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End Stage Pain And Symptom Management

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End Stage Pain And Symptom Management

Postby Cathyann » Mon Jan 31, 2011 2:25 am

I posted 3 weeks ago about my younger sisters 2 yr battle with colon cancer. She is in the end stages of this disease and symptoms are becoming hard to manage. She has a fentanyl patch, Oxycodone and morphine for break through pain. She can drink liquids but no solid foods because they cause pain and she also throws it up. Another big problem seem to be that the medicine is upsetting her stomach because it is empty and the advanced cancer is taking up more and more room. Often she is throwing up her meds. She is on a prescription strength antacid and anti nausea drugs but is not really wanting to take any meds because of the adverse effects. We do have a wonderful hospice nurse but just wondering if anyone had any ideas or diet recommendations that worked for them or their loved one.
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Re: END STAGE PAIN AND SYMPTOM MANAGEMENT

Postby Kathleen808 » Mon Jan 31, 2011 3:09 am

Cathyann,
I don't have any information about how to make your sister more comfortable at this point. I just want to say I am sorry that she is in pain. I hope and pray she can get some relief and all of you can get some peace.
There are others here who have been down the difficult path you are on with your sister. They may be able to contribute.

Aloha,
Kathleen
Kathleen
DH 1/09 3c 51yr cln rsct
Folfx 3/09
1 l node 9/09 Flfri Avstn
surgery 5 nodes +
PET clear 6/10
Folfri Avstn 7/10
NED 10/10
1/11 lng mets Flfri Avastn
NED 2/12
9/12 cont Flfri Avastn
10/12 grwth lng mets Erbtx Avstn Irintcn
1/13 stabl
9/13 grwth
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Re: END STAGE PAIN AND SYMPTOM MANAGEMENT

Postby Terry » Mon Jan 31, 2011 4:38 am

I don't know which state you live in and what the rules are there. See if the hospice nurse can give her the pain meds for breakthru pain rectally. I believe some can be given either way. She may have to get a new prescription because they may come in a different form. Are you allowed to have a pain pump at home in the state you live in? That would probably give her the best relief. In this case if she's able to right now she can push the button herself. At some point it can be changed over to give her the amount automatically. She could then go on Dilaudid for pain and the reglan has an I.V. form that could be used also. As far as eating, you could try small bites of crackers but she most likely isn't going to eat. What has she decided out hydration at end of life? If she wants it I.V. fluids could be put in and if she doesn't they don't need to be used. Ativan for anxiety can also be given interveniously.

I'm sorry your going through this. I don't remember how old your sister is exactly but I believe it's to young:( Your being a wonderful sister helping her through this time. It's something that you won't look back on fondly but in a way that I'm sure is bringing you even closer together.

I hope this helps. You, your sister and her family are in my prayers.
DX 7/3/07
Chemo, radiation, 20 mo. chemo, IMRT, cyberknife, 6/11 lobectomy.
1/16 resection perm. colostomy intraop. rad.
PET 2/12 nose, thyroid, liver, lngs
Folfox 3/12
Lord I know You'll keep me here until
you know I cannot suffer any longer!
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Re: END STAGE PAIN AND SYMPTOM MANAGEMENT

Postby disco nap » Mon Jan 31, 2011 6:37 am

Anything dairy works for me. also, those Ensure/Boost type drinks. If she's lactose intolerant then Soy, Almond or Rice milk. They coat thc lining of thc stomach.
DX July 2 '10 CC Stage IIIC, 11/18 nodes+
Right Hemi July 6 '10
Folfox: Aug 17'10 - Feb 17'11
Mar 13 '12: Lynch Syndrome MLH1
"Declared well" and been well ever since.
Update: CT scan April 25 2014: clean. Or maybe not!
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Re: END STAGE PAIN AND SYMPTOM MANAGEMENT

Postby LLVV » Mon Jan 31, 2011 10:55 am

I just went through this with my dad.

Before he was admitted into the hospice he told me that he had started throwing up his pain medications. My mom said that it was due to him taking the pain medications on an empty stomach. At that point his appetite had been decreasing but he was still able to eat solids. He found that drinking a glass of milk with his pain medications helped with the vomiting issue and it also helped with his increasing heartburn. I think his heartburn was from his growing lung tumors but I am not sure. He thought it was from all of the medications he was on.

His pain issue never truly resolved. Near the end it was hard for him to judge how much pain he truly had as he was getting confused and couldn't really answer the question. It was only when he was screaming in pain that his doctors knew he needed more medication.

Prior to his death he was on: methadone for long term pain medication and dilaudid for breakthrough pain medication. His new oncologist played around with the idea of giving him Celebrex for inflammation (it also has anti-cancer properties) and a muscle relaxer that started with a "t". He didn't like the muscle relaxer as it really made him loopy. Up to the time that he became unsconscious, he was getting some of these medications orally. I think the dilaudid eventually was given intravenously as it was more effective that way. It was administered through his port IV. This made him very sleepy. The fentanyl patch did nothing for his pain. Vicodin and Percocet were jokes for his pain.

Near the end (he was in a lot of pain and very agitated) all oral medications were stopped because they had to give him morphine intraveneously and Ativan at times to calm him down. This sedated him and eventually rendered him unconscious so I don't think this type of pain medication application is done until the patient is near the very end because it can cause a very ill patient to become unconscious. In terms of pain management it is very effective but the patient and his/her family pay a very high price for this pain relief.

Try talking with her hospice nurse. Sometimes the pain meds and their doses need to be played around with until the right combination is found. Hospice is usually very good at doing this while trying to allow the patient to be as alert as possible especially if the patient is put on hospice care before they get too ill. You may also wish to talk with your sister about her wishes for pain relief as the end gets closer. I feel so guilty that my dad was rendered unconscious and then put into hospice. We didn't get a chance to say good-bye while he was alert. I really hate that this happened but at the time we didn't have any other choice because my dad waited too long to get hospice care. He never made any final arrangements. He didn't get to say good-bye. He didn't even know he was getting hospice care. His conscious state was gone in the blink of an eye. To bring him out of sedation would of caused him immense suffering which is why we didn't do this. As hard as these conversations are to have, it's better to have them before it's too late.

This is an extremely difficult situation to be in. The best thing you can do is to communicate openly with her hospice nurse. Tell your sister you love her. Be around her as much as possible. Spoil her. Let her know that you will not let anything horrible happen to her and that everyone will be ok. Make sure that she has an awesome hospice care team. Make sure she lets you know what her wishes are.
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Re: END STAGE PAIN AND SYMPTOM MANAGEMENT

Postby RixInPhx » Mon Jan 31, 2011 12:39 pm

If medical marijuana is an option in your state, it can be provided via vaporizer.
I don't know how effective it would be for severe pain.
M 61, Dx 6/10 CRC st 4, unknown primary CEA 843
2 kg peritoneal mass, met to skull; no surgery
Various regimens of all CRC chemo drugs
Mets to lung 8/11 CEA 135
Folfiri/Erb/Ava 12/11 CEA 320
No progression 5/12 CEA 192
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Re: END STAGE PAIN AND SYMPTOM MANAGEMENT

Postby catwraa@msn.com » Wed Feb 02, 2011 12:45 am

has the nurse suggested sublingual morphine?
I am sorry you are going through such a rough road.
My prayers are with you.
Last edited by catwraa@msn.com on Wed Feb 02, 2011 12:14 pm, edited 3 times in total.
wife of husband age 38
who was dx with stage2a low grade CC sigmoid
T3;N0;M0
surgery Sept 29,2010
CEA's hovering under 5
01/11PET Scan needed-clear
01/11balloon dilation for sticture
03/11colonoscopy-clear;CEA 3.5
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Re: END STAGE PAIN AND SYMPTOM MANAGEMENT

Postby Terry » Wed Feb 02, 2011 1:09 am

I just wanted to check in and see how you and your sister are doing? This has to be such a hard time for you all.
DX 7/3/07
Chemo, radiation, 20 mo. chemo, IMRT, cyberknife, 6/11 lobectomy.
1/16 resection perm. colostomy intraop. rad.
PET 2/12 nose, thyroid, liver, lngs
Folfox 3/12
Lord I know You'll keep me here until
you know I cannot suffer any longer!
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Re: END STAGE PAIN AND SYMPTOM MANAGEMENT

Postby nurtrk18 » Wed Feb 02, 2011 10:57 pm

I am so sorry to hear about your sister's struggles. My father was on hopice in June with gastric cancer. He was unable to tolerate anything orally, so we switched him to liquid Morphine, which was extremely concentrated (so a tiny amount went a long way). We were also giving him IV fluids to provide him with a little energy. He was also taking sublingual zofran and IV phenergan for nausea. We tried several medications for reflux and Nexium worked wonders for him. I can't say that he was 100% comfortable, but we did the best that we could for him. He was also on a fentanyl patch. There are other medications for nausea, which are really expensive, but are way better than Phenergan, Zofran etc. One medication is called Kytril.

My sister also has Stage IV colorectal cancer. She suffers from severe pain as well. He pain management physician just put her on a medication called Fentora. It is fentanyl, but she puts in in the side of her cheek. She utilizes it for breakthrough and severe pain. She tried the fentanyl patch, but this didn't seem to work well for her. I hope this helps. I will pray for your sister and your family.

Tammy
Sister - dx with Stage III signet cell CRC in 04/10 @ age 29
07/10 - completed 5 weeks of radiation & 5FU
10/10 - attempted tumor removal but found mets to
PC and omentum - now Stage IV
10/10 - started Folfox & Avastin
05/11 - possible HIPEC
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Re: END STAGE PAIN AND SYMPTOM MANAGEMENT

Postby hospicenurse28 » Sun Mar 03, 2013 10:49 am

Hi to all. I am a hospice nurse who is currently taking care of a pt who has had severe pain due to colorectal cancer. Currently we have his pain managed with an epidural infusion of bupivacaine and hydromorphone via cad prism pump. Also, his port is accessed and has has hydromorphone 1mg/ml concentration running via cad prism pump with the basal rate (continous rate) at 0.3mg/hr and 0.5mg every 10 mins prn (prn is as needed, he controls this amount). He takes a GI cocktail every 4-5 hours along with simethicone. Ativan is helping him relax and sleep at night. I'm sorry that some of this may sound jibberish but ask your hospice nurse about this treatment. She/he should be able to sort it out. If she/he can't ask the oncologist or the hospice medical director. It may be a treatment they have not heard of. I have been a hospice nurse for 4 years and this is my 1st epidural for pain management. Hope this helps! Take care!
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