krishdgl
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Very sorry to say my Dad passed away on 23rd Aug. Last two days was erratic, was gaining conscious on and off pain was becoming more during the end stage though he was on morphine. Tried increasing the dosage. but this pain seemed to be different. Pulse and BP dropped and last one hour breathing become shallow and took the final breath. Last night was horrible to handle for me, my sister and mother. We will never forget that night.
I am still trying digest the fact. But i am only getting thoughts of the last night 12 hrs.
Thank you all for the guidance. Your valuable inputs helped me a lot. It has been a tough journey for the past 15 months but nothing tough than what my Dad went through. I feel now he is relieved of the pain permanently.
Dad we miss you. R.I.P
Finally, found a dedicated comfort care clinic who does hospice services. Took dad to them admitted for two days and they brought the pain under control. Duragesic was removed. Shellina, yes you were right, his muscle mass was very less in the arms. Now he takes tab.Morphine 20 mg twice a day along with half tab triptomer and pregbalin for nerve pain.
Though he is mostly sleeping, not complaining of pain.
It is very sad that the the link between Cancer institute and comfort care does not exist, even if it does awareness is not there. There are only few people who do this here. Out of them mostly they would treat only at their premises. But, i could also get another organization who could support us at home. They are supposed to come today and they will take over. Hopefully, it happens as planned.
Thank you very much for all your comments. It helped me a lot. Now i am little bit relieved (not in the literal sense), that his pain will be controlled.
Dad’s Present condition :
Bilirubin level is high 3.8 when tested last a week ago. He is on Duragesic 25 mcg patch. Mostly drowsy. Speaks with lot of difficulty. Unable to relate time, day or night but responds to questions. Does little bit of walking to the toilet. Takes liquid diet 2-3 hrs once. Gets fever once in a day. Urine is dark yellow and the frequency and quantity is reducing. Ascites and edema are not increasing.
His pain is increasing on and off. Manageble with addnok sublingual tablet once in 6-8 hrs. Not sure should we ask for next dosage (50 mcg) of the patch.
I am not sure whether he is shifting towards coma due to liver failure or because of the pain medicine. Not sure to ask for increase in dosage (50mcg). The doctor says there is a risk of becoming more drowsy and slip into coma.
We are now combining duragesic and addnok to a level of manageable pain. but it is increasing. Will talk with the oncologist soon about increasing the dosage.
Also started looking for Hospice service here and found very few. trying to get help from them. I am worried if they will change the course of pain management totally and start from scratch. I am not willing to totally stop consulting oncologist.
While i will ask the onc., can somebody clarify What is risk of increasing dosage of the medicine. My intention is to understand, how far it is possible to increase dosage without getting into coma.
Does duragesic and morphine combination or only higher dose of any one will help.
While i know the end, i am trying hard with all possible resources to keep him comfort. Any suggestion is much appreciated.
Thanks and regards,
Krish
Today i had a discussion with onc. The ALT level is 79 (Normal range 5-35) and ALP is 795 (Normal range 75-275), Clearly showing damage of liver.
The onc. said nothing can be done much and objective is to keep my dad in comfort.
He is now on Durogesic 25 patch. Able to control pain. The onc. has told if the pain is getting more he will increase the dosage.
He also has a burning/pain in the lower abdomen on and off. The onc. said it may be due to some nerve compression and has prescribed Amitriptyline to control the nerve pain.
My mind is blank now. Hope his pain will be under control and he suffers less in this last journey.
Though my interaction with this group is in later stage, i have been a silent observer in the past and others experiences have helped me a lot.
Thanks for all the support.
regards,
Krish
PCL1029, Thanks for your comments, helped me to understand better. Will check with for the mentioned procedure.
Lainy, we took opinion from one more onc. here and he said we may try TACE to only help the liver for a bit longer and nothing can be done with lymph nodes. But to ascertain that he required another PET-CT. My father said he does not want any more tests and no need any other procedures as he could not tolerate them. He was just ok with pills. We decided to go by his wish. Thanks for you concern.
Marions, you are right. Palliative care is yet to catch up here with western world, but is improving. Morphine is given here only at the last stage. While my father is hesitant to take them myself and doc are insisting that he dont have to suffer with pain. I will talk about the right dosage for him.
On a side note, is Buprenorphine better than Morpine? pardon my ignorance, which one would reduce pain effectively?
Gavin, I can understand what you have gone through. He is now prescribed with lasilactone tab. to increase fluid passage to see if the conditions improves. I will update.
Again a big thanks for all you guys. It helps a lot to share shoulders rather than struggling alone.
Will keep you posted after the test results of CBC, ALT/ALP and meeting with onc on friday.
regards,
Krish
