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My mother, who has Alzheimers, now has a lump in her breast, which the specialist says is almost surely cancer. They can't do a biopsy because of her blood thinner, but they are pretty sure. She has to decide whether to have a lumpectomy or have the breast completely removed. I am beginning to believe that my mom isn't capable of making any decisions at all and I am scared to death that, in the end, I will be making that decision. She will have the surgery at the end of August and she keeps forgetting about the whole thing. When I bring anything up about the cancer, first I have to remind her of what I'm talking about, then she changes her mind moment to moment about what she wants. I am trying not bring it up, since she is happier not thinking about it, but there are so many dr. appts. and I have to re-explain each time why we are going there. I guess I need to talk about this, but she doesn't. The reaction I am getting from friends I have told is they are sorry, but I get the feeling that people don't think this is such a big deal, since she is 82 years old and also has Alzheimers. Maybe people think it is some kind of blessing. I realize it isn't the tragedy it would be if she was 30 and had small children, but it is still a big deal to me. I don't mean that anyone has been cruel or anything, just not as much interest as I expected.

What are the opinions out there about what I should do if I do wind up having to make the decision? When the dr. first told us, Mom's first gut reaction was "I don't want them to remove my breast," but in a way I feel like that would be best at her age, since there is less chance of it coming back. But my husband wonders how long it would take to come back, since they say she has probably had this for years; he feels like the less we put her through now, the better.

To be honest, I am also suffering from a guilt trip because of the times I've hoped that she would pass away before the Alz completely took over her mind. I wonder if that is terrible or if others have had that thought. Of course, I meant painlessly in her sleep, not this. Now I don't want to lose her no matter what. I am so confused.
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{{{Dear Bridget}}}

Oh gosh, if it were any other kind of cancer than breast cancer - what would you say? I would try to think of it that way. There is something so emotional about breast cancer in women (and for good reason)... If it were another type of cancer that could be removed, it would be different, but still the same end result. The cancer would be gone and neither your nor your mother would suffer from the growth of cancer throughout her body over time. What does the doctor say I wonder?

I think we all understand how people react when someone is older... Oh, it's their time to go anyway or they dismiss it by saying oh, they've have had a long life so it's no big deal. HA! I have often wondered if that is the same reaction that they have when it is their own parent or loved one? I hope my tone isn't too ballistic today... Been a rough weekend for me and I am exhausted tonight. But, Bridget, the minute I saw your posting I knew you needed a lot of support and some advice on this subject.

There is nothing wrong with giving your mother the surgery she needs to survive cancer. When my dad was in the hospital after a TIA and they found colon cancer at 87 years-old, there was no question that he would get the operation. (I am sure the doctors might have been motivated by the money aspect of the operation however - not lol) Then, when they sent dad home on hospice, I asked him one question and that was: "Do you want to die?" and, even though that TIA was a bad one, he said emphatically NO!

So, I guess that what I am saying here is, even though your mother is suffering from AD and old age, what do you think she would want. We are our parents advocates... I am so sorry you are going through this dear heart. Just know that we are here for you and that you and your beloved mother are surely in my thoughts and prayers tonight...

Love and Hugs from Glenda


[This message has been edited by glenderella (edited 07-31-2006).]
Dear Bridget

I felt so strongly when reading your post that I must reply. My Mom was diagnosed in Sept 2005 with breast cancer. She is 89 and suffers from a multitude of illnesses, heart disease, lung disease, diabetes to name a few. She also has some dementia, although she comprehends most things (and then some days can not remember much of anything). When the cancer was found, it was in the Emergency Room where she had been taken after a breathing problem.The doctor was very kind and recommended we do nothing as Mom could not have the biopsy or the surgery due to her fragile condition. Chemo was not likely to help and would worsen her other conditions. Like you, everyone I told felt that she has had a good life and as one put it, "she is old and what do you expect". I agonized about what to do, and then Mom's family doctor came over to talk to us (he actually makes house calls). He said he would let nature take its course as many times this is common in older women and is just not found.However he did tell us he would treat the cancer in any patient that could tolerate the treatment. It is never easy to make life and death decisions for our loved ones, but the one thought that has kept me going is one I learned from a very dear friend (she is a nurse)and it is that any decison you make out of love for your Mom will never be the wrong one. There is no right or wrong choice in this situation, if you let your heart be your guide.One final note, Mom stil has not shown any ill effects from the cancer (the tumor was small). I did not mean to ramble on, but I did want to share my experience with you.
My prayers are for you and your Mom.

Vicki
Thank you so much for the quick responses and support. The nurse we talk to said she would probably not have chemotherapy. A cousin who has had breast cancer said "How can they possibly say that before they have looked at the tumor?" I am wondering if that, plus the fact that they have been conducive to waiting so long to do the surgery, are their way of letting nature take it's course. That maybe the medical team is thinking that perhaps she won't survive until the operation and then won't have to go through this. Not sure how I feel about that, although if that is what they are thinking, it is probably a compassionate decision.

I tend towards removing the whole breast and just get rid of it, but I know this is a highly personal decision, which I would hate to make for someone else. After all, it is easy for me to say, since it isn't part of my anatomy. I wonder if we should go with her first reaction, that it may have been the correct one. I just don't know. I guess I would rather have the higher risk of the cancer returning than have her live longer and be miserable.
Good Morning Bridget:
I will keep your mom in my prayers. As if AD isn't enough, now this. I will pray for both of you.
Bridget, I do not recall whether your mom is seeing a geriatrician? I would feel more comfortable talking to a physician that has experience with older folks; even a specialist in memory problems/dementia/AD. Or call the Alzheimer's Assn hotline and speak to a volunteer that has experience with Alz. Hospitalization can be extremely difficult for Alz patients. They become even more confused and it can bring on some major catastrophic reactions resulting in having to have the patient tied down. My ex-father in law had Alzheimer's and needed an angiogram. The poor guy was ripping his IV out continuously because he was in a constant state of confusion and fear. They found he needed open heart surgery, but it was not performed because of what he would go through during his postoperative phase. They felt that he would become so disoriented and decline so much further so they decided to not do the surgery.
Bridget, I think you need to speak to someone who is an expert in the field of Alzheimer's and find out what his/her opinion is. You will need to know what stage your mom is in too.
Bless you Bridget, I am feeling your pain and indeed I am praying for you and your mom,
Mimi
{{{Bridget}}}

Oh, Sweetie, this is so tough for you. If your mom is not able to make a decision it will be up to you - and it all so much depends on other things. Where is the tumor, how large, etc. How is she physically otherwise? How frightened would she be afterward, if her breast were gone and she couldn't remember why?

As with all difficult decisions, get as educated as you can about the surgery itself and the implications for after-care. Write down pro and con lists. Pray alot. Then look at quality of life. It may be that they can just do a lumpectomy and follow-up with radiation. They can also do a test the day of surgery on the sentinel nodes and find out if it has already spread.

Whatever happens, dear Bridget, please know that you are on my prayer list.

Hugs,
Barb
Thank you for your thoughts. Vicky, it is interesting to me that your mother hasn't shown any signs of the cancer. I have had two friends now tell me that after a lumpectomy, it took them 10 years for their cancer to return, although when I asked the cancer nurse how long was average, she wouldn't give me a straight answer. I am now thinking that perhaps the least invasive thing is the best for my mother. Maybe complete mastectomys are for younger people who should expect to live many more years. Mimi, I think I will call the Alz Assoc. today and see if I can talk to someone. You are so right that the way of looking at this has to be so completely different for an older person and one who has AD than a young woman and I am not sure the cancer professionals get that.

Does anyone know if the radiation treatments are optional? When they said she would "have to have them," it didn't occur to me that we could say no. When you get into this, it is easy to forget that we can make our own decisions. The medical people are so adamant about everything. Mom's first opinion was that she didn't want to do anything, at least unless it began bothering her, but the nurse said that isn't an option, because it would become a wound that would break through the skin. The lump is about the size of a golf ball, so I guess it must be removed.

Seems like I am as bad as my mom, that I change my mind about what is best from minute to mine.
We are now leaning towards the lumpectomy and radiation. At first, I thought at her age, what does she need the breast for, but now I am thinking that, at her age, the entire breast removal would be too much for her both physically and mentally. I am now putting quality of life as a higher priority than length of survival time. Especially under the circumstances. Thanks again for your support.
Hello Bridget...

I am sorry to learn of your mother's current diagnosis.. Mimi's suggestion was excellent and I think by the sound of your last post you have made your decision.

The truth is if she does have alzheimer's it would be good to know what stage she was in... and the rate of deterioration... you both were in NYC,,, is she frail at this time?

I am concerned if she really has a somewhat advanced stage of alz, would you just be prolonging her life.. or if the prognosis combined with the alz and the surgery is really optimistic.. many might think it would be wiser to just let her spend her time without any invasive treatments or surgeries.. and then treat her palliatively with pain meds... you might aklso want to check on the affects the anesthsia might have on your mothers Alz, blood etc. it truly is a difficult call.

I would get at least a second opinion and keep asking quetions to do what is really best for your mom.

my thoughts and prayers are with you and your mom. Research as much as you can to make the right choices...

Gail

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