How much time does Mom have?
My mother-in-law was diagnosed with a brain tumor (GlioBlastoma Multiforme) in February, we have been through radiation and chemo, following the radiation cycle we had another MRI done and discovered the tumor was indeed larger and had spread. Her condition has deteriorated progressively. She has been unable to swallow for some time now and we have been feeding her via a nasal tube exclusively for about 6 weeks now. We have been told that as she nears the end of her life we will have residual nutritional supplement between feedings due to her organs beginning to shut down. Once we confirm there is a residual issue what sort of time frame should we expect? Weeks? Days? Her doctor gave a prognosis of "weeks to a couple of months" at her last visit in June.
Glioblastoma is well documented as a very aggressive type of cancer. It appears that your mother –in-law has undergone all of the available treatment and unfortunately as you described her condition has deteriorated. I am sure this situation is very difficult for your mother in law and yourself.
The feeding tube does provide nutrition; however, once her organs begin to shut down the feedings will most likely not be absorbed. Because of the need for the body to require nutrients, and as this need decreases, the residual amount of feedings will increase.
Unfortunately the time frame you are questioning is very difficult for anyone to answer, generally speaking once the liver and kidneys begin to lose the ability to filter, toxins increase within the body and will influence a person’s ability to think clearly as well as may cause limitations with mobility.
It sounds like it has been a month since your last physician visit, I would recommend reflecting on the changes you have seen within this time frame and if you are noticing a rapid decline with mobility, cognition and an increase in residual feedings - day to day for example, then I would suspect her health is declining rapidly. On the other hand, if she appears to be maintaining her current level of activity she may have more time, as you stated the physician described. I would suggest the best person to talk with in more detail would be the physician. You may want to plan more frequent visits with him/her to help during this difficult time.
Finally, I would hope that you and your mother in law have some sort of help during this time such as home health nurses, and or hospice care. Being able to evaluate the feedings and the day to day activity both physically and emotionally can be very difficult both for you and your mother in law. I think having professional health care providers helping in a home setting may ease some of this stress.
As soon as your Mother in Law stopped curative cancer treatments she became eligible for hospice care. Hospice care brings the medical treatment to your home and can provide support and answers to your questions. It is never too early to seek hospice care. It is a benefit category that gives you more, not less care.
How difficult to have to work with this situation. Even if your loved one has a lot of time, Hospice can work wonders with quality of life once treatments have stopped. Their nurses, staff and volunteers are a God-send. Prayers for your support are coming.
Yes hospice is your answer. Have your physician qualify you. I brought in hospice for my husband and he had this wonderful team around him for 11 months. He was able to die in peace with loving support. They were a Godsend to me! I couldn't have managed without them. Take good care of yourself during this tough challenge. You cannot support another if you are not healthy and whole and rested. That's where to use in home hourly care if you can afford it .... to take a respite break. If you can't afford it ask a friend for a day off or contact a council on aging in your community for support.
I'm sorry for the challenges you are facing. I would hope that your mother in law had/has advance directives and has had discussions with family about what is meaningful to her on a day to day basis. As your mother in law's advocate/health care agent, that individual/those individuals need to focus on what your mother in law's wishes are/would be. Her health care proxy is charged with making decisions on her behalf. If you (or her health care agent) are faced with making further decisions regarding her care, I strongly suggest you talk with physicians about ALL treatment options (INCLUDING no treatment-just comfort care) and the potential side effects/outcomes. Then, you can fully understand what realistic options there are and can stay focused on a meaningful quality of life for her, no matter how much time she has left. This is a very difficult time for your family, but can also be a blessing to spend as much quality time with her as possible, assuring that her sense of comfort and love are first and foremost. Stay focused on love and the rest will fall into place. May your mother in law and your family be blessed with peace as you face this difficult time.
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