And now cancer along with everything else

Please don’t feel guilty for thinking that an ‘off ramp’ ( as it’s known here) would be preferable to a lingering dementia death. I know you are correct in your thoughts that he won’t be able to handle the treatments. I have a good friend who had this and she had surgery and is still taking chemo every three weeks almost two years later.

I know we all look at this differently but to me it is a no-brainer. I would much rather die of cancer than experience stage 6 & 7 and die of aspiration pneumonia or urosepsis.

Now in Stage 5, if my DW where to be diagnosed with cancer, I would let that run its course. Such a hard decision, but like others, I watched her father die an extended, painful death from dementia. I don't want that for her.

I’m so sorry about the cancer diagnosis. Someone posted on this forum that if you must make difficult decisions for your LO to “play it all the way out”. Little did I know that I would soon need that advice. My DH passed last August due to aspiration pneumonia. Before that he had a severe fast decline and wasn’t swallowing most of the time. The MC facility asked me if I wanted an XRay to confirm pneumonia. At first I said of course. The head nurse said if they found anything that they must transport him to the hospital. Then I remember the post. I asked the nurse questions and based on her answers I made the extremely difficult decision to not transport him and asked them to call Hospice. I did feel guilty but this group helped me realize it was the right decision for my husband. Had he gone to the hospital for a week to ten days and returned to the facility he would have aspirated again. My sister also has dementia and breast cancer. The oncologist put her on medication to slow the growth but it stopped working and they recently changed it. I hope when the time comes that her husband and children will not approve other treatments. Without the help and support on this forum I doubt I would have had the strength to make the decision. I do know what my husband would say. He would not want to live that way. Praying for your strength and comfort in the coming days. 🙏💜

I am sorry you are dealing with this duel diagnosis. The question I have always asked myself if she had a cancer diagnosis is could my DW tolerate cancer treatment and what impact would it have on the dementia progression. My experience tells me that she could not tolerate treatment and that the would most likely accelerate the dementia progression so I stopped screenings for cancer several years ago. I know this is an agonizing decision and I wish you strength going forward.

@aconite

I am so sorry this additional heartbreak has landed on your shoulders. The weight of decision making on behalf of another is heavy.

My advice would be to be wary of the follow up appointment. Given his disease progression and other health issues, it might be prudent to take the meeting without your DH. There's an old saying, when you only have a hammer, everything looks like a nail. You don't want your DH agreeing to aggressive treatment that he doesn't comprehend because the doctor lays out a plan appropriate for someone who doesn't already have a terminal diagnosis. My dad once reversed his decision on a DNR in the mid-stages when some underling from the SNF where he was doing rehab explained the form as "if you're sick, do you want us to just let you die" after he asked her to explain it to him.

Once the doctor has explained the options, including letting the cancer run its course with comfort measures only, you will have a better idea how to proceed. In weighing the decision, you might want to check in with his neurologist about the likely impact treatment will have on his cognition and ability to function. Anesthesia and hospitalization can deliver a PWD into the next stage of progression. Likewise, chemo can worsen cognition with side effects.

My dad was diagnosed with a recurrence of prostate cancer months before his dementia diagnosis. He opted for treatment as was indicated by his original Gleason score. In his case, treatment was a twice-yearly androgen therapy shot to flush testosterone out of his system. We agreed to continue as we'd hoped it would damp down dad's aggression and the icky fixation on all things sexual. The cancer hadn't metastasized to his bones, so treatment helped protect against fractures from a fall as well. FWIW, my mom's sister used to call me to encourage me to pull the treatment and let him die. She justifiably was not a fan of the man, but it didn't really matter, he passed within 2 years of his diagnosis.

My dear friend's mom had mid-stage dementia when she was diagnosed with breast cancer. Her mom had opted out of mammography at the age of 80 saying she would not treat if diagnosed. As difficult as it was for my friend, she honored her mom's wishes and they rode out the dual diagnoses to the end at home, under the care of an internal medicine PCP, nursing care and hospice.

Wishing you peace and strength.

HB