Alzheimer's - now cancer, to treat or not to treat?

Tough choice. Modern medicine adds years to your life, unfortunately, mostly they can be some of your worst years.
Chemo is such a difficult thing to withstand, I would opt for pallative care for an elderly person with dementia.
I do not believe there is any right or wrong in this choice, whatever you decide as a family needs the support of all.
God Bless you and grant you all wisdom and strength in this journey.
L

I want palliative care as she lives with me and I am watching her deteriorate from the Alzheimers. Other family members think I'm terrible :(

I would opt for palliative care. I would not criticize someone who made a different choice. This is extremely hard!

I take it she is your husband's mother? What is his attitude about this decision?

Your family thinks you're terrible because they don't see what you see on a daily basis.

They undoubtedly think that not treating your MIL will serve to hasten her death. That may or may not be true.

We should all remember that medical intervention can work miracles but it also can prolong the agony and devastation. Sometimes it's best to step back and let make your take its course.

My vote: palliative care if it comes to that.

My mother is in mid-stage dementia. She is still able to understand many things, though. I would let her make the decision whether she wanted surgery and chemotherapy, because it is her life. Left up to me, I would opt for palliative care, but I know it would have to be her decision until she was totally incompetent to choose. This doesn't mean that I would continue to care for her as usual if she became too ill.

MariaLake, a spot on her scan could mean just about anything. Even if it is cancer, it may be slow growing. What did her doctor recommend doing?

That was supposed to be: let Nature take its course.

BTW, you are the DIL and your husband has passed on. Maybe it's time for the bio-family to take charge of the in laws. Either by moving them into THEIR home or by locating them in a facility, either way becoming the true caretakers.

Maybe you aren't doing that because it isn't what you want, but it seems like it should be time for you to get back to your life, your children and grandchildren, no?

How old is she, and what type of cancer? Has it been diagnosed? My father (95yr old) has late stage dementia and has late stage cancer (prostate and colon). His oncologist determined he would never survive chemo treatment, and used injection type chemo after surgery. After a few years of that, it no longer worked, and we went on a new pill - extremely expensive for a year. Now he's not on any cancer treatment, and is on hospice, but he's pretty strong even though he can't walk. I wouldn't doubt if he surpasses the limit time of being on hospice. If she's able to understand what is going on, and wants treatment - on the advice of her physician (oncologist) she should have a say about it I would think.

You say a suspicious spot has shown up on a scan. Isn't a bit early to make a decision to treat or not? I would want to know more about the spot - have a full diagnosis before making any decisions. Then, I would also want to know what the docs involved recommend. You have a huge load having had your husband fight a hard battle with cancer and lose, and now having both in-laws needing some serious care living with you. There must be a story behind that. Why are their children not looking after them or why are they not in a facility? It seems to me this would get to be too much for you. I appreciate you are likely honouring the memory of your late husband by looking after his parents, but you have other responsibilities. Your profile shows you have a mother of 88 who surely needs some help or will do shortly, and also grandchildren, and full time work from home. I don't know how you cope with all of this and why you agreed to take in your in-laws considering their health and your situation.

Maybe it is time to re-evaluate it all and look for some other solutions to the care of your in laws, They are going to need more and more care. Very likely the family members not closely involved with the care of your in laws do not appreciate your mil's downhill journey. and the amount of work in caregiving both. Nor, likely, do they know as well as you do what a "really awful cancer battle" (your words) is. I suspect that your experience with your husband dying of cancer is colouring your view. That is not a criticism, but I don't see how it cannot colour your view and I suspect you dread going through it again - understandably.
After the diagnosis is complete can you and the family sit down together with some 3rd party - professional(s) - perhaps a social worker from a hospital or doctors office and look at this whole picture and make a plan of care for your in-laws that does not rest entirely on you. I really think this is going to get too hard for you quickly and there is no reason you should be shouldering this burden alone. You are already feeling cooped up and unable to see your grandbabies and it will only get worse.
To the decision re palliative care, if that is one choice according to the docs, I would support that, but understand that some family disagrees. And btw, who has financial and medical POA? I think it very important that efforts be made to allow everyone to have their say. and to get everyone on the same page, or at least a decent majority. Good luck and keep us updated. This is a very difficult situation. ((((((((((((((((((((hugs))))))))))))))))))))

My mom had a spot on a scan a few years ago while she was in a rehab facility. When she was released and saw her own geriatrician that doctor asked if she should make an appointment for further diagnosis. My mother, who was then in earliest stage dementia and still "in her right mind" for this kind of decision, said No, she did not want to find out what that spot was. The doctor said she would respect that but had to point out that if the spot was cancer that treatment would be possible. My mother replied, "If it is cancer I will not have it treated. I have lived a good long life and if cancer is the way I'm going to go, so be it."

So I can understand even questioning whether more testing is a good idea. If you know MIL's attitude when she was in her right mind, and/or you have some written guidelines, and/or she is reasonable enough to give a rational opinion now, then I think her wishes must come first.

My mom, now in moderate dementia, was in ICU last week with an uti and also a GI bleed. The GI doctor urged us to have a scope done. Her primary care doc did not think that was a good idea. A partner in that practice told us if it was his mom he would not have a scope done. (We didn't.)

Even among medical professionals you are going to get different opinions of what should be done. Certainly family members may not agree among themselves. If MIL designated someone as her health care proxy (medical POA) then that is the person who ultimately needs to make the decision.

My heart goes out to you. This is not a position any of us want to be in, even if we've agreed to take the responsibility for decision-making. Whatever you decide, if you are acting in love that is the best you can do. Please do not look back at all the "what ifs." Do what you think best and move forward.

makes sense Jeanne...

Thanks all for your kind responses. I am taking MIL to her doctor tomorrow for more information and diagnosis. As several of you mentioned, that should be my first step. As far as deciding anything herself, my MIL is rarely "in her right mind" and I'd be hard pressed to say she really understands much at all. FIL was living with us............died a few days ago. I'm embarrassed to say that I am relieved. Just one incontinent, strong willed elderly person is so much easier to care for ....than two. Explaining that he died has been tough here as MIL forgets what I say almost immediately and then we start all over again. I try to change subject etc and that helps. Family wants a memorial service in a few weeks (he was cremated). I think a memorial will be difficult for my MIL but family wants this so I'll deal with the "aftermath."
Note: If I just say to her....oh he died a while ago. She says oh yes, I forgot and then she is fine. However, if someone says he just died days ago.........she gets very upset, cries a lot. Then a minute later she doesn't remember but she remains agitated. So it's the mood that sticks around. How have you all handled explaining a recent death to Alzheimers sufferer?

Oh dear, you are going through it aren't you. I'm not sure how much or often the related family is around her, but it helps of course for everyone to be relatively consistent in their response to her. My dad asks me sometimes where my mother is and I'll tell him either "she's around" or she's not here right now, and then he forgets about her. I also go through this with my deceased brothers. I know my dad sometimes realizes they're gone. But with ALz and Dementia - they will always forget, so that's truly a blessing. I'm sure it's different for everyone as to how to deal with this....I think you're response sounds like it's working alright...Maybe make sure to tell everyone to use that same answer. All the best to you :)

Just to say my friends auntie had mid/late als she developed breast cancer her family decided she had been through too much and opted against it. She died 2 wks later from heart failure. Personally I would not want my mum to go through this but then it is a very delicate subject and really only family can decide so hard when family never seem to be on the same page.

My mom is 95, and 1/1/2 yrs ago, discovered a golf size lump in her breast(she has dimentia-no short term memory). 2 separate dr's said to emove the breast since it was easiest, where the lump could get bigger and burst and then it would be major. they suggested no radiation or chemo because of her age, and also no further testing because nothing would be done anyway. It was so simple--we call it drive thru mastectomy-took her in at 9:30 and had her back home at AL in time for dinner at 6! no pain, no problem-amazing. they said usually breast cancer in older patients is slow growing

What would be the benefit to treatment that for sure has negative side effects, in order to prolong a life in which quality declines daily? My 89 yr old mom with moderate dementia who still has some cognitive function and has lived a wonderful life, wants very much to die before she is in diapers, does not know her loved ones, and would require nursing home care if she progresses to advanced dementia. She is still pretty upbeat, but sees "the writing on the wall" and would be happy to know she was going to die before any of that happens, while she is still in her home with me as her caregiver. While spiritually our loved ones are still "in there somewhere", living until the Alzheimer's kills them is an awful ending for all involved, and avoiding that can preserve whatever is left of their sense of dignity, not to mention the extreme burden on caregivers.

My Dad has dimentia, and grew a tumor in his upper jaw. it was the size of a lemon. He would not have responded to surgery, and Chemo would not work for it. Surgery would remove the bones and flesh, leaving the side of his face with an open hole. Not treating would cause the cancer to ultimately burst thru his face. I was initially worried that treatment would prolong his suffering. After 25 radiation treatements, the tumor is nearly gone, and has continued to shrink. If it comes back, he is at risk of the cancer going to the brain. I'm hoping he will simply expire in his sleep- He's 87 and I don't want to see him suffer cancer in the brain, or liver. I would treat if the cancer is treatable. Dimentia is normal stage of aging. Nobody deserves to die because thier brain is old. In my dad's case, they gave him another year or two. I'm not going to regret the time I have with him now.
If you have no emotional ties to the patient, then step out. You have a long road ahead!

Oh, the neurologist gave my Dad a medicine for his memory. It is improving, but we did have a set back the other day. We went to the Aquarium, and after walking out the door he could not remember what we just did. When he realized he forgot, it was a wake-up call for all of us!

Dementia is NOT a normal stage of aging, it is a disease that destroys brain function.

Dementia has many negative and/or ranging from memory loss to delusions to paranoia to frustration to depression, anger, hostilities, violence, etc.

There ARE dementias that destroy the brain and brain function directly (Alzheimer's, Lewy Body, Frontotemporal, etc.).

There are medical conditions that lead to dementia symptoms but don't cause brain damage unless they're left untreated (urinary tract infections, nutritional deficiencies, alcoholism, etc.).

There are also medical conditions or emergencies (stroke, heart attack, traumatic head injury, aneurysm, anoxia, etc.) which cause brain damage and where the effect is some kind of dementia or dementia symptoms (vascular, infarct, etc.). In these cases, if the cause can be corrected, halted or reversed, the brain damage may either resolve or become static without further progression or deterioration unless Alzheimer's or some other type that does deteriorate the brain begins to coexist.

Then there's dementia that stems from Parkinson's disease, cancer that metastasizes is to the brain, illegal drug use, and the list goes on.

Not enough research has been done looking into the long-term sufferers of schizophrenia and bipolar disease (and may never be able to be done because many of these people are unable to make themselves available just due to their condition). And no one knows the long term side effects on the btain of psycho-active drugs which haven't been on the market long enough to know. And let's not forget that there can also be a genetic component which often causes and early onset form of dementia.

So, not all patients who have dementia or dementia symptoms are elderly. However, when researchers plot a curve, the percentages of people affected rise exponentially with age. dementia may not be a "normal" stage of aging, but a large majority of dementias ARE age-related.