Two comorbidities- Alzheimer’s and Leukemia

If i were in your shoes i wouldn't treat it. My partner is now early stage 6 and has an indolent lymphoma that has never yet required treatment. She has forgotten that she has it, and she hasn't been to the oncologist in over two years. I have made the decision that I will not seek treatment for it if it recurs or transforms. She wouldn't have a clue, and honestly i would be relieved that she might have an off ramp (those were Butterfly Wings' words) from the ravages of dementia.

I don’t think he would ‘enjoy life’ during the treatments. He would be ill and miserable and would’ not understand or remember why. Sometimes the treatment is worse than the disease. Why put him through it when the even the most optimistic outcome is continuing down the dementia progression complicated by hospital delirium… and the worst is going through the treatments without remission and still going down the dementia path with hospital delirium? And being scared, confused, ill and miserable during the six month treatment when that same six months time period is possibly the last months he will be cognitively with it enough to ‘enjoy life?

My wife going through 6 weeks 5x a week radiation treatment and must stay still , I'm so lucky that she's still very cooperative can't imagine if she was in advanced stage.

Does your DH have an advanced medical directive? We have both done advanced medical directives that indicate that if we have dementia we do not want treatments that would prolong our lives for any reason just comfort care. It sounds like the doctors advice was that it wouldn't be ethical to give chemo to someone who cannot consent. If you are comfortable with the doctor maybe consider that reasoning in making a decision.

In stage 6 I don't think I would do any invasive treatments given the untreatable and terminal condition that is Alz. Anything as small as a fever from a cold can send a stage 6 PWD into a tailspin, so cancer treatments could potentially really strip any quality of life from the extra months that the treatment may preserve, and even if that wasn't the case the dementia will march on and he would reach the end soon anyway. I'd focus on comfort and quality of his remaining time.

My husband has heart disease. My daughters and I made the decision not to treat with any surgical interventions.

My goodness. This damn disease. I am so sorry that this difficult decision has been added to an already devastating path.

Yes, on some level we are imposing are own standards for quality of life. That said, as his spouse, you likely know what he would want better than anyone else and because you love him, you will act in his best interest.

Perhaps we are, but I don't know any way around that. I firmly believe that there are things worse than death, and unreasonable suffering in an irrational being is one of them. Does it help to think about what choice you might make for yourself? Or what the outcome is likely to be? The treatment will be difficult, regardless. If it works, he still faces a death from dementia with prolonged and progressive suffering. If it doesn't work, he has suffered more than he might have in the time he has left, for reasons he can't understand and consent to. The only reason i can see to treat him is if there were some outcome that led to improved health and quality of life overall, and I don't see that as a possible outcome here.

This comparison may sound harsh jb, but I also wouldn't put an animal through treatment in a similar circumstance. The vets sometimes have it easier than the human docs. And for the record, i am not an advocate of human euthanasia. But "can" and "should" are two very different things.

I know I would have done the same, because I know me. That had to be very difficult.

My dh is in early stage 7, so my opinion is I would not put him through anything like the treatment for leukemia or any thing else. Just knowing he is dying a little every day is bad enough. But this is my opinion.

Best of luck to you and I know you will make what ever decision you feel is right for both of you.

As a physician who also watched my father endure treatment for chronic leukemia (probably a different kind from the one your husband has), I would choose no treatment. I would not want to endure treatment and live through late stage dementia. To me, a terminal cancer diagnosis would actually be a gift in that situation. I’m sorry if this sounds cruel to say. I have also cared for children with cancer during my training, who didn’t understand they had cancer and had to suffer. Obviously that’s a different situation, but I cannot imagine subjecting someone who has another terminal illness (dementia) to very difficult treatment to maybe prolong their life so they can reach severe dementia. My opinion only.