Topic: Help. Lots of pain- beginning of end?

Hi. My mother is in extreme pain for the last week, and it is hard to tell what is caused by the cancer and what is associated with all the meds she's on.
A brief history: my mom was diagnosed as CC (specifically gallbladder cancer, but it is apparently very similar to bileduct, and that is where her initial large tumour was) stage IV in april 2012, went through 4 months of chemo, then abandoned it as it stopped being effective. In November she was told she probably had 4-7 months, but that she could travel if she felt up to it. As I'm in the uk and she was in Israel, we planned for her to come for the holiday season. She travelled a week ago, but hasn't left her bed since she arrived. Her pain levels were increasing a bit back home, and she has lots of meds (mostly codeine based) to control it; but since arriving here she has had to double or triple some doses, and even then it doesnt seem to make much of an impact.
I have seen some discussions here about constipation, and I do think this is playing a role. Her tummy is distended. She is on laxatives although they are not helping much, and I think she can probably shift to taking them more often. She is barely eating and we are struggling to get much fluid in her, so it is hard to know how much we should expect her to 'go'. Similarly she has lots of gas, and she is also taking something for that (simeticone).
What I wish I knew is how much of her current (constant as well as intermittent sharp) pains are to do with cancer and how much are result of constipation? And if she is in as much pain as this, does it signal the beginning of an end? Is this one of the signs?
I have already been in touch with her GP (=family doctor) back home who is monitoring her day to day, and he recommended tweaking some of her meds. That helped a little although now it seems not to be working. If she has a severe obstruction issue, is this something that requires hospitalisation to sort out? Shall I try bombarding her with laxatives first?
Any advice would be much appreciated.
Thanks
Dina

Re: Help. Lots of pain- beginning of end?

Dina, I am so sorry to hear all of this. The best suggestion I can give you is to take her to the hospital. No matter what the problem may be they will be best to handle it. Not sure if ER operates as ours does here in the U>S>A> but would get her in. Perhaps her Doctor at home can pave the way?

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Help. Lots of pain- beginning of end?

Dear Dina,

I'm so sorry to hear about this. Obviously we are not medical professionals, but I agree with Lainy. With this sharp increase in pain, distended stomach, and severe constipation, I'd take her to the hospital. Given her symptoms, they might do a complete GI work up to rule out anything like an obstruction or pancreatitis. At the very least it seems like she needs to be evaluated.

I hope they can get her feeling better. Please keep us posted.

Mark

Re: Help. Lots of pain- beginning of end?

Hi mark and Lainy
Thanks for your replies. I did take her to the hospital, and after 30 hours, 2 X-rays and a ct scan, they've turned around and said there is nothing they can do. They have explained that her very distended abdomen is caused by fluids which are the result of lesions in the small intestines. Additionally there are lesions throughout the peritoneal cavity. I only got a brief resume from the doctor about it, and am going to get the complete picture tomorrow morning. But he said if they drain the fluid it will only come back tomorrow, and they might introduce an infection. she was in so much misery when I brought her into the hospital (by ambulance) that the idea of bringing her back home in no better state, and then finding a way to fly her back to Israel, is daunting to say the least. I was so hoping they could at least relieve her immediate pain and discomfort.

Is this kind of end a common one? I mean the horrible bowel problems and the pain and the obstruction and the distension? Is there anything palliative that we can do for her? How urgent is it for me to get her back home?

I realise this is clearly the beginning of the end, but if others have had the misfortune to see this kind of ending, it would be useful for me to know what the next few weeks have in store.

Thanks
Dina

Re: Help. Lots of pain- beginning of end?

Dear Dina, I am so sorry to hear this news about you Mother. I  know this is so cliche but everyone is  so different. Perhaps you will have a better picture tomorrow. Do you feel that she can make that flight to Israel? Looking forward to more insight tomorrow. Sending tons of hugs a wishing you the best.

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Help. Lots of pain- beginning of end?

Hi Dinawest,
     I'm so sorry to hear of your Mom's pain.  My husband seems to be in the same boat with the exception of the constipation, which he does not have a problem with.  He has been having 5-6 liters of fluid aspirated from his abdomen (paracentesis) every week for about 6 weeks now and it does help.  The doctors don't recommend a drain placement due to infection concerns.  Eating is always a challenge, but he's not lost too much weight at this point.  I hope the doctors can give your Mom some relief soon and get her back to her home.
                                              Dianne

Re: Help. Lots of pain- beginning of end?

Dina......I would not take her home unless the pain has been brought under control and the constipation has resolved.  In re: to the fluid retention I would make sure to obtain a second opinion. Dina, have you mentioned to the physicians that your Mom wants to return to Israel?
Please, keep us posted.
Hugs,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Help. Lots of pain- beginning of end?

Hi
Dianne I am sorry to hear about your husband. It is interesting that his doctors drain him, since the doc here said they wouldn't - I will definitely mention the paracentesis when I see him today. But i think that the health system here tends to be less interventionist than in the states. perhaps I can push for having it done at least once so she is more comfortable for the journey home.
Marion I agree it seems daft to let her out no better than she got in. I have told them about her being from abroad, and they seemed to suggest that we should make that trip as soon as possible.
I hope I will be wiser after I meet with the doctor. Thanks for your responses they are really helpful.
Dina