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Mom's anemia improved but more than likely is again in decline according to her recent lab work earlier this week. This means she will have to maintain or decline in health and this past week she took a turn and has been extremely weak.


I was looking for placement originally only if she didn't have her mental faculties, and then considered it out of frustration because there is no one but myself and I'm tired. Now her primary doctor, who insensitively mentions more than needed that mom is 96, has said she will consider hospice at home. But without a diagnosis other than the anemia, is that sufficient?


Her doctor didn't order labs last April when I noted a change in mom and by my second request in October we found mom was severely anemic. She didn't count on mom agreeing to a transfusion which did happen in ER, and now doc is saying it won't happen again. Meaning what? That mom can't have an iron shot or infusion if needed? Another doctor from the office answer a call after hours and ordered another lab for B12/folate. Mom's pcp didn't address the results showing an elevated b12. The anemia and elevated b12 may point to cancer.


Should I push for further evaluation or maintain this status quo without hospice. Or is the doctor suggesting letting my mom's anemia decline naturally. I think I need to speak with a hospice provider. Sorry for the muddled stream of thought. I'm on the border of a likely flu and another somber outcome.

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All the responses have been so very comforting somehow, because it feels so all alone for the most part.
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Insensitive? Not to me. I am an RN. It is time now to ask you. Is your Mom tired? Is your Mom ready to go. As an RN I had to tell so many families that, while it is hard to recognize, people do tire of life. Death is the end that faces us all. And many elders come to long to it. Please speak with your mother about her wishes now, and please fulfill them for her. If she wants to FIGHT for the last single second with everything there is to fight with, then that is what you will advocate for her. If she is tired and she tells you she is ready for rest then THAT is what you must advocate for her. If she cannot speak I trust you to have spent a life time in knowing what she might prefer. My heart is with you. We are NEVER EVER ready to lose them. But I promise you this. If you Mom has been there for you, and you for her, you will NEVER lose her. My Mom is gone 15 years now this Thanksgiving time (and I am 77) and she is not gone from me, not my Dad either, any time at all. They are right here with me. My heart goes out to you in this time of pain and decision. Think only of her, and what SHE would want, and be her VOICE now. Hugs and love out to you.
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Pasa18 Nov 21, 2019
I said it was insensitive of doc only because it rubbed me, personally, as ageist. (Mom's side of the family has long lifers. A great grandfather lived to 107 and an uncle remarried happily at age 92). From the pcp, I expected a medical reason not a reference to age as a reason to pursue or not pursue any medical options. The option would be for mom, the patient, to decide. Not the doctor to assume what's best.

I have been with mom for the long haul. I think it was sometime earlier this year that a sense of acceptance sank in. Although I've become increasingly tired because of the support system or current lack in our case, we've had good moments. The realizations of times she's not been the mother I needed growing up don't really matter now, so we've come full circle.

Think only of her, and what SHE would want, and be her VOICE now.

This is what I needed to hear. TY for your kind words. RNs are wonderful and straightforward people.
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Please consider switching your PCP. Your mom might be 96, but that doesn't mean that she could not benefit from a panel of tests. In the mean time, she needs Iron, so find a way to get that element into her system. Iron is an easy mineral, You could cook every meal on a caste Iron pans, or provide supplements... If she has cancer then there's not much anyone will be willing to do. So sorry you're experiencing this... It seems that it might be best to regroup and consider all options available to a 96-year-old
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Pasa18 Nov 21, 2019
Yes, I use the cast iron. The supplement may further constipate her. I think she has lasted this long because of diet, and in the last year my soup concoctions.
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Oh, PS....if the doctor thinks cancer may be at play here, they may want to do a bone marrow biopsy which is VERY unpleasant. Anemia can be a sign of leukemia or another type of blood cancer which may require the bone marrow biopsy. My husband had one last month (negative) and it was awful! And he's a tough guy!
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@Pasa18, you are receiving some good answers about your mom. Have you had time to see a doctor about the influenza you feel coming on?
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OMG, you sound totally burned out, and I don't wonder at that!

If your mom has recurring anemia, doesn't that mean that either she's got an internal bleed somewhere, or that her bone marrow isn't making enough red blood cells?

The real question is how much poking are you willing to do to your frail mom to find out what is wrong and to what lengths will you go to "solve" whatever issue is found?

My mom, at 92, started having pleural effusions secondary to CHF; she had dementia and was in a nursing home. After a second draining of fluid from her chest, her pulmonologist sat me down and said "honey, stop poking holes in your mom".

I'm of the school of "let them down easy". The only thing I ever promised my mother was a death without pain, and I got that for her, with hospice.

It sounds as though you are at the end of your rope. Being an exhausted caregiver doesn't lead to good decision making. I'm hoping that you can get some respite, and some clarity.
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Pasa18 Nov 21, 2019
Yesterday, I felt the need to just stop. I got a 20 minute chair massage (which I believe might have been longer). And then - I picked up the liver, onions, potatoes, got gas, etc. ....
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I think that you should decide what treatment would be pursued if she was diagnosed with cancer. If you aren't going to treat it, I don't think you should find out. It just adds one more worry.

I would give her an iron supplement that is derived from vegetable sources and see if that helps her feel better.

Our bodies wear out and don't do what they are supposed to do or don't do it as efficiently as it used to, it needs a little help from added nutrients.

Be careful with any iron, it can give nasty headaches.

I use a great natural product that I am happy to give you the name, just send me a message.

If you choose hospice you can give your mom supplements, she just won't be going to the ER or seeking treatment for anything. You can always cancel hospice and seek care if you or she changes your mind.
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If your mother's physician feels that she has 6 months or less to live, due to any medical reason at all, she can order hospice services to come into the home to provide comfort care and no further medical treatment. No further testing would be done to determine if your mother has cancer once hospice gets involved. She can avoid going to the hospital for transfusions or any other interventions, unless of course she broke a bone or something like that. The anemia would not be medically treated, either, which may lead to her passing.

I think it's up to you and your mother whether you choose to have further testing and medical treatments done. How would SHE like to proceed? I know my mother is exhausted from having one issue after another, and tired of hospitalizations and rehabs, etc. She will be 93 in January. Have a heart to heart with mom and that may help clarify the situation a bit better for you. At 96, she may not want any more heroic efforts taken to keep her alive. On the other hand, she may...........who knows, right?

Sending you a big HUG tonight and a prayer that you find peace with whatever decision you arrive at
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