My mom has stage 4 metastatic bladder cancer. She had surgery 23 months ago to remove her bladder/complete hysterectomy. Last January she was given a year to live when the doctors found the cancer had spread to her lymph nodes in her left groin area and chest. Everything had been fine until last October when she had back problems, then we found out the cancer had spread to lymph nodes in the back. At this time she went on hospice, at the suggestion of her oncologist. Everything was fine until the first of June this year when she began having swelling in her left leg. It was finally diagnosed as lymphedema. Now she has lymphedema in both legs. Hospice didn't feel it would be beneficial to do lymphedema therapy due to her active cancer. A lymphedema specialist I have talked to is also uncertain it would be beneficial and may cause additional problems. When the lymphedema started we also started having problems with her urostemy bag. The feeling of the ostemy nurse I have talked with feels this is most likely due to the extra protein in her body with the lymphedema and that she is in bed much more now. My biggest questions are how can I expect the lymphedema to progress? What is the best thing to do for lymphedema (it is pitting edema to almost the knees)? What is the best thing to do for an ostemy bag that doesn't adhere because the adhesive is being deteriorated by the protein in the urine other than change it daily? And my biggest question is how long can someone be expected to live with stage 4 metastatic bladder cancer?
Expert Answer by Dan Tobin, M.D.
Hi:
It is clear that you are facing a difficult and complex situation. In our 8 step method for family caregiving the first step is understanding the doctors' treatment plans. It will be helpful to ask your Mom's treating physicians the exact questions you post. They will tell you what they think is the best treatment for her cancer and lymphedema.
it is very hard to predict how long she will live. I suggest talking with all the health counselors you can find. That includes her doctors, nurses and anyone from hospice who is trained to help you with the emotional and spiritual questions around dying. Most of all, your support for your Mom and the good times spent together will create strong positive memories. Try and see how valuable your support is and take care of your self .
Dan Tobin
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Hello,
It is obvious how very much you love your Mom - I am sure she is very grateful to have you for a daughter. I personally do not think there is enough attention paid to bladder cancer in the world. The cigarette packages don't make reference to it, and there is hardly ever any fund raising events for it, and at funerals it seems no one ever requests contributions to bladder cancer research specifically. As we all go along concerning ourselves with pap smears, breast exams, lung cancer, colonoscopies, and heart disease, then "POW" bladder cancer hits out of the blue! And the treatment is life changing, traumatic, and dramatic - a person's whole bladder is removed along with nearby organs such as the uterus, and the bowels cut also to use in the surgery - all this, and as immediately as the surgery can be scheduled. The symptom of blood in the urine as a sign - red/pink urine should be attended to as soon as possible. The knowledge of the importance of this symptom is not well enough known. I went 2 years after this symptom because a lab tech at my clinic told me that was a common symptom in women so I didn't need to see a doctor about it. Then 2 years later I was diagnosed with bladder cancer and had the surgery your Mom had right away. Then my husband was diagnosed 3 years later also with bladder cancer - we got him in for the surgery right away because we knew the symptoms this time. We were told there is no good chemo yet for this type of cancer. He had chemo anyways, but maybe because he was older in age than myself, the cancer spread and he passed away last year from it. The hospital kept looking at his kidneys for a month (even with an MRI) and didn't see cancer so he was encouraged to "stay off the Vicodin" for his back pain - he wanted to go home. At home for one day, now with bed sores from the hospital, I could not get him out of the bathtub! I could not leave him alone to go to work, and he could not get out of the chair alone - so I brought him to a nursing home. The next morning he had a low sugar crisis at the nursing home and was taken to the emergency room. There they did a Cat Scan and informed us his liver and lungs were FULL of cancer that had spread from the original bladder cancer. He died a week later - thankfully he was now able to receive pain medication. All he wanted to do was to go home but he never got a chance. I am telling you all this because I want you to know that medical personnel cannot predict how long a person will live. I was shocked at the aggressiveness of this cancer. I thought my husband would be around longer - I even worked the day he died and was planning to bring him home on hospice the next day. In hind sight even though he didn't complain and was surprised he was terminal I should have noticed his present symptoms - it happened over time little be little so I didn't see the dramatic amount of change in him over the previous year. Like your Mom he had back pain and leg pain. He died on Monday but the weekend before he had an energy surge and was able to talk to all his siblings and children in person or by phone. He was in much pain but I brought him outside anyways in a wheelchair after much help from the wonderful nursing home personnel. He was ornery from pain, and wanted to escape to home. He did not want to eat or drink. It hurt him to bath him. He tried but could not squiggle out of bed even though he had managed to fall out of bed at the hospital. The last night before he died he had hallucinations in his dreams. He wanted to see pictures of the family. He did not talk about dying. Because he didn't say much I did not either - I realize now he wasn't able to talk - I could not read what was going on in his mind. I should have spent time talking to him had I been aware of this. I should have made others leave the room and spent time alone with him talking about our 26 years of marriage together, etc. I had no idea we had so little time left together.
I am telling you all this because I don't think you will get the answer from your Mom or anyone else as to how much time you and she have together. If she is already on hospice I feel you should take the initiative and tell her everything you feel about her as if she will be gone tomorrow. If she is with you another year or two it will not hurt to do this now as she is most aware at this time. Take off work, spend alone time with her, make sure she receives pain medication, and if she gets cranky at times don't take it personally, and take advantage of the breaks provided by the hospice team, etc. We have a daughter too and she had to stay and take finals at college and would be home in 3 more days, but her Dad could not stay with us any longer - that is how fast this cancer works, even though he tried so hard to hang on until she got home. Many parents do not want their children to worry about them or suffer their pain so your Mom may not let you know how bad she's feeling. I only hope if my bladder cancer spreads that I can be as strong as my husband was and not whine. He sat in bed with a little smile on his face to be social, not talking up until the end. It is good that you are trying to make her more comfortable about the lymphedema because it shows her how much you care. My husband and I were both in denial and its in this area I hope you can get through so you don't lose any of the precious time you have left with your Mom. I pray that God gives you the strength to help both of you during this difficult time. Tell her you love her, and give freely of kisses and hugs......
Kindest regards,
Kay
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I am so sorry to hear of all that you are going through with your mother. I have lived through it- so I know it is a very difficult time. I just wanted to add to the comments already made. I lost my mother this past January to colon cancer. She was diagnosed in 2001 and fought for 8 years! In the end it had spread to her brain. I understand your question about how long can someone live because we asked it over and over again. Doctors really couldn't tell us how long she had to live. They were very vague and said it differs case by case-but they said it would maybe be 6 months. Which was SO frustrating because we just wanted to prepare ourselves for the worse. They discovered the legions on her brain in October 2008, she went into hospice in early January 2009 after having a seizure and she was gone by January 14th. But in the end the person that was able to give us the answer to that question was not my mother's doctors-but my mom herself. All the signs were there. She kept saying she felt so close to God- like He was in the room with her. She kept seeing relatives who had passed on. She kept asking to see family members. She was tired and she knew she was ready to go, but she wanted to spare us the pain. And we wanted to have hope. But ultimately we stopped asking the doctors and just asked her the tough question-'Do you feel like it's your time?' And her answer was-she was tired and she was ready. I was 9 months pregnant and I know that she would NEVER have let go if she didn't have to. I know she wanted to be here to see her grandaughter, but she couldn't hold on. I think giving her the peace in knowing that we were going to be okay if she did decide to let go-helped her to pass on. I told her I know she was in pain and I know she was tired and if she wanted to let go she could- that we'd be okay. She passed on the 14th and my baby was born 2 weeks later. So I say this to say to you dear heart-ask her the tough question. And even if she can't give you an answer-love her like she won't be here tomorrow. Hug her, kiss her, smell her (I miss my mom's scent), tell her you love her and tell her all you need to tell her, ask her questions-if she's able to talk, make her comfortable (do the crazy things she may ask of you-and don't take any yelling personally) make sure you have all her things in order and pray without ceasing for the strength to endure God's will. Whatever that will be. And like the other responder said- if she is here a year or two from now-then WONDERFUL. But if she's not, you will have no regrets and you will have the peace of these memories to last you. Eight months later-knowing I did all of those things helps ease the pain of missing her. I pray your mother survives, that you have the strength & support you need and that you all are granted peace beyond your own understanding. You are in my prayers.
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Hi. It iss so obvious that you truly care for your mother. I cared for my grandmother for 15 months (she had pancreatic cancer). She didn't want to go to the hospital or have hospice so my mom and I cared for her round the clock and she passed away on 9/25/03 in our home. Last year, my mom was diagnosed with breast cancer. She had a right breast mastectomy this year. Last year she began having problems with lymphedema in her right arm (due to having lymph nodes removed). She is now in physical therapy three times weekly and has to wear a sleeve to help the edema move back into her system. My advice...address the lymphedema!! It can be very uncomfortable. At this point in your mom's care, comfort is key. Some may tell you that it is not important or the "least" important issue but I disagree. I think her comfort is key!!!
Hospice can refer you to person's experienced in relieving the discomfort of lymphedema. My thoughts and prayers are with you and your family. Please know that I will be praying for you all.
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I'm very sorry your Mother is having such a hard time. My experience with this is that my 28 year old son passed away this year after battling a very nasty soft tissue sarcoma. However one of his symptoms were his legs swelling from all the excess fluid in his body. What we found that helped tremendously was the compression stockings. They come in knee high and thigh high lengths and they gave him a lot of relief. They are available in any of the pharmacys and also Wal Mart has them. My son suffered from this for about 4 months before he passed away. I miss him every day. I hope this helps. Christine
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Bless you all. I am so sorry. Yesterday I lit a candle for my Brother John. By you sharing your experience about your mom - I have been helped. Thank You! You see my Brother John is five years older than me. I came from a caring family of five. Dad, Mom, Brother Harry and Brother John. John and I are the last two living. We both have Bladder Cancer. I was diagonosed 11 years ago with Stage 1 Bladder Cancer - my brother was diagonosed 2 years ago with Stage 4 Bladder Cancer. I am so sad for my brother and his family. Like your mom, John's bladder cancer had metasosized and he had to have many organs taken out. Now he has been going through chemo since April '09 because the cancer had spread to his lymph nodes. Cancer is terrible. I am so sad. I'm sad but happy to know that others are sharing their experiences...which does help me to face reality. We all know that it's easier to white wash what's really happening. To face what's really happening is difficult. I could go on and on. Like I have always preached to others. "WHEN THERE IS NO ONE ON EARTH THAT CAN HELP YOU TURN TO YOUR HIGHER POWER....For me that is God.
How long can my Mom live with stage 4 metastatic bladder cancer?


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