Advice on how to handle anxiety attacks

[mickeyboat]

FIL has been diagnosed with terminal pancreatic cancer. And while is his still physically able to care for himself for the most part, he is having terrible anxiety attacks which have necessitated ER visits on Saturday and again yesterday.

He is taking some medicine (Ativan) that is supposed to help with anxiety, but it does not seem to be working. Does anyone have any experience with this who might have some suggestions on how to help?

TIA,
Denae

 

[Christine]

A couple of points:

1. Is your FIL actually seeing a psychiatrist to help deal with this? If it is his GP or oncologist, they may not be the best for handling this. Often times, and oncology group with have a psychiatrist they work with for this specific purpose.

2. His dose of Ativan might not be high enough for full-blown panic attacks. It might just be enough to work for people who get nervous going to the dentist. So I would have the dosage evaluated.

3. He may do better on a long-acting benzodiazipine such as Klonopin which will keep him from roller-coastering. Ativan and Xanax are very short acting meds and the panic can come back quickly in between dosages.

4. I don't know if I'd get involved with the SSRIs at this point. With his cancer diagnosis and side effects, I personally think trying to adjust to a Prozac-type drug might be too difficult.

 

[tikilyn]

I was given zoloft for my anxiety attacks. It took some time (like a month) for it to work but so far I haven't had any attacks in over 3 months.

I think he needs to call his doctor and let them know that the Atavin isn't working.

 

[abdmom]

Hugs to you and your FIL. He must be totally scared witless. Does he live alone? Even though he may be cognitively able to care for himself at this point doesn't mean that he's able to from an emotional standpoint. If he doesn't live with anyone, is there someone he can move in with? Both my dh and my father had terminal cancer diagnoses....

 

[The Mystery Machine]

Is he open to seeing a counselor, doing meditation, or something else that is non drug related to assist his meds?

I know you can do things like "four square breathing" and other techniques to try and get thru an attack or calm yourself.

I am so sorry.

 

[mickeyboat]

A couple of points:

1. Is your FIL actually seeing a psychiatrist to help deal with this? If it is his GP or oncologist, they may not be the best for handling this. Often times, and oncology group with have a psychiatrist they work with for this specific purpose.

2. His dose of Ativan might not be high enough for full-blown panic attacks. It might just be enough to work for people who get nervous going to the dentist. So I would have the dosage evaluated.

3. He may do better on a long-acting benzodiazipine such as Klonopin which will keep him from roller-coastering. Ativan and Xanax are very short acting meds and the panic can come back quickly in between dosages.

4. I don't know if I'd get involved with the SSRIs at this point. With his cancer diagnosis and side effects, I personally think trying to adjust to a Prozac-type drug might be too difficult.

He is only seeing his oncologist and GP at this point, and the palliative care team at the cancer center. He was actually admitted last night and has chemo today, and DH is hoping to be able to talk with someone about seeing a psychiatrists and about adjusting his meds. FIL is also not very good about taking the right meds at the right time, so it's going to be a battle no matter what we try.

I was given zoloft for my anxiety attacks. It took some time (like a month) for it to work but so far I haven't had any attacks in over 3 months.

I think he needs to call his doctor and let them know that the Atavin isn't working.

I think DH will talk to FIL's doctor about it today. I am hoping they try something new because the Ativan also makes FIL very confused.

Hugs to you and your FIL. He must be totally scared witless. Does he live alone? Even though he may be cognitively able to care for himself at this point doesn't mean that he's able to from an emotional standpoint. If he doesn't live with anyone, is there someone he can move in with? Both my dh and my father had terminal cancer diagnoses....

I think we have all decided that we are at the point where someone needs to be there 24/7. It's tough because we have all prepared ourselves to have to physically care for him, but we were unprepared to have to meet his emotional needs, especially when for the most part he is able to care for himself physically.

DH has one job he needs to finish, and then he is going to take some time off from work until DH's sister starts her leave from work. I guess we all thought we would save our leaves until FIL needed physical care. We didn't expect this issue at all.

 

[mickeyboat]

Is he open to seeing a counselor, doing meditation, or something else that is non drug related to assist his meds?

I know you can do things like "four square breathing" and other techniques to try and get thru an attack or calm yourself.

I am so sorry.

I don't think he would be able to do any self-help kind of treatment to be honest. He is not emotionally strong enough. He is very afraid of dying but he just wants the pain and fear to go away. Over the holidays he was taking a lot of pain medication - not because of the pain, but because he could just sleep away the day. We encouraged him not to do that because he was not really living his life the way he wanted to and because we were afraid that the meds would not work once he really needed them for pain. Now I wonder if it would be better to just let him sleep his days away - so he does not have to be afraid all the time.

 

[abdmom]

I think we have all decided that we are at the point where someone needs to be there 24/7. It's tough because we have all prepared ourselves to have to physically care for him, but we were unprepared to have to meet his emotional needs, especially when for the most part he is able to care for himself physically.

DH has one job he needs to finish, and then he is going to take some time off from work until DH's sister starts her leave from work. I guess we all thought we would save our leaves until FIL needed physical care. We didn't expect this issue at all.

Your FIL is blessed to have such great children. When my dh was first diagnosed, it was via surgery, which he seemed to recover from, if you didn't know him. He was quite wiped out and lost some of his cognitive faculties. Chemo made it much worse.

 

[mickeyboat]

Your FIL is blessed to have such great children. When my dh was first diagnosed, it was via surgery, which he seemed to recover from, if you didn't know him. He was quite wiped out and lost some of his cognitive faculties. Chemo made it much worse.

I am so sorry for your loss. Thank you for your insight.

 

[abdmom]

I think we have all decided that we are at the point where someone needs to be there 24/7.

Another thought - Look into hiring a personal aide or nurse who can take some burden off whichever family member is staying with him. It may not be necessary now, but will likely be after a very short time. I wish I had looked into that with my dh.

 

[missypie]

If he's truly terminal, how about something nice like hydrocodone? He doesn't need to worry about being adicted, so why not get him something that make him feel beautifully mellow?

Also, how about a visit with a minister? A whole lot of people were raised on hellfire and brimstone. If he was raised that way and has not been a religious person in adulthood, he may have worries about burning in a lake of fire for all eternity. If you were raised this way, you understand what I'm saying. It may sound courny, but he may need to make peace with God, or at least make peace with what he was taught as a child about God.

 

[hippiemama76]

I'm so sorry you're going through this. Emotional issues are just as hard, if not harder, than physical issues.

My grandfather is 91 (92 in March, hopefully) and has developed major depression after 1)losing his vision, 2)losing his hearing, and 3)having a fall last year that has left him extremely physically limited (bed to recliner, recliner to bed all via transport chair). He's on Zoloft (50 mg/day) and Buspirone (not sure of the dosage, but daily) and can also take Klonopin for individual episodes.

Another thing that really works is physical touch. Someone will sit as close to him as possible and hold his hand or stroke his arm and just let him talk it through. It's really draining for the listener b/c you have to be calm and soothing no matter what, but it works.

You mentioned your DH and SIL taking time off work, so it sounds like he's living alone. Even if he can take care of himself (washing, cooking, etc.) I think it would be so sad to be alone with nothing to do but think about your disease and impending death. Have you thought about moving him in with either your family or your SILs family? It sounds like he's already needing help (unable to take pills at right time).

A good grief counselor is also a great idea, not just for him, but also for whoever is his primary caregiver. Even though my grandparents live in their own house still, it's just around the block from my parents and my mom has to do all their shopping, transport to doctors, etc. It's been a hard adjustment on my mom, and she has benefited by having a professional to vent to.

 

[Pea-n-Me]

Such a difficult situation.

Ativan often is used with cancer patients because of it's unique anti-nausea properties (as well as anti-anxiety/muscle relaxant). How is he taking it that it's not working? A simple adjustment of dosage times or dosage could do the trick. I'd work/play around with it before switching. Doses round the clock are usually more effective than doses taken when anxiety hits, if that makes sense.

Under normal circumstances, I'd say a psychiatrist could be helpful. But in this case I'd say the palliative care team, who may well have a psychiatrist on board or at least available for consults, is very used to dealing with the issues that your poor FIL faces. Pain and anxiety are a tough combination. Medicines used to treat both also can negatively affect one's mental status so that sleeping and potential for falls, confusion, etc, are going to be likely side effects. Finding medications that adequately control pain and anxiety without the negative effects in a patient in such a short time is a very tall order, unfortunately.

My suggestion would be to alter the ativan dosing if you can and see if it helps. I'd also want to add in some complementary therapies which can help your FIL cope in a non-medical way. Is there a cancer support center nearby? They have volunteers there who can offer things like individual counseling, Reiki, accupressure, etc. At home you can try to provide other complementary therapies like music, prayer (#1 used complementary therapy, btw), aromatherapy, meditation, relaxation, etc - whichever you think he might benefit from. If he's religious, you might consider taking him to a Healing Mass**. Give it a shot. PM me if I can be of any help.

(**Remember, healing can be not only physical, but emotional. I've had patients that were terrified to die because they were harboring something inside that they were afraid of. Spiritual counseling, different from religious counseling, can help lessen someone's anxiety and get to the stage of peace. Not sure this would apply here, but you never know.)

 

[missypie]

I've heard that pancreatic cancer is among the most painful ways to go. If I've heard this, I bet your FIL has heard this. Maybe if he can talk to someone in palliative care, he can gain some peace of mind. Some people are loathe to take pain medication. A friend told me of some elderly friends. The husband was in the last stages of his final illness and the doctor was going to give him morphine...the wife was very afraid that he'd become a drug addict!

 

[mickeyboat]

I do think that part of his problem is his complete lack of spirituality. He might take some comfort in religion, but he has never been religious and is too stubborn to start now. He also is not a believer in therapy or support groups. He is looking to his children to provide some peace and we are all standing here like deer in headlights.

He does like someone to fuss over him and baby him, so once we have someone living with him, and we find the right meds, I hope things will improve.

 

[Pea-n-Me]

He also is not a believer in therapy or support groups.

A situation like this often changes that. Most people facing something like this find it beneficial to talk, so it would probably be helpful for him to talk to *someone*. The trick will be finding who it is that can help him. And help might take a different form than you think.

He is looking to his children to provide some peace and we are all standing here like deer in headlights.

Many people just want to reflect on their lives. All someone needs to do is pull up a chair and unhurriedly listen. (In the hospital, sometimes this person is me.) Surely one of his children or other relatives would be a good choice for him. Or what about you? (I bet you'd do a good job; caring is half the battle.) Just take the time and ask him to tell the story. Ask him about his childhood. His teen years. Where he lived. What it was like. What he wanted to be when he was younger. What he became and why. Was he in the war? How did he meet MIL? What were their dating years like? How did he know he wanted to marry her? What was buying his first home like? Etc. People love telling these stories. It absolutely has a calming effect on them (and you as well), and those calming hormones will have a beneficial effect for hours. If you want, you can play some soothing music or light a candle - or not, it's up to you and him. After he becomes engaged and comfortable (perhaps this can be done on a daily basis), maybe including his other children or grandchildren might be helpful as he's aware this might be the last time he gets to tell these stories. Talking such as this can often help people see that they did have a purpose in life, which is what people want and need to know when they're facing death. With your questions you can help him see that he was a good father, great husband, dedicated employee, good son, etc. Like many of us, he may not have done anything earth shattering, but just the simple things in life do still have meaning. Help him find that meaning.