I have a situation I'd ask you all for some kindly help dealing with.

[DeadCat (OP)]

OK. This might be kind of long so I will try to write a condensed version. You can ask me questions if some things are unclear either in the thread or by email, both are more than welcome.

My mother is 72 years old. I live with her in large part because I feel as her only surviving relative she is going to need me more and more. About 7 years ago, she was diagnosed with breast cancer in both breasts. Instead of doing anything about it at the time, She ignored her doctors' advice and decided to start traveling while she could. FWIW, all her older relatives died of cancer and they underwent long and painful chemotherapy first, so in her mind chemo is just torture doctors do to you that doesn't cure anything (true or not).

2 years later she noticed that the lumps were now large and THEN she rushed in to get a double mastectomies. The doctors wanted her to follow though with radiation and chemo but she declined them.

She was told to get chemotherapy to try to prevent the mastastises of the cancers that would lead to her (quick)death if it happened. Of course she refused because to her mind, chemo is just a painful, useless thing that results in death anyway. I understand this thinking because of the deaths she had to watch in her family. She fails to understand that chemo can work and might just work for her, she just won't do it.

Now the breast breast cancer has spread  to her bones and liver and with her docotors and my urging, she is getting Endocrine therapy. In short, the cancer is "estrogen positive" and they can chemically shut down her natural estrogen output to retard its growth.

(She's 72 and post menopausal anyway) the treatment in order to deny the cancr the whatever estrogen she still produces and consequently  fuels the cancer cells nutrition it needs to grow. Her doctors told her; "If she does nothing she MIGHT live a few more months to a year, if she does this treatment (WHICH IS NOT "chemo") she could very well live indefinitely." It didn't take TOO much convincing(but SOME, trust me) from all of us that NO, this was not "chemotherapy" and not doing it would be much worse.

Plus, she would all but  be asking to die quickly if she declined it. BTW, doctors here will not force any therapy on you unless you are suicidal or a risk to others.

The above is all the background. What follows is why I am writing this: She really doesn't have a clear answer from her doctors as either diagnosis or prognosis and she doesn' know how to ask persistently, just where she stands after all this and what she might expect and what her options are for both her quality of  life and estimated survival time  and just what the remaining cancer is actually doing, if anything and most evreything else concerning her diagnosis and prognosis. 

To help sort this out I have cleared it with her and the hospital staff  that I can be present at all doctors' visits and can ask any questions I think should be addressed (one of the benefits of being the responsible next of kin) She has (reluctantly) agreed to this but the fact is she doesn't have the slightest training in science, biology or medicine and although I don't have much I am not completely ignorant to most of those topics.

The PROBLEM is between her ignorance, and her fear and the horrors she witnessed with other family members,it is almost impossible to have a rational cnversation about where she stands, how she should best fight it and otherwise use her time, whatver it actually is, how involved I should be wih her care, when do we need to arrange hospice and what, exactly will they do (and not do).

Plus, there is her estate and several other things that just have to be dealt with that she has neglected making clear. She doens't want to talk abut it, she flip-flops between denial and "ending discussions with "I'm dying, leave me alone!" when in fact no doctor has told her that death is imminent  to other melodramatic statements like "This may be the last meal I ever cook." to: "I should go visit my friends in Alaska."

Her health is clearly on the decline. I talked her into taking painkillers so she could at least walk around and the doc gave her (get this) 5 mg methadone in the AM and 5 mg in the PM.Of course she is worried about becoming a junkie. And she complains about her stomach being upset. I have explained to her 5mg is little more than a placebo or a test dose and she shoud be taking probaly 40+ mg to manage pain, but she is resistant.

She is also on Celexa to help her mood,but several weeks into it, I can't tell if it is working. Thursday is another "Pallative Care" appointment and

i will be able to talk to the doc w/o her in the room while they give her a transfusion. I was thinking that one of the benzodiazepines a few times day, or an ER Xanax might help her stop being so defeatist and might help her  to take as needed for stress and worry. It is tricky though, she thinks doctors want to give her "Happy Pills" so she won't care if she is dying.

Obviously, this is all a complicated , multi-layered problem and this post only scrtches the surface. She thinks doctors can't be trusted, that " am just "waiting for her to die to get her money. (it ain't millions.)

No matter how much I try to be a helpful presence. (She thinks me being a helpful presence is vaccuming, cleaning the house and washing her clothes and kitchen, while I do many of those things my thinking it is that being present to care for her emotionally and listen to her and her complaining without arguing. And giving her encoraging feeback and telling her her whole family loves her dearly, etc. Short of regresseing to her pre-pubescnt childshe can dress up, I don't know what would make her happy and even then she would then criticise me for "not being a man."

Sorry, detour, it is all very stressful. My question is: if I can get the palliative care doctor to help adjust her attitude
(chemically, and I think he will) do any of you have ideas on what medicines would help? If it were up to me alone, I'd give her a low dose- Xanax, MDMA and Oxycodone cocktail mixed in to 3 meals a day. SHe has indicated whe would smoke medical marijuana.

However, this is all a real problem, likeley to get worse without reall help so I am humbly asking for this group's collective wisdom.'Thaks in advance.

-DC

[LoneRanger7]

Oh gosh DC I'm sorry.  That it's such a tough spot. I agree with you that xanax and oxycodone would likely make her feel much,  much better about life - not sure if the combo will be acceptable to the doctor though.

I lived with three different family members as they died of cancer,  so if I can be of any help please don't hesitate to reach out.

[thetalkingasshole]

I'd recommend seeing a psychologist
NOT  a psychiatrist
Find someone who specializes in end-of-life/palliative care

I know you don't have an answer on her prognosis but still
It sounds like she is detriorating quickly, both mentally and physically
So the best thing would be to get her to sign a disclosure agreement
So whatever she tells a psychologist can be shared with you

Depending where you are there are lots of options
And I hope that she does not have to suffer any pain, physical or mental
Illnesses like breastfeeding cancer can cause severe psychological trauma
If you're trying to go the legal way you are limited
But if she is healthy otherwise there is always low doses of psilocybin and mdma

I wish you and her the best and will keep you in my thoughts

[Esoteric Anhydride]

40mg, plus benzos?

You trying to off her? Elderly people are notoriously MUCH more sensitive to medications than healthy adults. Based on what I've read here, I'd strongly advise you to stick to the prescribed regimen, I'm not sure that quadrupling her dose and adding in benzos is such a great idea at all, especially considering that you're dealing with methadone.

If you do go implementing your own regimen here, change ONE thing at a time, and remember that methadone builds up in the system over a period of many days. It may take awhile to determine just how she reacts to the methadone itself, and during that period, giving her benzos (especially if this is a novel script) will likely make it hard to judge just how the methadone itself is working for her.

One thing at a time.

[Dopeless Hopefiend]

First of all, I'm really sorry to hear about your mom @DeadCat. My husband died of liver cancer 2 years ago and I can remember very well the feelings of helplessness that I felt. I think it's great that she's open to using MMJ. My husband's cancer was too advanced by the time he was diagnosed to even do chemo, but he did do a drug regimen that caused a lot of the same side effects and weed was so helpful for him. He was also on monster doses of pain meds but he was someone who had a history of addiction so his tolerance was high. I think with the way methadone builds in one's system you may find that her pain is well controlled at a low dose. It's likely that a low dose benzo could be helpful but would suggest a milder one like ativan or even a low dose of Valium because it's longer acting. I'm sure if you talk to the palliative care doc they will help with that. Their main concern should be making her comfortable.

[corpus striatum]

Sorry to hear about your mums illness Deadcat.

The treatment for breast cancer has come a long way in the past 10-15 years and in a post-menopausal lady with an estrogen-receptor positive tumour the group of drugs known as aromatase inhibitors (eg anastrozole, letrozole , exemastane) can significantly slow down the rate of progression of even metastatic deposits. However, the prognosis really depends on how extensive the metastatic disease is, and its impact on the affected areas at the time of starting the treatment ie risk of pathological bone fractures from tumour deposits as an example. I have seen some patients live for several years with metastatic breast cancer on this class of drugs. They work by preventing the conversion of androgens to estrogen which reduces the 'drive' towards tumour growth.

I wish you and your mum all the best.

[Chip]

My condolences and i feel your pain as my dad just wants to end it all asap.

[DeadCat (OP)]

40mg, plus benzos?

You trying to off her? Elderly people are notoriously MUCH more sensitive to medications than healthy adults. Based on what I've read here, I'd strongly advise you to stick to the prescribed regimen, I'm not sure that quadrupling her dose and adding in benzos is such a great idea at all, especially considering that you're dealing with methadone.

If you do go implementing your own regimen here, change ONE thing at a time, and remember that methadone builds up in the system over a period of many days. It may take awhile to determine just how she reacts to the methadone itself, and during that period, giving her benzos (especially if this is a novel script) will likely make it hard to judge just how the methadone itself is working for her.

One thing at a time.

That 40 + Benzos was just off the top of my head and based on my own experiences/ If it IS too much I am glad to know it.

Tomorow morning she goes in for an endocrine treatement which will take a couple hours. I am scheduled to accompany her and wii use the time that she is getting her transfusion to talk candidly with the doctors and describe he symptoms and outlook privately. It is my hope that they will give here some drugs that lift her mood and improve her outlook to one that is a bit more positive.

And yes, being the hopeless junkie I am, If I can get then to give her some GOOD drugs and a big supply of them that will not miss a few if I pinch some. One selfish thing I learned about being around cancer patients is that their doctore don't generally worry about how many pills they pop and write for more.

If this goes on for months I'll stop taking the buprenorphine and use some of her short term opiods to ease the trasnition off them.

A guy can dream right?

[Griffin]

Yeah i think 40mg is a bit much, when I started and was completely opiate naive 10mg of hydrocodone would make me blissful, 15mg of oxycodone would have me under my blanket scratching my face sweating without any benzos at all. My poor liver, it seemed like 10-30mg of hydrocodone plus tylenol plus 1-2 beers was the perfect anxiety, and depression remover. So I am sure 5-10 mg of methadone is probably doing a lot for her depending on length of use, and tolerance. Like said above done builds up because of half life and older folks are usually a lot more sensitive to medications and I could see 40 mgs of done without benzos being enough for an OD.

[Z]

Doctors seem to be fairly hesitant about prescribing benzos and opiates.  Especially together for the first time. 


As for the methadone dose, around here they dose tolerant people with 30mg for a first time dose.  There are cases where that has killed someone.  10mg isn't an insignificant amount, and if your Mom takes it as prescribed it would probably help her.  I don't want to sound judgemental here, but you should probably let her take her meds.  Whatever else the doc prescribes will have the done taken into account.  If you're the one taking the prescribed done, then it might have a negative impact on her care.


Why don't you just go to a clinic?  I remember having this conversation before, but I don't remember why you didn't want to go.

[DeadCat (OP)]

Doctors seem to be fairly hesitant about prescribing benzos and opiates.  Especially together for the first time. 


As for the methadone dose, around here they dose tolerant people with 30mg for a first time dose.  There are cases where that has killed someone.  10mg isn't an insignificant amount, and if your Mom takes it as prescribed it would probably help her.  I don't want to sound judgemental here, but you should probably let her take her meds.  Whatever else the doc prescribes will have the done taken into account.  If you're the one taking the prescribed done, then it might have a negative impact on her care.


Why don't you just go to a clinic?  I remember having this conversation before, but I don't remember why you didn't want to go.

The only reason I' go to a clinic would be to completely detox off the bupenorphine. I'm not really interested in picking up an opiate habit again and short of some spare prescribed pills or perhaps fentanyl patches but it would only be available in the short term.

As far as my mother goes, she's still complaining of pain taking 5mg methadone 2X/Day and she has .5mg  Ambien to take as needed from the same pallative care doctor. I suspect that methadone really isn't the best pain medication for her. In fact I was there when the doctor told her they were just starting her at the low dose of methodone to see if she could tolerate it and he encouraged her to take more gradually and he would write more if she needed.

I do have permission to speak directly with her various doctors and nurses (I'M on the "official" list). I think I will use that authority to contact her pallative care doctor to tell him the truth: she's still complaining about pain everyday, she's depressed and doesn't seem to want to fight.

As most of you know just about 2 years ago my sister died of an overdose that was caused as much by police harassment and doctors passing her around and undermedicating her chronic pain until she just didn't care if she lived or died and started shooting too much dope and overdosing regularly.

Friday, in a conversation with my own doctor I told him about my mom's maddening (to me) reluctance to TRY to fight the cancer and he told me something I hand't really considered before: "Cancer is so scary to some people that when they get that diagnosis they just give up." at that point I realized that she really hasn't shown any desire to enjoy life since my sister died.

Of course I always knew it was depressing, as it was for me but I never really understood that for someone like my mother who lost both her parents to cancer and he youngest child to depression and drugs and life just beating the shit out of her probably has left my mother with very little to look forward to.

If that's the case and she's not going to rally emotionally she will either be gone in a couple years or turn into a depresssed old woman and be cursed with 20 more years. I'm hoping they can get her out of pain and give her eSOMETHING that will elevate her mood even if it is just for a long enough for her to start looking toward the futrue with a little more hope. 72 is not all that old any more. He next door neighbor is 88 and doing better than her.

Thanks for the feedback. I appreciate it being pointed out that seniors and opiate naieve people get results with doses we here thing aren't worth taking.

[Lolleedee]

So sorry to hear about what you and your mom are going through!  And you are right that 72 isn't old any more!  My mom is 73 and we went zip-lining last weekend in the mountains of North Carolina!  and she isn't the exception...all of her friend are very active and do all sorts of cool things.  Her one girlfriend came to visit last month and I took her up to the barn where I board my horse and we went trail riding...she was 75!  Older folks are living healthier, fulfiliing lives..and I hope maybe your mom can start to do the same!

Cancer can absolutely stop someone in their tracks, as can the death of a child.  Would she be willing to talk to someone?  Sometimes that can be more therapeutic than any medication.  Also, untreated pain can cause anyone to be horribly depressed and pessimistic so talking to her doctor and changing her pain meds would be a good first step.  I find it weird that they started her on methadone.  Usually they try the short acting opiates first and I for one find the short acting ones to be more "mood enhancing".

Maybe if they give her a different pain med it will help  all around.  I woul still try to get her to talk to someone..therapist or even a clergy person if she has a religious affiliation.

I don't know if she reads but there are some good books out there about living with cancer and dealing with grief.  I know none of what I am tossing out is probably helpful, but I hope that your mom feels better soon!

I'm sorry to hear about your sister. 

[Chip]

Deadcat, I would suggest switching your mom to Oxycodone or Oxymorphone as they are so much better for pain than Methadone.

Did you say half a mg of Ambien ? That's tiny and wouldn't do anything.

[DeadCat (OP)]

Thanks for the feedback.

Yes, somehow she has to shake the depression (I know, it isn't "just a mood"), become convinced that her cancer is managable and her physical pain is complicating all of it. It is all a big knot of a mess, with each issue complicating the others. Ultimately she has to find some motivation to get more out of her life because the cancer (I suspect) isn't killing her any time soon and she COULD live another 20 years but they will be lousy years if she doesn't get through the depression.

She is also sleeping much more than I have ever known her to sleepand I don't know if it is the meds or the depression or illness or all 3. She definitely inslt concentrating very well and never learned how to articulate her symptoms to doctors, and she doesn't trust them. Needless to say it is a challenging situation and I'm about the only family she has left.

They have her on Celexa but I don't think it is helping and it has been a couple of months now so it should be reavaluated as well. I think I am going to have to meet privately with her pallative care doctor and clue him in that she needs a more effective/euphoric narcotic, different  (and more) benzos  and definitely more counseling.

I'm afraid though that they will discount my opinion because the same medical center know that I am taking buprenorphine and will think I am drug seeking by proxy.  Oddly enough she has a large bottle of methodone and it doesn't tempt me in the slightest.

Then (pardon the indulgence) at the same time, since taking the testosterone and dialing back the bupe and having a blast in Colombia I desperately want my own life back but feel that helping her takes a sort of moral priority.  I don't want to resent her for not doing more to help herself but I know firsthand that when faced with real problems that taking charge of finding a solution is in itself an "empowering" step that makes the solution clearer or if there is no solution, acceptance.

Life can be such a shit show.

[DeadCat (OP)]

Deadcat, I would suggest switching your mom to Oxycodone or Oxymorphone as they are so much better for pain than Methadone.

Did you say half a mg of Ambien ? That's tiny and wouldn't do anything.

My mistake, I meant Ativan (lorazapam).