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Medical Forum / Diseases and Disorders / Breast Cancer / October 2004How much time question ....
A relative of mine has bravely been through about seven gamma knifes and a brain surgery and seven or eight different chemo protocols. She has been in stage four for five years and one week. A doctor tells us now that she has large growths in the liver that are not responding to chemo, as well as cancer in her bones, for which there may be a protocol or two left, and her liver duct is blocked; they will do a stent -- her second in five years. But they also said, discreetly and sensitively, that this may mark a turn for the worse; they initially didn't even want to do the stent again. She has a new jauncided look. So, what I am wondering is whether we are talking days and weeks here or possibly another six months or even longer. I know these things are impossible to gauge accurately, but I'm just trying to get a sense of the time here. For over five years, we have all been optimistic and fighting and working on that level. Is, well, I sense you know what I am trying to say, to ask .... >A relative of mine has bravely been through about seven gamma knifes > and a brain surgery and seven or eight different chemo protocols. She [quoted text clipped - 11 lines] > fighting and working on that level. Is, well, I sense you know what I > am trying to say, to ask .... It is hard, and often foolish, to try to predict longevity under such circumstances. Jaundice implies rather significant liver failure. If the stent works, it might clear and she might enjoy life for some months or perhaps even years. If it does not, you may be looking at several weeks, at the most. the standard formula is: Hope for the best, prepare for the worst, then live each day to the fullest. Best wishes, Sandy L > A relative of mine has bravely been through about seven gamma knifes > and a brain surgery and seven or eight different chemo protocols. She [quoted text clipped - 11 lines] > fighting and working on that level. Is, well, I sense you know what I > am trying to say, to ask .... Our late contributor Catharine once said she was circling the drain. There are periodic close approaches to going down the plughole, one escapes so many times, but eventually the vortex takes you. Your relative is clearly on a close approach. Getting jaundiced is usually a sign that the end is imminent, without intervention survival is down to days or a few weeks at most. Maybe with the aid of the stent she may live to circle once more, maybe not. Reading between the lines, it sounds like the professionals rather suspect not. It also calls into question whether a strong intervention at this stage would be doing her any favours. With advanced bone mets and poor liver function her quality of life must be pretty poor - pain, drug side effects, digestive problems. It might be better not to carry out an intervention which will only condemn her to maybe another six months of suffering. I am not saying this is necessarily the case, but I do think her potential suffering should be taken into account in this decision, not just her longevity. I know if it were me, I would decline surgery. I've seen the end game at close hand and it isn't fun. Tim Jackson Thanks very much for your insights. David Kilo > > A relative of mine has bravely been through about seven gamma knifes > > and a brain surgery and seven or eight different chemo protocols. She [quoted text clipped - 32 lines] > > Tim Jackson The relative has now been jaundiced for two to three weeks; the oncologist concurrs that she may have but a couple more weeks. So far, the patient is up and about and in good spirits, planning a dinner out, etc. Question: What should I, as a care-giver, expect in terms of the final few days -- pain, loss of consciousness, hospitalization necessary? There's no hospice or at home hospice involved. Advice? Steps to be taken? > Thanks very much for your insights. > [quoted text clipped - 36 lines] > > > > Tim Jackson > The relative has now been jaundiced for two to three weeks; the > oncologist concurrs that she may have but a couple more weeks. So far, [quoted text clipped - 7 lines] > > David Kilo Everyone is different, but increasing lethargy, sleeping time and disorientation could be expected. In particular increase in side effects of drugs if kidney function is failing, as the metabolites build up. Pain can sometimes be an issue but isn't usually, if anything the effects of the analgesic tend to increase. My wife had to be in hospice for the last couple of days because she tended to fall out of bed, (or maybe she tried to get up, and fell due to her incompetent skeleton) and I couldn't keep an eye on her 24/7 - I had to sleep sometime. In fact, once she was there and hooked up, she fell asleep fairly soon and didn't wake again. I suspect that may have been helped a little by the medication, I don't know what they were giving her in the IV pump, diamorphine at a guess. Prior to that she had been on fentanyl and I had been controlling her drug dosages. Tim > Question: What should I, as a care-giver, expect in terms of the final > few days -- pain, loss of consciousness, hospitalization necessary? > There's no hospice or at home hospice involved. Advice? Steps to be > taken? If there's a hospice locally, one option would be to ask if they have information available. My husband died of esophageal cancer at home at age 45. He was not formally in hospice, but the home nurse service gave me a very plain-spoken booklet that outlined some of the things to expect. It was informative and helpful. I hope/assume you have all the legal stuff in place if that's possible (wills, health care power of attorney, DNR orders, relative's funeral preferences, etc.). Get the phone numbers handy right by the phone for your doctors, 24-hour nurse-staffed Q&A lines if they have those where you are, etc. Your doctor may be able to refer you to a medical social worker who can identify issues & resources. If you're doing home care & administering meds, make sure you have a system that works for giving the right stuff on the right schedule when you're so tired you can't see straight. You don't want to find yourself wondering whether you gave that late-afternoon dose of pain meds or not, or at what time. They may change pain meds & dosing schedules right down to the wire. Beyond that, expect some suprises - medical, emotional, metaphysical, and beyond. It won't all sink in right away, but expect to learn a lot about yourself and how you think about life. Ann T. |
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