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Old 06-04-2013, 07:07 AM   #1
pibikay
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in a dilemma

Hema has not been told. I think she gusses.I have a full time nurse to take care of her and change diapers. She is only taking liquids.
Once she refuses to take even liquids I do not know what to do.She has taken a promianse from me NOT to give her life support like nasal feeding etc.I wonder if that is correct.My son has come from the USand my daughter late tonight after our grans graduation on the 2nd.I need your advice
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huband of Hema
Metstatic Breast Cancer Stage 4
Left breast cauliflower 25x20cm
ossousmetstatis in vertbrae secondaries L4=L5secondary
nodules in both liver lobes secondary
Diagnosed 10th March 2010
ER/PR-ve
Her 2 neu +++
Taxotrne Zylotec started 16th March
Herceptin added 5th April.9th Herceptin over on 20th Sep '10.Started on Tykerb and Xeloda on 22nd Oct2010TYKERB 4 TAB A DAY XELODA 4 TAB A DAY ONE WEEK ON ONE WEEK OFFZoletrust infusion every 4 months.Lesion in Brain 3D CRT Radiation started on 1st Feb'12 for 20 days ,5 days a week for 4 weeks.Devloped a small lump in breast.Xeloda stopped from 11th April '12.On Taxol.After 3 cycles of Taxol Taxol stopped.Back to Xeloda regime from 3rd July
Herceptin started again on 27th Dec 2012.Xeloda stopped Navelbin added on 7th February 2013.Now on Tykerb Herceptin and Navelbin
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Old 06-04-2013, 07:39 AM   #2
NEDenise
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Re: in a dilemma

PBK
Of course, you know Hema better than anyone...and will do what is best. Of this, I am certain.

Having said that...As the devoted and loving husband you have always been....I believe you have to honor your promise to Hema, and because of that promise, I also believe you must be honest about what she faces in the days and weeks ahead. I would want a chance to make peace with what lay ahead of me. I wonder if Hema would not feel the same way.

Only my humble opinion...given because I admire and honor both you, and Hema.

You, and your family continue to be in my thoughts and prayers. I wish you all peace, and I hope with all my heart that Hema's transition will be pain free.
Denise
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Old 06-04-2013, 07:51 AM   #3
Lien
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Re: in a dilemma

Dear PBK,

First, let me say how sorry I am that this is happening.

For what it's worth: when my Mom was terminally ill with esophagal cancer, she knew she was dying. Nobody had to tell her. She just knew. And when everybody around her tried to encourage her to keep fighting, to keep living, she felt so very alone. She needed to talk about her feelings, her fears, and she needed to let go of life. She specifically asked me to let her go. That was difficult for me, as I had just found out I was pregnant with our second son. I wanted the news of a new grandchild to give her a boost, but it didn't. I wanted to show her pictures of the ultrasound, but she didn't want to see them. She was ready to go and didn't want us to try to hold her back.

Now I know most people are not like that, but there is only one way to find out: Communicate. Talk to her about how she feels, what she wants, what she needs. Whether she wants to continue fighting or to say things she doesn't want to leave unsaid. Dying is a thing we have to do alone, but the path we walk towards death can take many shapes. We all have different needs. If we don't talk about them, or at least give the person who is dying a chance to express their wishes, I think we are keeping something important from them.

Just my humble opinion. I am sure you know her well enough to make a wise choice. But sometimes our own fear and grief is keeping us from seeing what the other person wants and needs.

If she refuses liquids, you could try to ask her why she refuses. If it is because she has had enough, that's a clear answer. If it is because of nausea, you can ask her if she wants you to find a way to reduce her discomfort, even if that means a nasal tube. Life support could prolong her life a bit, but not much. I think the most important thing would be to keep her comfortable.

But again, these are my thoughts, my views. They don't necessarily apply to you.

I wish you strength and love and for Hema that she be as comfortable as possible.

Love

Jacqueline
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Diagnosed age 44, January 2004, 0.7 cm IDC & DCIS. Stage 1, grade 3, ER/PR pos. HER2 pos. clear margins, no nodes. SNB. 35 rads. On Zoladex and Armidex since Dec. 2004. Stopped Zoladex/Arimidex sept 2009 Still taking mistletoe shots (CAM therapy) Doing fine.
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Old 06-04-2013, 08:00 AM   #4
ammebarb
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Re: in a dilemma

I am so very sorry your family are facing end of life issues. The choices are so deeply personal, that it is difficult for anyone else to advise about the "right" thing to do. Do you have access to a hospice program? My family used hospice services when my father was terminally ill with cancer, and they were wonderful. About the promise about nasal feeding, I would want you to honor your promise if I were in that situation. I actually have an "advance directive" which spells out what I want done and not done. My heart aches for you and Hema and I send my most loving wishes for your whole family.

Barb A.
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Old 06-04-2013, 03:16 PM   #5
Mtngrl
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Re: in a dilemma

PBK,

The others have given excellent advice, and food for thought.

It is my understanding that when people quit taking any nourishment or fluids as they are dying, they don't suffer. I think it's a natural part of the body's process of shutting down.

I think feeding tubes are pretty awful. I'm not sure I'd want one even if I was expected to get well.

I know how devoted you are to Hema, and how much you love her. You know her better than anyone else. Your presence, your touch, your voice will help ease her transition.
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4/19/11 Diagnosed invasive ductal carcinoma in left breast; 2.3 cm tumor, 1 axillary lymph node, weakly ER+, HER2+++
4/29/11 CT scan shows suspicious lesions on liver and lungs
5/17/11 liver biopsy
5/24/11 liver met confirmed--Stage IV at diagnosis
5/27/11 Begin weekly Taxol & Herceptin for 3 months (standard of care at the time of my DX)
7/18/11 Switch to weekly Abraxane & Herceptin due to Taxol allergy
8/29/11 CT scan shows no new lesions & old lesions shrinking
9/27/11 Finish Abraxane. Start Herceptin every 3 weeks. Begin taking Arimidex
10/17/11--Brain MRI--No Brain mets
12/5/11 PET scan--Almost NED
5/15/12 PET scan shows progression-breast/chest/spine (one vertebra)
5/22/12 Stop taking Arimidex; stay on Herceptin
6/11/12 Started Tykerb and Herceptin on clinical trial (w/no chemo)
9/24/12 CT scan--No new mets. Everything stable.
3/11/13 CT Scan--two small new possible mets and odd looking area in left lung getting larger.
4/2/13--Biopsy of suspicious area in lower left lung. Mets to lung confirmed.
4/30/13 Begin Kadcyla/TDM-1
8/16/13 PET scan "mixed," with some areas of increased uptake, but also some definite improvement, so I'll stay on TDM-1/Kadcyla.
11/11/13 Finally get hormone receptor results from lung biopsy of 4/2/13. My cancer is no longer ER positive.
11/13/13 PET scan mixed results again. We're calling it "stable." Problems breathing on exertion.
2/18/14 PET scan shows a new lesion and newly active lymph node in chest, other progression. Bye bye TDM-1.
2/28/14 Begin Herceptin/Perjeta every 3 weeks.
6/8/14 PET "mixed," with no new lesions, and everything but lower lungs improving. My breathing is better.
8/18/14 PET "mixed" again. Upper lungs & one spine met stable, lower lungs less FDG avid, original tumor more avid, one lymph node in mediastinum more avid.
9/1/14 Begin taking Xeloda one week on, one week off. Will also stay on Herceptin and Perjeta every three weeks.
12/11/14 PET Scan--no new lesions, and everything looks better than it did.
3/20/15 PET Scan--no new lesions, but lower lung lesions larger and a bit more avid.
4/13/15 Increasing Xeloda dose to 10 days on, one week off.
7/1/15 Scan "mixed" again, but suggests continuing progression. Stop Xeloda. Substitute Abraxane every 3 weeks starting 7/13.
10/28/15 PET scan shows dramatic improvement everywhere. All lesions except lower lungs have resolved; lower lungs noticeably improved.
12/18/15 Last Abraxane. Continue on Herceptin and Perjeta alone beginning 1/8/16.
1/27/16 PET scan shows cancer is stable.
5/11/16 PET scan shows uptake in some areas that were resolved on the last two scans.
6/3/16 Begin Kadcyla and Tykerb combination
6/5 - 6/23 Horrible diarrhea from K&T together. Got pneumonia.
7/15/16 Begin Kadcyla only every 3 weeks.
9/6/16 Begin radiation therapy on right lung lesion that caused the pneumonia.
10/3/16 Last of 12 radiation treatments to right lung.
11/4/16 Huffing and puffing, low O2, high heart rate, on tiniest bit of exertion. Diagnosed as radiation pneumonitis. Treated with Prednisone.
11/11/16 PET scan shows significant improvement to radiated part of right lung BUT a bunch of new lung lesions, and the bone met is getting worse.
11/22/16 Begin Eribulin and Herceptin. H every 3 weeks. E two weeks on, one week off.
3/6/17 Scan shows progression in lungs. Bone met a little better.
3/23/17 Lung biopsy. Tumor sampled is ER-, PR+ (5%), HER2+++. Getting Herceptin and Perjeta as a maintenance treatment.
5/31/17 Port placement
6/1/17 Start Navelbine & Tykerb
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Old 06-04-2013, 04:02 PM   #6
ElaineM
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Wink Re: in a dilemma

I agree with the other people who responded to your message about what to do. I also think Hema knows.
Our bodies and our spirits know what is happening on some level even if nobody tells us the whole story.
Spend as much time as you can with Hema. Talk to her. Tell her how much you love her. Ask her what she wants. Assure her that you will do everything you can to make sure she gets as much care as she needs and wants.
Hugs to both you and Hema during this difficult time.
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Old 06-04-2013, 04:03 PM   #7
ElaineM
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Wink Re: in a dilemma

P. S. Also answer any questions Hema may have.
Hugs again.
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ElaineM
12 years and counting
http://her2support.org/vbulletin/showthread.php?t=48247
Lucky 13 !! I hope so !!!!!!
http://her2support.org/vbulletin/showthread.php?t=52807
14 Year Survivor
http://her2support.org/vbulletin/showthread.php?t=57053
"You never know how strong you are until being strong is the only choice you have." author unknown
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Old 06-04-2013, 04:09 PM   #8
tricia keegan
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Re: in a dilemma

I agree with all of the above which is great advice and I'm sorry this is happening to Hema
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Dx July '05 IDC 1.9cm Triple positive 3/9 nodes positive
A/C X 4 ..Taxol/Herceptin x 12 wks then herceptin 1 yr
Rads x 36 ..oophorectomy August '06
Currently taking Arimidex..
June 2011 osteopenia/ zometa x1 yearly- stopped Zometa 2015 as Dexa show normal bone density.
Stopped Arimidex July 2014- Restarted Arimidex 2015 for a further two years on the advice of my Onc.
2014 Normal Dexa scan
2018 Mammo all clear, still NED!
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Old 06-04-2013, 05:54 PM   #9
karen z
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Re: in a dilemma

I think Hema knows everything that is going on but I would ask again if she is sure what she wants for you (and her) to be sure. I think you will know what to do when the time comes. But I believe that further communication will not hurt and will only help with the decisions that Hema and you are facing. My heart is with you.
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Old 06-05-2013, 12:19 PM   #10
dchips1
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Re: in a dilemma

You can use mouth swaps to keep her mouth /lips clean and refreshed making talking, mouth feel a little better, do not force her to take in nourishment, fluids, chances are she will choke and aspirate into her lungs.

Letting go is harder on the living then those whom are ready to go. Play her favorite music, movies, I made a picture DVD with music for my mother in law to listen and occasionally watch, I think it was more therapeutic for every one else.
My mother in law died 7 days before her 89 birthday, last year. She did not let go till all family had come and went. A volunteer playing a harp was in the room.

I am so sorry she is rejecting everyone and things, support your family and spend time together and cherish the memories together, and it is ok to laugh and live in her presence.

God bless you and your family prayers for all. Darita
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dx 1/06 IDC 2cm 38 at dx
2/06 L mast nodes 3/9+ SNB neg ER-/Pr - her2 + Stg 4 liver/pelvis
3/06-9/06Taxol/Carbo/zometa/Herceptin
3/07 6 brain mets WBR down to c-2
4/07 osteonecrosis jaw
1/08 mri new 9mm lesion right lower side
2/08 gamma knife 1 lesion 11/08 regamma
10/09 latent rad necrosis to brain met,
1/20/10 crani: lesion necrosis w active cells continue her add tykerb
1/11 NED just Ingrown toenail! YEAH GOD
8/11 Tykerb, herceptin weekly, elevated her2 levels, negative scans
oct -march 11 new neuro deficits lower legs
3/12 2 spinal metsTykerb, Herceptin
04/12 4050cGY rads T 2-4 & T7-9
5/12 Brain,cervical lumbar clear/thoracic slight decrease
10/12 t 2-4 shrunk t-9 grew start Xeloda, 02/13 stop xeloda,5/13 on metformin, decadron, Tykerb, iv and IT herceptin 5/30/13 total #11 #2 of 80mg dose weekly.
9/13 100mg of IT her, IV hern, 750 mg tykerb, 3mg dec.
last Mri T--3 SHRUNK t7-9 shrunk no edema. Left shift in CBC bone marrow BX negative.
10/13 Ct has shown Double left ureters with stones/cysts in them, after 3 births and lots and U/S iit takes cancer to figure out you have 2 smaller ureters going into 1 kidney!
12/13 Mri brain no new lesions, cervical and lumbar arthritis.
Tspine lesion at T3 stable, T 7-9 GROWTH lots of pain

1/29/14 HIHO HIHO its off to Neuro surgery I go





Life is Good when you wake up in the morning and take a breath and know that God has given me another day.


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Old 06-05-2013, 03:47 PM   #11
BonnieR
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Re: in a dilemma

I join the others in expressing my support to you at this very sad time. You have been such a rock for Hema and she needs you to honor the promise you made, as hard as it is for you
Remember that ones sense of hearing is the last thing to go, so just speak to her and reassure her. She can hear you even if she might not seem to
Keep the faith.
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Post menopause
May 2007 Core biopsy, Rt breast
ER+, Pr-, HER2 +++, Grade 3
Ki-67: 90%
"suspicious area" left breast
Bilateral mastectomy, (NED on left) May 2007
Sentinel Node Neg
Stage 1, DCIS with microinvasion, 3 mm, mostly removed during the biopsy....
Femara (discontinued 7/07) Resumed 10/07
OncoType score 36 (July 07)
Began THC 7/26/07 (d/c taxol and carboplatin 10/07)
Began Herceptin alone 10/07
Finished Herceptin July /08
D/C Femara 4/10 (joint pain/trigger thumb!)
5/10 mistakenly dx with lung cancer. Middle rt lobe removed!
Aromasin started 5/10
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Old 06-05-2013, 04:59 PM   #12
Bill
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Re: in a dilemma

PBK, I'm so sorry that you and Hema have had to go through this. Please understand that you have both done your best, at every step of the way, that you possibly could have. It's obvious from the posts you have made and the questions you have asked. Your love for Hema shines through in each and every one. You're an amazing man and an awesome husband and caregiver for your lovely wife. I think you have received some good advice from these wonderful ladies here. There's not much for me to add, except for the sad fact that I walked in your shoes a few years back and know what you're dealing with. As said, I'm sure at this point Hema knows what's happening and the best thing you can do at this point, in my opinion, is just be there with her and tell her how much you love her and that you're not going anywhere and that you will stay by her side and take care of everything. She will hear you and understand. I lit some candles, put on some nice music in the room, and sat nearby, reassuring her that everything would be ok. I'm glad that you have family coming in to be with you both. Try to rest when you can. You're both in my thoughts and prayers. Take care, brother.
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Old 06-06-2013, 12:43 AM   #13
KsGal
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Re: in a dilemma

I, also, do not have much to add, except that you are a wonderful, loving husband and caregiver to Hema, and I think that you will do exactly what you know is right for her in your heart. I hope that Hema is not in pain, and I send many prayers to you and your family.
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Diagnosed in October 2011 Stage IV with metastasis to liver.
January 2012 after double mastectomy, started taxotere, carboplatin and herceptin.
Clear.
December 2012 was diagnosed with five brain mets, and had whole brain radiation.
Around July 2014 two mets in brain, one a residual spot and one new one growing in size. Received Cyberknife on both areas
Clear/NED
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Old 06-06-2013, 12:49 AM   #14
Bunty
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Re: in a dilemma

Just to let you know Pibikay that you are amazing and strong and the most wonderful man. I can't add anything more to the advice here - it is shared with you with much love. I wish peace for Hema.
Marie
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dx Dec 2000 dcis 2.5cm clear sentinel node, ER/PR- Her-2+
lumpectomy, 6 cycles AC, 6 weeks rads
October 2007 three x 2.5cm lung mets. 8 months Taxol, started Herceptin and continue. Significant reduction in lung mets.
June 2011 3cm x 4cm liver tumour. Started Abraxane and continue with Herceptin.
November 2011. Finished with Abraxane, continue with just Herceptin. Liver tumour now reduced to 15mm x 12mm. Lung tumour now 10mm x 0.5mm
February 2012. Scans show everything stable, and brain scan clear.
July 2012. PET/CT scans show I'm in remission - no active cancer!
]Dec CT brain cllear, lungs stable, liver tumour has increased to 20mm. PET scans showed active liver met and active lung thinglet, and possible bone met.
Jan 2013 recommence Abraxane, continue with Herceptin.
June 2013 finish Cycle 6 Abraxane, continue with Herceptin. 30% reduction in liver tumour, everything stable.
December 2013. CA15-3 on rise.
February 2014. PET and CT scans show single liver tumour has increased to 35mm. No other activity.
March 2014. Planned for SBRT for liver met, but couldn't have treatment as tumour too close to bowel. Continue Herceptin.
April 2014. Surgeon advises that I am a good candidate for liver resection, so will have operation early May (after camping holiday). Tumour now 44mm x 29mm.
May 7, 2014. Two liver tumours surgically removed. Third of liver removed, and gall bladder. Am I NED?May 2014. Pathology of tumour shows it's now ER+ (95% staining).
June 2014. CA15-3 has decreased to 18 from a pre-surgery reading of 59!
June 2014. Started Femara, continue with Herceptin.
July 2014. Stop Femara due to severe Osteoporosis. Commence Tamoxifen, continue Herceptin. Waiting to hear if I can have Aclasta infusion.
August 2014. CA15-3 has decreased further to 12 - YAY!
October 2014. Aclasta infusion for Osteoporosis. November 2014, CA15-3 decreased to 11. Scans of liver all clear, something new showing up on lung, but just watching at the moment.
November 2015. Started SBRT on solitary lung met.
November 2015. Bone density scan showed very good improvement so back on Femara - yay!
December 2016. 6 treatments of SBRT radiation on lung. Seems to have had some effect.
June 2016. CA15-3 still stable and low at 9.
June 2016. Started subcutaneous Herceptin replacing infusion.
Jan 2017. LVEF dropped to 46%. Stopped Herceptin.
Feb 2017. Started ACE Inhibitor and BETA Blocker. Still off Herceptin.
Aug 2017. Two new mets - Portacaval lymph node and mediastinal lymph node.
Aug 2017. Blood tests show extremely elevated liver enzyme levels. Many tests to investigate.
Sept 2017. Portacaval lymph node blocking liver bile duct causing liver enzyme and Bilirubin problems.
Oct 2017. 8cm stent inserted into liver bile duct. Procedure caused pancreatitis, and hospitalised for 3 days. Liver enzymes improving rapidly.
Nov 2017. Commenced 4 weeks of radiation on Portacaval lymph node. 5 week break before chemo.
Jan 2018. CT scan. 11 new small liver mets, and new superclavical lymph node med.
Jan 2018. Start Kadcyla. CA15-3 426.
Apr 2018. First scans since starting Kadcyla. All tumours reducing. CA15-3 dropped to 30 from 426.
Dec 2019. Still on Kadcyla, but two small brain mets have been treated in the past month with SRS. CA15-3 stable for 12 months at 11.
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Old 06-06-2013, 06:06 AM   #15
vballmom
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Re: in a dilemma

PBK, you and Hema have touched my life in ways you will never know. I wish you much peace - Hema is a lucky lady to have you in her world. Take care. You are in my thoughts and prayers.
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