Rachael attended S Hospice for her appointment with Dr P. Rachael and Dr P discussed how she is feeling at present. They reviewed the feed situation, Rachael said that the bolus feed did not help her as she felt wretched and bloated all day after only 15ml. She does not want to use this any more.
Rachael then told Dr P that she has bad stomach pain and constipation. He suggested that she could try using Movicol again as this will soften the stool, it will take a while to work. He recommended that she takes four sachets a day to begin with and then to take less as it begins to work. Rachael can increase the amount taken when necessary. Rachael agreed to this.
Every time Rachael uses the nebuliser she coughs all day. Dr P recommended reducing Salbutamol to 2.5mg and to use less frequently. It is less frightening for Rachael when we can suction well, skills vary with the suctioning.
Rachael told Dr P that her feelings of anxiety and her bleak thoughts are getting worse. Dr P asked her how often she uses Lorazepam. Rachael said that it is different from the blind panic that she uses Lorazepam for. Rachael said that she can be easily distracted, 'power of Disney' helps. Dr P then suggested taking a regular anti depressant/anti anxiety drug. Rachael said that she was worried about possible side effects. Dr P recommended starting on a small dose of Citalopram drops once a day through her rig and to increase the dose if tolerated. Rachael has used this before, it was stopped by her GP due to stomach problems. She will start again when her stomach feels better.
Another appointment was made for six weeks time.