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Medical Forum / Diseases and Disorders / Cancer / September 2004Chronic psin Management????
Hi Folks, its me back again with a few questions about this girls next consultation with her specialist......I am a few posts back ranting about a person who has severe pain after extensive abdominal surgery for cancer of the bile duct. The person is finally being reclled for a consultation....she is currently an a drug called DS118 every 4 hrs along with 2 Panadol......she is assured that the pain is not cancer related, and she is clear of cancer. ata he side effects are mainly severe constipation which is making life very difficult. What I am helping her to do is draw up a list of questions for this next consultation which she can present to the specialist.....eg what is the short term/long term prognosis on this condition....what is the cause, what is the cure if any. I know this is an awkward one to answere but If you guys can think of any questions which she should ask, i would appreciate yer input. TIA John > Hi Folks, > its me back again with a few questions about this girls next [quoted text clipped - 14 lines] > I know this is an awkward one to answere but If you guys can think of any > questions which she should ask, i would appreciate yer input. TIA John Hi John, In an ideal world: 1) you would have answered the questions that I posed to you earlier. Go back up the threads and see if you can find the post? 2) somebody would tell me what DS118 is (because I've searched it and cannot find a blessed thing that relates to that). 3) you would have a pharmaceutical pamphlet about it, in which it gives other names (that might be familiar to me). 4) Your friend would be seen by an internist or generalist and would work through (#1 above) and some of the items here (to rule some out) http://www.postgradmed.com/issues/1999/09_99/debanto.htm Maybe Mike R can comment about the meds. I assume it's some type of opoid http://www.cancer-pain.org/treatments/treatments.html There's tips there about drinking water and eating foods with fibre. There's 4 or 5 types of meds to help with constipation. I just posted a post about that. Let's see what others have to offer. Since they're saying that it's non-cancer related, you may eventually wish to post to news:alt.support.chronic-pain there's significant problem posters there. I hope if you do, you'll read a bit first, figure out who is who and try to avoid the trouble-makers. Best I can do, right now. J Hi J, Thanks for the reply, I have all those replies on my HD, is it the following questions you refer to:- Age?.........................................40 Is she up and around?...............yes but fatigued Is she eating?............................a little/about 20% of normal What helps the pain?..................DS118 Is the pain constant or only on movement?........constant Have they ruled out pancreatitis? ............nothing has been ruled in or out yet I believe that CT scan can see shadows (indicating inflammation) Is she still on some type(s) of antibiotic?...........no Are they monitoring her temperature?...............no, she has been discharged. Any details you can think of.............................pain moved to stomach initially but subsequently seems to be in lumbar region. I'll watch for your updates, I guess may attend with her and ask a few questions about what they have concluded in terms of cause, also what shortterm/longterm treatment prognosis might be. Her biggest concern after the possibility of a return of the cancer is the risk of having to endure longterm pain or longterm drug treatment. John "J> Hi John, > In an ideal world: > 1) you would have answered the questions that I posed to you earlier. Go [quoted text clipped - 30 lines] > Best I can do, right now. > J Glad to hear they think she is cancer free. Is your friend drinking any alcohol in hopes of dulling the pain? Has she asked/tried any methods to relieve the supposed constipation? Constipation can be very painful if it is extreme and eating 20% of what she eats normally would fall into place. All pain should be treat appropriately. Is she reporting the pain to the doctor? I can't tell you how many times people will complain to their family's yet when asked by the doctor they say everything is fine. Never heard of DS118 does it have another name? Is she keeping a pain diary....on a scale of 0-10 the level of her pain. Is she going to make an appoitment with a pain clinic. Hi again, she has never drank and does not now.....it only makes her feel even more unwell. "supposed constipation".....that term worries me, all she tries are 3 different treatments, a laxative,a bulking agent and I cant remember the 3rd at present. She does not keep a pain diary....its an intense dull ache that starts as the DS or DF118 wears off. She will see the specialist next wednesday and we will take it from there John > Glad to hear they think she is cancer free. > Is your friend drinking any alcohol in hopes of dulling the pain? [quoted text clipped - 8 lines] > Is she keeping a pain diary....on a scale of 0-10 the level of her pain. > Is she going to make an appoitment with a pain clinic. I wish your friend good luck and hope it is something simple like constipation. A specialist may put her on a long acting pain medication but best to know the source. Hopefully she'll get some answers. > Hi again, > she has never drank and does not now.....it only makes her [quoted text clipped - 19 lines] >> Is she keeping a pain diary....on a scale of 0-10 the level of her pain. >> Is she going to make an appoitment with a pain clinic. It's DF118 (dihydrocodiene) opioid for moderate to severe pain probably similar to oxycodone. what is needed is a long acting (slow release) opioid like oxycontin or tramal sr together with a good regular laxative regimen. MIKE sorry for the top post > I wish your friend good luck and hope it is something simple like > constipation. A specialist may put her on a long acting pain medication but [quoted text clipped - 23 lines] > >> Is she keeping a pain diary....on a scale of 0-10 the level of her pain. > >> Is she going to make an appoitment with a pain clinic. http://www.netdoctor.co.uk/medicines/100000744.html Could it be DF118? That is a narcotic and constipating. > Hi J, > Thanks for the reply, I have all those replies on my HD, [quoted text clipped - 58 lines] >> Best I can do, right now. >> J Hi John, > Hi J, > Thanks for the reply, I have all those replies on my HD, > is it the following questions you refer to:- That's good. (so I don't have to find it in Google and tinyurl it to show you it.) > Age?.........................................40 > Is she up and around?...............yes but fatigued > Is she eating?............................a little/about 20% of normal > What helps the pain?..................DS118 Ha! that wasn't quite what I was looking for. I was looking for (examples): Does heating pad make it better? Does a certain position make it better? Does having a bowel movement give her temporary relief? What type of pain is it? Is it crampy pain? gassy pain? sharp pain? "sore" pain? Does eating certain foods make it worse? Does eating certain foods make it better? etc etc. > Is the pain constant or only on movement?........constant > Have they ruled out pancreatitis? ............nothing has been ruled in or [quoted text clipped - 12 lines] > the cancer is the risk of having to endure longterm pain or longterm drug > treatment. Well John, I understand her concerns and I hate the idea of treating pain without knowing the cause. Because if the cause can be corrected, that makes more sense to me. I hope you'll be able to attend and take a writing pad to write the answers down. We don't want their "guesses" or "conclusions", we want them to rule some things out. (some of it might be by physical exam, some by bloodwork, some scans might be required). Does that make sense? has she been having regular bowel movements every day? I have seen on other newsgroups where being constipated causes low back pain (in some). She could have a partially obstructed bowel. If she had a total obstruction she could get into big trouble fast. (but I think that she would be vomiting - not sure because she's only eating a little). We lost one patient (from UK) 18 months ago due to something that went wrong with the surgery. It was only after she was at home that the problems started to develop (if I recall) and she succumbed to an overwhelming infection (because the attachments gave out (if I recall) and fecal matter got into places it shouldn't have and caused infection. So if your friend has an impaction or partial obstruction she has to make sure she's going "regular" but gets properly assessed for that. There's a lot here about that. http://www.meb.uni-bonn.de/cancernet/303510.html but darned if I know which laxative, because too much straining or forceful movement could cause perforation or other problems. Here's the place that I mentioned shows the organs and also mentions that "During the operation the bile ducts containing the cancer are removed and the remaining ducts in the liver are joined to the small bowel" http://www.cancerbacup.org.uk/Cancertype/Bileduct/Bileduct Also it shows the gallbladder. I forget now, was that removed? So her problems could be some variant of constipation and needs ongoing (but the correct) laxative. On the other hand, it could be one of the previously discussed or listed on that web page issues. Or even ulcers? There's zebras (rarer things) like heart attacks, women present (symptoms) sometimes differently than males. like prophyria http://ghr.nlm.nih.gov/condition=acuteintermittentporphyria They actually mention Ireland there. It's genetic and the attacks can be triggered at any time in life and it's my understanding that frequent small, high-carb meals are the way to go to prevent attacks. An expert in that field would have to instruct how to test for that. (bloodwork and urine collection). Some medications are "unsafe" to take (cause worsening) and some are "safe" So at this point, it's anyone's guess as to what is going on. Start with the simplest and make sure that she's having bowel movements every day. (have her) Keep a journal of what she eats and her bowel movements, make her understand that she has to share, so that you can help her to get the doctors to help her, ok? J Hi J. thanks again to all for yer input there`s certainly a lot of stuff there to ponder. Taking your "look for the obvious/simplest" things, my opinion is that the source of the problem is the back pain which leads to the morphine then to the constipation. Eliminate the cause of the pain may well fix the problem completly, and thats a process of elimination of possible causes. So lets get the professionals to expedite the process........I fear they may be using the old "lets wait and see if something becomes obvious" to save cost. The thoughts which cross yer mind at times are very dark......is it a case of non-disclosure??, are they waiting for the cause to become blatantly obvious as a measn of breaking bad news????? ect. All we can do is follow the process to a conclusion, and I am sure it will be a positive one. Thanks again foloks and I WILL let ye know the final outcome. John > Hi John, > [quoted text clipped - 121 lines] > ok? > J Or it could be nothing and your friend could have a very low pain threshold. If I was in horrible pain all the time, I would find a doctor who would give me a honest answer even if they couldn't find a cause. A pain specialist will help determine the cause. > Hi J. > thanks again to all for yer input there`s certainly a lot of stuff [quoted text clipped - 144 lines] >> ok? >> J > Hi J. > thanks again to all for yer input there`s certainly a lot of stuff [quoted text clipped - 10 lines] > obvious as a measn of breaking bad news????? ect. All we can do is follow > the process to a conclusion, and I am sure it will be a positive one. John, Maybe they know, maybe they don't know. It's sad when the patient (or friend) has to keep looking for possible causes and they aren't. the most common cause of low back (lumbar) pain is sciatica. Sometimes it's caused by "pulled muscles". That cannot be viewed on imaging. Sometimes it can be caused by herniated discs. Those can be viewed by imaging. Conservative therapy is pain meds (I've never taken opioids for that, but it is very painful), resting the back, heating pad on the lower back especially during sleep Sleeping on one side or the other (not her back) with a pillow in front of her and a pillow in back of her to stop her from changing positions and/or twisting. AND a pillow between her knees (during sleep) to reduce the strain on her lower back. Takes a few weeks to several months to go away if it's caused by muscles. Can be chronic if it's due to disc problems. Another one I was thinking of is shingles (is usually one-sided pain -abdominal coming from the back), but there's usually an appearance first of blisters, the blisters heal and go away, but the pain remains. This can sometimes follow an infection. Another possible is spread of the cancer to her spine? another possible http://www.medicinenet.com/pancreatic_cancer/article.htm (the gall bladder cancer has spread to the pancreas). there's a number of other spine problems mentioned here (including two which might occur as a result of infection, but I would have thought you would have mentioned other signs) http://www.spineuniverse.com/displayarticle.php/article2007.html Another one http://www.spondylitis.org/about/as/symptoms.aspx The possibilities are endless from the very painful benign to very serious. Wish I could help more. J |
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