice - I know people think hospice means dying but it also means better pain choices with a consultant that understands managing pain & other side effects related to cancer. For example managing his breathless better. They also offer respite care which might be of benefit at some point.

That’s a really good idea. It’s hard to do this but it’s better to be ahead and have access to everything that’s on often earlier rather than later. They could be better placed to meet his needs at this point. Also just to get the lie of the land. Good luck OP for tomorrow morning. Thinking of you.

@sprigatito chest xrays at Stafford are done as walk-ins, not sure if Stoke is the same though.

def worth calling the imaging dept and asking.

DH and I both up vomiting...mine was so violent I wet myself, never had anything like it. Really hope Dad doesn't catch it...and he is supposed to be seen urgently by dermatology today, not sure how I am going to make that happen

Oh no, what a nightmare. Do you have a friend/neighbour who could take him?

Oh no! Is there anyone, who can take him?

If you phone the clinic they might be able to arrange an ambulance for transport, or a volunteer driver, phone from 0800 there should be staff in.

Could your son or your kind friend with the van take him ?
I know these might seem unlikely but I'm mentioning because you mustn't be put off asking anyone and everyone.

So sorry you're unwell op, as a pp said ask your 20yr old son to take him if he's fully recovered, he'll be able to manage taking grandad to hospital?

Or any relative tbh, people want to help in situations like this you just need to ask. You've done such a brilliant job of managing everything but it is absolutely ok to ask for practical assistance. Hope you feel better soon.

Oh bless you, what a nightmare

I'm sorry you are all having such a rubbish time. It really is one thing after another isn't it?

That eGFR is very low, do you get the impression medical professionals have given up?
I only ask because it is definitely that way with my own father. Twice in the last couple of years he's come out of hospital with Do Not Resuscitate orders completed for him saying that he is not capable of making the decision himself. Annoyingly this is due to delirium caused by infections rather than anything long lasting.

Cancer or not, are you at the point of having to talk about palliative care?

I hope you managed to get your dad to his appointment and are all okay, OP.