When is the end near?

confusedNscared · Regular Joined: 11 Jun 2009 Posts: 14

My father, 85, was diagnosed late October 2008, with cancer... no origin could be found, but they have told him it seems to be prostate cancer. However, no PSA score has been given, several prostate biopsies with negative results, in fact, he was told by the doctor that he has never seen such a small prostate in a man his age.

Unfortunately, it has metastasized to his bones, throughout his skeleton. All major organs seem to be fine, at this point. He has refused chemo and radiation, and has chosen to go in to palliative care at home. His doctor gave him 3 to 6 months. That was almost 6 months ago.

He is on 75mg Fentanyl patches, and has had to use 2 hydromorphone (unsure of exact dosage) every 4 hours when his pain is intense. He has just started to receive an injection, once daily, for pain (unsure of dosage or Rx name).

He's bed bound now, too weak to go up and down stairs. His waking time has diminished, sleeping 22+ hours a day. His appetite is non-existent some days. Meals for the past week have been a black coffee for breakfast and lunch, and 1/4 potato for supper. Although, today he ate more than he's had in weeks, possibly even months!

When this all started, last summer, he weighed 166#, and now weighs 115#. He's very weak, and cannot maintain any conversation for longer than a few minutes. A few days ago he couldn't even figure out where he was after waking up.

Last night, I was sure he was on death's door, today, he seems to be much better, joking around with me a bit. I don't want him to die, but God help me, I feel so guilty for praying for a faster death.

Is this roller coaster ride coming to an end soon?

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

I'm sorry to hear about your father.

It doesn't sound to this layperson like prostate cancer. I would bet that he's had his PSA checked at some point, and then there are those multiple negative biopsies. If there was a clear indication that it was prostate cancer, hormone therapy would undoubtedly have been initiated.

It's not possible for anyone on the Internet to tell you what will happen and when.

Does he have in-home hospice care?

Radiation can be palliative. It is often used to reduce tumors in bone, giving some relief from pain.

Have you looked into support groups for you and/or your dad? They can be a great help.

Best wishes to you and your father.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Hawk · Senior User Joined: 22 Nov 2006 Posts: 406

I guess the doctors are really saying your father has metastatic cancer of unknown origin. That is uncommon but I do not think it is rare. I too have to doubt that it is Prostate cancer.

If your dad has started wasting (rapidly losing weight) the end cannot be far but a lot depends on his current size and a host of other factors.

If he stops drinking several cups of fluid the end is with in a few days is most cases.

Hospice can advise you much more specifically and help both your dad and you and the family during this time.

It is understandable that you want peace and rest for your Dad. It only shows unselfish love. You should not feel guilty. My daughter-in-law was a nurse in a nursing home and now works in an inpatient hospice care. She once stated that, " with cancer deaths the families are often at peace because by the time of death, the family has already been through so many greater trials."

I hope for peace as your Dad embarks on this journey.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

confusedNscared · Regular Joined: 11 Jun 2009 Posts: 14

@Replicant - I never thought it sounded like prostate cancer either, but nope, no PSA test. The first doctor actually was a hematologist. Then an oncologist, radiologist and now palliative care doctors.

He has in-home care, nurse and doctor stop in daily, but there is nothing beyond that... at this time.

I'm not in the same province, which lends to the guilt as well.

@Hawk - yes, that's what the radiologist said, but his palliative care doctor says it's "showing like prostate cancer". I'm assuming it has similarities to it. ?? Dad is 5' 8", currently weighs 112#. My understanding is his fluid intake is 2 cups of coffee and maybe a glass of water a day.

Thank you both for your responses. Last night he had several tumbles trying to get up for the bathroom. He's hurt his wrist and hip, and spent most of the day in his bed. I gather yesterday he was feeling very good and over exerted himself "while the energy was high".

melkissa · Posted: Sun Jun 14, 2009 12:14 am Post subject: Re: When is the end near?

If you want me to be completely honest, I think it sounds like your dad was possible rallying? (If you are not familiar with rallying PM me and I will send you links to a couple of articles) Rallying is very common with cancer patients nearing death. My dad did it about a week before he passed. Sad

I don't mean to imply that is definitely the case, it just sounds like what my dad did. He was walking, talking, eating, drinking, etc. It was his last hoorah.
How is your dad's pain (besides from falling)? Do you think Hospice in patient care would be a better option for him to be more comfortable? I would also try speaking to his Hospice nurse or doctor to find out where they think he is right now in the dying process. Maybe you could go stay with him if he's only days away, like in the active dying process? I think this would help relieve your guilt and help your dad. If that's not possible push to see if they can approve a 24 hour care nurse. It really sounds like your dad needs someone there to monitor him 24 hours a day.
Anyways, I am just throwing out ideas and suggestions. I am so sorry for your situation. Many hugs and positive thoughts going your way.
_________________
My dad was diag w/nsclc stage 4 & mets to spine & hips on 11/08 at age 43. Large mass on R lung & collapsed L lung. No surgery so chemo & rad 5d/wk. No results. 4/09 rushed to the hospital b/c breathing issues. Hooked up to o2 & treated for infection. Released when o2 levels were good w/help from Hospice at home. In Hospice as of 6/2/09. Passed 6/10/09. Missing you forever daddy.

confusedNscared · Regular Joined: 11 Jun 2009 Posts: 14

@ melkissa - I was thinking it sounded like rallying as well. Sad

His pain has been pretty high this week, his doctor increased his Rx to manage it. As of last night it was still nagging him.

Dad refuses to leave the house. There is no way to persuade him otherwise. As I said in my last post, I'm unfortunately not in the same province as him. With kids in school, it's not easy to get to him. We were planning on spending most of July with them.

My mom seems to be doing well, but I've been pushing for her to get more help. Dad didn't even call out to her when he fell. Parents can be so annoying at times. Mad

Thanks for your suggestions.

melkissa · Posted: Sun Jun 14, 2009 4:04 pm Post subject: Re: When is the end near?

Sounds like a tough situation. I hope you guys figure out a solution that allows you to spend time with him and for him to be in less pain. Many hugs!
_________________
My dad was diag w/nsclc stage 4 & mets to spine & hips on 11/08 at age 43. Large mass on R lung & collapsed L lung. No surgery so chemo & rad 5d/wk. No results. 4/09 rushed to the hospital b/c breathing issues. Hooked up to o2 & treated for infection. Released when o2 levels were good w/help from Hospice at home. In Hospice as of 6/2/09. Passed 6/10/09. Missing you forever daddy.

confusedNscared · Regular Joined: 11 Jun 2009 Posts: 14

Dad is now under 110#, and in a hospital bed at home. Mom has nurses coming in 3x/week roughly 2-3 hours each time PLUS the regular nurse 2x/week for vitals. The doctor comes in every other day, and calls when she can't make it.

They've given him the "what to expect" talk, and although no exact time frame has been given, it seems to be an understanding that we have 4-6 weeks left.

As I stated earlier, no PSA score had been given, however, I have yet to speak directly with the doctor or nurses. Once I'm up there, I will inquire.

School's almost over... this week is going to go on forever! Crying or Very sad

Hawk · Senior User Joined: 22 Nov 2006 Posts: 406

I wish you the best and the opportunity to have a good visit with your Dad.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

confusedNscared · Regular Joined: 11 Jun 2009 Posts: 14

It's been a rough couple of weeks. I finally am here with my parents. Dad is now down to 106#, barely eating or drinking, and only voiding 3-4x/day. His urine is dark in colour, almost as if bloody. The doctor explained the discolouration to us today as part and parcel with the cancer progression.

I've asked about the PSA score, and the doctor said it was negligible, although no number was given to me.

The injection Rx was Decadron, 4mg/day. It seems he was "near the end" at the beginning of June. His O2 was 89%, pulse 107. His doctor suggested using this Rx to help him improve and hopefully make the visit date. It increased his appetite and energy levels, raising his O2 to 97%, and lowered his pulse to 77.

He stopped the drug as of Tuesday and is rapidly deteriorating. His O2 was 93%, P 85 today. He's been up once to pee, and ate a small bit of cereal almost 12 hours ago. The rest of the day has been sleep, sleep and more sleep.

We now have overnight staff, as well as early morning/afternoon staff, as well as daily nurse visits and the doctor every other day. When the doctor was leaving, I asked for an approximate time left, and she said, when I start coming daily, he'll be days away. She figures by end of month.

Now my biggest concern is how do I tell him to stop worrying about my mother's failing memory and her ability to do bills without him when I go back home? He's insistent that Mom must stay in the house until it is sold, but I am equally as adamant that she will move when I leave after his death (as is her wish as well). He's insisting he has to get someone in to show them how to take care of the bills and the house, as she will be incapable once I'm gone. When I've told him she's coming with me, he gets agitated and furious, insisting the house cannot be left alone. It will be empty... nothing in it except old rugs and some cobwebs. I'll have a friend check on the house. NOPE, still not good enough.

Help me... how do I deal with this? I guess it's my problem, as I'm feeling as though I'm defying him by moving Mom without his permission, and my ego is being bruised that he feels the need to bring in someone who hasn't even bothered to find time to visit more than a dozen times to do the finances. Argh!!!!

Jean222 · Senior User Joined: 14 Dec 2008 Posts: 249

Hi, Sorry to hear that you're caught up in such a tough situation.

Is it possible for you to 'go along' with his wishes, ask him if he can show/tell you and your mother (as a team) how he'd like it to be done once he's gone.

If he wants your Mother to stay in the house, I'd 'go along' with his wishes for now, as he doesn't need to be worrying about his wife while he's in the process of dying.

You also don't need the extra stress. Your plate is more than full too but with other issues.

Once your father has passed away, you and your Mother will continue on with whatever is best for your Mother but your father will have had the comfort of not having to worry about her and your stress will be lessened if you're not clashing with him now.

As a friend told me, the person dying doesn't need to be worrying about you, meaning me. She's been a widow for a number of years and told me to reassure my Hubby that I'll be fine......it's a lie but a lie with a compassionate purpose.

On a practical level, make sure that the insurance company that holds the insurance on the home, will allow it to remain vacant. Sometimes, a vacant home will make the insurance null and void. They are very opposed to insuring an unoccupied property.

You and your family are in my thoughts and prayers.

Jean

confusedNscared · Regular Joined: 11 Jun 2009 Posts: 14

Thank you Jean for your response. That is what I have been doing, "just smile, nod and agree". But thank you for giving me a different view... I never considered an issue with the house insurance.

I guess my next call is to his insurance company. Hopefully they will give me some good news, if not, my next thought is to rent it out to a friend.

Hawk · Senior User Joined: 22 Nov 2006 Posts: 406

I agree with every aspect of Jean's response including the insurance issue since I have been down that road.

Reassure him so he feels free to go in peace. We are often driven by a frantic need to take care of our responsibilities. Your job may be to help him have the peace that all will be well.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

notme · Guest

When I was going through this with a sister the hospice nurse told me that she wouldn't die until I told her it was "okay to die", and I had to use that word. So I told her that I would think of her every day and miss her more, but it was okay with me for her to die, I would be joining her someday, and I would look for her. It was hard. She died in two days.

confusedNscared · Regular Joined: 11 Jun 2009 Posts: 14

Thank you hawk and notme.

Two days ago I told him it was time to stop fighting the cancer, and that I will take care of Mom. He said he knows I will.

But I wonder if it's Mom he needs to hear it from?

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