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Please choose from the following:
Death & Dying QuestionsDeath & Dying Qnswers:
1. Your question shows a very well-adjusted approach to a desperately difficult and distressing situation. The practical answer is that when someone dies at home you should let your GP know at once. They, or someone who is covering for them, will then be able to come and confirm and certify the death. Once this has been done you can then call the undertaker who will not only see to the laying out of your husband's body and all the funeral arrangements but will be able to answer all your questions about what to do next.
Most undertakers do operate a 24 hours service but if your husband dies during the night there is no need for you to call them immediately if you would rather wait for a few hours.
As it is your GP, or one of his or her colleagues, who actually has to confirm and certify death it is important that you make sure they are aware of your husband's situation (the hospital should have notified them but it is best to double check). Ideally it would also help if your husband could visit your GP, or your GP come and visit him at home, once he is back from hospital, if they have not been seeing him regularly.
When your GP confirms the death he or she will give you a medical certificate of the cause of death, together with a slip of paper 'Notice to informant' which tells you about the information you will need to register your husband's death. Your GP would also let you know if a post-mortem was necessary, although this is not usually needed when death is due to cancer.
Obviously even if you know your husband is dying and feel you are managing to cope, the end can still come as a shock and leave you, temporarily at least, confused and bewildered. If you have a friend or relative who you can contact at that time to be with you through those first few hours it might be very helpful.
2. Macmillan Cancer Relief is a UK wide charity devoted to supporting people living with cancer. For man years the charity has provided funds for Macmillan nurses. This means that patients do not have to pay to see a Macmillan nurse. Macmillan Cancer Relief pays the salaries of these nurses for three years and then the NHS takes over their funding, although they continue to be known as Macmillan nurses.
There are almost 2000 Macmillan nurses. Most of them are based in the community and see patients at home but some work in hospitals or hospices.
Macmillan nurses are specially trained to help cancer patients and their carers in a number of ways. These include
explaining the best way to control pain and other symptoms advising patients about the different treatments available and guiding them through those treatments, including helping with the control of side-effects spending time with patients and their families to give emotional and psychological support advising on ways of getting practical help, including advice on benefits and other financial matters. Macmillan nurses are available to people at any time after a cancer has been discovered and are not just involved in the support of those who are terminally ill or dying. They often give invaluable support to people with curable cancer as they go through their treatment journey.
If you think you would like to see a Macmillan nurse then all you have to do is talk to your GP or your hospital medical team (either the doctors or the nurses) and they will arrange it for you.
3. A diagnosis of leukaemia is always a great shock to patients and their families. Your mother's doctors are there to answer her questions about her illness and to give her information about possible treatments and their chances of success. Once a patient knows all the facts, the decision to have treatment or not is ultimately theirs. Although your mother has decided not to have chemotherapy it is important not to feel that there is nothing else that can be done for her. Chemotherapy is just one part of the care for somebody with AML. She will continue to be closely monitored by her doctors so that any unpleasant symptoms which develop can be controlled. This includes symptoms like tiredness, nausea and breathlessness, for example.
Her doctors may also wish to ask for the help of the palliative care doctors and nurses who specialise in symptom control. They can liaise with her GP, district and Macmillan nurses and the local hospice if necessary.
The natural course for somebody with untreated AML is very variable. The bone marrow will remain abnormal and unable to make normal red cells, white cells and platelets. If she is anaemic, she may be tired and breathless and the low platelet count will mean she may have problems with bleeding and bruising. Because of this she will need transfusions of red cells and platelets. She will also be at risk of getting infections. The blood may start to become thick and sludgy from the increasing leukaemic white cells. This will affect the blood supply to the brain (causing tiredness, confusion, weakness, and headache) and to the lung (causing breathlessness). Importantly, pain is very uncommon in this situation.
Sadly, he average life expectancy of a person with untreated AML is usually only a few months. However, some people may live for 3 to 6 months from their diagnosis. Inevitably most people develop a serious infection or a bleed that proves fatal. This can happen suddenly, or more commonly as part of a general decline as the white count rises. It is important to discuss these possibilities with your mother and her doctors so that everybody knows her wishes regarding the last stages of her life, for example whether she would want to be given antibiotics or admitted to hospital if she developed a serious infection.
With the support which is widely available, the great majority of patients with terminal leukaemia can be cared for in the surroundings of their choice in comfort and dignity
CARERSWhat is a Macmillan nurse?
Macmillan Cancer Relief is a UK wide charity devoted to supporting people living with cancer.
For man years the charity has provided funds for Macmillan nurses. This means that patients do not have to pay to see a Macmillan nurse. Macmillan Cancer Relief pays the salaries of these nurses for three years and then the NHS takes over their funding, although they continue to be known as Macmillan nurses.
There are almost 2000 Macmillan nurses. Most of them are based in the community and see patients at home but some work in hospitals or hospices.
Macmillan nurses are specially trained to help cancer patients and their carers in a number of ways. These include
explaining the best way to control pain and other symptoms advising patients about the different treatments available and guiding them through those treatments, including helping with the control of side-effects spending time with patients and their families to give emotional and psychological support advising on ways of getting practical help, including advice on benefits and other financial matters. Macmillan nurses are available to people at any time after a cancer has been discovered and are not just involved in the support of those who are terminally ill or dying. They often give invaluable support to people with curable cancer as they go through their treatment journey.
If you think you would like to see a Macmillan nurse then all you have to do is talk to your GP or your hospital medical team (either the doctors or the nurses) and they will arrange it for you.
I am worried about my friend is coping with their cancer. What can I do to help?When a good friend or a relative gets cancer it is often a very difficult time and people often handle the situation by cutting down the number of visits and meetings because they might be difficult or distressing. Although this is understandable it is often very upsetting for the person who has the cancer who can find themselves apparently deserted by long-time friends and members of the family at a time when they really need them. So the first way in which you can help is simply by keeping in touch and keeping up with your regular contacts just as you did before the cancer was discovered.
There are then two main ways in which you can make a difference: by giving emotional support and offering practical help. The best way to make a start with these is by talking, or perhaps even more importantly, by listening.
Everyone is different and some people with cancer will find it very helpful to talk about their illness and its treatment whilst others cope by acting as though everything was normal and life was going on as usual, so knowing just the right thing to say is difficult. If someone is happy to talk about how they feel and how they are coping then listening sympathetically can be very useful indeed and make a real difference. If they are less forthcoming and keeping things more to themselves then direct questions like 'how are you feeling?' or 'how are you managing?' will probably get short answers like 'fine' or 'OK' and lead nowhere. On the other hand using questions asking about specific aspects of well being, like 'how are you sleeping?', 'do you get very tired?', 'what sort of things do you enjoy eating?', can be easier to answer and can often get people talking more about how they are and what problems there might be.
This can also open opportunities for practical help, things like doing a bit of shopping, walking the dog, taking your friend to the hospital for their next appointment, taking the children to school one morning a week and a hundred and one other possible ways in which quite small things you could do would not only make the day to day chores of life a bit easier for your friend but also show her that you do care and are there to help her.
For a while at least your friendship may be under strain, especially if your friend is having great difficulty in coping and coming to terms with the diagnosis and its treatment but by keeping in touch, by 'being there' and letting them know they can rely on you then you will be making a real contribution to their quality of life at a time when it really matters. .
Symptom Control Questions:Symptom Control Answers:
1. Cancer can spread from one part of the body to other areas. Where the cancer started is called the primary cancer and where it spreads to is called the secondary cancer. Your doctor has told you that you have a primary bowel cancer that has spread to your lungs. This is one of the commonest areas in the body for a bowel cancer to spread. Cancer cells have broken away from the primary bowel cancer and travelled round your body through the bloodstream. This probably happened some time ago, before your primary cancer was diagnosed and treated. These bowel cancer cells have lodged in your lungs and started to grow so the cancer in your lungs is secondary to your bowel cancer. This is different to a primary lung cancer where the cancer originates in the lung.
As the cancer in your lungs is made up of bowel cancer cells, it will respond to treatment that is designed for bowel cancer. The most common treatment for bowel cancer that has spread is chemotherapy. This may be with 5-FU and Folinic acid or, if you have had 5-FU before, with one of the newer chemotherapy drugs used for bowel cancer. Radiotherapy can also be used, but is less commonly given. CancerBACUP has online booklets on colon cancer and chemotherapy, and a factsheet on secondary lung cancer.
You mention that you are very breathless. Secondary cancer in the lungs can sometimes cause fluid to collect in the chest cavity, reducing the space available for the lungs to expand during normal breathing. It is possible to have this fluid drained off and this should relieve breathlessness almost immediately. If the fluid continues to collect, it is possible to have treatment to prevent or reduce it. This involves having an injection into the pleural cavity (the space surrounding the lungs). The injection irritates the two linings covering the lung and causes them to stick together. Once this has happened, there is no longer a space between the linings in which the fluid can collect.
2. The lungs are wrapped in a filmy membrane, which is called the pleura. The pleura is made up of two layers, the one encloses the lungs, the other lines the inside of the chest wall and ribcage. The pleura produces small amounts of fluid which lubricate the two layers so that they slide easily over one another as we breathe in and out.When they spread, some cancers will form little seedlings, or plaques, of secondary cancer (also called, metastases) on the surface of the pleura. These seedlings irritate the pleural membrane and make it inflamed. To try and soothe this inflammation the pleura produces more of its lubricant fluid.
This pleural fluid is then trapped between the two layers of the membrane. As more fluid builds up so it will begin to press on the lungs. As it increases this pressure will gradually lead to symptoms of breathlessness, chest pain and cough.
This accumulation of fluid in the pleural lining of the chest is called a pleural effusion.
Any condition which causes irritation of the pleura can lead to the formation of a pleural effusion. So pleural effusions can occur in people who do not have cancer.
A simple physical examination and an ordinary chest x-ray are often all that are needed to diagnose a pleural effusion.
The usual treatment for a pleural effusion caused by a cancer is to drain the fluid, as this gives very rapid relief from troublesome symptoms like shortness of breath.
In contrast to some other conditions, taking water tablets, or diuretics, which can remove excess fluid from the body, does not help to clear pleural effusions.
The drainage procedure is quite simple. A local anaesthetic is given into the skin of the chest and a small tube inserted between the ribs. The fluid is then drawn off with a syringe or a drainage bottle. Depending on the amount of fluid present this may take anywhere from minutes to hours, or occasionally a day or so. Depending on the time it takes the drainage may be done as a day -patient or might need a short stay in hospital. The procedure is a bit uncomfortable but not usually painful.
Sometimes the drainage tube is inserted in the x-ray department, using an ultrasound scanner, to increase the accuracy of its positioning.
Often when the pleural fluid has finished draining a drug is instilled through the drainage tube, into the pleural lining, to try and stop the fluid coming back. These drugs work by sticking the two layers of the pleura together, so there is no space for fluid to form. This may cause some temporary chest pain and patients often need pain killers for a day or two to ease this.
A chest x-ray will usually be done to check that the fluid has cleared and the lung has not been damaged.
Often the drainage procedure (which is called a thoracentesis) may be followed by other treatment, such as chemotherapy, to help control the cancer.
Sometimes, despite all these measures, pleural effusions can come back. If this does happen the drainage procedure can often be repeated.
3. Ascites is an abnormal build up of fluid in the abdominal cavity which leads to progressive swelling of the abdomen. It has many different causes but is an occasional complication of some types of cancer. When ascites occurs as a result of an underlying cancer the usual treatment is to put a fine tube through the muscle wall of the abdomen (using a local anaesthetic) and slowly drain off the excess fluid over a day or two. This fluid drainage, which is called paracentesis, can be repeated at intervals. Sometimes paracentesis is combined with chemotherapy to try and control the cancer and so prevent further fluid forming.
A peritoneo-venous shunt, also known as a Le Veen shunt, is another approach to the treatment of ascites. This involves an operation, under a general anaesthetic. During the operation a long perforated tube is placed inside the abdomen. This is then connected to a valve which leads to another tube which is tunnelled up, under the skin, over the chest. The end of this tube is fixed into one of the main veins in the neck, the internal jugular vein.
The way the shunt works is that as you breath in your diaphragm (the muscle which separates the chest and the abdomen) moves down and this will push fluid through the holes in the perforated tube. As you breath out the valve will stop the fluid going back into the abdomen and it will be sucked into the vein. From there it will pass into the blood stream and the excess fluid will be removed by the kidneys.
Although this sounds fairly straightforward the shunts often do not work very well. They also have quite a high risk of complications like the leakage of fluid, infections and bleeding as well as causing circulatory problems.
For these reasons a shunt would usually only be considered for a very carefully selected group of people whose ascites could not be controlled by the usual treatment of fluid drainage by paracentesis.
4. Brain tumours, like most cancers, are usually covered by a rim of inflammation, where the tumour meets the surrounding normal tissue. This area of inflammation is found with both primary brain tumours (those which start off in the brain) and secondary tumours which have spread to the brain from a cancer elsewhere in the body. The layer of inflammatory tissue makes the tumour seem larger than it actually is. It also causes pressure on the surrounding normal tissue. Because the brain fits quite tightly into the bony framework of the skull this means that the normal tissue is squeezed between the swelling caused by the tumour and inflammation and the rigid structure of the skull. The pressure this causes on the normal brain tissue leads to unpleasant symptoms like headache and sickness.
Steroids are drugs which can reduce inflammation in the body. One steroid in particular, called dexamethasone, is very effective in easing the inflammation caused by brain tumours.
Taking dexamethasone tablets can shrink the area of inflamed tissue surrounding tumours in the brain. This reduces the volume of abnormal tissue and so eases pressure and relieves symptoms.
Unfortunately dexamethasone does not have any effect on the cancer itself and so the benefit that it gives is only temporary. But very often taking dexamethsaone can give a very valuable respite from problems like headache and sickness for some weeks or even months. In addition the steroid does have other benefits, like increasing appetite and energy levels, which can lead to an overall improvement in quality of life.