At Lakeridge Health it takes a team to manage pain

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Doreen Bagley, a patient at Lakeridge Health is a charming woman, full of laughter and a zest for life. In 1985 she was diagnosed with breast cancer; despite treatment and surgery, her cancer spread to the bone in 2002. Radiation treatment helped to decrease her pain, allowing Mrs. Bagley to get back to knitting, beading and visiting with friends.

In 2008, the cancer invaded Mrs. Bagley’s left femur and she suffered a spontaneous fracture. A partial hip replacement repaired the fracture however she was experiencing severe pain. It was at this point that her physician called in the expertise of the Palliative Care Service (PCS) from Lakeridge Health to provide support for Mrs. Bagley. With their assistance, her pain was again controlled and the twinkle was back in her eyes.

Dr. Nicole Devost, a physician with the Palliative Care Service at Lakeridge Health’s R. S. McLaughlin Durham Region Cancer Centre, is dedicated to providing palliative patients with an optimal quality of life.

“Managing a patient’s pain is best achieved through the efforts of all members of the health-care team, which includes the patient’s GP, medical oncologist, radiation oncologist, palliative physician, nursing and allied health professionals,” noted Dr. Devost. “Home care support and other community partners are also vital members of the team.”

Dr. Devost and her colleagues provide a wide range of therapies that relieve severe cancer pain. Carefully balanced use of opiod medications administered by pills, injection or pain pumps are the first line of defense. Anti-inflammatories and anti-convulsants are also used, as are anti-depressants which help to alleviate the perception of pain and improve the overall sense of wellness.

In November 2010, Mrs. Bagley became alarmed as numbness spread across her face. Fortunately, once a patient has been referred by physician to the PCS, she remains on the service and can call 24 hours a day, seven days a week.

Mrs. Bagley called and told Anita Hartwig, RN. “I feel as if I have gone to the dentist and they have frozen my jaw. I keep biting the inside of my cheek when I am chewing food because I can’t feel anything”.

Ms. Hartwig immediately arranged for Mrs. Bagley to see a palliative care physician. An MRI revealed a lesion at the base of her skull; a visit to Dr. Wayne Koll, Radiation Oncologist, was quickly organized and radiation therapy was initiated.

As Mrs. Bagley neared the end of her radiation treatments, she began to experience severe pain in her back, saying, “I could hardly sit; there was constant, terrible pain that shot up from the base of my spine”.

Once again a call to the PCS was made and this time she spoke with Kasie Penney, RN.

Using the Edmonton Symptom Assessment System (ESAS), Ms. Penney asked Mrs. Bagley to asses her levels of pain, fatigue, nausea, drowsiness, emotional state, appetite and shortness of breath. “Whten a patient’s assessment in any area is more than five on a scale, his/her ability to function has been significantly impacted,” said Ms. Penny. Mrs. Bagley assessed her back pain at a seven.

That set the wheels in motion. Dr. Koll immediately did an MRI of the spine, admitted her to hospital and started a new course of radiation treatments, this time to Mrs. Bagley’s spine.

Within a few days of treatment and daily morphine, Mrs. Bagley’s pain was controlled and she was discharged. Methylphenidate was also prescribed to offset the drowsiness brought on by her drugs and enabled Mrs. Bagley to resume her activities.

In Mrs. Bagley’s case, radiation therapy reduced the size of her tumours and provided pain relief; chemotherapy is used for the same reason. Massage and therapeutic exercise have also proven helpful; patients can also seek additional relief through alternative medicine such as acupuncture, reflexology, reiki, and therapeutic touch.

“All therapies are intended to prolong life expectancy with quality. And the only person who can decide what is important to their quality of life is the patient; it is unique to each person,” says Dr. Devost.

Thanks to Mrs. Bagley’s health-care team, the pain in her spine and the numbness in her jaw have subsided. Her smile and laughter are back; she is content. Mrs. Bagley’s future is not filled with the fear of pain, but with the comfort of knowing there is a team ready to help her whenever she calls. Medicine has not yet found a cure for all cancers, but at Lakeridge Health’s R.S. McLaughlin Durham Regional Cancer Centre hope and care offer a remedy for pain and despair.