I am a caregiver in an assisted living, we have a lady that was diagnosed in Dec. 2003 with malignant neoplasm of the larynx and squamous cell cancer of the palate. She is fairly young. surgury and radiation is not an option. We are working with Hospice, but they don't have a whole lot of info on what we should expect, I have been searching the internet for 2 months now, all I find is treatments. Can someone please help me. We want to be able to keep her pain free and active for as long as we possibly can. We just don't really know what will happen from day to day, she is now having swallowing problems, is on a scheduled pain med and has breakthrough pain meds, which she is getting 2-3 times per day. All we have gotten is that she will probably bleed to death, before an ambulance could even get there, which is why Hospice is involved also. If anyone has any info I would greatly appreciate it. Thank you and god bless everyone

There are 72 hour patches that can be used for pain management Fentanyl Duragesic patches that come in various strenths if she has trouble swallowing. In addition medicine used for breakthrough pain can be obtained in liquid form so it is easier to swallow and if it becomes a real problem it can be administered via syringe in the back of the mouth. Hospice should be able to help with this if they haven't already.

If you go to the the NCCN practice guidelines there are guidelines for managing palliative care, pain and stress management. The hospice doctors and nurses should be educating you on what to expect as the terminal phase usually has markers along the way. If the person has a DNR order, keep it in a prominent place like attached to the refrigerator. The EMR people are required by law to attempt rescitation without it.

http://www.nccn.org/physician_gls/index.html See "guidelines for supportive care"