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Old 06-12-2009, 03:16 PM   #1
Believe51
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Question ~At What Point Do I Contact Hospice?~

We are not giving up just getting ready because I heard that you should not wait too long before contacting Hospice. Any suggestions as to when? Although I do not want to even say these words I do not want to miss the bus. It is important to him to be at home during the end phase whenever that may be.

Does he need to give up on treatment before they get involved?>>Believe51
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Old 06-12-2009, 03:40 PM   #2
Mary Jo
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Dear Marie and Ed,

I don't have an answer to your question but after reading your post felt the need to offer you my love, support and a hug! It isn't much, I know....but hopefully knowing I care offers a bit of peace to your souls.

Love you guys...

Mary Jo
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Dx. 6/24/05 age 45 Right Breast IDC
ER/PR. Neg., - Her2+++
RB Mast. - 7/28/05 - 4 cm. tumor
Margins clear - 1 microscopic cell 1 sent. node
No Vasucular Invasion
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Old 06-12-2009, 03:58 PM   #3
Bill
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Hi Marie! The quick version I have here- Nicola was approaching liver failure, and her nurse practioner suggested that she call hospice to get the mechanism in place for when it was needed. A few days later, we saw her onc., who was a little upset at that. She said that hospice didn't need to be involved until ALL treatments had failed. I guess, like most things, the right course of action is in between. Personally, rightly or wrongly, I didn't want to contact hospice prematurely, because I thought it may "lessen" Nikki's will to fight, you know what I mean? Eventually, we did call. I called hospice and was told that the doctor needs to be the one to call. (This was in VA) Keep in mind, for ins. purposes, once "Hospice" is involved and there is no other course of treatment involved, certain things will no longer be covered, at least with our insurance that's the way it was. Hospice does provide alot of help and services that you may not be aware of. One example, if you need a "lift-chair" my ins. covered it, but once we went into hospice care, it didn't. I had to buy one. Talk to your onc. and your ins. people. I'll help however I can, Marie. You and Ed hang in there.
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Old 06-12-2009, 04:24 PM   #4
pattyz
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Marie,

Not knowing anything about what is exactly available to you I hesitate to say.

I'm pretty sure you can at the very least call the hospice available to you, find out, have a meeting even. You'd know from the 'horses' mouth', have some paper work and the like.

Also, to my knowledge the other info here is correct. you are not 'eligible' until tx's have been stopped or there is nothing left to even try.

This I have learned most recently through our dear friend who is at end stage -lung cancer.

IMHO it makes me feel better to have as many ducks in a row as I can. Whatever I still have some control over........

MORE of these XOXOXOXOXOX
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Old 06-12-2009, 04:27 PM   #5
Vi Schorpp
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Hi Marie

Palliative Care vs. Hospice Care - Definition

This article may be of help to you. My husband, too, wanted to be at home. He had seen so many specialists and was getting much weaker. His GP (the general of the group) on Tuesday recommended that hospice be called in. I waited until Thursday to call hospice in (as my husband's birthday was Ths. and I just wanted to get through his birthday) and then hospice started the following Monday. My husband had a birthday on March 30th, and on April 9th he died. People that visited the week of his death thought he looked pretty good and didn't look sick, but you know your husband best. Cliff's doctor was amazing. He knew he would never see him again and put his arms around him and told him what a brave man he was and he was amazed by the courage Cliff showed throughout.

I personally would have liked hospice in a little sooner, but my husband wasn't ready and that was his choice. Once hospice was involved there was a weight lifted because I knew at a moment's notice someone could be here. One day they were in 6 times, but it was warranted.

What are Ed's thoughts on hospice? It might be a good idea to talk with a hospice provider and then you'll know what to expect when it's needed. I hope this helps and I'm thinking about both of you.
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Old 06-12-2009, 04:33 PM   #6
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Hugs and more hugs. You have good info from others here who are experienced and wise. I have nothing to offer but hugs, and lots of them.
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NOV 2012 - 9 yr anniversary
JULY 2012 - 7 yr anniversary stage IV (of 50...)

Nov'03~ dX stage 2B
Dec'03~
Rt side mastectomy, Her2+, ER/PR+, 10 nodes out, one node positive
Jan'04~
Taxotere/Adria/Cytoxan x 6, NED, no Rads, Tamox. 1 year, Arimadex 3 mo., NED 14 mo.
Sept'05~
micro mets lungs/chest nodes/underarm node, Switched to Aromasin, T/C/H x 7, NED 6 months - Herceptin only
Aug'06~
micro mets chest nodes, & bone spot @ C3 neck, Added Taxol to Herceptin
Feb'07~ Genetic testing, BRCA 1&2 neg

Apr'07~
MRI - two 9mm brain mets & 5 punctates, new left chest met, & small increase of bone spot C3 neck, Stopped Aromasin
May'07~
Started Tykerb/Xeloda, no WBR for now
June'07~
MRI - stable brain mets, no new mets, 9mm spots less enhanced, CA15.3 down 45.5 to 9.3 in 10 wks, Ty/Xel working magic!
Aug'07~
MRI - brain mets shrunk half, NO NEW BRAIN METS!!, TMs stable @ 9.2
Oct'07~
PET/CT & MRI show NED
Apr'08~
scans still show NED in the head, small bone spot on right iliac crest (rear pelvic bone)
Sept'08~
MRI shows activity in brain mets, completed 5 fractions/5 consecutive days of IMRT to zap the pesky buggers
Oct'08~
dropped Xeloda, switched to tri-weekly Herceptin in combo with Tykerb, extend to tri-monthly Zometa infusion
Dec'08~
Brain MRI- 4 spots reduced to punctate size, large spot shrunk by 3mm, CT of torso clear/pelvis spot stable
June'09~
new 3-4mm left cerrebellar spot zapped with IMRT targeted rads
Sept'09~
new 6mm & 1 cm spots in pituitary/optic chiasm area. Rx= 25 days of 3D conformal fractionated targeted IMRT to the tumors.
Oct'09~
25 days of low dose 3D conformal fractionated targeted IMRT to the bone mets spot on rt. iliac crest that have been watching for 2 years. Added daily Aromasin back into treatment regimen.
Apr'10~ Brain MRI clear! But, see new small spot on adrenal gland. Change from Aromasin back to Tamoxifen.
June'10~ Tumor markers (CA15.3) dropped from 37 to 23 after one month on Tamoxifen. Continue to monitor adrenal gland spot. Remain on Tykerb/Herceptin/Tamoxifen.
Nov'10~ Radiate positive mediastinal node that was pressing on recurrent laryngeal nerve, causing paralyzed larynx and a funny voice.
Jan'11~ MRI shows possible activity or perhaps just scar tissue/necrotic increase on 3 previously treated brain spots and a pituitary spot. 5 days of IMRT on 4 spots.
Feb'11~ Enrolled in T-DM1 EAP in Denver, first treatment March 25, 2011.
Mar'11~ Finally started T-DM1 EAP in Denver at Rocky Mountain Cancer Center/Rose on Mar. 25... hallelujah.

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Old 06-12-2009, 04:58 PM   #7
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I would at least contact them and talk to your doctors about. I have had a number of close friends die from cancer, and all had hospice services; one only in the last week, which everyone felt was too short; another for at least a month (maybe more), and she had a very good experience with them. I know aggressive treatment has to end before hospice. Have a peaceful weekend.
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Old 06-12-2009, 05:02 PM   #8
MJo
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I would call and talk with Hospice. It's getting your ducks in a row. I think of hospice as not only making the patient comfortable, but helping the family care for the patient and themselves. I know that some people have improved and left hospice, and some people have been in hospice for more than a year before passing. In fact. I think insurance regs have tightened because people are surviving so much longer in hospice due to new treatments. So talk with hospice.
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IDC, Stage I, Grade 2
Oncotype DX Score 32
Her2++ E+P+, Node Neg.
Lumpectomy 11/04/05 Clear Margins
3 Dose dense AC (Couldn't tolerate 4)
4 Dose dense Taxol & Herc. (Tolerated well)
36 weeks Herceptin (Could not complete one year due to decrease in MUGA score)
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Old 06-12-2009, 07:55 PM   #9
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Marie
I was sad to log on and read your post about Ed, but I do know there is much strength between you, and love and prayers from all your friends here...lean on us as you need to...we are here for you. When my Mother in Law lived with us, she progressively got worse, and was constantly going for transfusions...it cam to a point where the Dr suggested Hospice...she was all for it, until she found out that proactive treatment would cease, and she would be kept comfortable, but without blood infusions etc. She changed her mind...now maybe things have changed since 2001, but it is a very personal decision when no other options seem available....you are in my prayers Marie, please stay strong....miracles happen every day.
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Diagnosed at age 49.99999 2/21/2002 via Mammography (Calcifications)
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L. Mastectomy 2/25/2002
Stage 1, 0.7cm IDC, Node Neg from 19 nodes Her2+++ ER PR Neg
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7/2010 Back to walking a mile a day...YEAH!!!!
9/2010 Nodes are back with a vengence in neck
Qualified for TDM-1 EAP
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Old 06-13-2009, 07:05 PM   #10
suzan w
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I, too, was saddened to log on and read your post. Then I was immediately struck by your bravery, both of you, going through this journey. What a wonderful thing this support group is. I do not have any answers to your question but know that you will get the right advice here. And what a blessing to us all to have a place where we can ask the hard ( if not impossible ) questions. And get answers. Strength to you!!
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Old 06-13-2009, 07:39 PM   #11
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Marie,

I am heartbroken to read your post. Follow your heart and you will find the right answer. I have also heard of people who have flunked out of hospice . I hope and pray that your miracle comes soon.

Holding you both up in prayer.
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AC x 4, Taxol x 4, Added Herceptin
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Old 06-13-2009, 08:01 PM   #12
Believe51
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Thanks for these posts, I appreciate the honesty involved here. We have agreed together that this will remain with the fire extinguisher, use for emergencies only and do not play with fire (smiling).

I will continue with more detailed palliative care for Ed as we seek to find the answers.

Hospice will be reserved to help me to help him into Angelhood.

And I am thinking of seeking a grief counselor which I always thought you met afterwards. Any thoughts on this? I have just started to mourn my Mother-in-Law's passing.

Hope I do not sound morbid or sad. I need to start looking at this aspect of the disease. I never had to look this hard at these issues.>>Believe51
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9/7/06Husband 50yrs=StageIV IBC/HER2+,BoneMets10/06TaxotereX10,'H'1X wk,Zometa,Tamoxifen4/12/07Last Tax5/18/07Pet=Rapid Cell Activity,No Organ Mets,Lytic Lesions,Degeneration,Some Bone Repair5/07ChemoFail6/01/07Pleural Thoracentisis=Effusions,NoMalignantCells6/19/07+7/2/07DFCI
6/25/07BrainMRI=BrainMets,Many<9mm7/10/07WBR/PelvisRad37.5Gx15&Nutritionist8/19/07T/X9/20/07BrainMRI=2<2mm10/6/07Pet=BoneProgression
10/24/07ChemoFail11/9/07A/Cx10,EndTam12/7/07Faslodex12/10/07Muga7512/13/07BlasticLesions1/7/08BrainMRI=Clear4/1/08Pet=BoneImprovement,
NoProgression,Stable4/7/08BrainPerfect5/16/08Last A/C8/26/08BrainMets=10(<9mm)9/10/08Gamma10/30/08Met=5mm12/19/08Gamma5mets5
12/22/08SpinalMets1/14/09SpinalRads2/17/09BrainMRI=NoNewMets4/20/09BoneScan5/14/09Ixempra6/1/09BrainMRI=NumerousMets6/24/09DFCIw/DrBurstein6/26/09Continue
Ixempra/Faslodex/Zometa~TM now lower7/17/09Stop Ixempra By Choice9/21/09HOSPICE10/16/09Earned His Deserved Wings And Halo=37 Month Fight w/Stage 4 IBC, Her2+++,My Hero!!
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Old 06-14-2009, 08:31 AM   #13
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Marie,

'Hospice care' should be used whenever Ed is entitled to it. My Mother-in-law was under hospice care twice - yes, 'twice'. First time happend when she had had a mini stroke which made her condition 'appeared' to be going downhills fast. But she came out of it (a natural by-pass?) and stayed in the nursing home for another half year and the hospice care was provided again when her condition deteriorated again.

As long as Ed is not under treatment, I think he's entitled to hospice care. Is he staying home with you? As to the 'grief counselor', Ed's doctor or nurses should have the best information for you in the 'local area' aspect. Do you have a family doctor? Check with your own clinic and insurance company first see what's available. The most economic way is probably contacting your County Health Department and talk to a certified grief counselor if there is one.

You have done such a tremendous job for Ed and members on this site. I think we all feel like a big family here. Somewhere I have read that the best counselor is someone that is close to you - someone that knows you well and able to provide comfort and guidance. I do think one should seek counseling when feel the need. But I don't think it's necessary for anyone to 'get counseling' in order to come here in a 'better' shape. We are sort of in a 'group counseling' session here. And we are your friends and sisters. We've been reading 'Today's joy' from you; we sure like to share 'Tomorrow's sorrow' when it happens.
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Old 06-14-2009, 11:02 AM   #14
Jean
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Dear Maire,
You are not being morbid or sad.
You are being brave and facing the part of life that everyone fears or runs from....

Sending you much love,
Jean
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Old 06-14-2009, 02:20 PM   #15
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Marie, My love and hope to both you and Ed. You are the "dream team" here at Her2.... wish I could help in some way. Ceesun
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Old 06-14-2009, 05:03 PM   #16
tricia keegan
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Marie I don't have answer's but am sorry you have to even think of this.
I have a nurse friend who used to work in this area and she tells me it's very important to get pain management before it becomes critical when it's harder to manage, just like taking nausea pills during chemo.
I hope Ed does'nt need this for a long time and will be thinking of you both
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Dx July '05 IDC 1.9cm Triple positive 3/9 nodes positive
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Old 06-14-2009, 05:57 PM   #17
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And I am thinking of seeking a grief counselor which I always thought you met afterwards. Any thoughts on this? I have just started to mourn my Mother-in-Law's passing.

Marie,

I think this is a really good idea. Of course, I realize your first priority and time commitment is to support MO - you would not ever have it otherwise.

But you are dealing with overwhelming emotions, and if you are able to make some time to do this for yourself, it may help you both.

Of course we are always her for you, and I myself am overwhelmed by the depth of love and support your sisters and brothers here have shown. But we are both blinded by love for you and perhaps not actually qualified to support you in the way that a grief counselor might be able to.

Much love
Chris
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June 2002 extensive hi grade DCIS (pre-cancer-stage 0, clean sentinal node) Mastectomy/implant - no chemo, rads. "cured?"
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04/05 - 4/07 Herception every 3 wks, Continue NED
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02/08 Begin (TDM1) trial
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02/09 Continue NED
02/10 Continue NED. 5/10 9/10 Scans NED 10/10 Scans NED
12/10 Scans not clear....4/11 Scans suggest progression 6/11 progression confirmed in liver
07/11 - 11/11 Herceptin/Xeloda -not working:(
12/11 Begin MM302 Phase I trial - bust:(
03/12 3rd times the charm? AKT trial

5/12 Scan shows reduction! 7/12 More reduction!!!!
8/12 Whoops...progression...trying for Perjeta/Herceptin (plus some more nasty chemo!)
9/12 Start Perjeta/Herceptin, chemo on hold due to infection/wound in leg, added on cycle 2 &3
11/12 Poops! progression in liver, Stop Perjeta/Taxo/Herc
11/12 Navelbine/Herce[ptin - try for a 3 cycles, no go.
2/13 Gemzar/Carbo/Herceptin - no go.
3/13 TACE procedure
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Old 06-14-2009, 07:05 PM   #18
Believe51
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Join Date: Jun 2007
Location: RHODE ISLAND (Ed getting me a latte on 2nd Cancerversary Cruise 2008) 'BELIEVE': To accept as true or real, To have faith in, To presume ALWAYS BELIEVE
Posts: 2,999
Yes, the support here is incredible and I am myself overwhelmed by the outpour of love and knowledge. Chrisy, my main concern to see a grief counselor is primarily so I do not sound depressing here. There are so many here that are fighting so hard and I worry that my sadness will affect them, as it is I already know this sadness touches many. I also know that there is no other place I could be that would help me better through this journey. There are many more things that a counselor cannot provide to me. This home completes me and satisfies almost all my needs and this my Dears is more than I could ever dream of. Thank God for this site and this family!>>Believe51
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9/7/06Husband 50yrs=StageIV IBC/HER2+,BoneMets10/06TaxotereX10,'H'1X wk,Zometa,Tamoxifen4/12/07Last Tax5/18/07Pet=Rapid Cell Activity,No Organ Mets,Lytic Lesions,Degeneration,Some Bone Repair5/07ChemoFail6/01/07Pleural Thoracentisis=Effusions,NoMalignantCells6/19/07+7/2/07DFCI
6/25/07BrainMRI=BrainMets,Many<9mm7/10/07WBR/PelvisRad37.5Gx15&Nutritionist8/19/07T/X9/20/07BrainMRI=2<2mm10/6/07Pet=BoneProgression
10/24/07ChemoFail11/9/07A/Cx10,EndTam12/7/07Faslodex12/10/07Muga7512/13/07BlasticLesions1/7/08BrainMRI=Clear4/1/08Pet=BoneImprovement,
NoProgression,Stable4/7/08BrainPerfect5/16/08Last A/C8/26/08BrainMets=10(<9mm)9/10/08Gamma10/30/08Met=5mm12/19/08Gamma5mets5
12/22/08SpinalMets1/14/09SpinalRads2/17/09BrainMRI=NoNewMets4/20/09BoneScan5/14/09Ixempra6/1/09BrainMRI=NumerousMets6/24/09DFCIw/DrBurstein6/26/09Continue
Ixempra/Faslodex/Zometa~TM now lower7/17/09Stop Ixempra By Choice9/21/09HOSPICE10/16/09Earned His Deserved Wings And Halo=37 Month Fight w/Stage 4 IBC, Her2+++,My Hero!!
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Old 06-14-2009, 07:26 PM   #19
CindyE
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Join Date: Apr 2008
Location: WA State
Posts: 199
Marie,
My thoughts and prayers continue for you and Ed. May you feel our loving Lord's arms around you both, lifting you and Ed up, and knowing that he is always there through all things that we endure on this earth.
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Cindy

L/IDC, 1.2 cm, Stage 1, Her2+, ER+/PR+ at age 48
4/15/2008 Lumpectomy + sentinel node biopsy
Margins neg and Nodes neg (2 tested)
MUGA score 55 on 5/6/2008

Treatment starting 05/08/2008:
Chemo 4 cycles, 3 weeks apart with Taxotere & Cytoxan - Chemo - Done 7/24/2008!
Herceptin for 1 year
Radiation starting in 9/2008
MUGA score 61.9 on 9/04/2008
33 Rads with boost - Done 10/13/2008
MUGA score 58 on 12/01/2008
MUGA score 59 on 3/16/2009
Herceptin for 1 year - Done 4/27/2009
MUGA score 64 on 6/22/2009
All scans - NED 6/24/2009
MRI - NED 11/10/2009
All scans - Still NED 8/25/2011
Still NED 2017!



I am calling this my pink journey
Follow my journey into the pink at my blog here

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Old 06-14-2009, 07:37 PM   #20
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Marie,
You dont have to appear to be abything but what/who are are with us,I hope you know that. But if you feel the need for help..get it...there is no shame in seeking help. You have had an incredible amount of sadness these past few years.YOU are an incredible wife,daughter-in-law and an exceptional human..take care of YOU and Mighty Oak in any way you can. We will be here...
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