My mother who is 90, and has been in a Memory Care unit for 4 years now has been recently diagnosed with a malignant form of skin cancer. We are waiting on the labs to confirm the doctors suspicions. It was not there on Jan 12 and now on Feb 24 it is 2 cm x 2 cm and growing fast with necrotic tissue in the middle. All very bad signs.
Doctor wants to operate on March 9. He says it's outpatient surgery and may require rehab for wound care post op. The doc wants to do a skin graft, she won't be able to walk, anesthesia will affect her quality of life and care, etc. Mom's LBD is already stage 6 almost to stage 7. She talks in loops, can't remember what she had for breakfast (at lunch) and is in pain.
I had her in the doctors office to look at her Venous Stasis and have a doctors opinion as the Memory Care medical system is slow and were not taking note of the lesions rapid growth.
I am wondering if we don't do surgery? But start the walk with hospice? It is a gut wrenching decision.
I don't know much about palliative care. Could someone point me in the direction of good information?
The dermatologist can order skilled home health care for wound management of the lesion, and that team may come up with a dressing that only needs changing 2x/week, with a goal of teaching family how to do wound care.
Hospice can provide wound care and other supports as she approaches the end of her long life. Help with bathing, some supplies in addition to wound care supplies. medications related to her hospice qualifying diagnosis, and education and support for her and for you and your family. Hospice does not cause death, but provides some comfort and support to families to reduce your regrets after she is gone.
A squamous cell lesion can grow rapidly and look very nasty at her age. And the likelihood of a skin graft site healing in this situation is very very very low.
Her primary care provider is the one to refer to hospice, I imagine the dermatologist would consider that out of his/her sphere of practice.
If this were my mother who had advanced dementia as she did at 95, I'd leave her alone and give her no treatment at all. She, in fact, did have squamous cell cancer on her chin and also on her face (upper cheek) that the dermatologist kept warning me NEEDED to be removed. I finally told the dermatologist to stop visiting mom in the Memory Care after they'd removed the wart on her hand that was bothering her.
Mom passed on Tuesday of other causes, not from skin cancer.
The decision is up to you, of course, but consider the quality of her life NOW, with stage 6 dementia at play, and how life would be after a surgery, anesthesia, and rehab, then make your decision accordingly. My condolences over this entire situation and that you're both in such a position to begin with. Sending you a hug and a prayer for peace, whatever you decide to do.
"So. Doc is mum until labs come back. He is calling it squamous cell, BUT. IT HAS tripled in size in 5 weeks time. ? I am beginning to see it is about how we feel when we die... not when we die. or how. It is about the emotional memory we want to create for our loved one".
So, about 2 years before her death, mom had a rapidly growing neoplasm on her face. She'd had melanoma before and wanted that thing gone.
The dermatologist who visited her NH facility gave us some choices.. Mohs surgery, or a punch biopsy. We opted for the punch biopsy in his office with local anesthesia.
Once they'd looked at the cells, it was a squamous cell cancer. From there the choice was Mohs surgery to get the rest, do nothing or a chemo topical cream to get what was at the margins. We opted for the cream.
Man, that thing REALLY looked like melanoma. Even to the docs. Don't panic before you need to,
an elderly, infirm patient through a skin cancer treatment does. Don't agree to the surgery, it is too much, and VERY stressful for them. (skin grafts, open wounds,
bleeding) Make her as comfortable and happy in her time left. End of life care is
very advanced, dignified and the kindest you can do for her.
God Bless You for being such a loving child.
I use to work as a physical therapy aide in a hospital. Needed to get a 90 year old women up out of her chair. I recall vividly how the women kept saying she wanted to just die. She had a pacemaker placed the year before…I wondered how that impacted the rest of her life…
Obviously this is fast, whatever it is but, if post operation care isn't possible because mom can't comply, what happens?
What happens if she can't keep her hands off it?
I would wait for the labs. I have seen to many people that had skin cancer and it led to one surgery after another until death. Never adding anything to the quality of life for the patient, just one sore that wouldn't heal because ALL the cancer couldn't be removed.
That's what I would want to know, because you already know that the anesthesia is going to adversely effect her. So what are the REAL chances of getting everything and this being a one time surgery.
I would never let anyone cut on my loved ones without proper testing.
I am sorry you are having to face this type of decision. Life gets to a point when there are no choices, only options, especially with dementia.
You will do what is best for your mom and that is all you can expect from yourself.
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