tag:blogger.com,1999:blog-5650979411395789660.post1688934196176581878..comments2023-12-24T06:06:51.548+08:00Comments on Shin's Cancer Blog: Managing PainShinhttp://www.blogger.com/profile/12174401097883054144noreply@blogger.comBlogger26125tag:blogger.com,1999:blog-5650979411395789660.post-4579903790629011912009-02-21T16:15:00.000+08:002009-02-21T16:15:00.000+08:00Tony, I think it should be perfectly ok since is d...Tony, I think it should be perfectly ok since is done with Shin's clear intention made and with medical professionals. Though is a debatable issue, I think the priority is still the intention of Shin and yours (not to see her suffer in pain and distress,etc). And I suppose this is different from "brain death and vegetables", so is less debatable.<BR/><BR/>If I were you and even Shin, most likely I will do that too. Suffer in pain and distress,etc, for cancer patient is clearly different from "brain death or vegetables" because the latters may have "chances" of recovery and they are not in pain,etc(I suppose). Ethical and religions underlying concepts are "right" but I suppose "wisdom" and "exceptional cases or case by case basis" should be taken into consideration.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-81089168231621711312009-02-21T11:14:00.000+08:002009-02-21T11:14:00.000+08:00Anon,Ethics. I'm glad you brought it up actually....Anon,<BR/><BR/>Ethics. I'm glad you brought it up actually. Its sort of the elephant in the room that i suspect everyone is too polite to mention. I think there are a few levels to the ethics discussion.<BR/><BR/>1. The palliative care team were very clear in their view that this process was not euthanasia. We are giving her medication in an attempt to relieve her symptoms. I think the same logic would apply to any medical procedure that has the risk of going wrong. It is possible that an operation leads to a patients death, but that was clearly not the intention of the procedure. <BR/><BR/>2. In Shin's case the morphine was used to both relieve pain and steady her breathing. The breathing part is more clear cut not a grey area ethically. If we do not calm her breathing there are clear risks form the panic making the breathing problems worse, to the heart racing to make up for the lack of oxygen and heart failure (which was already a risk due to some of the chemo regimes she had been on that has a side effect of weakening the heart). <BR/><BR/>3. And then there is the potential case of using morphine for just pain relief. I suppose one could argue that ethically you should allow pain and suffering instead of increasing morphine when you get to higher levels of morphine (and of course we are dealing with terminally ill patients). Personally, I think this is an unethical decision in itself but I could see how opinions could differ.<BR/><BR/>4. Then there is the case of clear euthanasia. I essentially said in my post that under certain situations I would have been open to euthanasia. The first conditions would be a) that this was something we were clear about before medication started to affect decision making process (and Shin had made her views slear repeatedly over the past few years) b) that it was a terminal situation, c) the patient was very clear about the decision. I realize there may be legal and religious problems with this view, but to me the ethics of the decision would be such that I couldn't really live my self for letting Shin suffer beyond her wishes, due to personal self interest to avoid legal headaches. And I am not religious.<BR/><BR/>I am sure there are differing opinions on this, but these are mine.<BR/><BR/>TonyAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-39169016247256192472009-02-21T00:10:00.000+08:002009-02-21T00:10:00.000+08:00TonyIt is a known medical fact that increasing the...Tony<BR/><BR/>It is a known medical fact that increasing the morphine level can slow down breathing.So, isn't this an ethical issue about who and what conditions should drugs such as morphine be administered ? Indeed ,as has been shared, increasing the morphine level has risk factors.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-10181957142527727762009-02-19T14:28:00.000+08:002009-02-19T14:28:00.000+08:00Hi Tony, I also wish I had come across the link so...Hi Tony, I also wish I had come across the link sooner. But I wanted you to know that I shared the link with you for 2 reasons - firstly to give you the reassurance & comfort that you and Shin's caregivers did all the right things and secondly I hope it will benefit other blog readers. The information is very detailed and neutral (not religion biased). The fear of the unknown, not knowing what to expect when the end is near, not knowing what the dying process is like can be quite scary. In the Asian culture especially, many people think it is taboo to talk about cancer, about death and even about making a will. Even cancer patients themselves do not feel comfortable discussing it openly with their friends and relatives (that is why having someone blog about it so openly like Shin did is something very rare). They even find it hard to say the word "Cancer". I had 2 colleagues who died of cancer, and to this day, no one even knows for sure what type of cancer they died of (cos they did not talk about it). People do not know what to say & how to react to a cancer patient, especially one who is terminally ill. It takes a lot of courage to be open about it. When I first came across Shin's blog, I thought it was very courageous of her to have this blog and to be so open about it. I think this blog is great, and I am sure you will do a good job in keeping this blog alive and sharing with us your personal experiences to help other cancer patients and their families. IdaAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-29797949524531523662009-02-18T21:25:00.000+08:002009-02-18T21:25:00.000+08:00Hi Tony,thanks for all your replies and I really t...Hi Tony,thanks for all your replies and I really think that Josie and Toby will grow up to be like Shin and you. Because you and Shin are actually "of the same kind" :). Just that we get to know more of Shin.<BR/><BR/>Maybe we Asians who grow up in "asian style", are more "narrow minded" or more "conservative" which make us "closed" but you and Shin are always ready to answer and see all that as "positive and no a bother" at all. This is what we can learn from you too. :)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-75170812708471079502009-02-18T17:56:00.000+08:002009-02-18T17:56:00.000+08:00Ida,That was an excellent link. I wish i found it...Ida,<BR/><BR/>That was an excellent link. I wish i found it a few weeks ago. <BR/><BR/>I'll see if I can add it to the links section of this blog.<BR/><BR/>TonyAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-83488094801437229842009-02-18T17:52:00.000+08:002009-02-18T17:52:00.000+08:00Hi Evelyn,Its a very good point about insurance. ...Hi Evelyn,<BR/><BR/>Its a very good point about insurance. I think it is worthy of a full post at some point. I thought we were doubly insured through a private plan and through my work plan. They both only covered a fraction of total costs as they both had annual limits that were far below the actual cost of cancer. Quick numbers is that a per year cost was close to $200k while insurance covered $50k. Maybe not all cases will be that expensive since Shin was a good candidate for some of the new cancer drugs that really added to the costs. But your point is right on. Everyone needs good medical insurance and check the plans to make sure the coverage levels are reasonable.<BR/><BR/>Also, I would say that I really don't mind curious questions about what was happening at the end (for the record, no the kids were not there when she died, in fact we mostly kept the kids out with friends except for a few times like when they said goodbye as in my previous post). I think that I've decided to be open about Shin's last weeks, and hopefully people can think about, prepare and maybe learn. Questions about what was happening don't bother me. I think Shin would have wanted it this way. And I've already heard from a couple of friends about how it already helps. One friend, just flew back to the UK yesterday to be with her father who has been told he should get the help of a palliative care doctor. She emailed me that she is obviously very worried but these posts have helped. That makes it worth it already i guess.<BR/><BR/>TonyAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-82889523227031169702009-02-18T16:04:00.000+08:002009-02-18T16:04:00.000+08:00My father died of stomach cancer in 2004,before hi...My father died of stomach cancer in 2004,before his death, he was in pain, he was screaming and hitting his chest, and even want to jumped out of the hospital window, if possible, i know he would have do that. the doctors gave him pain killers, morphine to reduce his pain. it doesn't work well. I hope that his pain would somehow go away....he fought and lose the battle, and died peacefully in his sleep. his pain had go away, there was no more pain for him anymore, he died at age of 80.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-74075870192863448612009-02-18T12:38:00.000+08:002009-02-18T12:38:00.000+08:00Hi Tony, I came across some information on the dyi...Hi Tony, I came across some information on the dying process which I found very useful and wanted to share it here: http://www.hospicenet.org/html/preparing_for.html<BR/><BR/>I hope you will find comfort and reassurance that you, and all the people around you who have cared for Shin in her final days, had done all the right things to make sure that Shin was at peace and ready to let go. <BR/><BR/>I am sure that what you will continue to do from now - for yourself, Josie and Toby, this blog, the cancer cause and everything else that mattered to Shin - will make Shin very proud of you. <BR/><BR/>Lastly, I would like to wish Josie a very Happy 6th Birthday this Friday :-) <BR/><BR/>IdaAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-88264479246935993762009-02-18T10:13:00.000+08:002009-02-18T10:13:00.000+08:00..thank u soo much Tony for sharing!! Take good ca.....thank u soo much Tony for sharing!! <BR/><BR/>Take good care of yrself and d kids...Josie and Toby..SINCITYhttps://www.blogger.com/profile/06060331873111460661noreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-37930876562539079482009-02-18T09:43:00.000+08:002009-02-18T09:43:00.000+08:00Hmmm, don’t know if I will start an argument in th...Hmmm, don’t know if I will start an argument in the blog by saying this.<BR/><BR/>I find some readers asking insensitive questions. Questions like “Are the children by Shin’s side when she passes away?”, “Did Shin say goodbye?” What does the reader want to know? Does it comfort Tony whether or not the children are by the bedside? What is the point that reader is trying to say?<BR/><BR/>I am just putting myself in Tony’s shoes and personally these are the questions I find people asked to satisfy themselves rather than concern.<BR/><BR/>EvelynAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-66827541607180587432009-02-18T09:28:00.000+08:002009-02-18T09:28:00.000+08:00Hi Tony,I don’t know if it is appropriate to bring...Hi Tony,<BR/><BR/>I don’t know if it is appropriate to bring this up in Shin’s blog.<BR/><BR/>My husband was very fit and took care of his body well, always want it toned and all. He exercises at least 3 times a week. He does not smoke nor drink. If anything, he works hard. So the cancer hit us by surprise. He was only 34.<BR/><BR/>I would like to highlight to the readers the importance of insurance. I guess like all young healthy adults, I did not pay much attention to it. But really health should not be taken for granted. So I would really encourage the readers to take a serious look at their insurance coverage for critical illness and hospitalization plan. People don’t see the importance of it till something hit them. <BR/><BR/>I think you will readily agree that the medical cost these days are not what we can afford based on income alone. Especially so when one is hit – more income loss yet more expenses to incur.<BR/><BR/>EvelynAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-14829488187995904132009-02-18T00:57:00.000+08:002009-02-18T00:57:00.000+08:00it is impossible to give an adequate amount of tha...it is impossible to give an adequate amount of thanks for sharing something so sacred and painfully personal. i know you garnered strength from shin and thought of her purpose with this blog when writing the last few entries. <BR/><BR/>as someone who is also very methodical, i appreciate reading your account simply to know what is happening on a physical/human level, in a detailed day-to-day account. it's incredibly insightful and helpful tony.<BR/><BR/>thank you so much.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-23764850710104082522009-02-17T23:08:00.000+08:002009-02-17T23:08:00.000+08:00You are amazing..I have told you that a few times ...You are amazing..I have told you that a few times but I can't believe how many times I have thought it...Leighbeehttps://www.blogger.com/profile/16376700098397659407noreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-59941204948493285542009-02-17T21:59:00.000+08:002009-02-17T21:59:00.000+08:00Tony,It must be incredibly hard writing all of thi...Tony,<BR/>It must be incredibly hard writing all of this down. But you are really doing us a great service by sharing what hardly anyone shares, thereby giving us important insight which helps to comfort and give hope. <BR/>THANK YOU TONY!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-1059169092218977072009-02-17T21:42:00.000+08:002009-02-17T21:42:00.000+08:00Thanks Tony, i believe you know & did what was...Thanks Tony, i believe you know & did what was best for Shin. She mentioned in her past post that the worst was the suffocation & that was just unbearable to have to gasp for air. I'd like to think that she is in a better place now.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-77697285405683600892009-02-17T21:28:00.000+08:002009-02-17T21:28:00.000+08:00Hi Emily,Its a fair point, but we were mindful of ...Hi Emily,<BR/><BR/>Its a fair point, but we were mindful of that. Although in this post I only spoke about morphine, there were really 3 drugs that were in her injection driver - 1) morphine - for pain relief and to help make breathing easier, 2) Midazolam - which helped with anxiety and sleeping and 3) Haloperidal - which helped with the hallucinations. <BR/><BR/>Theoretically if we had given the midazolam without the morphine, she could have been sedated but in pain (i think). But at the level of morphine we were giving her, pain was not really a problem even when she was awake. The main concern was breathing (which to Shin was a terrible suffocating feeling) and we could see when she her breathing was racing and we would boost the morphine and midazolam which was effective (both when awake and asleep) in making the suffocating gasping ease.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-75143377122906227072009-02-17T21:20:00.000+08:002009-02-17T21:20:00.000+08:00- "You mentioned about the person who died a hor...- "You mentioned about the person who died a horrible and painful death. Just wish to know if this person have gone through the terminal stage without pain relief using drug such as morphine?"<BR/><BR/>Hi Anon, actually this was just a fictional TV show. Even worse it was Battlestar Gallactica (which I'm embarrased to admit I really like). What I meant to convey was that if I had seen the scene of the person dieing a horrible death with cancer before, I guess I would have thought it was fairly realistic. Maybe some die in a lot of pain like that, but our palliative care doctors were quite emphatic that the pain should be managed and no one should suffer.<BR/><BR/>TonyAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-74039911780680838862009-02-17T20:30:00.000+08:002009-02-17T20:30:00.000+08:00Shin's finaly days was very similiar to my cousin'...Shin's finaly days was very similiar to my cousin's....Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-18063983435898859522009-02-17T17:37:00.000+08:002009-02-17T17:37:00.000+08:00Dear Tony, I've been reading Shin's blog s...Dear Tony, <BR/><BR/>I've been reading Shin's blog since I saw the TV program on her some months back. Shin is truly a role model and I have learnt so much from her. <BR/><BR/>A significant thing happened to me as a result of this blog - I now seem to be ok to face dying and death ... I am composed & calm about this, whereas I used to be very very scared about what will happen to me, where will I go, what will become of me ?<BR/><BR/>Thank you very very much for sharing Shin's last days and for passing on the knowledge of palliative care, it really offers the right perspective instead of the horrific painful and fearful images we are so familiar with. <BR/><BR/>The most important thing is to live a meaningful life and strive to do our best and help others.<BR/><BR/>Thank you very much.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-82377691964755025312009-02-17T13:33:00.000+08:002009-02-17T13:33:00.000+08:00I read somewhere that a sedated patient is still a...I read somewhere that a sedated patient is still able to feel pain but just can't express it... I really hope this is not true & didn't happen to Shin.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-52880747779737846122009-02-17T13:06:00.000+08:002009-02-17T13:06:00.000+08:00Shin's Family and Friends: I came to your blog af...Shin's Family and Friends: I came to your blog after doing a Google search looking for information on my Uncle who has terminal brain cancer. Not only did I find information, but a warm and touching story of a strong woman. The pictures of the children touched my heart, since all three of my children are adopted from South Korea. Please know that you and your family and friends will be in my thoughts and prayers.Dawnhttps://www.blogger.com/profile/08577581879232636340noreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-85964519045233451272009-02-17T12:13:00.000+08:002009-02-17T12:13:00.000+08:00Thank you, Tony, for sharing. Take care.Thank you, Tony, for sharing. Take care.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-31902879793649540552009-02-17T11:35:00.000+08:002009-02-17T11:35:00.000+08:00Thanks so much for sharing. Knowledge is power.Thanks so much for sharing. Knowledge is power.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5650979411395789660.post-57808304742924693402009-02-17T10:04:00.000+08:002009-02-17T10:04:00.000+08:00"I was holding her hand as her breathing stop..."I was holding her hand as her breathing stopped. I was telling her everything was going to be ok. She's done a great job, and she can trust me now. The kids are going to be just fine. Go to sleep and rest peacefully."=> This will definitely set her mind in peace. Shin is lucky to have you and Michelle and the pallative professionals. And I think is also Shin and your courage and wisdom to have them to help! Is not easy for you and Shin's love ones to let go even Shin had talked about not prolonging her life. Many cancer patients fear about talking about death, fear about facing death (which are all normal reaction and feeling) or even when they decided not to prolong because of the pain, their love ones may not bear to let go. I really admire the "systematic" and rational process and decision taken by you and Shin...This can be a good lesson to be learn...Though you and Shin,etc, had been through the fears, dilemma,etc, but you all had done very well! :) Tony, are the children by her bed side when her breathing is going to stop or stopped? Did Shin wake up after the kids,etc, say good bye to her?<BR/>Another qn is did the doc say whether if Shin(cancer patient) is actually awake when she looked uncomfort or having racing breathing in her sleep?<BR/><BR/>Can see that Shin still undergo some discomfort and pain but I am glad that she wasn't feeling too much of pain,etc, as compared to many. <BR/><BR/>Shin really can rest in peace as you are really a good and responsible daddy and husband. :)Anonymousnoreply@blogger.com