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[40th consult; text]
Jun. 19th, 2010 12:51 am( private )
Pain management is one of the most important but often overlooked aspects of the treatment of cancer. Priority is given-- and given rightfully-- to combating the cancer itself, getting the growth of damaged cells under control through whatever means possible. The growth of cancerous cells can cause pain in patients, if a tumor is growing against an organ, bone or nerve. More often, however, the treatments themselves cause an extensive amount of discomfort. Chemotherapy, for instance, can cause a slew of side effects including peripheral neuropathy, abdominal cramps, vomiting, nausea, bone and joint pain. The medications used to offset the impact of the chemotherapy on blood counts and risk of infection can also contribute to pain.
Most patients are able to fight through it as long as they have hope, as long as their prognosis is good. Pain becomes a greater issue in terminal cases. The distinction between physical and emotional pain has been discussed extensively this week, but the interaction and correlation of the two is could fuel endless further discussion. When a terminal patient is dealing with chronic, severe pain, there's often no sense of hope left to counteract it. Their emotional state can both contribute to the physical pain, making it all the more severe, and react to it, making death seem like a welcome release. For those who have loved ones with them through the ordeal, it impacts both the patient and their families.
One of my patients, a few years back, was a 63-year old female suffering from stage 4 lung cancer. It was in both lungs, had spread to the lymph nodes, and caused a malignant pleural effusion; fluid containing cancerous cells had collected between the membranes covering the outside of the lungs. She'd been in treatment for years, but she couldn't fight it off any longer. Towards the end, she was in such severe pain that she avoided contact with her children and grandchildren, all but cutting them off entirely as she went into her final months. Her pain was causing her to choose isolation, to spend the last days that she had left alone and suffering.
Finding the right combination of treatments took time, determining not only what would be most effective, but what would be least likely to cause negative side effects. After trying several medications administered both orally and through transdermal patches (adhesive patches applied to the skin, allowing the body to absorb the medication), it was found that orally administered methadone had the greatest effect on her pain. The relief provided by this medication alone was not significant enough to have a considerable effect on her emotional state, however. After further testing, it was revealed that her shoulder had become the predominant source of her pain, as the cancer had spread to affect the nerves. A series of injections - a combination of bupivicaine and methylprednisolone acetate - were administered to the area.
Within weeks, she began to improve significantly. Her physical pain was still present, but downgraded to such an extent that she was able to enjoy interaction with her family again. Though her cancer did end her life four months later, she spent a significant amount of that time with her loved ones and died knowing that she was loved. Without finding the most effective means of managing her physical pain, her emotional state would have deteriorated to such an extent that she would have welcomed death as a release from suffering in solitude. The treatments administered improved not only the quality of what life she had left, but allowed her family to spend time with her that they would never have had otherwise. When the time came for them to say goodbye to her, they were able to do so with the comfort of knowing that they had been able to provide support and love for her every step of the way.
[ooc: HI! Medical errors are on me, not Wilson. I researched and researched but if it's wrong, yeah, that's my bad. I play with Photoshop for a living, not internal organs. XD
In other news, Wilson is not happy. At all. But you don't know that. SHH.
ALSO really really backdated, like way early on Friday. 'Cause that Photoshop playing? Yeah. That shit's been crazy this week. BACKTAGS FOREVER I love you all.]
Pain management is one of the most important but often overlooked aspects of the treatment of cancer. Priority is given-- and given rightfully-- to combating the cancer itself, getting the growth of damaged cells under control through whatever means possible. The growth of cancerous cells can cause pain in patients, if a tumor is growing against an organ, bone or nerve. More often, however, the treatments themselves cause an extensive amount of discomfort. Chemotherapy, for instance, can cause a slew of side effects including peripheral neuropathy, abdominal cramps, vomiting, nausea, bone and joint pain. The medications used to offset the impact of the chemotherapy on blood counts and risk of infection can also contribute to pain.
Most patients are able to fight through it as long as they have hope, as long as their prognosis is good. Pain becomes a greater issue in terminal cases. The distinction between physical and emotional pain has been discussed extensively this week, but the interaction and correlation of the two is could fuel endless further discussion. When a terminal patient is dealing with chronic, severe pain, there's often no sense of hope left to counteract it. Their emotional state can both contribute to the physical pain, making it all the more severe, and react to it, making death seem like a welcome release. For those who have loved ones with them through the ordeal, it impacts both the patient and their families.
One of my patients, a few years back, was a 63-year old female suffering from stage 4 lung cancer. It was in both lungs, had spread to the lymph nodes, and caused a malignant pleural effusion; fluid containing cancerous cells had collected between the membranes covering the outside of the lungs. She'd been in treatment for years, but she couldn't fight it off any longer. Towards the end, she was in such severe pain that she avoided contact with her children and grandchildren, all but cutting them off entirely as she went into her final months. Her pain was causing her to choose isolation, to spend the last days that she had left alone and suffering.
Finding the right combination of treatments took time, determining not only what would be most effective, but what would be least likely to cause negative side effects. After trying several medications administered both orally and through transdermal patches (adhesive patches applied to the skin, allowing the body to absorb the medication), it was found that orally administered methadone had the greatest effect on her pain. The relief provided by this medication alone was not significant enough to have a considerable effect on her emotional state, however. After further testing, it was revealed that her shoulder had become the predominant source of her pain, as the cancer had spread to affect the nerves. A series of injections - a combination of bupivicaine and methylprednisolone acetate - were administered to the area.
Within weeks, she began to improve significantly. Her physical pain was still present, but downgraded to such an extent that she was able to enjoy interaction with her family again. Though her cancer did end her life four months later, she spent a significant amount of that time with her loved ones and died knowing that she was loved. Without finding the most effective means of managing her physical pain, her emotional state would have deteriorated to such an extent that she would have welcomed death as a release from suffering in solitude. The treatments administered improved not only the quality of what life she had left, but allowed her family to spend time with her that they would never have had otherwise. When the time came for them to say goodbye to her, they were able to do so with the comfort of knowing that they had been able to provide support and love for her every step of the way.
[ooc: HI! Medical errors are on me, not Wilson. I researched and researched but if it's wrong, yeah, that's my bad. I play with Photoshop for a living, not internal organs. XD
In other news, Wilson is not happy. At all. But you don't know that. SHH.
ALSO really really backdated, like way early on Friday. 'Cause that Photoshop playing? Yeah. That shit's been crazy this week. BACKTAGS FOREVER I love you all.]
