need a nurses candid discussion

**Missy** · 12-09-2006, 12:01 PM

My mom has been ill a very long time with follicular lymphoma and diffuse group b cell lymphoma. Now the docs believe her tumor has invaded her bladder. (It was not connected to the bladder but lurked just outside) She has always struggled with her weight, barely ever topping 115. Never had a eating disorder. However as a teen she had to have half her stomach and a large portion of intestine removed due to cancer there. Her docs have answered her questions, however in an effort to protect me she hasn't been as forthcomming about some of the concerns I have. She is currently at 79-82 lbs. I live two time zones away so going to have a discussion with her docs isn't an option. So here are my questions...please don't try to protect my heart. I need to know. Her Chemo and radiation have made her vomit everything she eats.

1. what dangers are there in her being so thin/ underweight?

2. what dangers are there in the cancer invading her bladder? She already has lost some control there.

3. what are some signs I should watch (well, listen to menti ned when i speak to her, or my gram) that I would know that aren't good...or are wonderful news.

I am scared. She knows it but nothing i have said about wanting to know has really broken through. She's a mom and she wants to protect. Sigh. So I turn to my fellow villagers to help me out.

**Darlene** · 12-09-2006, 12:14 PM

Wish I had answers for you but all I can offer is a heartfelt hug to you and a wish for comfort & strength for your Mom. I'm sorry you are hurting so.

**Missy** · 12-09-2006, 12:20 PM

Thanks Darlene, it really means alot. :Hugz:

**baxjul** · 12-09-2006, 04:34 PM

Missy, I just PM'd you!

**MOMMYDEAREST** · 12-09-2006, 08:14 PM

missy- i'm only in nursing school so i still don't know everything. i just wanted to give you a hug & let you know you & your family are in my prayers!!!

**sunshine** · 12-09-2006, 10:25 PM

((( Missy )))

I'm sorry you're having to deal with this . . especially now, at the holidays, etc.

I'll try to answer some of your questions, unfortunatly - you've given me limited information (I know, you have limited information from your mom).

The dangers of being too thin? All the vomiting can cause electrolyte imbalances -- low potassium, calcium, proteins especially. These are necessary for proper muscle function -- including the heart muscle. Her body might well attack it's self for needed nutrients-- leaving her muscles wasted, and her bones brittle. Fractures could be an issue.

As for the cancer invading her bladder-- I don't know the extent/type of tumor there. . . but if the cancer invaded the bladder, she'd need to have it removed and she'd either have a bag attached to her abdomen to collect urine, or occasionally they can divert it to the intestines -- but that's rarely done.

Signs to listen for good news : red blood cell count is up (hemaglobin), white cell count is down (WBC) , no metastisis ( it's not spreading)

Things that signal not so good news: any mention of hospice, needing blood transfusions (although it can be a normal side effect of chemo), any infections - hard to fight off when you're immune system is suppressed by chemo, etc. etc.

I'll be praying for your mom and her caregivers, as well as you.

**Missy** · 12-09-2006, 10:37 PM

Thanks so much Denise!! KNowing those words will help me in my conversations...i'll know what the heck is being said! That in itself is a huge thing. Big hugs to you. Thank you so much for your answer!

**Valerie in WA** · 12-09-2006, 10:42 PM

Missy, I don't have a lot of information. Nursing school was a long time ago, and since then I worked peds and NICU. But long ago, I worked in a nursing home. Most of the residents were in the 100-120 lb range. If your mother's ideal body weight was 115, and she currently weighs around 80lbs, that puts her at 70% of her ideal body weight. She is significantly malnourished.

I don't know anything about bladder cancer specifically. It seems likely that some incontinence would occur. If the tumor blocked the flow of urine from the kidney to the bladder, that would be bad because then the body couldn't excrete what it needs to. If the tumor blocked the flow of urine from the bladder thru the urethra to the outside that would also be bad.

I'm not so concerned about the cancer invading the bladder, as I am about it spreading, particularly with a history of cancer as a teen ager. I'm so sorry, Missy

but I would be fearful that the end of her life is growing nearer.

As for what to watch for... well, are they continuing to attempt to treat the cancer? That's a big one. If she's still going for chemo and radiation, then there's some hope for a cure. I assume your mom does not live independantly. If her caregivers mention that she's been sleeping since yesterday or that her breathing pattern has changed, I might think that she was within a few days of passing on.

I don't know about your relationship with your mom, but I would encourage you to speak plainly with her. Just say, "Mom, I'm afraid. It will help me to know the truth. Are you dying?" Those are very difficult words to say. I'm sorry.

Sometimes, I'm not all fluffy and sweet and nice, but I think I am honest, and I hope what I've said is helpful in some way to you.

I am so sorry that you are suffering and grieving. I'm also sorry that your mother is suffering medical treatments, nausea and pain. Does she have adequate pain control? It sometimes takes monstrous doses to control cancer pain - and those big doses are appropriate. Does she know the Lord? Is she awaiting 'permission' (from you or someone else) to let go?

I would be happy to give you any other information I have. I wish I had more.