Hi there,
I'm hoping someone can help out here. I brought my mom-in-law home from the hospital friday after her g-tube procedure. She is just supposed to be here a few days until she gets the hang of her feeding pump and giving her own meds. This morning when I went to give her meds she had green bile coming out of her g-tube. I decided to wait for the home care nurse and she thought it was "probably" normal however she didn't exude confidence!! Anyone else had this issue?
I don't know if this is going to work out or not, she really wants to go home but it is a lot for her to learn, she has oxygen as well now, but the main concern is her meds. She doesn't seem to know when to take them. I fill little syringes for her at night with morphine, small doses for breakthrough pain and larger ones for her 4 hourly doses, I have everything colour-coded to make it easier but she still takes the wrong ones or when I got up this morning there was morphine all over the floor, so I don't think she got much of that one. She didn't want to do anything for herself today, she was supposed to show the nurse if she could set up her own feeding but she didn't want to. I don't have a problem doing it for her but she soooo wants to go home I'm not sure what to do. Thanks for letting me vent guys.
Karen

Hi Karen,
I didn't have a feeding tube so others will answer that one for you.

I would not assume anything is "normal" - you are then taking direct responsibility if it is not. Always consult with a doctor or if you have an oncolgy advice nurse, all the better. It sounds to me like your mother-in-law will need a caregiver. I honestly couldn't even imagine going through this alone. As I got more into treatment I got increasingly more helpless and dependent on my wife. Always ask the doctors for explicit instructions and/or complications to watch for - take detailed notes or tape record it.

I need to ask this - why is she taking morphine? Is she in treatment? What stage of treatment?

Assuming that she is in treatment and needing long term pain management:

Managing potent drugs like morphine need to be carefully done. If she were to do the opposite scenario, she might forget she took them, double or triple dose and OD. She shouldn't have to be waking up in the middle of the night to medicate anyway. Morphine is a fast acting opioid, typically prescribed for occasional breakthrough pain. Breakthough pain is caused by specific events such as eating or drinking. I never had to use a breakthrough med in the middle of the night. Some people have weird reactions to morphine also so keep an eye out for that.

It sounds like she needs to be on a long term opioid such as Fentanyl (AKA Duragesic). It is a 72 hour time release patch and fairly brainless to use. They can keep increasing the patch strength until the desired pain masking is achieved. And better yet, there is nothing to swallow or get stuck in the PEG tube - it also can't be vomited out.

Here are the NCCN cancer pain management guidelines:

http://www.nccn.org/professionals/physician_gls/PDF/pain.pdf

There are always constipation issues with pain medications so those eventually will have to be managed also.

Karen-

I agree with Gary. Your mother-in-law will definitely need a caregiver if she wants to go home. There is no way my husband could have done it on his own. He didn't remember when to take the meds or what meds he'd already taken. I had to write a time table just for myself so I don't know how anyone in treatment going through all that pain could possibly remember. It is common for them to be a little "fuzzy" during treatment.

As far as the green bile in her tube I would definitely contact the G.I. doctor that put the PEG tube in. I was never afraid to call them in the middle of the night if that is when something happened. Don't be afraid to ask questions...better to be worried about nothing then to not worry about something that is important for the doctor to know. Give the doctor a call and hopefully he/she can re-assure you that it is nothing. From experience, I know it is better to know you have one less thing to worry about.

I don't know your mother-in-law's situation but if it is possible for a caregiver to move in with her during this time then that would probably be best...if she still wants to go home.

Hang in there. Sounds like you are being the best daughter-in-law in the whole world! And don't hesitate to yell, scream, and ask tons of questions on this site...that is what we are all here for and believe me we've all been right where you are.

You are in my prayers, Lorie

Gary and Lorie,

Thanks for replying. It's a bad situation thats for sure. The possibility of someone moving in with her isn't there. I am the only person close by enough to look after her and I have 3 kids at home, the oldest being 13 and the youngest 5, so I cannot stay with her. She will come to stay here when she is ready, her room is ready but I can't drag her here. But she has come to the conclusion that she won't be going home this week!
Before the peg she was on a slow release morphine pill and another for breakthrough. The doc in the hospital prescribed the liquid because of the peg but it isn't going to work. She doesn't have a clue as to when to take it. We are seeing her oncologist on wednesday and I will be requesting the patch. Her breakthrough is strange. You said Gary that it usually occurs because of some activity. She isn't taking anything by mouth at all and she isn't even talking much but she has a tumour (in-operable) in her cheek area that is creeping down her neck and she gets the most severe pain in it. She uses a hot compress on it, thats pretty much the only relief she gets.
As for the bile, I will be talking to her doc hopefully tomorrow, or someone at the hospital, its a long weekend here. Again, thankyou for the help.

Karen

Karen,
it sounds to me like her pain management plan is not adequate. I would call the doctors on it and ask them point blank if they are following the NCCN oncology practice guideline for pain management. They gave me liquid morphine also, planning on my having a PEG tube but the duragesic was the backbone of my pain management plan. If the morphine causes problems then oxycontin is a suitable substitute. Even though morphine is a relatively fast acting opioid, in tablet or liquid form it could take 1/2 hour for the desired results.

Be sure that when you describe the pain that you use the pain intensity rating scale in table 1, Pain 8-9. of the document in the link I sent you earlier. Also ask her to describe the pain to you - she may not tell the truth to the doctors - we have seen that here before. Older people are terrified of losing their independence.

In the US pain management is a basic patient right.

Karen
I remember being scared silly when Pete got his PEG put in. We had the same problem and when I called the home caregiver service we had been recommended to the advice I got was ...well, if its a lot open the PEG and let it drain out!
N
Needless to say that was the WRONG advice and that company was promptly fired. Some one should have been sent out by now to show you guys how to deal with the PEG. The green bile is a normal occurance. Were you given a syringe to insert in PEG and measure the bile? I don`t want to give you the idea that you can just do this yourself with no direction, you have to be taught.
Karen, there is no way your mother -in- law can be responsible for her medications. Some arrangements have to be made to help you and her through this. Has the Doctor or hospital put you in touch with a social worker or a case manager?
You need some help here...start Yelling!

Marica

Ok, well I started yelling and man am I tired...
Saw the oncologist today, tumour has grown slightly in 6 weeks, doesn't sound good to me. Got a new pain med, Hydromorph contin, twice a day with Dilaudid for breakthrough. Also got palliative care on the way. They are going to set it up at my house since it doesn't look like mom-in-law is going anywhere soon, if ever. She still says she would like to go home but is scared to, and rightly so. She dozed off with a cigarette today and burnt a hole in my couch!! So, unfortunately I can no longer allow her to smoke without supervision. Not sure how I'm gonna tell her that yet. My head is pounding and I have felt like I was gonna meltdown all day, so I thought I would vent a little. Thanks for listening guys. Keep us in your prayers.

Karen

Karen,

Sorry to hear things are reaching the boiling point. Vent all you want, we all go through that as caregivers or patients. When my mother had developed 4 brain tumors from mets from her ovarian cancer, she went into this feeding/cooking frenzy. One day she made about 3 gallons of oxtail soup and the next day she made about 2 gallons of chicken and noodles. Our refrigerator was stuffed as it was. We went to a church class and came back with the house full of smoke and her sound asleep in the bedroom having forgot she even went in to cook something. Her life was cooking. After about 20 big burns on the carpet I just gave up and replaced it after she was gone. I came home once and the home health care nurse that was filling in for the regular one that was on vacation had my mother sprawled out on the white leather couch, changing her ostomy bag. Needless to say, it was a mess and I was not kind to the nurse after my mother went back to bed in her bedroom. The oncology psychiatrist we were working with wanted us to hide all the knives (mom was getting a bit agitated at everything), turn off the gas to the stove when we left and keep the medicine available but controlled (she was contemplating suicide often).

You are an angel for being there and especially for your mother-in-law. It is a thankless and total stress position you have put yourself in. I will be praying daily for God to provide you with peace and comfort.

God Bless,

Ed

Hello, Karen. With regard to the smoking, I had to take my dad's pipe away after several strokes when he kept setting fire to everything around him. It did not please him, but it was a serious safety concern. So just do what you must. It is tough, but something that must be done. My dad adjusted and I hope your mother-in-law will understand also. Keep in mind that this is a safety issue for the entire family and do not let go of that thought.

Ed and Joanna,

Thankyou both for your input. Its a crazy situation but one that is going to be okay. With regards to the smoking, I told her (rather sheepishly, she is still my elder) that she couldn't smoke without supervision and she was ok with it. I think she really scared herself the other day and realised that it isn't just her anymore, we have 3 kids in this house. So I take her cigarettes away when she goes to bed with no complaints. Still a worry though, it's 8am and I just got home from work and I was concerned all night that something would happen. But I guess I have to give my husband credit, everyones still here. So on with the day.

Karen