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Severe asthma. Got paralyzed on half body after gallbladder cancer treatment. Facing weight loss, abdominal pain

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General & Family Physician
Practicing since : 1978
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I am seeking your esteemed help and advise on treatment of my mother Smt XXXXXXX XXXXXXX XXXXXXX Age 67. In regards, at first I would wish to give you a brief history about her ailment and past medical record. She has been treated in BSP hospital.

My mother Smt XXXXXXX XXXXXXX XXXXXXX is a patient with Gall bladder cancer that was diagnosed around in 2012. She is a severe asthematic patient since past 15 years, hence the option of surgery was ruled out to treat the gall bladder cancer. She was been treated with Chemotherapy in Bhilai since sept 2012, in which 3 chemos went well and she was recovering. But subsequently after the 4th chemo, she lost weight drastically and had a sudden paralytic attack paralysing her on one side of the body in XXXXXXX 2013. Since then she is been treated for neuro & paralysis and is recovering now with medicines.
This is about her past diagnosis, i have attached her reports in reference.
She is consistently complaining of pain in the abdomen for last 5-6 days. She is finding difficult to get the nights. She is unable to sit or sleep at one position for long. She is taking Ultracet pain killer 1-2 a day but this is only giving some relieve for a short time.

We are seeking some advise to overcome her pain and have a comfortable sleep at first. We are also looking for further treatment on gall bladder by modes other than surgery.
Posted Fri, 5 Apr 2013 in Cancer
Answered by Dr. Pavan Kumar Gupta 2 hours later
Thanks for the query.
I feel sorry for the pain being suffered by your mother as result of advanced gall bladder cancer.
The most common painkillers in cancer care are morphine-based drugs. Drugs that are similar to morphine are called opioids. Your mother is already using ULTRACET, which is also an opioid.
I would advise you to increase the dose to 4 tablets a day and see the response.
If this is unable to control the pain, then stronger ones can be used like OXYCODONE or VICODIN.
Since all these are prescription based drugs, you would have to talk to your doctor for their prescription.
In cases of severe pain, procedures like COELIAC PLEXUS NEVE BLOCK or SPLANCHANIC NERVE BLOCK can be undertaken. However for all these you have to discuss with your treating doctor.
Other non medical methods o be employed are
...Hot water pack locally
...Frequent shifting of position
...Distraction of her mind by asking her to see TV or read magazine, if possible.
...Massage at her back.

As far as any other treatment is concerned, besides surgery, chemotherapy and radiotherapy, there is nothing else except to control her symptoms.

I hope it helps. However, you may revert to me for any further query.
May god bless you and your mother.
Above answer was peer-reviewed by
Follow-up: Severe asthma. Got paralyzed on half body after gallbladder cancer treatment. Facing weight loss, abdominal pain 12 hours later
Dear Sir,

Thank you very much for your kind response and thanks your kind words. Your advise is indeed very helpful and we as a family are very grateful to you.

I have a few questions further to your response, i am seeking more clarification:

1. Will the increase in dose of ULTRACET have any side effects to her? She is already very drowsy and sleepy throughout the day with 1-2 doses. She is feeling more sick. For many days she has not moved out.
Usually the pain creeps in morning around 9-10 AM, evening betwn 6-8 PM and early morning 3-4 AM. She starts crying and we have to give her pain killer but my father tries to control it to 2 only maximum a day if required. Past 3-4 days pain has
increased, so he has increased the dose today.

2. Is the pain control management and the below medicines also controlling the cancer? What is the EXPECTANCY beyond this?

3. How is the procedure for 'COELIAC PLEXUS NEVE BLOCK or SPLANCHANIC NERVE BLOCK' carried out? Is it advisable considering her present condition? Does it require surgery and anaesthesia? If it requires her to take anaesthesia we doubt since we were advised not to go for surgery due to her been severe asthamatic and her overall condition being very week and lean post 4th chemo.

If you advise NERVE BLOCK can be a better option for pain control, request can you please provide any reference in Nagpur/Bhilai/Raipur where we can take her for treatment?

Thank you very much for giving non-medical methods, this is very helpful and we will certainly be able to care for her with these methods. Thank you !!

4. Also, can you please advise on her DIET? She is on a very low diet as of now:

She usually takes following in her diet:-
[She gets up usually at 5 AM)
Morning 6-7 AM: Anjeer & XXXXXXX (kept in water in night)
Morning breakfast 7 AM: Oats with milk
9 AM : Bread Butter / paneer ( made by adding lemon to boiling milk) / Bread Jam + Badaam Milk => Medicines
11 AM: Gud Roti ( 1 roti/chapati)
1 PM noon lunch: 1 Roti + Daal + sabji (sometimes add nutrilite) => Medicines + tonic(jhandu pancharishtha)
4 -5 PM: Oats with milk
8.30 PM Dinner: Daal Roti, Sabji => Medicines

She is unable to digest much hence she has to take in small quantities and at regular intervals. Roti is broken into very small pieces.

We are very helpless at this stage and seeking guidance and advise through all possible sources. A light of hope is a great satisfaction to us at this stage.

We would be highly obliged to you if you could kindly advise a better diet for that can improve her health. We have also realized irregular intake or delays in food intake is a cause of pain for her at many times.

Sir, many many thanks to you for your kind advise, we as a family are indebted to you.

I understand the fees charged was very nominal and not appropriate for such detailed consultation, however i would be very glad to pay additional fees for your esteemed consultation and guidance.

Thank you so much !!

With Best regards,
Answered by Dr. Pavan Kumar Gupta 6 hours later
I would reply you one by one.
1.. You can give ULTRACET every 4 to 6 hours.As far as side effects are concerned, all pain killers have some side effect. We are more concerned with her pain management at the moment and giving 4 tablets a day won’t cause any problem.
2...these pain controlling procedures don't have any effect on increasing the life expectancy of the patient. Such types of patient normally live from 6 months to 2 years after the diagnosis. Life expectancy in a patient of gall bladder cancer is good only if it can be totally removed by surgery. Patients with non operable stage rarely live beyond two years of diagnosis.
3...regarding nerve blocks are concerned, you would have to discuss with your treating doctor regarding this. Although splanchnic nerve block requires anesthesia to be given, coeliac plexus nerve block does not require any anesthesia and can be given by either CT or ultrasound guidance. It involves only injection of anesthetic agent in coeliac nerve plexus located in your tummy. far as diet is concerned, you may add some protein powder like PROTEINEX OR RESOURCE protein in the milk. You may give some fruits and fruit juice to her. Rest whatever is being given is all right, as she is not in a position to take more. Keep giving her small quantities at regular intervals.

Since there is no treatment left to cure your mother of her illness, I would advise you to give her your maximum love, attention and care in twilight of her life.

May god bless you and your family.

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