I have been caring for my mother who is suffering from breast cancer. My mother has suffered from cancer for 8 yrs. now and it has spread to her lungs, bones and liver. We learned that the cancer had returned and spread for over 2 yrs now and my mother is doing much better than you would expect from the sound of her condition. That being said, my mom is in a great deal of pain on a daily basis. For the most part, it seems that she has a great deal of bone pain. She is able to move around when she is not experiencing severe pain. when her pain was controlled she was able to function well on a daily basis,even get out in the world and do normal things.
My mother goes to an army medical hospital so from time to time her doctor changes. Previously,her doctor was prescribing her lortab 7.5 mill. (1-2 tablets up to 4 x day). For the most part this seemed to manage her pain on most days. Then a new doctor came in and changed her from Lortab to Percocet (5mill). She tried the Percocet for a few days and ended up having to go to the ER because she noticed that after each dose she would have a horrible migraine headache. My mother knew that in the past when prescribed Percocet she also had a really bad headache as well.

When she went to the ER the nurse was VERY rude to her and made her feel like she was some sort of addict. She really isn't anything of the sort. She wasn't taking more of the medicine than she was suppose to take,she was taking less because it was giving her a migraine. She brought the rest of the tablets to the ER to give them to them and show she just needed to be prescribed a different med and would give them the bottle of Percocet back. The nurse told her really loudly that she was in withdrawal because she was addicted to the lortab! My mom started crying and left out of the ER. I got upset with the nurse and began explaining to her my mothers condition and showed her the entire bottle of percocet counting them out showing IF she was an addict she would be taking them and there are way more in the bottle than there should be.... I explained that while Percocet is schedule 2 lortab is schedule 3 and don't most addicts want a stronger opiod rather than a weaker one? This wasn't about wanting more meds or even caring which meds were prescribed, she just needs something that relieves her pain w/o giving her a migraine or possibly the migraine was coming from a more serious problem, we did not know for sure which is why I brought her to the ER.

Well, the nurse tried to get her to stay, but my mom would not do it. The problem is now my mom is to afraid to talk to her doctor about the pain she is experiencing. She just tells me maybe she is an addict because since she has not been taking the lortab she experiences withdrawal symptoms. I try telling her she is dependent on the meds, not addicted and that she has every right to be treated for her pain.

Does anyone have any advice on how I can help my mom get adequate treatment for her pain? I feel that the doctors should not have a problem prescribing her lortab if that is what helps her pain. I would think that there are many cancer patients who take even stronger meds than lortab and my mom never ask for anything stronger than that. She says she is afraid to take anything stronger and she can not take percocet for some reason. This is the second time she has had the same reaction from Percocet. When she had her masectomy they prescribed Percocet and she couldn't take them then either.

My mom is very strong, she has been going through chemo treatments for about 2 years now and she handles it really well. She hardly ever complains so I know when she says she is in pain, she really is. It is hard enough for her to know she is terminally ill, shouldn't she have the best quality of life that she can have?

Since I am the person in charge of caring for her I feel that I need to do whatever I can do to see to it that she isn't in pain daily, if it can be helped. Would it be best if I talked to her doctors myself, kept a daily journal regarding her pain, etc...? My mom has been prescribed pain patches at one point, but they kept falling off and her doctor stopped prescribing them, but did not put her on another longer acting medication.

I was confused as to why her doctor had put her on lortab 7.5/500 in the first place. I thought that since the cancer had spread to her liver that might be too much tylenol. Maybe, that is why her new doctor took her off the lortab and began prescribing percocet w/ less tylenol. I suppose under normal circumstances they could prescribe Norco, but the medical hospital pharmacy only carries a limited selection of meds and Norco isn't on the list. They don't carry 10 mill of hydrocodone either.

I'd just like to advice on how to approach her doctor about this problem, while assuring them my mom is not an addict. Even though in my opinion "addiction" should not be as important to my moms oncologist, as they MUST realize the amount of pain my mother is in. To me it seems like malpractice to allow a terminally ill patient to suffer in pain. I know my mom would be happy to try any sort of option they feel would help her.

Thanks in advance and I am sorry for rambling on and on, just needed to vent.

Have you thought of getting Hospice for your Mother? They work with their patients for the best pain management. The physician has to refer, but in the past I have taken care of my Brother with Hospice care and my husbands Mother. It is just a thought, maybe you just don't want to go that route, but it sounds as if your Mother would qualify. Let me know if you have any questions. God Bless you -

Karma, your mother does seem like a very strong person. The ER always treats patients like they are addicts no matter what the age. If she can't take percs, then maybe she can get a morphine pump. The doctor may be just trying out different meds to see which one will work for her. Seems like your doing a great job with your mother. I admire that.
Take care,
Taz

Thank you all very much for your help,support and kind words. It is truly appreciated.

I have thought of going the hospice route for pain control reasons, but I just don't know if we are at this point yet. I know how this would make my mother feel hopeless. See... my mom use to run a personal care home. Even when 1st diagnosed and undergoing chemo she ran the personal care home for as long as she could. We cared for her sister who had lung cancer that spread to her brain, she only lived 6 months after diagnosed (she had a bad reaction to chemo and only had 1 treatment). My aunt was on hospice and my mom had to administer liquid morphine to her in the end. My mom later saw a program on TV explaining that liquid morphine actually supresess the cancer patients breathing and my mother still believes she caused her to die sooner than she would have. This makes it very hard for me to even bring up this option. My aunt was unable to get out of bed and really was just in and out of consciousness. My mom is completely coherrant and able to function, just with pain that at times causes her to scream out. I truly believe that she would experience even more pain if she wasn't also diabetic. I have read the diabetics feel pain differently.

I guess it is possible that the doctor is trying different meds to see what works best, its just that it has been 2 years at this point and when my mom tells the doctor that her previous doctor had her taking lortab 7.5 and it did help better than anything she has tried thus far, they don't listen to her. I know that it does help her because I can see the difference in her when she is appropriately medicated and when she isn't.

Once my Mom went to hospice care, her last days became far more manageable for her and us as well. Hospice nurses are compassionate and understand the pain a terminally I'll cancer patient is going through.

All opioids suppress (or depress) breathing, including hydrocodone. Sounds like the TV program was not produced very well. Liquid morphine, solid morphine - it makes no difference. When given IV, it is done slowly so as not to cause sudden respiratory collapse, but there is no reason for your mother not to take morphine.

I agree - about the TV program. My brother was diagonised with 4th stage throat cancer - doc only gave him six months. He lived two years. Only had the morphine the last 8 months of his life. But he was interrible shape when he died. The morphine that Hospice provided was the only thing that kept him pain free.

My step Father got poor treatment for cancer pain, till my Mother relented and called Hospice.
After that, he got practically a unlimited access to morphine in the form of pills and patches.
It allowed him to at least be more comfortable till the end and he passed away at home, surrounded by family and not in some impersonal hospital where one must beg for pain relief.

Hospice was a god send and wonderfull organization !!
This was 1993. I do not know if things have changed because of our sick laws ?

Karma,

Maybe you could talk to the hospice and see what they suggest. Maybe they would make a house calls so your mom could stay in her home?

I know when my mom was at the very end of her life, we called the hospice and they came. Granted we all knew she did not have much time left.

But I would call them and I would even call her doctor and make an appt to talk to him and see where he is coming from w/swapping her meds.

Also, percocet is stronger than lortab so I don't know why the doc would want to prescribe her a stronger narcotic if the lortab was working for her.

Lots of folks do better on hydro than oxy. There is a thread about it somewhere here. I myself was scripted Percocets (which I just found out was oxy) and they made me sick. Maybe they were too strong from me. Who knows. But my doc was glad to drop me down to vicoden.

Anyway, keep fighting for your mom. Darn medical system makes no sense. But keep a cool head. Docs don't like irate folks at all.

Your poor mom. Stupid doctor.

Karma,

Sorry for the late reply, but after reading your post I was in a state of shock. My heart goes out to you and your mother and I hope you can find a solution.

As for my recommendation, I will play the devils advocate here and just say that I would much rather have my mother with me than in hospice care no matter if it caused me work related problems etc etc. I mean and my mother dittos it, that towards the end, we want to be a together as a family. I would feel like I would be passing her off. And while I know she might be taken better care of, I also know that I could care for her just as well and she would be much happier. I have also heard bad things about hospice places and would never take a chance with her. Fortunately I am not in this situation myself, but this is just my opinion on when/if it will happen.

Now with your doctor, this is my advice: I assume she is with a pm doctor through the VA? They generally are liberal in pain medicine. So I would go with her to her next visit, and you should schedule an immediate follow-up before the next visit. Bring all the pills in, and basically explain the situation to them. That she is having a bad reaction to the percs, and that we need to either change back or find a new regimen, there is nothing wrong with this. Also ask the doctor why he changed, is it related to the acetaminophen levels? if so, maybe you can discuss long acting opiates other than oxy that can help. Sometimes they will give you a couple of 5 days scripts for different ones for you to try out and figure out what works best. But the idea behind any of this, is that you must have an effective communication with your doctor. The idea is finding what works best with the least amount of side effects. And if your doctor does not care, then maybe it is time to find another VA doctor, bc a painful terminal illness is basically grounds for a blank prescription!


As for the ER situation, you know its a two sided coin. The ERs are plagued by both legitimate people in pain and addicts, and I mean they are seriously getting overloaded, and RHA did not help. The idea is to effectively screen and separate the two groups. Also, most ERs do not wish to treat patients with no emergency symptoms or who are in pain contracts. I believe the nurse severely erred in judgment of the situation. She did this and then followed by digging a deeper whole with the attitude and advice for her problems of which she knew known. I think your approach initially should have been done.

If you need to go to an ER, and most PM docs make arrangements for this. You take the PM docs card or info, the prescription etc. And the first thing you do is explain the whole situation, show the script bottle, and then give them your docs telephone number to call to confirm or to authorize the change.

This situation is sad for all of us as this is the future for us when need to go to the ER. And the cause all stems from two things: RHA and the prevalence of script abuse. The latter part is a separate issue and I think much to complicated for me to attempt to resolve. But it all stems back to the DEA, who regulates it and tells doctors what they can and cannot do. What we need is more lobbying to our government on the topic of pain management! And education to the public on narcotic medications. The media frenzy has not helped at all, in fact I would say the media is the cause for the recent surge in script abuse.

Please keep us updated!

In my state in order to get hospice care and have medicare pay for it the patient had to tell her doctor she wanted no more preventive care just pallative care. Patients can stay in their home and be cared for by family members with hospice assisting in getting the needed equipment and helping with comfort medicines.

My family members that I cared for was also at home with me and other family members. A nurse came every day and we also had help with their other patient needs, such as help with personal care and help with bathing, nutrican( sp. wrong) needs, etc. Hospice was a God send, and very caring people overall.

Ok, the in home nurse is a great idea. I did not realize they did that. I would much rather prefer that then an actually hospice care center.

Another vote for in home nurse care. My wife's grandmother had that in her last days, and she was so much more at peace in her own home, looking out the window at her garden, having the grandchildren visiting her in her home where she had watched them play as little children, etc. And I have found the nurses who do in-home care tend to be very caring, gentle, compassionate people (darn, now I've got tears in my eyes thinking of Granny - but they are good tears! )

I got tears in my eyes Too.

Karma - I cared for my mother when she was dying of ovarian cancer. She had a myriad of meds - morphine (which she hated and my ex would take and replace it with water - Now you know why he is my ex). She benefited most from the Tylox.

I did everything for her - bathed her, fed her, etc. Did the "death watch". It was a privilege. Karma - you are a good child (I know you are not a child). Many just abandon. It is supremely stressful. I was exhausted for weeks. But I would not have it any other way.

Her demise happened relatively soon - was it 6 months? Can't remember. She died when I was 30. I'm 57 now. Took me years to get "over" it. But I would do it again.

Why any doctor would deny your Mom of her much needed meds is beyond me. Guess I would confront them. Hey, my Mom is terminal, what's the problem? It can be difficult to go face to face with a doctor, but if not you - who? And if not now, when? Your Mom should never, ever need to suffer. End of life care is crucial.

I know what you are going through. Been there. Take care of yourself - it is not easy.

Hugs & love, Laurie