AboutMargot RN BScN CGN Expertise I nursed my own Mother and Grandmother at home when they were dying so I have personal experience with the emotions involved. I have also spent the last 15+ years as a Registered Nurse caring for The Elderly and Terminally Ill and it has brought me great satisfaction. I am willing to answer any questions I can.
Experience
Past/Present clients Hundreds of Long Term Care Residents as well as hundreds of Cleitns and families in the community (including my Mother and Grandmother).
Question Hi-we just found out yesterday that my mom's liver in no longer "working".Two years ago she was diagnosed with malignant melanoma which has spread to liver,lung, bone and brain. She had been on a month long course of chemo (Nexavar) which initially seemed to be helping the tumors in the liver,but last week her liver size increased and they did full body scan yesterday. They found the liver not "working" and stopped all chemo. My question is this. Is she considered in "liver failure"? She is still mentally intact at the moment-some occasional confusion but able to carry on conversations appropriately (about the grandkids, etc.)The doctor suggested Hospice, which they will probably do, but they wanted to take "a week or so" to let it all sink in. My other question is this (and i know each situation is different-she is 74, having difficulty eating much of anything, sleeps most of the day, isn't vomiting yet,or complaining of itching,no active bleeding/no extensive bruising, still able to toilet thus far, ambulatory but very weak)-what is the time frame and sequence of events that may follow? I was hoping they would contact hospice before confusion/encephalopathy sets in,so they can know HER true wishes and desires. I am wondering if the confusion or possibly lapsing into a coma may happen before the next week or two? Can her doctor answer questions for family members (ie the offspring, like her daughters) or is that a violation of patient privelege, confidentiality, etc. Also,would Laculose do more harm than good, or would that be helpful at all-in eliminating the toxins to try to ward off the toxic buildup and delay the confusion. I don't want her to end up with diarrhea and be having to try to get to the bathroom every five minutes. What about the possibility of her having esophageal varices? How could we know that, except for obvious bleeding from the mouth or blood tinged spit? I am concerned about her suddenly bleeding out before hospice gets involved because I don't think mom and dad have an DNR in place yet.Any other suggestions?I am a nurse but havent' worked as such in years,and my sister is social worker,who also has not worked in years, but both of us know the great work hospice does and are gently trying to enncourage our parents to let hospice in to help mom be comfortable at home-so she can spend her remaining time peacefully in her own surroundings. thanks for your help. Obviously we have lots of questions and concerns, but ultimately know that it will all play out the way it is supposed to on GOd's timetable. thanks again
Answer Hi Lori and thanks for writing,
I'm sorry to hear about your Mom, her condition sounds very similar to my own Mom's battle with Ca (except hers was Breast Ca with Mets to Liver, Lung, Bone & Brain). I'll try to answer your questions to the best of my ability.
Symptoms of Esophageal Varices can include nausea and vomiting, tarry stools, excessive thirst, paleness and light-headedness. I would use the Lactulose, but discuss it with her physician if you're concerned. Yes she would be considered to be in "Liver Failure due to Mets".
I'm not sure Hospice will get involved until she needs to be there as the beds as usually full and they need to focus on their current patients. Don't worry about them "not knowing her", Hospice will care for her needs and as the family you can share her likes and dislikes with the staff upon admission.
Obviously I am not familiar with your Mom's prognosis, but unless her condition has rapidly deteriorated in the past 2-3 weeks I would not thin she would suddenly progress quickly; generally Ca progresses at a gradual rate.
I hope this helps. The best thing you can do is to spend s much time with your Mom as possible and watch for new symptoms. I took 18 months off to care for my Mom full-time and value every memory I have and would do it again if given the option.
