Any medical professionals out there? (off-topic)

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I was going post this in the health, fitness and sports forum, but it seems pretty inactive. I have a few questions i'd like to ask one of you doctors or nurses out there (and I know some of you Wp-ers are one or other) in behalf of my grandfather. He just had Mohs surgery on his scalp to remove squamous cell carcinoma. The oncologist who performed the surgery told him to apply Polysporin everyday after his wife cleans the surgical site and replaces the bandages.

Unfortunately this is causing him an enormous amount of pain. He is 93 y/o and cannot tolerate any narcotic analgesics like Percocet or Vicodin. Thus far...he is only taking Tylenol for the pain and he CLAIMS it helps. The trouble is....it only "helps" after roughly two hours of agony and i'm not convinced that it's helping at all. After all....this subsidence of pain likely has much, if not everything, to do with the passage of time rather than the Tylenol. Whatever the case, he says the pain is nearly unbearable for around two hours after the aforementioned (and daily) procedures.

So basically i'm wondering why his doctor didn't recommend a topical analgesic. Would a topical antibiotic like Polysporin which also contains a local anesthetic like Lidocaine help with the pain AT ALL? For example...there's Polysporin for kids which contains Lidocaine, but it's only supposed to relieve the pain of minor cuts and scrapes. There is also Neosporin plus pain relief which contains the topical anesthetic pramoxine hydrochloride. I can only assume one of two things in regards to why his doctor didn't recommend some sort of topical analgesic (whether it's an topical antibiotic integrated with an analgesic like the two I mentioned or not). That is....either none of these topical analgesics are strong to provide him with any substantial pain relief (as this Mohs surgery went quite deep into his scalp and can hardly be called a "minor cut or scrape") or there may be some complications associated with applying them in his case. The former seems far more likely to me than the latter, but then again, i'm not a doctor or a nurse and I can't be certain.

If the latter is not a factor and the former is....IS there ANY topical analgesic (again...whether it's integrated into a topical antibiotic like polysporin or not) he could use which would be strong enough to provide him some significant relief from the pain? If so....I would think the Dr. would've told him so, but you never know when it comes to doctors. There are many important things they have failed to tell me which I had to figure out on my own. Needless to say....I told him to CALL THE DR. AND ASK, (at 93...such things just don't seem to readily occur to him even though he does not have Alzheimer's or any other form of dementia) but this Dr. is apparently exceptionally difficult to get ahold of. I told him he could also talk to a pharmacist or a nurse practitioner at Walgreens or something, but whether he'll follow through with that or not is another question. I have trouble talking to people in person or over the phone about such things, so i'd be the wrong person to speak to a pharmacist on his behalf. His wife could do it, but he won't let her as he doesn't (unjustifiably..but he's a stubborn old man set in his ways and can't be reasoned with) her judgement. He gets very moody and will simply neglect things like this. Thus...i'm tempted to wash my hands of the whole matter since he seems so reluctant to help himself. Still....he IS 93 and while he is not significantly cognitively impaired, his behavior has become quite childish and I don't think he can help it.

Anyway.....I would appreciate any advice about all this from those with medical knowledge.

Thanks in advance

It's hard for me to offer much of an opinion, since I don't know your grandfather's medical history. Lidocaine is contraindicated in a few circumstances, particularly those related to cardiovascular conditions. These would have to be ruled out.

I would recommend your grandfather speaking to his family doctor. This pain seems to me to be only collaterally related to the surgery, and so the GP should be in a position to prescribe a more effective control without the need to go back to the oncologist. If there is a post-operative contraindication to the use of lidocaine, then his family doctor is likely to be able to get in touch with the oncologist fairly readily.

The other advantage of speaking with the GP is that the GP can prescribe prepartions of lidocaine (or another topical anesthetic) that are not available over-the-counter and are likely to be more effective than the mild preparations that are used for minor irritations..

However, if your grandfather refuses to speak to his doctor about this, then there may be nothing that anyone can do.

I'm going to be a vet.

visagrunt wrote

He does have a heart murmur and hypothyroidism (he has been taking armour thyroid for years) so i'm not CERTAIN if Lidocaine would contraindicated for either or both. AFAIK, lidocaine is not contraindicated for either condition though. I don't know anything in regards to the classification/grading of his particular murmur, but i'm pretty sure topical (at least) lidocaine wouldn't be a problem for him. Aside from these conditions and the squamous cell carcinoma, he's in pretty good health for a 93y/o man. This is somewhat remarkable considering the man has never done any serious physical exercise a day in his life and it's not as if his diet is ideal either. In spite of his hypothyroidism, he's been slightly below his ideal body weight for much of his life. I doubt he would have squamous cell carcinoma on his head either if he would've protected himself while golfing in Florida every year. He was almost entirely bald by his mid-thirties and now he's paying for years of exposure to the subtropical Florida sun. Little was known about the harmful effects of UV rays in 1955 though, so he can certainly be forgiven for that.




That's probably the best idea...I just told him to get ahold of the oncologist directly. Again...he is already applying polysporin to the site everyday, so I thought that maybe polysporin for kids or neosporin with pramoxine hydrochloride might be an option for him. I suppose there could be a post-operative contraindication to the use of lidocaine in his case, but I obviously don't have the expertise to know much about that. In any case...he said he would try to contact the oncologist today and i'll call him later to find out if he got in touch with him.




That's exactly what I was thinking. It doesn't seem like most of these OTC topical anesthetics would be strong enough for this. They may provide some relief, but I don't know how significant said relief would be.





He will call, he just procrastinates with things like this if something happens (and it doesn't take much) to set him off and put him in a bad mood. I'll call him later and tell him to contact his GP if he hasn't spoken to the oncologist about all this already.

Thanks for your advice!! !

Hypothyroidism, especially treated, is not a problem. I don't know what's causing the heart murmur and depending on what that is (and his family doc would know if it's been investigated) may or may not be a problem with lidocaine or another local anesthetic agent should it enter the bloodstream through an open wound. I'd talk to the family doctor and see what would be safe to use...no need to suffer.

~Kate

Sounds like you have gotten good advice regarding topicals and contraindications etc.
I'm wondering about the cleansing and dressing process itself i.e. what your grandmother is using to cleanse the area and if this might be a factor i.e. stinging, also amount of pressure to cleanse the area - not much needed. Wondering if dressings are sticking or she is using non-stick dressings over the area, any special materials. All these can contribute to post cleansing/dressing discomfort.
Hope things are better soon.

I didn't think it would be, but it turns out he's allergic to lidocaine in the first place. His oncologist TOLD HIM THIS after performing the Mohs surgery. They used lidocaine as a local anesthetic during the procedure and apparently he had a bad reaction to it. For some reason, it didn't occur to him to tell me this last night when I told him a topical anesthetic like polysporin with lidocaine might be helpful for him. Oh well....he is 93 and while he doesn't have any form of dementia, his memory probably isn't what it used to be and I guess he just forgot that the oncologist told him he's allergic to lidocaine. I told him he might want to ask about topical anesthetic which doesn't contain lidocaine (such as neosporin with pramoxine hydrochloride), but apparently he had little pain today when (or after) his wife cleaned/dressed the area. Anyway...I guess he's ok now and I just told him to contact his GP or the oncologist if the pain becomes unbearable again. Perhaps they can recommend an OTC topical anesthetic which doesn't contain lidocaine or prescribe him one if he needs something stronger.

Thanks for your advice!

I asked him about all this and he said she cleans it very gently using ivory soap. He also told me she doesn't apply much pressure when cleansing the area and she is using non-stick dressings. He claims there was little pain today, so I suppose he's alright now. He is just going to continue taking tylenol after she cleans/dresses the site. I told him to contact either his GP or the oncologist himself if the pain becomes intolerable again. Perhaps they can recommend/prescribe a topical anesthetic which doesn't contain lidocaine since it turns out he's allergic to lidocaine.

Thanks for your advice!

Another possibility is that he was having some ongoing allergic reactions to the initial use of lidocaine (like hives) and that with their abatement, the cleaning and redressing has been less irritating.