Cancer & Pain Control

About Cancer and Pain Control.

Pain can be a major problem for people with some forms of cancer. Pain is not typical of all kinds of cancer. Some cancers, depending on their type or location, cause little or no pain at all. Today, most cancer pain can be managed and controlled because of the advances made in understanding what causes pain and how to treat it.

People with cancer can experience pain at any point during the illness. Pain can result from aggressive, curative cancer treatment such as nerve damage following surgery. Pain Control clinics treat this kind of pain. People with advanced illness can experience pain due to the spread of disease to other parts of the body, such as spread of the cancer to bones. Pain is not something you must "learn to live with." Pain must be treated because it interferes with every part of a person's life. Don't accept pain as a "way of life" because you have cancer. Be assured that it can be managed with help from knowledgeable health care professionals.

Many myths about pain still exist. The most troubling one is that too much medication will cause addiction Research has shown this to be completely false. Addiction is a psychological or emotional dependence on feeling "high". People with cancer do not take drugs to get "high" but to relieve their pain. When the proper dosage of medication is taken around the clock, addiction does not occur. People with cancer can take pain medications indefinitely, if properly used, without concern that they will become addicted.

People also worry that if they take their medications continuously, they will become "immune" to that dosage and need higher dosages until no dosage will work. There is no such thing as "running out" of pain medicine. Pain management and hospice teams are experts in pain control. They will work with you to find the right treatment or combination of medications to keep you pain-free and alert so that you can participate in life.

Describing pain in detail to your doctor or nurse will help them decide the best way to treat your pain. Try to use descriptive words such as sharp burning, dull or aching etc. It may also be helpful to keep a diary of your pain so that you can describe what makes the pain better or worse.

HOW PAIN-CONTROL SERVICES CAN HELP.

Provide outpatient or home evaluation and treatment with pills, liquid medications, and / or intravenous infusion with the assistance of a portable pump. Keeping pain continuously under control is important. If people "hold off" on their medications, the pain will return. Then the pain may be harder to control with the next dose of medication.

Prescribe brief hospitalization in cases of severe or poorly managed pain so that treatments can be evaluated and the best method of control determined. Offer nerve blocks and surgical procedures, in certain cases, to provide permanent relief from pain. Provide counseling to help you cope with the problems of pain.

Because pain has been such a problem in the past for people with cancer, it has become an area of great interest and the subject of research studies for many doctors and nurses. Specialists in pain control are doctors who have advanced training in this field. If your doctor is unable to refer you to a specialist in pain management, call the Cancer Association of S.A. (Cape Town ---37 a Main Road Mowbray. Tel. 6895347.). Living with uncontrolled pain will make it very difficult for you to cope with day-to-day living. If you have been referred to a Hospice program, (Cape Town--St Luke's Hospice. Harfield Road Kenilworth--Tel.7975335) you can expect the doctors and nurses to provide the necessary pain control. If you are not participating in a Hospice program, talk to the doctor who is treating you for your cancer. If your doctor has been unable to control your pain, ask to be referred to a specialist in pain management or to a Pain clinic.

Sometimes doctors have the same misconceptions about pain as the general public. They may not be aware of the advances made in this field, or they may be reluctant to experiment with medications and the dosages necessary to control the pain. Most doctors are as anxious as you are for you to be comfortable and free from pain. If you need a specialist to control your pain, ask for a referral. Family members sometimes worry that the patient will "overdose" on their medications or that medications given through injections will cause a coma or death. The goal of good pain management is to relieve suffering. Pain management programs or Hospice programs will teach you and your family about the proper amount of medication that will give you relief without any danger of harm.

A Few Guidelines for Spiritual Councilors on the approach to Muslim Patients.

Tasks of the Councilor.

(a) To accompany the terminally ill patient on his/her journey. Do not approach a patient about his / her death. Wait until he/she brings up the topic of death and dying.

(b) To listen, identify and discern needs. Attend to needs where possible, before any form of counseling can take place.

(d) To be able to identify different stages of "denial", "anger", "why me" "bargaining" and "acceptance".

(e) Be yourself, give of yourself, and answer questions honestly and openly.

(f) To avail yourself wherever the patient need to communicate or interact.

Training and Qualities -

The Councilor need to,

(a) Develop sensitivity and Confidentiality..

(b) Develop listening skills and people knowledge to understand distress, hopelessness and anger.

(c) Learn Quranic verses about patience (sabr / forbearance) and on "death and dying" e.g. HQ. 2/155-157. 3/185. 23/100.

(d) Answer questions to various phases.

Why me? - " I don't know Why you? "But why not you - since all of us have to face death and dying sooner or later. - (The patient is really asking Why me now?). Allow him /her to express his anger and anguish and ventilate all his feelings of dismay and other concerns. - Quote Quranic verses 2/155-157 at appropriate and opportune moments when patient wants to listen.

ANGER. - A patient who is angry and nasty can display all his anger and envy onto his caregiver, friends, relatives and Medical / Hospice staff /volunteers. Try to discover whether there is reasonable justification for his/her anger. If for example, he is at home and the food is miserable or the caregivers are not giving enough attention, then talk to the caregivers to prepare what he desires. (There is no point in adhering to any form of Diet etc.) Let the patient ventilate his anger and anguish without making him feel guilty, and without giving him the feeling that you are belittling him. Advise the patient when he is angry to remember GOD (Almighty ALLAH S.H.W.A.) in ZIKRULLAH, TASBEEH, TAHMEED and TAHLEEL. (Hymning the praises and Glory of Almighty God) Remind him that there is no excuse for not performing the SALAAH. (The Daily canonical prayer) Interaction / connection with ALMIGHTY ALLAH) Supply copies of Surah Yaaseen and Surah Mulk (Well known Chapters of the Holy Quran) (In transliteration, if he is unable to recite the Arabic). Remind him/her of repentance (Taubah) and seeking forgiveness (Istighfar).

Bargaining, Depression and Grief -- In these stages listen and give honest answers. Empathise with the patient and advise friends and relatives to visit and express love (Touching and caressing by offspring, relatives and kinsfolk are important) and assure patient that they will avail themselves when needed-- In these stage questions, which are sometimes asked. Who am I? What's the point of it all? Is there a GOD out there? Advise patient about Quranic verses 2/28 6/122 3/156 6/95 15/23 96/8 and reassure him of God's (ALLAH (S.H.W.A)) existence, mercy and compassion. The food for his journey will be repentance, forgiveness and hope. Hope for a good death and hope for a good hereafter.

Acceptance -- Patients who are in the stage of "acceptance" normally show feelings of equanimity and peace. There is something very dignified about these patients, while patients in the stage of resignation are very often indignant, full of bitterness and anguish. Patients see many different meanings in death. (Sometimes depending on the lives they have led) If they are at peace and comfortable with their own interpretation, that is the best we can hope for. The ideal would be if both the patient and his family could reach the stage of acceptance before death occurs.

Please note that not all patients necessarily follow a classical pattern from the stage of denial to anger, bargaining etc. to acceptance. Some patients exhibit two stages simultaneously and these do not always occur in the same order. It should not be our goal to push patients from one stage to another. If the patient requires more time in a given stage, we will do him a better service to allow him to stay in that stage.

If a patient has been angry and aggressive all his life, it is likely that he will remain in the stage of anger until he dies. If someone has been a depressed personality and is filled with self-pity, it is very unlikely that he will be cheerful at the time of his death. A patient who was involved in an accident and then dies a few hours later does not have the time to work through the stages of dying. Most of these patients will die in the stage of shock and denial or sometimes very angry at being cheated out of life.

(e) Be a spiritual person.

One cannot attend to other's spiritual needs if one is not a spiritual person or are dealing with one's own grief, anger and inner trauma.

(f) Have some Islamic educational background.

To be able to answer questions by Muslim patients on dying, death and life after death and offer prayers (DUAS) the Councilor should be schooled on the various Islamic perspectives. He/ She should also be able to recite passages of the Holy Quran and recite "KALIMAH SHAHAADA" to the patient at point of death and be able to offer grief Counseling to bereaved family members.

M.N. Salie.

Death and Dying –

Short Talk “Fine Music Radio” 103 FM.

Monday 13/2/2000

What Happens at point of death.

Imagine yourself at the moment your death. What thoughts cross your mind? Memories of family and friends? Panic? Regrets? Remembrance of Allah? What is death? What happens to us after we die? What is life in the Hereafter like, this new and strange world after death? Do we lose consciousness of this life? Where does our soul go? Do we feel and think the same? The ineffable feeling of crossing the boundary between this world and the next cannot be described in words, nor imagined in the mind, but can be understood only through divine revelation and inspiration. Let us seek a little understanding of this, "death, the only certainty in life."

What is the Islamic Concept?

In Islam, every person has a soul. When he dies, his soul enters the next stage of life. Thus, it is a fundamental Principal of Islam that life continues in the Hereafter after one's physical death. Death is just a gateway or transmigration to another (higher) form of life. It is therefore important that the soul is "clean," pure" and uncontaminated because the life in the Hereafter is spiritual in nature, sublime and eternal. When a baby is in the womb of its mother (the confines of the womb is itself a world of its own), there is no way for it to understand the vast potential of the world outside. But, the outside world is a reality. In the same way, people in this world cannot fathom the Hereafter. However, the next world is real and it is described in the Quran with words which man can relate to and identify with, such as "Gardens" for Paradise and "Fire" for Hell

Sometimes we may not want to know about the processes that occur after we die because we are afraid or don't want to think about it. However, this should not be the attitude of a Muslim. We should be foremost in learning and understanding death, so we can organize our lives accordingly. The prophet Muhammad (pbuh) said, "Live in this world as though you are a stranger or a traveler (passing through it)." [Muslim] We as Muslims are on a journey and should know about the whole journey's itinerary, not just one part.

Death is inevitable. It is the one thing that we can be certain about in life. We are born to die. Every soul shall have a taste of death no matter who they are. This is confirmed for us many times in the Quran: "Every soul shall have a taste of death: and only on the Day of Judgement shall you be paid your full recompense." (Quran 3:185) -- and -- "Every soul shall have a taste of death: and we test you by evil and by good, by way of trial. To us must you return." (21:35) "Every soul shall have a taste of death: In the end you will be brought back to us." (29:57)

Death is not pure annihilation, but rather both the living and dead are aware, but there is a difference that can't be compared. Death is merely a movement from one state to another or transmigration from our form of existence to another in another zone or dimension. It can be described as a journey through a wormhole to a separate dimension of existence.

In this life, the soul and the body are together except during sleep when the soul may leave the body and come back in the morning or Allah may take the soul at that time. "It is Allah that takes the souls at death; and those that die not (He takes) during their sleep: those on whom He has passed the decree of death, He keeps back (from returning to life), but the rest He sends (to their bodies) for a term appointed. Verily in this are Signs for those who reflect." (39:42) It is indeed something to be pondered; that we die each night and Allah gives us another chance at life when we wake up the next day. We also find continuous biological processes of life and death during this time. In every cell, organ or system of organs, life and death is occurring. There are several hundreds of thousands of enzymatic reactions that take place in the body every fraction of a second. Some of these biochemical reactions are used to synthesize living materials while others are either used to synthesize dead materials or to get rid of living materials. "You (Allah) bring the Living out of the Dead, and You bring the Dead out of the Living" (3:27)

This part of our journey ends as our death begins. No one knows where, how and when he or she will die. "Verily, the knowledge of the hour is with Allah (alone). It is not He who sends down rain, and He who knows what is in the wombs, nor does anyone know what it is that he will earn on the morrow. Nor does anyone know in what land he is to die. Verily, with Allah is full knowledge and He is acquainted (with all things.)" (31:34) Nor does anyone have the right to take his or her own life. The One who gave life is the only one who has the right to take life. When someone begins to die the Angel of Death (Izraeel) comes to take the soul out of the body and puts it in a place called the Barzakh. (A zone or dimension beyond human conception)."Say: 'The Angel of Death, put in charge of you, will (duly) take your souls. Then shall you be brought back to your Lord." (32:11) "Wherever you are, Death will find you out, even if you are in towers built up strong and high! " (4:78)