Mum's panic attacks are getting to be horrible and I don't know how to help...

[MoniqueU]

As somene who suffers greatly from panic atttacks she nees help and fast, this really is a horrible way to feel and IMHO as bad as any physical pain you could feel.

Also others are right, you are not causing this it just happens. I had one of the most traumatizing attacks yesterday after shopping at a particular store and a friend had to remind me it wasn't that stores fault it was the time of day, crowd condition etc.

I am a strong believer in medication. I am betting her dose isn't high enough and that is a shame, she has no risk of being addicted since she is terminal and needs to be kept as comfortable as possible. I would speak to her dr.s asap and if one won't listen try and get her seen by someone else. I had to switch dr's because one wasn't litstening to me about how bad it was. I take xanax and at a higher dose then most people would but that is what works for me. You can take up to 10 mgs a day of it or so I have read, most people would be knocked out for a couple of days at that dose but for severe disorders it is ok. I would ask about that.

 

[Ember]

To answer some questions: We have a care team in place right now. Her case worker is an RN. She comes twice a week to the home to check on mum. We also have a social worker who comes to talk and to help with anxiety about once every two weeks. Then there's a day worker who comes in every day while I'm gone to work to help with medications and personal care. We also have a doctor, who we like but who can be hard to see outside of her appointments. (Finding her a new doctor isn't as easy as it seems because of the situation. She needs someone who can make home visits, which is very hard to find.) As of yesterday, we also have a priest (and helpers) who will come every weekend to let her take communion. Lastly, I'm in the process of finding a massage therapist to come once a week to help with her circulation. So, as you can see, there's a lot of people helping me.

She has suffered from panic most of her adult life. After 30 years, it is as much a learned habit as it is a mental illness. I say a learned habit because I feel (and I may be off base completely, but this is my gut feeling) that whenever she panics, I drop everything to try to help. I always have. It's a way to getting attention as much as it is being scared.

Treating her panic through therapy isn't an option at this point. She won't do it and I simply can't afford it. My finances are stretched to the breaking point as it is and it will only get worse when she requires full time care when I'm at work. I was doing great financially up until Christmas (climbing out of debt and making real progress) but each new care service costs money and her benefits only cover portions of it. Anyway, money has nothing to do with this, I think I'm just tired.

Her nurse is in this afternoon, so we're going to talk to her and see if she can get anything from the doctor. To make matters worse, she's been bleeding from down there since yesterday. It's not bright and not a lot, but she's past menopause, so it's worrying. I'm hoping our nurse can get some movement on finding out what's going on.

I'm so scared and tired and lost right now. I feel like I'm juggling a dozen glass balls and one day something is going to drop and shatter and then everything will come crashing down. At work, it's also report card time, which probably isn't helping with the feelings of overwhelming stress.

Anyway, thanks (again) for listening. It does help.

 

[Pea-n-Me]

She screams when she lays down because she says she can't breathe. She's seeking things to panic about, real or imagined. Every night there are new terrors and every night I stay up with her for hours.

I'm not sure I recall all the details about your mother's case. She is receiving hospice care IIR, is that correct?

Some of this depends on where she is in her disease state. Is she at the point of "comfort measures only" or is she actively fighting her disease? Because the approach might be different depending on that.

Anyway, when fluids and secretions build up in the lungs, it does cause shortness of breath, especially when laying down. It is frightening to anyone who experiences it because it feels as if they're drowning.

Is she on oxygen? Does it get better during the daytime? Positioning can help somewhat. If she rests in a sitting position, gravity helps pull the fluids down so that she can breathe easier. A reclining chair can work well for this (in the up position) and sometimes people even place a pillow on a table and lean over that to sleep.

Her plan of care might be different for nighttime than it is for daytime - if she gets worse at night. Generally (if she is on comfort measures only) morphine is given to ease the breathing and help the person relax. They could consider increasing the dosage at bedtime and as needed during the night.

Unfortunately, morphine has a bad rap, but it is what's used for comfort measures during the end stage of life. And there's a reson for that - because it works well when given properly. The thing about morphine is, though, that it can slow respiratons and even "hasten death", which people not in the field have difficulty understanding. But it is accepted practice by the AMA and ANA that, ultimately, if pain and symptom management are the goal, then you must treat those symptoms even if death is hastened. Because the alternative is as you've described. Nobody should have to die a painful, fearful death in this day and age.

I would talk to your nurse today and make sure she understands what's been happening at night. Your Mom is not being made comfortable at this point.

Hang in there. What you're living through is a very difficult situation. You are doing a great job, and your mother is very fortunate to have you.

PS have you contacted your local cancer support center at all? I would ask if there is anyone they can send over, perhaps in the evening, for maybe some Reiki therapy? (They generally use volunteers and are free of charge.) You could supplement that with some soft music or whatever your mother enjoys to help her start the evening off in a relaxing way. The endorphins that are released during this time will help her relax for hours afterward.

 

[MoniqueU]

I honestly doubt that your mom is doing this for attention or that it is a learned response. Your mom needs a psychiatrist and has needed one for the past 30 years since she started suffering from this. This isn't going to go away on its own and I hate the thought of her suffering this way in her final days. I can't believe this is happening to her and no one is getting her the help she needs.

 

[Ember]

Never mind.

 

[Wishing on a star]

She has suffered from panic most of her adult life. ....

And she has never seen a psychiatrist and received the appropriate necessary medications????

This level of panic requires medication.

Has she completely and totally refused to see a psychiatric doctor???

If you, yourself, need help dealing with this, then I would be getting her the needed meds, today.

 

[hellokitty86]

Thinking of you.

 

[Wishing on a star]

Okay, I see your post that just came thru...

At this point, YOU need to make sure that your mother receives the care and medications that will help her.

We KNOW that you are not sitting around eating candy!!!

But, seriously, you shouldn't bear this burden any longer.

Your mother needs a LOT more than you running to her bedside.

Has your mother been using/abusing you in this way (making you responsible for her issues) since you were young?

 

[Ember]

And she has never seen a psychiatrist and received the appropriate necessary medications????

This level of panic requires medication.

Has she completely and totally refused to see a psychiatric doctor???

If you, yourself, need help dealing with this, then I would be getting her the needed meds, today.

She's on medications, two of them. And she won't talk to anyone, has refused to do so for years. Believe me when I say that I'm doing everything in my power here. I have been in contact with her case worker for two days and the case worker in turn is trying to get the doctor out. But her panic is getting worse and worse. Until she tires herself out and finally goes to sleep.

 

[Pea-n-Me]

Never mind.

How did it go today with the nurse's visit?

 

[Ember]

How did it go today with the nurse's visit?

I think it went alright. Neither DH or I could be home, but DH talked to her on the phone to keep her fully up to date. She's been trying since yesterday to get the doctor out, and apparently is still trying. She's very concerned about the panic attacks and is doing what she can. She's also arranged for visitors from the hospice just for social company during the day starting next week.

Right now mum is calm and watching tv, it's an night when the panic flares up.

 

[EdiePA]

You might want to check with the doctor and let him know specifically what time of day this happens. It sounds like it might be "sundowning". (I'm not a doctor, nor do I play one on TV, but my mom has Alzheimers disease and exhibits the behavior that you're talking about.) It's taken awhile, but we now have a handle on her medication and the best time of day to give it to her to avoid these episodes.

Just a thought,
Edie

 

[MoniqueU]

OP I am not trying to flame or blame you but if your moms anxiety is so bad she is screaming at night something should be done about it IMHO. I know here in the US that most people would seek treatment for that if it is indeed that bad at a hospital. I know if I were screaming in the night my DH would take me in and have me checked. As your mother is terminal I just feel so badly for her that nothing is being done to help her in a timely manner. I sure wouldn't want my last however long to be filled with terror.

 

[Ember]

OP I am not trying to flame or blame you but if your moms anxiety is so bad she is screaming at night something should be done about it IMHO. I know here in the US that most people would seek treatment for that if it is indeed that bad at a hospital. I know if I were screaming in the night my DH would take me in and have me checked. As your mother is terminal I just feel so badly for her that nothing is being done to help her in a timely manner. I sure wouldn't want my last however long to be filled with terror.

I mean no disrespect, but what part of my previous posts regarding our case worker nurse that said: "She's been trying since yesterday to get the doctor out, and apparently is still trying. She's very concerned about the panic attacks and is doing what she can," made it sound like we were sitting around doing nothing? Or the fact that she is already on medication that was working, but things are now getting worse? This level of panic is new and we're dealing with it as quickly as possible.

I also appreciate that you feel you know best and would be a far better care taker than I would, I really do. But my mum doesn't want to leave home. Even in the middle of her panic attacks she will ask, "you aren't going to send me away, are you?" I am doing everything is my power to meet every need my mother has and I admit that I am very upset and resent that fact that you could suggest otherwise. I promise that we are not sitting by doing nothing and watching her suffer, as you seem to think we are.

 

[Ember]

You might want to check with the doctor and let him know specifically what time of day this happens. It sounds like it might be "sundowning". (I'm not a doctor, nor do I play one on TV, but my mom has Alzheimers disease and exhibits the behavior that you're talking about.) It's taken awhile, but we now have a handle on her medication and the best time of day to give it to her to avoid these episodes.

Just a thought,
Edie

I will bring this up with our nurse and doctor, thank you. Also, I really appreciate the understanding that sometimes the situation changes rapidly and that things can take time to get back under control.

 

[RadioNate]

Op - are you talking to someone yourself? Being the full time care giver to someone terminal is stressful without the panic attacks and other mental issues that your mother is having.

I believe that you are doing the absolute best you can for your mother. You need to do the same for yourself.

 

[tar heel]

Are you in the United States? Most insurance plans/Medicare cover hospice services as a package -- you don't pay more when you get more services. Is there a possibility of the social worker coming more often? I used to work for a hospice and our social workers were amazing counselors. I think we all agree that your mother is in desperate need of therapy, and she might accept it from someone already part of her care team because it wouldn't seem that different from what is already happening.

I'm glad to hear the hospice volunteers are starting next week. That can be very helpful.

RadioNate is so right about what YOU (and probably your DH) need, too. Your insurance as a teacher would probably enable you to see a therapist for just a small co-pay. There also might be something at the hospice for you. The one I worked for had support groups for caregivers, for example.

 

[Ember]

Are you in the United States? Most insurance plans/Medicare cover hospice services as a package -- you don't pay more when you get more services. Is there a possibility of the social worker coming more often? I used to work for a hospice and our social workers were amazing counselors. I think we all agree that your mother is in desperate need of therapy, and she might accept it from someone already part of her care team because it wouldn't seem that different from what is already happening.

I'm glad to hear the hospice volunteers are starting next week. That can be very helpful.

RadioNate is so right about what YOU (and probably your DH) need, too. Your insurance as a teacher would probably enable you to see a therapist for just a small co-pay. There also might be something at the hospice for you. The one I worked for had support groups for caregivers, for example.

I'm in Canada. Our health care system covers a lot, and mum's benefits from work cover most other things at least partially. But it's still a lot of out of pocket expense for various services and needs. (Example: massage therapy is covered at $25 per visit up to 20 visits a year. That's great, but the massage therapist is $70, which is still $45 out of pocket.) Right now I'm only teaching part time, which is why we're feeling the pinch. But, really, I don't care about the money. There will be lots of time later to pay things off.

As for me, yes I am talking to someone. Not on a regular basis, but I do make the effort. I also get a monthly massage to help with stress and have a wonderful support system in my friends. They even come over every once in a while so DH and I can go out together.

 

[MoniqueU]

Yes I read the part about the nurse trying to get a dr. I just think she needs help NOW if it happens tonight. If this were me my DH would drive me and if I wasnt able to sit in the car call an ambulence.. Yes people do that for a panic attack and I most certainly would if her own dr doesnt treat this properly. There is a msconception IMHO that anxiety sufferes can just suck it up and change how they feell or talk through it. Yhst may be the case for some people who don't have as severe sympyoms as your mom. I would look for the closest emergency psychiatric facility and eithet call an ambulance to take her ot at least call and describe her symptoms and see what they say.. She has a condition NOT beiinh properly cared for at this point and you may want to bypass her dr that can't make time for her or doesn't see this as a serious problem.

I am not attacking you or insinuating that you aren't caring for her I am just posting that yhis does sound urgetn, scary for her and for you and needs to be treated asap just as you would if she were in physical pain. This is just as real as that.

ETA I just read she doesnt want to go to a hospital, well I still think she needs one but that is her wish. Could you page the dr and ask if she can take more of the meds she is on? Or look up on the internet yourself dosages and see if she can safely increase them while you wait for a horrid dr (JMHO) to show up??

 

[mickeyplanner08]

Ember, first of all, big hugs for you! You are doing the most amazing thing for your mom. Your love for her is obvious.

As far as her anxiety goes, it probably will calm down. Part of that increase is due to the process. Hospice calls it "terminal restlessness" and it is quite common for there to be a period of increased anxiety and agitation, and then as your mom makes peace with the process-you will see an improvement. In the mean time, I hope you get some answers from your medical team soon. Meds can help some, but she may not get complete relief.

Do you have someone who could spend even one night a week with all of you so you could get some sleep? You would be amazed how much better you would feel if you could just get one decent night's sleep. I know this may not be possible, but its something that I thought of as I read your posts.

Take care of you!