Thanks for the Zometa. I couldn't remember the name.

That's not how I remember. He'd stopped posting and was trying the speech
software and wasn't having much success with that and subsequently (I think)
posted that the RT helped quite a bit, because for a whle there, he was back in
fine form posting. (posted quite a bit, but like me, wasn't terribly good at
CAPS), so maybe it helped some, but didn't help some of the other. Below is two
of his combined posts.

From:   Socks the Whitehouse Cat -
Date:  Sun, Jun 26 2005 5:19 am

fwiw, at least the pinched nerve that the radiation was intended to treat
seems to be history. figgertoes tells me that the squeeze test shows that
I'm back at least to 50%, probably even better by now.  I can feel a
difference too.

Meanwhile, I am back to two handed typing.  Figgertoes says my grip is
definitely stronger, although still not normal.  The typing is a godsend,
since the voice activated software has trouble keeping up with my talking
speed even when it gets all the words right.  I stopped using the voice
activated stuff this morning.

thanks for sharing, Fig.
I've just been rereading his posts from April, May, June, July and think I want
to take a break for a bit.
Hugs
J

I guess the rest is moot and what follows might be as well, if you expect to not be able to dose her and you
and the oncologist think that she'll slow down and slip away without agitation or other disruptive
behaviour.
Some of the following might help you know what to watch for or expect... ( I hoonestly don't know)

Personality changes (eg, inappropriate behavior, altered mood, impaired judgment) are common early
manifestations that may antedate apparent change in consciousness. Sophisticated psychomotor tests can often
detect such abnormalities not suspected clinically. Usually, impaired consciousness occurs. Initially,
subtle sleep pattern changes or sluggish movement and speech may be present. Drowsiness, confusion, stupor,
and frank coma indicate increasingly advanced encephalopathy. Constructional apraxia, in which the patient
cannot reproduce simple designs (eg, a star), is a characteristic early sign. A typical musty sweet odor of
the breath, called fetor hepaticus, often occurs. A peculiar, characteristic flapping tremor, asterixis, is
elicited when the patient holds his arms outstretched with wrists dorsiflexed; as coma progresses, this sign
disappears and hyperreflexia and the Babinski response may occur. Agitation or mania may occur in fulminant
cases and in children but is otherwise uncommon. Seizures and localizing neurologic signs are also uncommon
and suggest another cause (eg, subdural hematoma).

. Coma associated with fulminant hepatitis is fatal in up to 80% of patients, despite intensive therapy;
patients with advanced chronic liver failure often die with portal-systemic encephalopathy.

Sedation deepens encephalopathy and should be avoided, even if the patient is agitated. Treating coma caused
by fulminant hepatitis with high-dose corticosteroids or with exchange transfusion and other complex
procedures designed to remove circulating toxins has not proved effective
<selections from http://www.merck.com/mrkshared/mmanual/section4/chapter38/38f.jsp>

Have you called to find out if there's a case manager, at the hospital, to help you out?
The sooner disability is applied for the better.
It's my understanding that when approved, the money is paid retroactively to the date of the
application.<double check this - unsure>
I don't know if it is paid to you, if your wife passes away, in the meantime.
If this were so, that needs to be a priority, so you can have some money to hire someone to be there with
you and watch your wife, while you take care of other things such as arranging hospice, shopping and tasks
around the home. If there's a case manageris available for you, perhaps the application can be fast-tracked,
but that still leaves you alone, in the meantime caring for her.
If there's a way to get a wheelchair (reread Alex's posts or maybe you made notes?), she would probably have
to have a restraints of some type, that attach at the back of the chair (or living room chair) to hold her
in, so she does not wander and fall and hurt herself, and so you can take care of things around the home.

I don't know the timeline, perhaps the oncologist can fill you in?
You really need help there, John.
You can't have her wandering while you're sleeping. Sedation seems to make it worse (see above).
Sounds like restraints for bed and sitting will be required.

Sounds like someone physically strong needs to be there, while you sleep and at least part of the day.
And I can't figure out how to do it, unless you can think of someone in your community, family,
ex-coworkers, who would be willing to do it and get paid later.
Is there anything you can sell to get some cash? 2nd car?  non-family heirloom jewelry, furs?
Loan on a life insurance policy, to be paid back after disability pays or her life insurance pays after her
death
<no need to answer  those questions - things to think about or ask about>

I suppose the only other option is to have her admitted to hospital, (unknown if it would be a psych ward or
hospice type ward). Ask the oncologist - explain the home situation.
I'll have to leave this with you, hoping you'll get some help there, as soon as possible.
J

Ammonia is produced from the breakdown of proteins, so maybe it's more common than I realized, in
gastro-related cancers, and since we've not usually privy to the last months' of a patient, perhaps that's
why I hadn't heard of it before.
J