Gallstones

What is Gall bladder?

Gall bladder is a small organ below the liver in the upper right abdomen. It’s a pouch that stores bile, a green-yellow liquid that helps with digestion.

What are Gallstones?

80 %  of gallstones are formed when there’s too much cholesterol in the bile. Other 20 percent of gallstones are made of calcium salts . The exact reason behind formation of gallstones is still unknown.

Having too much cholesterol in your bile can lead to yellow cholesterol stones. These hard stones may develop if your liver makes more cholesterol than your bile can dissolve.

Symptoms

Gallstones can lead to pain in the upper right abdomen. You may start to have gallbladder pain from time to time when you eat foods that are high in fat, such as fried foods. The pain doesn’t usually last more than a few hours.

Symptoms (Biliary Colic)  

1. Indigestion
2. Stomach pain
3. Nausea 
4. Vomiting
5. Colored stools
6. Colored Urine
7. Burp
8. Diarrhea 

Asymptomatic Gallstones

Gallstones actually don’t cause pain. The pain usually occurs when the gallstones blocks the movement of bile from the gallbladder.

Gallstones are detected through X-rays or during abdomen surgery.

I love you papa, forever!

Opioids for CANCER pain

In my previous post I have talked about “PAIN” relief in cancer. In this post, I will be talking about about opioids- drugs which are used to provide some relief from the constant "difficult" pain.

With each passing day, cancer becoming more aggressive, pain becomes a 'constant' part of life. The pain is not only acute but is chronic and with time, it tends to become more uncontrollable. At this stage doctors prescribe OPIOIDS.

What are opioids?

Opioids are medicines that are used to provide relief from moderate to  severe pain( usually in cancer) .These medicines work on the principle of "reducing the intensity" of the pain signals being sent to the brain and affect those areas controlling these senses, and thereby considerably minimising the effects of the painful signals.

Opioids act much like endorphins-  natural substances created by the body to restrict or limit pain. Some of them work better than others in terms of providing  relief from terrible pain. 

Opioids were once formulated from the opium poppy( plant), but today many pharmaceutical companies are creating these drugs synthetically in laboratory, though addiction to these drugs still remains a critical issue .

Types of Opioids

Severe Pain

• Morphine 
• Buprenorphine
• Fentanyl and Alfentanil  
• Hydromorphone 
• Diamorphine
• Methadone
• Oxycodone 

Moderate to mild pain 

• Tramadol
• Codeine 

All  of the above mentioned drugs are available at drugs store strictly on prescription. 

Side effects

Most of the people taking these drugs over a period of time develop a kind of tolerance to these drugs. Therefore, the doctor has to prescribe higher dosage to provide relief from pain  or the other reason can be  increase in pain due to the advancement of the disease. 

A little  increases in the dosage or a change in the type of medicine will help in relieving the pain.

Common Side-effects

• Hallucinations
• Confusion
• Vivid dreams 
• Myoclonic jerks.
• Sedation
• Nausea and vomiting 
• Constipation
• Dry mouth 
• Itchy Skin 
• Coughing,wheezing, and shortness of breath
• Difficulty in passing urine
• Blurred vision

All these symptoms are common, and usually the treating doctors provide medicine to help overcome these effects. 

Im my personal view these symptoms never actually go away. Though the doctor’s do prescribe some medications to control these symptoms, but they prove to be of little or no help. Eventually all the symptoms emerge. ( In case of my father, where I tried my level best to read about the symptoms before hand, so that I could "prevent" them from emerging. With absolutely no result, my father went away!)

Towards the end, when pain becomes “difficult", the body has become resistant to opioids and nothing helps- the focus should be on making life easy- good palliative care.

Because you love them, tell them, show them- be with them. They need you, for the last time!

I love you papa!

Chapter 6- Radiation therapy begins...

As time passed, pain only increased and papa spent most of his time lying on the bed. Even for turning to his sides, he now needed support. He stopped having food. The last time he had anything to eat was on 12th August 2012 and then finally having his last meal ( half a cup of his favorite apple juice),  on the morning of 26th October 2012  - the day he left us! 

I remember,  once i got his favorite sweet. He got very annoyed and threw it. Cancer has reached his mouth and he had stopped feeling taste. In my last frantic attempt, I decided to go ahead with RADIATION THERAPY. Papa’s oncologist has suggested it as the last resort to help my fading father.  

I had reached at a stage in my life, where if anyone  would have told me about something that can help my father in easing his pain. I would have done with my eyes closed. I don’t care. I just wanted papa to be  free of pain. 

An ambulance was arranged. Papa had to be carried on a stretcher. Our house being on  2nd floor, with the help of my brother, my husband and 2 more people,  papa was brought down and  taken to the hospital.

I have often have come across a saying,

"The only permanent thing in life is change"

And, now when I think of it, having seen it  with my own eyes. I can say,  how true it is.

When i was a baby, my father  held my hand and I followed him because i believed him. Papa will only decide the best for me. And now years later. I am holding his hand and he is following me. He believed in me, in my decisions. He knew, I knew-  nothing was happening. But our  belief in each other kept us strong all through  the treatment.  

Papa lay on his bed, when the nurse came and said, it’s time for the therapy. He looked at me and I looked at him. I got up. Papa was helped on the stretcher by the attendants . I carried his reports/files in my hand. On our way to the radiation therapy “room",  I started telling him about the man, i met in the lobby and how radiation therapy has helped him walk again. He was listening very carefully. Like every other time, this time also -I was sure, papa will feel good after the therapy. 

I waited outside the room. After 15 minutes, papa was brought out. His eyes were closed. He looked exhausted. His dark circle looked more prominent now. And his hands- the hands that taught me too walk, write and paint were frozen. I held his hand, and put his shoes under the stretcher and started walking with the stretcher, towards the room. 

In all 9 cycles were planned by the oncologist. Papa did feel better for the initial few days. But as the days progressed, so did CANCER. Side effects of radiation therapy emerged. Skin problems like itching, dryness, lumps formed behind his ears, changes in bowel movement, mouth ulcers, nausea, vomiting and difficulty in swallowing or coughing. 

The emerging symptoms only added to his miseries. Despite of taking preventive measures,  symptoms could not be controlled and papa’s condition deteriorated further.

After 6 cycles, papa gave up. He din’t want to. In respect to his wish, I decided to stop taking further radiation therapy sessions. For many weeks- Papa, lay on the bed motionless for hours, absolutely unaware of what was happening to him or around him.  To avoid bed sores, we would turn him on the sides. But from his side- he would  open his eyes only for few seconds, as if trying to gain energy and then fall back to sleep. His back bone completely ruptured. He would continuously writhe in pain. Bed sores appeared. They were painful. The lump(node) behind papa’s ear burst and pus started flowing. The ulcer in papa’s mouth turned black and he could not even swallow a spoon of water. Days passed since papa had any bowel movements.

He lay motionless for weeks, under the effects of MORPHINE and other pain killers. I would sit all day, by his side (for fear,  i would not move for a  minute, what if...... ).  I prayed, prayed and  prayed. I wanted ....the AGONY to end!

The END came, Papa went far far away...

Dear papa,  no matter where you are ….I LOVE YOU , always!

Chapter 4- Chemotherapy begins

After papa got admitted to the hospital. I was  impatient. I was restless. I wanted the treatment to start as soon as possible. The chemotherapy (chemo) to start as soon as possible as already so much time has been lost. I wanted some thing to  look forward too. I wanted a miracle to happen. I wanted to hope. As as the famous saying in hindi goes, a straw is enough to save the drowning person, for me chemotherapy was the straw. 

Most of us know that chemotherapy is a very painful process and for those who don’t know, chemotherapy- strong acids are injected in the body to stop the growth of cancer cells. These acids are injected through veins( intravenous) . The cycle includes sending poisonous chemicals into the body through very slim needles. And then flushing out the toxin from the body by sending another chemical(s). 

Chemotherapy causes more harm then doing good to the body. But i wanted to give it a try for myself- who was desperate and would do anything that will add few years to my hero- my father's life. For papa, who wanted to live. For my mother- his partner of 42 years. For my brothers, who looked up to papa as their idol.

I was informed about the side of effects of chemotherapy.  Reduction in blood platelets count, nausea, fever, mouth ulcer, diarrhea and hair loss. During his two cycles of chemotherapy , papa suffered all  of these except for that he never lost a single hair. In fact, in the final few weeks, he was so irritated by his hairs, owing to being bedridden now for months (Papa had beautiful silky straight hairs and  he always kept his hair nicely trimmed and well combed) that to pacify him, I had to trim his hairs.

The first chemo cycle lasted for 3 months, at the end of the 3 months a review was done, to find out about the improvement in papa's condition and to ascertain the extent to which the disease has  been  controlled or has spread. The first cycle was divided in to two parts. The first phase, papa had to be admitted to the hospital. He was supposed to stay in the hospital for 3- 4days. Papa was tied to the bed for as long as 56hrs with a needle in his arm. First the medicines and after a break of 10hrs, the toxins were flushed out. The only time he was allowed to leave the bed when he wanted to use the washroom.He hated it. I hated it too. It was painful for him and for me. But he believed in me and i believed in the doctors, who said it is important if you  want to prolong your father’s life ( Is their any other answer). 

The second  phase- lasted a day. We would come to the hospital in the morning, get the chemo done and leave by evening. Both phase(s) were carried out in the alternate weeks. 

Every morning the schedule was same in both the chemotherapy phase(s). Reach the hospital early in the morning, get the blood test(s) done. Wait for the reports and on the basis of the results, it was decided to go ahead for the chemotherapy. 

After every chemotherapy session, papa felt weak and exhausted. But he refused to give up. He tried to be as normal as he could be and do most of his daily chores by himself. As days turned in to weeks and weeks in to months, papa grew more weak and lost considerable weight. Chemotherapy has started taking its toll. I could see but was helpless and at the same time hopeful.

It is said, that the first chemotherapy cycle is the rosy period of the treatment and it turned out to be true. After 3 months reviews were done. The results of the first cycle said, the cancer that started from gall bladder has shown 20% decrease and no growth  was reported in the pancreatic region. Papa blushed. He smiled after almost 4 months. I felt relieved. Finally after months of sadness, we have a good news. 

It was my 6th wedding anniversary, and i could not have received a better gift then this - my father’s improving health.

To my father’s courage and never say die spirit. I am so proud of you papa!

Chapter 2 -Symptoms

People say time is the biggest healer.. I say time heals wounds but scars are left to remind you, what you have been through....

For me loosing my father was not just about loosing a parent. Besides loosing a valuable relationship, i lost a friend. My father,  actually both my parents have given us, siblings the liberty to speak our mind. And say whatever we wanted to.

And,  we could tell our parents anything and everything.

Papa was always a very disciplined and an organized person. He did everything so neatly and perfectly that sometimes i wonder how did he. At times mom would forget about something, but papa was more perfect then  organized. He just knew everything( I think all children think about their parent the way i think).

With him gone, and doing all things by myself makes me feel how hectic it is to be a parent and that too a parent, which i could look forward too. Though its been 10months since papa left , it feel likes it was just yesterday when papa was here with us and doing what he was best at- taking care of his children. He was always there for us.

When the doctor told me, papa has stage 4 cancer, i could not believe my ears- did i  just hear cancer? Is it happening to me? Has time come for papa? Will papa leave in few months. And I said to myself, loud and clear - NO, NEVER. I will challenge and win!( If only i had known, what papa was going through)

I wanted to be alone, i went to the park and set with my tablet in my hand. I typed " Gall Bladder Cancer Symptoms".

The result was :-

• Loss of appetite.
• Losing weight without trying
• Abdominal bloating.
• Abdominal pain, particularly in the upper right portion of the abdomen.
• Itchiness.
• Fever.
• Nausea.
• Yellowing of the skin and whites of the eyes (jaundice)

Now, i could relate to papa's loss of appetite and weight, constant complaint of pain in the abdomen, he being tired. 

It was  Diwali ( 13Nov2012), and i wanted to buy this dining table, i asked my father to accompany me. Papa always loved shopping. It was difficult to match his enthusiasm. And i have inherited the same quality. This store had its dining furniture on 3rd floor. As papa started walking he began to shake, he could not climb and  refused to come upstairs. He waited downstairs. Something was wrong. Papa was moving away from us. And we had no idea.  Had i known it or had the slightest inclination of it being cancerous. May be papa would have been here with me.