This document discusses effective symptom management and working with a healthcare team. It covers managing common symptoms like pain, fatigue, gastrointestinal issues, and psychological concerns. It emphasizes the importance of communication with one's healthcare team, including providing details about pain location, intensity, and timeline of symptoms. Non-opioid and opioid pain medication, as well as other treatment options are reviewed. Palliative care is introduced as a team-based approach to improving quality of life and alleviating suffering at any stage of illness. The overall message is that patients should work with their healthcare team and not hesitate to seek help for symptoms.

1. Effective Symptom Management:
working with your team
Suzana Makowski, MD

2. Goals
• What are your goals for today's talk?
• Pain and other physical symptoms
• Psychological, spiritual, and social concerns
• Where to turn?

3. Managing Pain
• It is common
• Barriers to treatment are many
• What can you do?
• Keep track of your pain and use of medicines
• Work with your doctor, nurse, and pharmacist - team approach
• Address your worries

4. What doctors need to
know about your Pain
• Location
• Intensity: how bad is it?
• 'Quality': what does it feel like?
• Timeline
• What makes it better/worse
• What have you tried, were there side effects...

5. Understanding Pain
Management
Definitions:
• Adjuvant
• Non-opioid:
acetaminophen (Tylenol)
ibuprofen or naprosen
• Opioid: morphine,
oxycodone, fentanyl,
hydromorphone
(Dilaudid)

6. Opioids
• Addiction versus dependence versus tolerance
• Long-acting and short-acting (immediate release)
• Pill/liquid versus IV
• Side effects:
• constipation - doesn't go away
• Sleepiness, nausea
• Less common: confusion, twitching (myoclonus)

7. Other treatments for pain

8. Pain - other treatments
• Radiation therapy
• Interventional pain (anesthesia)
• Nerve blocks
• Intraspinal medicine/pumps
• Non-pharmacologic
• Physical therapy, including TENS, compresses
• Psychological/behavioral therapy
• Complementary or alternative therapy

9. Things to look out for
• Sudden changes in pain intensity or location
• New weakness
• New incontinence of urine or stool
Call your doctor right away

11. Gastrointestinal symptoms
• Nausea
• Vomiting
• Anorexia (loss of appetite)
• Megace
• Dexamethasone
• Small, frequent meals, plastic/wooden utensils
• Constipation
• Senna & colace
• Yakima paste

12. Weakness and fatigue
• Let your doctor know
• How are you sleeping?
• There are many causes and treatment is targeted when
possible
• Anemia
• Insomnia
• Anxiety, depression, stress
• Other...

13. Psychological symptoms
• Anxiety, fear, uncertainty
• Depression, sadness, grief
• Concern for family and future
• Dignity
• Resilience and hope

14. Your team
• Doctors
• Nurses
• Social worker
• Psychologist
• Family, friends, chaplains
• When you need more help: palliative care

15. What is palliative care?
• Treatment that focuses on alleviating suffering, improving
sense of well-being
• It is available at all stages of illness
• It can be offered alone or during other therapies/treatment
in the hospital, and sometimes at home or in a clinic
• It is a team approach - lending support to patients and
their family

16. Other resources
• The Center for Mindfulness
• www.cancer-pain.org
• www.getpalliativecare.org

17. Summary
• Work with your team... We're here to help
• Treat and identify symptoms early:
• pain, fatigue, GI symptoms, psychological concerns
You're not alone
We want to help
We can help

18. Thank you
Questions?