* Congestive Heart Failure

Written 08/11/2006 – 09/10/2006

Mom checked herself into the hospital again because of extreme weakness and trouble breathing. It turns out her blood oxygen level was dangerously low.

Here I have included updates to my family and friends so that you might understand the roller coaster ride that care givers experience. Hopefully my account will help others to cope and support each other:

Hi All,
Mom was moved to a room on the Physical Therapy floor and started some treatments this afternoon. Basically, they got her on her feet and walking a few steps with a walker, and teaching her how to breath correctly to keep her oxygen level up.
In dealing with all the issues of cancer and COPD, the third disease that she’s had for years has been ignored, that is heart disease. The doctor feels that Mom could be dealing with some heart failure along with everything else. Congestive Heart Failure is not something that I have researched until last night and did not know that it could very well be the cause of her current problems. I thought it strictly affected the heart when in fact it can cause congested lungs, swollen ankles, fatigue, weakness, confusion, a feeling of fullness, loss of appetite, all of which Mom has been experiencing the last few weeks and more so now.
Unless Mom makes some miraculous improvement (she’s surprised us before) the doctor does not anticipate her leaving the hospital without a lot of home care or a nursing home. The doctor has NOT stated this to Mom and neither have I, so DO NOT bring it up in a phone conversation. The doctor does not want to dump too much on her at this stage and just wants to try and get her stronger. I have not talked to the doctor today, but yesterday he was still leaning toward the infection getting her down and only mentioned heart failure as an aside. He feels that if the infection can be cleared up she’ll be able to regain some strength.
So, that’s it for now.
Emily


Hi All,
So, here’s the latest on Mom… Monday afternoon the doctor was talking about possibly moving Mom to a nursing home where he anticipated that she may last a month.
On Tuesday, Mom was then moved to the Physical Therapy floor to see if she could regain some of her strength.
On Wednesday, she seemed to sound stronger and feel a little better, but Emily told me that the nurses wanted to make sure that the family understood the dire condition that Mom was in.
This morning about 10am I talked to the doctor and he was talking about putting Mom back on Hospice, moving her to the hospice floor, and just trying to make her as comfortable as possible. In the course of the conversation he stated that he felt she only had a few days to live. I asked him to clarify his statement since only Monday he had given her a month. He stated that the physical therapists were very concerned that Mom’s oxygen level would drop drastically at the least effort, like just sitting up in a chair. I left work and got to the hospital around 11am. I had just missed the doctor but he had written in her chart to continue physical therapy and a normal diet. To add to the confusion, Mom had both an upper and lower GI done this morning – doesn’t sound like comfort care to me. In addition, Mom devoured her lunch, and looked and sounded better than I’ve seen her in weeks. I got a phone message from the doctor about 1:30pm stating that Mom was eating better, breathing better, feeling better, and moving around better. He said he would talk to me again in a couple of days.
Go figure… Is this Mom doing better just before the end? Possibly. Is this Mom showing us what she’s made of and fighting to get better? Very likely, she has surprised us in the past. Is this a doctor’s hour by hour best guess? Most definitely.
So, now you are as bewildered as I am. Should you come? When should you come? I have no idea. You have to follow your own heart on this one.
Emily


Hi All,
So, it was the doctor’s best guess at the time. I got a message update and then talked to the doctor directly this afternoon. The doctor stated that Mom was doing better yesterday and much better today. He's thinking that she had a very bad day on Wednesday but is now about the same as when she came into the hospital. He is no longer pushing Hospice and morphine, and is back to watching her progress. He said that he might have overreacted yesterday morning since Mom had such a bad day on Wednesday. He plans to leave her were she's at for now and continue the physical therapy to get Mom stronger. She is on an extended stay floor and can be there for 20 days. He does not anticipate her being there that long and is back to his original plan of getting her to where she can go back to her apartment with home help. All good news...
Emily


And then one last email to a friend:

Well, I’ve put this off long enough and I still can’t bring myself to call you, so this will have to do for now.
My Mamma died last Sunday, September 3, 2006. She was in the hospital for two weeks fighting an infection and suffering some heart failure. The doctor “said” that he had both under control. Personally, I think that Mom had been experiencing heart failure for at least a month. Anyway, she went from the hospital into a nursing home for a little over a week but was not gaining any strength back.
My brother had been scheduled to visit Memorial Day weekend and arrived on Saturday morning. My middle sister had been here for about two weeks, and my oldest sister arrived on Thursday before the weekend. So, all of Mom’s kids were here to visit on Saturday. We all had a feeling she was not going to be with us much longer and we each said goodbye in our own way. Sunday morning Mom got out of bed and her heart just gave up. It’s like she said, “I’ve seen you all one more time, now I’m out of here, I’ll see you later”. Official cause of death is Respiratory Failure as a consequence of lung cancer and COPD but I think it was the heart disease that actually took her.

* Morphine and COPD, Deadly Combo

Kaiser also promotes free rein of Morphine administration to their hospice
doctors and nurses:

http://www.kaiserpapers.org/hos.html

* Hospice, Morphine, and COPD

For another perspective on the Mophine / COPD issue, check out what Hospice Patients Alliance has to say:

http://www.hospicepatients.org/no-prn-morphine-copd.html

* Morphine and COPD Don't Mix

Written 04/18/2006

Dear Dr. [ ],

FYI pertaining to my Mom:

I believe I’ve identified the very likely cause of my Mom collapsing and ending up in the emergency room for the second time in a week and a half. Here is a record of the chain of events that led up to it.

• Mom came home on Sunday March 19, from an alternative cancer treatment center feeling better than she had in many months, with more energy, and breathing better
• On her way home she had trouble with the altitude in Black Forest but stabilized once she got home to Pueblo.
• Over the week her energy and breathing slowly declined to where on Friday March 24 she checked into the ER and found that her oxygen level was extremely low - in the 50s. Once she was warmed up and on hospital oxygen her level stabilized in the 90s. An X-ray was clear other than expected cancer and COPD – no pneumonia. An EKG came back normal. Once stabilized, she was sent home.
• The oxygen company was called to check out her equipment. The concentrator was checked and calibrated and her oxygen tube was switched to a liquid oxygen tank as a precaution. The tube and canella were not checked or replaced.
• By Saturday April 1 Mom was again feeling a lack of energy and shortness of breath but decided to keep a previously planned shopping trip with a friend. While shopping she was using her portable oxygen unit and started feeling better.
• Sunday morning April 2 Mom was again having a very difficult time breathing and no energy. I had her call the oxygen company and the hospice nurse. The oxygen company said that her tubing was clogged and replaced it along with the canella. The hospice nurse started administering Morphine to help with anxiety and breathing. When I arrived I questioned the Morphine because my Mom was not in pain or had she ever been in pain due to the cancer. I noticed that Mom was breathing through her mouth and repeatedly reminded her to breathe through her nose. After the oxygen company brought a mask at the request of the nurse, Mom’s oxygen level finally stabilized in the 90s. By this time she was pretty well out of it from the Morphine and slept most of the afternoon.
• On Monday April 3 the hospice nurse came by to check on Mom. She administered more Morphine and then left my Mom by herself. My aunt brought dinner for my Mom later and she ate most of it. About 9:30 pm my aunt tried calling Mom and it was busy. Since it is unusual for my Mom to be on the phone at that time of night, my aunt got concerned and went over to her house. She found my Mom collapsed on the floor and only barely conscious. She was taken to the ER where the ER Doctor ordered an X-ray to evaluate her condition but the hospice nurse canceled the order stating that it would not be paid for by Medicare. She was moved to a private room where more Morphine was administered on a regular basis. Albuteral lung treatments were administered, but no tests were ordered to evaluate her true condition.
• Throughout her treatment both at home and at the hospital I continued to question the use of Morphine. On April 5 Mom said that she did not want any more Morphine because of the way it made her feel. At the same time, hospice was discontinued and Dr. Shapiro was called in to take over her care. A Dextrose drip, antibiotics, and a steroid for her breathing were ordered and administered. A blood work and CT scan were also ordered. Mom took a sudden turn for the better.
• Mom was discharged from the hospital on April 8 and has continued to improve on a daily basis.
• On the evening of April 16 we dodged yet another bullet by noticing the oxygen tank was dangerously near empty. The oxygen company was called and the tank was filled.
• Not having any answers as to why Mom collapsed, I began researching all of the medications that Mom was / is taking and found some very disturbing information about Morphine and COPD.

I believe that Mom’s body was already compromised by the two weeks of oxygen level fluctuations and slow oxygen depravation that was then compounded by the Morphine. The night that Mom collapsed it was apparent that she had thrown up due to regurgitated remains of her dinner in the trash can. I feel that the Morphine made her sick and also caused her to pass out and possibly stop breathing for a short time. Continued administration of Morphine in the hospital hindered her recovery progress.

Attached is the information on Morphine that I have based my assumptions on. I know that all this is speculative and behinds us now, but for the future I have advised my Mom to refuse any further administration of Morphine or any of its derivatives.

I ask that you please keep this in mind with other COPD patients so that they do not have to go through the same agonizing experience or worse. I also ask that you make the hospice doctors and nurses aware of this so that they do not just follow standard practice with COPD patients and administer Morphine at the drop of a hat.

Thanks you for your time.

* Sugar Feeds Cancer - Letter to doctors

Written 03/11/2006

Dear Dr.[ ],
I’m the daughter of [Mom] who you have treated for lung cancer since February of 2005. I’m writing you because I believe you are a truly compassionate person who cares deeply for your patients.
After treating my mom with both chemotherapy and radiation simultaneously, we found that not only had the tumor not shrunk but it had actually grown somewhat. After monitoring my mom’s condition for six months it was determined that there was no other treatment that could benefit her. In late December of 2005 she was told that her life expectancy was measured in months and it was suggested that she go on Hospice.
My mom decided that she was not going to just roll over and wait to die. She chose to go to a Mexican holistic clinic to receive alternative treatments. The treatments have been extremely beneficial and I would be glad to share the details with you if you’re interested.
While discussing the different treatments and how they affect cancer cells, we learned that cancer cells thrive on sugar, so much so because cancer cells have from 10 to 100 times the number of insulin receptors of normal cells. This information raised a great concern in me since the radiation department provided my mom with cases of Resource to help boost her energy and gain weight. My understanding is that Resource is packed with sugar. It seems totally counter productive to try to kill cancer with chemotherapy and radiation and then feed it with mega doses of sugar. I also remember the radiation department provided cookies in the waiting area for the patients.
I don’t believe that you are one to knowingly counteract your own treatment and hinder the expected results. I’m asking you to please research this further and counsel your patients to stop eating sugar in any form.
There is one particular treatment that my mom received in Mexico that I would like to share. It is called IPT (Insulin Potentiation Therapy) or Potentiated Microdose Chemotherapy. This therapy is approved by the U.S. National Institute of Health but is practiced by very few. Basically how it works is that insulin is used to bring the blood glucose to below 50mg/dl. Minute amounts of chemotherapy are introduced in conjunction with the glucose necessary to bring blood glucose levels back to normal. This creates a concentration of the chemotherapy agent in the cancer cells because of the extra amounts of insulin receptor sites on the cancer cells. This results in an exceptional uptake of the chemotherapy by cancer cells. This therapy makes perfect sense to me and appears to have greatly benefited my mom where traditional chemotherapy has failed.
I ask that you share this information with your oncology associates. It is my greatest hope that doctors like you who truly want to cure their patients will research this further and implement it as part of their treatment protocol.
With the opening of [ ] Hospital’s new cancer center, let’s make it truly cutting edge by getting some of these new technologies implemented.
Thank you very much for your time.