Talk Cancer

Question:

I have a question for Steph (or anyone else who might have any thoughts). My mother-in-law, with colon cancer, cells found on all 4 biopsied lymphnodes, and with 5-6 nodules (7 to 20 mm in sixe) on liver found in 12/13/02 surgery, has decided against chemo (5-FU was oncologists’s initial proposal). We recognize death is on the horizon – either weeks or, less likely, months. She has signed a DNR, and is ready to check out. Last week, the hospice affiliated with the hospital started giving her tylenol w/codein to help her sleep and to minimize her agitation and upset.  She is eating little, but her plumbing is working – bowels moved (after enema).   After a few days, she continues to be very drowsy, and is now throwing up.  We are wondering whether codeine is the best thing for her to be taking – doesn’t it sometimes cause nausea/vomiting? Any thoughts are appreciated – Ken (previously posted qeustions re: same case at earlier stage, a couple weeks ago).

Response:

Ken, the vomoting could be disease related or due to drugs including codiene. If they suspect codiene is the culprit a change to tramadol, oxycodone , fentanyl , methadone or hydromorphone may be in order. If the disease is the problem then adding an anti-emetic to her drug regimen is needed. Hypercalcaemia is occcasionally a cause of nausea and confusion particularly when the is bone involvement. Codiene is a pain killer and would not be my first choice for sleeplessness and agitation, there are more specific drugs for that. MIKE

– Hide quoted text — Show quoted text – I have a question for Steph (or anyone else who might have any thoughts). My mother-in-law, with colon cancer, cells found on all 4 biopsied lymphnodes, and with 5-6 nodules (7 to 20 mm in sixe) on liver found in 12/13/02 surgery, has decided against chemo (5-FU was oncologists’s initial proposal). We recognize death is on the horizon – either weeks or, less likely, months. She has signed a DNR, and is ready to check out. Last week, the hospice affiliated with the hospital started giving her tylenol w/codein to help her sleep and to minimize her agitation and upset.  She is eating little, but her plumbing is working – bowels moved (after enema). After a few days, she continues to be very drowsy, and is now throwing up. We are wondering whether codeine is the best thing for her to be taking – doesn’t it sometimes cause nausea/vomiting? Any thoughts are appreciated – Ken (previously posted qeustions re: same case at earlier stage, a couple weeks ago).

Response:

– Hide quoted text — Show quoted text – I have a question for Steph (or anyone else who might have any thoughts). My mother-in-law, with colon cancer, cells found on all 4 biopsied lymphnodes, and with 5-6 nodules (7 to 20 mm in sixe) on liver found in 12/13/02 surgery, has decided against chemo (5-FU was oncologists’s initial proposal). We recognize death is on the horizon – either weeks or, less likely, months. She has signed a DNR, and is ready to check out. Last week, the hospice affiliated with the hospital started giving her tylenol w/codein to help her sleep and to minimize her agitation and upset.  She is eating little, but her plumbing is working – bowels moved (after enema). After a few days, she continues to be very drowsy, and is now throwing up. We are wondering whether codeine is the best thing for her to be taking – doesn’t it sometimes cause nausea/vomiting? Any thoughts are appreciated – Ken (previously posted qeustions re: same case at earlier stage, a couple weeks ago).

Codeine siuts some people, but often has side effecte like you are describing in elderly patients with liver disease. You should try to get a consultation twith the local palliative care specialist.

Response: