Palliative Care

[sandyRoe]

Can someone with a terminal illness be sure that their end will come without pain?

[silliemillie]

I am Mally, but thank you for caring. X

Took her to the Docs who suggested Counselling, but she refused saying by the time any appointment would come through she would be dead anyway. Just have to keep calm and carry on, as they say.
(Sorry for interrupting Sandy)

[anneasquith]

Difficult situation for you S . good luck.

[LadyCG]

Ummmm, you are the one being rude. And childish.

[rowanwitch]

No, sadly some pains are hard to control. However in that circumstance you can take the patient away from the pain with sedation. The team will always do what they can and it's rare someone in the palliative care system will suffer. Maybe like Redman who had pain intermittently until they got the doses right.

[anneasquith]

My friend in hospice recently, it took 7 dys to find the most efficient regime for her .

[LadyCG]

It can take a bit of tweaking.

My nan had morphine and Midazolam at the end and she was in a catatonic state.

[rowanwitch]

Zopiclone in depression is usually an adjuvant treatment to re establish sleep patterns in those for whom non medical means have failed. Sleep disturbance being an aggravating factor as well as a symptom. It would normally be given with an ssri type anti depressant like Prozac or citalopram usually allowing for low doses of both to be used. It is not an effective anti depressant in its own right. But sleep is.
It's use in cancer care is popular because it does not increase the sedative effects of analgesia to any great extent neither does it interact badly with many other drugs used for symptom control.

Amitriptyline has many uses, but you need to time taking it to avoid the morning hangover. I found four pm worked as it was better to fall asleep on the sofa, than over breakfast.

[LadyCG]

Depression can be due to iron deficiency too.

I had anaemia throughout pregnancy and my mood was low at the same time. When my bloods started to recover my energy levels and mood improved.

[AuntLydia]

Rowanwitch: Exactly! Zopiclone is an hypnotic used in some cases in with antidepressant drugs. On its own it is not an antidepressant.
The Imovane (zopiclone) monograph issues a caution for the
use of the drug with depressed patients, indicating that it is not
a treatment for depression and that Imovane may even mask
patients’ symptoms.

[nailit]

Never knew that Zopiclone was an anti depressant.
Last year when I was admitted to a psych hospital I was suffering from sleep deprivation (as well as suicidal depression) The first night in there I was given Zopiclone as well as Valium and ant depressants. I went bed at midnight and was wide awake again 2 hours later. This happened for a few nights until they realised that I just was not sleeping for any length of time and upped the Zopi dose. Then one night I slept for 13 hours. It was only after that, that my mental health began to improve and I got something of a sleep pattern back.

[rowanwitch]

I had one bout of severe depression treated with nitrazepam, I was with my first husband then, the GP told me to take it three times a day for three days. I slept almost all three days and started to improve after that. I think people are really only now starting to understand sleeps involvement in so many conditions.

[AuntLydia]

Nailit wrote: Never knew that Zopiclone was an antidepressant.

That's because it isn't. Chemically its an hypnotic. It helps in depression because sleep is very important to many conditions including anxiety and depression.

[nailit]

Chicken and egg situation. Is it depression causing lack of sleep or lack of sleep causing depression??

[AuntLydia]

nailit it doesn't really matter. Zopiclone is not an antidepressant as stated by a poster on here I was just correcting.

Sorry Sandy for transgressing your thread. No one can be 100% sure their death will be painless but with a terminal illness it is more likely to be as pain free as possible if as the patient will have appropriate Palliative care.

[rowanwitch]

Never underestimate the beneficial effect of love and affection on the final pathway. Emotional pain can be eased a lot by just talking , sharing fears, Dave didn't want to let go because he was worried I would be lonely and isolated, it wasn't until a couple of good friends reassured him they would be there for me that he relaxed. Then the physical pain was easier to manage.

[Peter Pedant]

// Sure? I don't known about that,//

yes I am
yes you can - - clearly you are to enter into some sort of agreement with your carers - ( like NOT to say 000 you have had some already! and so on). Try to make sure than your end is at home where you have more control ....

twenty years ago with the painful death debate, they looked out of a medical family where the death had been an awful tale to Calvary. They couldnt find one. - the key was that the doctors all made sure they died at home ....

[AuntLydia]

7 years fighting cancer my father died at home privately, in his own bedroom, with his doctor present and as much morphine as he needed.

[Peter Pedant]

come on babies we have wandered into Zopiclone and it use

can terminal care be painless - yes you can make sure it damn well is.
pain
we arent talking about anxiety or sleeplessness
pain (that is what the OP posted) - we have good drugs for that

[ and yes I have heard a carer say o! o! I dont want to give too much morphine because it may kill him! and I said if he is in pain, then give the morphine]

[Peter Pedant]

// My nan had morphine and Midazolam at the end and she was in a catatonic state.//

no sorry - we are talking about pain - was she in pain?
if the answer is no - then job done .....

[rowanwitch]

Analgesia to unconsciousness really should be the last resort. The aim is to have the person awake, talking and pain free, that's where modern medicine has improved.