Anyone have an opinion on this please?

[LeftyFingerPop]

My mom is 90 years old and in a nursing home. I am her power of Attorney.

She has been throwing up a few times a week, and is occasionally unable to get her food down.

I went to the hospital with her last week to get a barium x-ray done of her esophagus.

Today, I get a phone call from her GI doc, who I have not yet met.

She tells me that the x-ray showed showed an abnormality in her esophagus that had the characteristics of cancer, but the only way she could be certain would be to scope her and biopsy it.

She then asked me whether I wanted her to do the scope.

"Of course I do" I replied. Then I asked her why she asked me that.

She said "What would you do if your mom had cancer of the esophagus"?

I told her that would depend on many variables...ie: how advanced it was, how surgically accessible it was, the extent of chemo or radiation that might be needed, etc.

Then she said..."Your mother is very spry, but would you really want to put a 90 year old woman through open chest surgery, chemo, or radiation"?

I told her that I had no idea until I heard the details of her cancer, but at the very least, I certainly would want to know whether she had cancer or not.

Then, she kept going on about her age, etc.

In my opinion, just because she is 90 years old does not mean that we/she should still not expect a reasonable amount of diagnosis and potential options for treatment.

The more I think about this, the more pissed off I am getting. She even chuckled a few times during the conversation...like it is no big deal...because she "is 90 years old after all".

Am I looking at this wrong? Since when did doctors start treating old people like dogs on the verge of being euthanized?

[flvegan]

1. Potentially has another 20 years.

Gotta get ALL the data before you make a decision, so yeah, get the scope.

[LeftyFingerPop]

3. Agreed. Thanks. n/t

[KitchenWitch]

2. I guess I would see about finding another GI doc.

Really. The decisions about your mother's care are you and your mother's to make, and to have a doctor that believes she has one foot in the grave is not at all helpful.

[LeftyFingerPop]

4. My feelings too...

90 is indeed old, but, even if she had another 5 or 10 years....

[DarkTirade]

5. I'm with KW, get a new doctor.

That's just kinda ridiculous. It's a simple test, we're not talking about an organ replacement here. It shouldn't even be a question. And that kind of attitude is wrong no matter how close to death the doctor thinks the patient might be.

[LeftyFingerPop]

6. Yep. Thanks. n/t

[Sanity Claws]

7. What is the doctor telling your mother?

Something is missing here. I know you have the power of attorney but if your mother is still competent, she should be part of these decisions.
If your mother is not competent, I guess I understand why the doctor is saying these things. I'm not saying that you shouldn't treat her if she's incompetent, just that I better understand where the doctor is coming from.

[LeftyFingerPop]

9. My mother is almost completely deaf...

and has trouble understanding anyone but me. I am able to communicate with her in a way that does not confuse her.

So even though she is more or less completely competent, the staff at the nursing home, as well as her doctors, have been instructed to relay all medical results to me first. I would then sit down with my mom and tell her.

The thing that gets me is this...the doctor was hinting that maybe I would not even want to TELL my mother until I had to. I disagree with this...it's her body, and her life.

[Sanity Claws]

11. The doctor definitely should not hint that you shouldn't tell

your mother.
You are 100% right.
Good luck to you and your mother.:hug:

[LeftyFingerPop]

16. Thanks...I appreciate your kind words.

:hug:

[billyoc]

8. The scope's not that invasive, I'd at least get it and then see.

I know how you feel, and I'm not able to say that often. It's not easy making decisions like that, brother. :hug:

[LeftyFingerPop]

10. That's right billy.

I have 2 sisters out of town, and I can not rely on them to help me with either the decision, or telling my mom. They would just fall apart and upset my mom even more.

[billyoc]

13. I know you'll do what's best for your mother, whatever that will be.

I'll bet she's glad you're there.

[LeftyFingerPop]

15. She is....

:cry: :cry: :cry:

[quakerboy]

12. What does your mother have to say about it?

What the Dr wants is relatively unimportant, unless it comes to what is physically possible and medically responsible.

What I did not see in the description of events was what I think is a key part of the issue. What does your mom want. What is her quality of life? Is she currently responsive? If so, does she have an opinion. If not, given your best knowledge of her, what would her opinion be?

Seriously, I beg you to take yourself out of the equation as much as possible. Take the Dr's opinion out as much as possible as well. Focus on your mother.

[LeftyFingerPop]

14. My mom usually just asks me what I think...

and then follows my advice.

I told her last week after talking to the radiologist that the GI doc will probably recommend that she get scoped, which she has had many times in her life. She asked me what I thought, I told her she should get it, she said ok.

I'm steeling myself for the "cancer" discussion. I'm going to have to tell her, even if the doc advises against it. Then, I will help her make a decision.

[vard28]

17. Damn

I agree with finding a different doc for your mom. What a crappy way to think you would even consider handling this situation with her. I HATE (and I don't like to use that word) the majority of doctors, damn... :hug:

[LeftyFingerPop]

19. Thank you, vard

:hug:

[quakerboy]

32. Sounds like she has a lot of trust in you

and I do not think it is misplaced.

[auntAgonist]

18. I'm with you ...

I'd be very angry. I'd get a second opinion and do everything in my power to keep my Mom healthy and comfortable. If she needed treatment, I'd discuss all of that with her. Her age matters not. Her attitude, needs and wants do.

You're a good son philboy, a very good son.

:hug:

aA

[LeftyFingerPop]

20. Thank you, aA

:hug:

I'm not feeling like a very good one right now.

[auntAgonist]

21. Then you better go look in the mirror

and tell yourself you ARE a good son. I've been where you are and I know the doubts that creep in. Don't second guess your ability to deal with this. It's hard. It broke me down in ways I'd never imagined possible. I held strong and you will too. You are your Mother's son after all.

She sounds like a very strong lady.

kesha
:hug:

[erinlough]

22. You must, of course, do what is right for you and your mother

Another view from someone who went through very serious illnesses with aged parents (87,86) the elderly have a very difficult time physically coping with procedures that you or I would breeze through. Although my parents were able to make each decision for themselves after a few difficult tests my mother decided to keep going but my dad said stop. Every person is different and each one of my parents had a different tolerance for invasive procedures, but both of them had a terrible time coping physically with the things that were done to them. Talk to your mom if you can and hang in there, my thoughts are with you.

[LeftyFingerPop]

24. Thank you very much. n/t

[jobycom]

23. I think your doctor should speak frankly about your mother's condition

and should discuss with you all angles of treatment, including the possibility that you may not want to put her through such procedures. I also think the doctor should be as blunt as necessary about her own opinions on those options, even if it means telling you that in her opinion doing nothing would be best. It doesn't sound to me like she gave you all the info you needed to make the decision, and was not very considerate of your mother's best interests.

On the other hand, as I understand what you said, she asked if you wanted the test, you said yes, and then you asked why someone else wouldn't. She, already knowing you wanted the tests, explained why others might not want it, being less than sympathetic to your situation. Since you had already decided on the tests, maybe she wasn't thinking in terms of advising you, or your case specifically, but was just answering the general question of why someone might decide otherwise. Maybe you should schedule a meeting to discuss everything with her, and see if she responds better when she's prepared and focused on your case. That is, if you haven't already made up your mind to switch doctors.

She shouldn't have gone into so much detail about treatment options without having any firm evidence even of what is being treated, though.

I'm sure you've thought about the gist of her comments, though. It's possible that an elderly patient's life expectancy and the life expectancy of an illness would be roughly the same, in which case the treatment might not help, and would be perhaps more painful than the illness, if not outright fatal in itself. I think a doctor should point this out, but I don't think a doctor should discuss it until there is some specific evidence to have the discussion about.

Whatever you decide, I wish you the best of possible outcomes in all of this.

[LeftyFingerPop]

25. Thank you jobycom. n/t

[Tuesday Afternoon]

26. a perfect example of why we need some kind of national health care

wishing you and your Mom all the best, really.

For profit health care SUCKS

[LeftyFingerPop]

27. Agreed, and thank you. n/t

[FM Arouet666]

34. I hate to disagree but

I agree with the need for national health care but this case would be handled differently in Canada or the UK. I suspect that she could get the scope and diagnosis but would be flat out refused surgery or chemo therapy. National health care is also rationed health care. Only in the US do you see patients getting every conceivable treatment no matter what the cost or chance to cure or prolong life.

For profit health care will pump you full of expensive chemo therapy, big pharma wins and the oncologist gets rich, sometimes it is in the best interests of the patient but many times it is not. Surgeons do this all the time. I have seen surgeons do operations that had ZERO chance of helping the patient. The only reason I can see is for profit. "A case is a case" mentality. You will not see that in a rationed health care system. The GI doc in this case is insensitive, but I have seen greedy GI docs scope just about anything that moves. The indication to do a colonoscopy is a patient with an anus and good insurance. So yes, for profit health care does suck.

[ismnotwasm]

28. Can your mom say?

Or does she have a type of dementia? Anyway, I worked long term care for many years, and saw this attitude more than once. No matter how I personally feel, it's your decision and your mom's if she can. She is entitled to the same care everyone else is. You are entitled to an unbiased information regarding diagnosis, and risks and benefits of treatment.
Working long term care taught me that life is still sweet in to some in many circumstances that seem horribly hard. I'm sure you'll make the right decision for your mom. Don't let them push you around.

[XemaSab]

29. Is your mom senile?

Why not ask her?

My grandma was peeing blood last year, and she decided at age 80 she didn't want to deal with a major medical problem. Fortunately, whatever it was resolved itself.

But again, why not ask your mom? :shrug:

[Mutley]

30. I would be pissed, too.

Is something supposed to be wrong with getting a diagnosis just because of her age? What if it was something relatively simple to treat? Is she implying that you should just pretend nothing is wrong?

[Critters2]

31. As long as your mother is competent, you should discuss it with her

and get a sense of what she wants. Even if she says she'd leave it up to you, do a bit more probing to ask what she wants. Does she have a living will? A "do not resuscitate" order? These things can help you get a feel for what she would want to do. If her living will asks for no extreme measures, the question is whether you (and she) consider the cancer treatment an extreme measure.

The first step, istm, is to find out whether it's cancer or something else. I personally think you're right to first want to know whether she has cancer. After that, you can deal with the other questions. But finding out what it is doesn't seem unreasonable, unless your mother actively resists.

Just my $.02

[FM Arouet666]

33. Just had this conversation with a patient the other day...

Had a 90+ year old who was frightened out of a colonoscopy by the GI doc. Also said something to him like, "if we find a tumor are you really going to have an operation." In this case I think he could be treated successfully if he has an early stage tumor. Some docs are just insensitive and dismissive.

However, you have to weigh your options. Esophageal cancer is deadly and very difficult to treat. A 90 year old, no matter how healthy, is still not going to recover very easy from an esphagectomy, procedure to remove the esophagus. Most surgeons will likely advise against surgery and recommend some form of palliation. An oncologist would probably dissuade you from chemo as a palliative treatment for the same reason. I have seen a number of very old folks with esophageal tumors treated palliatively with stents to give them some quality of life. And you cant start talking about palliation until you have a diagnosis. A diagnosis requires tissue which requires a scope. A scope does have some risk, such as perforation which is an increased risk in the setting of a tumor.

As for treating elderly like dogs. I agree the GI doc was pretty insensitive. However, I have seen the flip side of the argument. Patients who were far too old or had too many medical conditions to undergo a procedure and end up dying a slow painful death because of an overly aggressive treatment.

Bottom line, if my mother had this I would get the scope, get the diagnosis and then talk with a surgeon and oncologist, get their recommendations. Age alone does not preclude treatment, but this particular diagnosis is very bad in a 90 year old and you need to weigh risks and benefits very carefully.

[dawgmom]

35. This doctor is one of the reasons they say medicine is an art, not a science

She (the doc) clearly needs a new set of crayons.

If the diagnostic procedure is not overly invasive and will not cause your mother additional pain and discomfort, then I think she should receive it. Without a proper diagnosis, you can't determine next steps -- including the sort of palliative care your Mom should receive, should the two of you decide not to pursue treatment.

End-of-life care is as important, if not MORE important, than the medical care we receive throughout the rest of our lives. Your Mom deserves to be treated with regard and with dignity, and I think she is very fortunate to have you as an advocate, watching out for her.

My own mother is 85, and I dread the decisions like this that we'll have to make in the near future. All the best to you.

[Parche]

36. Pubes

It could be just a obstruction in her esophogus, that a simple surgery would take care
of, hopefully instead of cancer.
I would do everything you can to keep her healthy

:hug: :hug: :hug: :hug: :hi:

[Deep13]

37. You can't decide without knowing.

What if it is something simple? Why not do it?

Yeah, that GI doc sounds like an asshole.

[WannaJumpMyScooter]

38. It is a simple risk/benefit algorithm

for the doc... and the usual (mind you usual) results of extensive cancer surgery at that age are not good

I doubt you will find a dramatically different opinion with any physician.

That said, yes, it sucks to be in that position for you and her, but there are realities.

PM me if you want to know more, or ignore me if this pisses you off.

[LibraLiz1973]

39. I'd be looking for a new DR. with a sunnier outlook and a more positive manner.

[easttexaslefty]

40. I would find out what my mother wants

and support her in that decision. Good vibes for you and your mom

[zanne]

41. Boy, does that sound familiar.

I went through the same thing with my mother. She had Alzheimer's. Once I took her into the ER because she had a bladder infection and had been crying for hours. The on-call doctor told me I should take her home and and let her pass away. I was furious. I yelled at him right there in the ER. It's easy for medical people to say things like that when they're not personally involved. At a certain point, even one of my sisters told me that I should stop giving her her medication.

Philboy, any time you want to talk to someone who's been there, send me a PM. By the way, YOU know your mother alot better than anyone else, and since you're her power of attorney, she's counting on you. If she can still smile, luagh and tell you she loves you, you have to follow your conscience.

[mdmc]

42. my thoughts and prayers are with you and your mom

I would just let it go... but no harm in getting a second opinion....

peace and low stress

[cwydro]

43. Fuck that.

Get a new doc, assuming your mom agrees.