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Need a sanity check or just to bounce this off of others
Old 12-17-2011, 09:06 AM   #1
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Need a sanity check or just to bounce this off of others

About three weeks ago MIL was diagnosed with stage four cancer. The cancer originated in the form of a tumor in the ascending colon and has metastasized to the liver and lungs. At that point in time she was in Ohio and the oncologist pretty much said they could start chemo and she may have a couple of years to live. Since that time we have moved her down to the Chattanooga area and she is splitting time between my place and my son's house. She has good days and some bads days but overall she is doing quite well considering what is going on inside her body. We went and saw a local oncologist and gave her the medical records to review. The doctor suggested a PET/CT scan in order to double check the size and location of the tumor. To my knowledge this had not been done in Ohio. After the PET/CT scan the doctor wanted to have her admitted and have a surgeon look at the PET/CT scan to see if the tumor should be removed before starting chemo as the doctor had a concern that if chemo were started and the tumor would move, be aggravated it may cause blockage and may have to come out anyways. The surgeon suggested the tumor be removed and she was given a stress test to determine if she could stand the surgery. She had a triple bypass a year and a half ago. After the test the surgeon and heart doctor suggested doing a balloon type procedure as one of her arteries is plugged off and her heart is only operating at about 40% capacity currently. She is scheduled for the heart procedure on Monday as well as the tumor removal. After this surgery she will start chemo at some point down the road when she is strong enough to stand the treatment.

Sorry if this is a long post and I may have a few things not exactly right but this is the way I understand things as of this morning. I guess my question is, is this the right path for a 78 year old woman ? She wants to go through with the procedures in hopes of having a better quality of life and some additional time. As far as I am concerned what the doctors have recommended seems very logical and the decision is hers to make.

She is covered with Medicare and supplemental insurance so I don't think there should be much cost to her, if any, but don't really know that for sure either.

Just wondered what others thought and if this route we are traveling is pretty much consistent with what others may have been through.



Appreciate any and all comments in advance.
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Old 12-17-2011, 09:34 AM   #2
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I'm sorry to hear that your family has this to endure.

Quote:
Originally Posted by frayne View Post
She wants to go through with the procedures in hopes of having a better quality of life and some additional time. As far as I am concerned what the doctors have recommended seems very logical and the decision is hers to make.
Given that the procedures are within mainstream best practices (not some "quack" cure promise), the decision needs to be hers and afterwards she needs the full support of her family in that decision.
Quote:

She is covered with Medicare and supplemental insurance so I don't think there should be much cost to her, if any, but don't really know that for sure either.
Even if there was a significant cost to her, as long as the resources were there cost shouldn't be a factor other than managing her resources for her overall well-being.
Quote:

Just wondered what others thought and if this route we are traveling is pretty much consistent with what others may have been through.
Everytime we've been in a similar situation, the relative has relieved us from much involvement in the decision process by promptly dieing. Our experience level is low. But my MIL is 87 now and having some health issues and we've been thinking about what our position should be in various scenarios. Of course, until the details manifest themselves sometime in the future, we can only hypothesize.......

Good luck to all of you.
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Tough Situation
Old 12-17-2011, 09:38 AM   #3
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Tough Situation

I'm very sorry to hear about your situation. Very difficult.

I can't make any comment on the medical stuff or recommend a path...I'm totally unqualified.

I can share similar experience tho:

My Dad was 70 years old, diabetic, and his heart was failing. Needed another bypass surgery. Essentially his choices were

1) go home and wait to die of a heart attack in the next 2 weeks
2) use a stint which might kill him or might get him 6-12 months
3) swing for the fence and have the bypass surgery. Would probably kill him but if it worked he'd get 5 years

He told me "I'm not going to go home and have your mother and I staring at each other waiting for me to die." He also didn't see the sense of the middle-ground stint option which he saw as 6 months of essentially the same thing.

Dad decided to swing for the fence.

We had some humorous moments before the surgery. My favorite line from my Dad was "I'm not scared to die...what the h*ll, its not like I killed the President or something." Another favorite was when they brought my Dad somehospital food and my brother told him "You know Dad, if you've really been wanting a sausage sandwich and beer, now's the time."

He had a heart attack on the operating table and he died 48 hours later...but he was confident in his decision and we were all proud of how he took it on. In many ways, his finest hour. I hope I go out with such grace.

There's no recommendation here -- all of these situations are different medically and from a family perspective. Just sharing a similar experience. You're not alone.

I hope it works out well for you and your family. Good luck.
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Old 12-17-2011, 09:39 AM   #4
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Sounds to me as if she's making an informed and perfectly reasonable decision.
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Old 12-17-2011, 10:05 AM   #5
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Sounds to me as if she's making an informed and perfectly reasonable decision.
+1
She is making the decision to go forward with the treatments. Give her your love and support (it sounds like you are). I hope you all enjoy additional quality time with her.
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Old 12-17-2011, 11:05 AM   #6
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Sounds to me as if she's making an informed and perfectly reasonable decision.
+2 It sounds like what I would choose too, were I in that situation and if my doctor wanted to do that. It would be worth the risk for the possibility of gaining some extra time.
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Old 12-17-2011, 11:30 AM   #7
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I happened to catch a podcast interview of Dr. Atul Gawande by Diane Rehm which may help the family cope with the decisions ahead. In this interview he discussions the questions health care givers need to ask the terminally ill. I remember that the core question was 'What is important to you?' Either in that interview or in the following article is that studies have disclosed that terminally ill patients live longer receiving hospice oriented care than those who were treated aggressively. Pain shortens life.


Here is one of his articles in the New Yorker that addresses your situation: Hospice medical care for dying patients : The New Yorker
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Old 12-17-2011, 03:47 PM   #8
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Sorry to hear about your MIL's situation.

About the medicare and supplemental insurance...I think there are varying coverages of supplemental insurance. I had a friend (passed away recently) who often was in and out of hospitals, having CATscans, taken by ambulances, etc. She had the best supplemental insurance one can buy (I think called Plan F) which I think covered 100% what medicare did not cover. We'd always say, no matter what, keep that insurance as one procedure without it can cost a bundle.
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Old 12-17-2011, 04:19 PM   #9
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It's MIL's choice to make. Given the same circumstances, not everyone would make the same choices. But it's MIL's choice.
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Old 12-17-2011, 05:49 PM   #10
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78 is not exactly ancient. I'd go with the doc's recommendations but get authorization from your MIL for a durable power of attorney to be used if things deteriorate.
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Old 12-17-2011, 07:04 PM   #11
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+1
She is making the decision to go forward with the treatments. Give her your love and support (it sounds like you are). I hope you all enjoy additional quality time with her.
+1

Making her remaining time quality time is what's important.

Here's a wiki link in case you've not already read it. There's a prognosis section, which is based on how involved the cancer has become.
Colorectal cancer - Wikipedia, the free encyclopedia

All the best...
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Old 12-17-2011, 09:18 PM   #12
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78 is not exactly ancient. I'd go with the doc's recommendations but get authorization from your MIL for a durable power of attorney to be used if things deteriorate.
Yep. You should support her until she's decided that she's had enough, or she'll always regret not trying what she thought would have been a cure.

But you should also emphasize that you'll be able to support her better if she has all her paperwork in place. She doesn't necessarily have to put a financial POA (and a medical POA and a DNR) in your hot little hands, but she should execute one (including the notary) and have it on file where you can find it if she decides that you should have it.

If you get pushback, you could point out that my family is spending over $5000 (and nearly 10 months) to have the lawyers & probate court accomplish what could've been done with a POA a year ago. My Dad turns 78 in a couple months and he's going through chemotherapy for multiple myeloma.
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Old 12-18-2011, 05:50 AM   #13
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Thanks everyone for the feedback and sanity check. Medical and financial POAs are already taken care of along with a living will. Next hurdle will be surgery on Monday and then we will take it from there.
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Old 12-18-2011, 02:31 PM   #14
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A thread on dying is found on Bogleheads: Bogleheads • View topic - How to Die with a link to an article "How Doctors Die".

When I worked in a hospital, I learned the following "Old People Get Sick and Die".

I have lived a full life and have thought on more than one occasion that I would not try to extend my life by extraordinary means nor would I want others to do so.

My father died of cancer about a year after the diagnosis. He was at home under hospice care.
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Old 12-18-2011, 03:03 PM   #15
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Thanks everyone for the feedback and sanity check. Medical and financial POAs are already taken care of along with a living will. Next hurdle will be surgery on Monday and then we will take it from there.
Best wishes for a successful surgery come Monday. I'm approaching that age and would hope I would get the same attention from my kids. Bless you and your family.
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Old 12-18-2011, 10:04 PM   #16
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It seems kinda strange that the Ohio doctors didn't seem to look into surgery, but the new doctors seem to be treating it aggressively. I don't have any experience with colon cancer, but it seems reasonable with what I've seen with other cancers. Best of luck with the surgery.
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