<p>The thing that immediately popped out at me is that Mom is still getting annual paps and mammograms, which now that I think about it, seems completely nuts. However, I did find this, which seems to indicate that for some elderly and some cancers, there are some treatments which might not do more harm than good:</p>
<p>Mom’s special terror is cancer, and if asked, she’d probably say that she’d rather die from cancer treatment than from cancer. And she’s not fragile or frail by any means. OTOH, she is 90 years old. </p>
<p>And then there’s the whole question of scarce health resources. </p>
<p>So sorry for your loss momofJandL . My friend’s father choked on some food last weekend (at the racetrack, no less), had to get CPR, and has deteriorated due to that. It is so tough, they do not know if he is going to last the week or weeks or months. His wife is completely torn apart, so my friend is of course breaking down from this. And he himself is going between lucidity and delusional comments :(</p>
<p>@LasMa, my dad gets skin cancer screening and anything suspicious biopsied, and he is 87. He had skin cancer around 10 years ago, and they used MOHS and removed it with no recurrence, and no chemo or radiation needed (we caught it early). </p>
<p>But honestly, I don’t think there would be any harm to decrease paps and mammograms, or do away with them entirely. Both range from annoying to painful IMHO, and unless she does have issues with either, I’m not sure if putting her through that is wise. She should be taught to do breast self-exams and assure you that if she does have post-menopausal bleeding or pain, she should get an exam.</p>
<p>There is a line between preventative care and screening, and not reporting a possible cancer symptom, or not having it taken seriously. A friend of mine had back pain for a year, and the doctors wouldn’t do more than an Xray. When they finally did a CAT scan, he did not have a back issue, he had pancreatic cancer And he was only 50. </p>
<p>Best wishes to all elderly parents, in-laws, and caregivers. Hugs all around.</p>
<p>Thanks for the great resources Cardinal Fang and Old Mom. LasMas, pap smears are no longer recommended after the age of 65. An argument can be made for extending that further in the case of multiple or new sexual partners, but to 90 is nuts. Also, mammograms after the age of 74 are questionable. Unfortunately, many doctors aren’t up to date on screening recommendations and many of our health care dollars are spent for screening that is totally unnecessary. For example, breast cancer in a 90 year old is slow growing and will not kill her before the end of her natural life and after the age of 65 the cervix is typically “mature” to the point that the HPV cannot act on it to cause cervical cancer. </p>
<p>Thanks for that info, GT, that’s very helpful. It could be that the doc is not up on the latest protocols, but I rather think it’s a case of Mom insisting, and the doc not being willing to deny her. I’ll share your info with Mom, though, and if she’s not convinced, perhaps go with her to the next appointment.</p>
<p>I think those screenings are not recommended at 90. Cancer is usually very slow growing in elders. I don’t look for anything that I wouldn’t be willing to treat with available therapies and interventions, especially if the procedure is difficult. Tricky thing about cancer treatment: not everyone can translate descriptions of side effects (like neuropathy, for example) into daily impact on elders. My mother had chemo enthusiastically recommended for her advanced CA at one point, “this one won’t cause nausea”. When I asked about neuropathy, that was the side effect. No thanks. Mother had massive issues with falling and joint pain at her baseline. Ruled it out in service of quality of life. Every situation is different. Just important to know how to run the decision tree with or for your relative. </p>
<p>Couldn’t get through the medscape link without registering and haven’t done that yet. Most cancer therapies (apart from removing a contained skin lesion) are challenging. Treating my 90 year old father with no memory even for pneumonia is not likely at this point due to research about its efficacy for someone with his status and how many things are one bad moment from being disastrous to him. He has major bones with zero cartilage rubbing against each other, etc. etc., that can not be fixed. I know he would prefer to be gone than suffer further pain and not remember why he is bedridden. I will seek the graceful exit for him if it becomes an option, knowing his wishes. I am more afraid of prolonging things just enough for more to go south than I am about death itself. At a recent consultation, massive, invasive surgery to repair a complex abdominal mesh issue (manageable without surgery) was proposed, even as my father lay on a gurney with the 2 attendants who had to transport him to the surgeon’s office. Hmm… he’s 90, has advanced memory loss, couldn’t ride in a car, but why not a 4 plus hour surgery with a 5 month minimum recovery period? I spoke up. Alternative management arranged. </p>
<p>Over the years, many professionals have taught me not to seek information that I would not use. On the other hand, family has a propensity for a genetic cancer with a recommended age for initiating screening that would have killed my husband. We were on that much earlier than recommended. It is always a judgment call. </p>
<p>The pap guidelines are consistent with ACOG (american college of OG-GYN) recommendations. But, they differ of whether a yearly pelvic is necessary (USPTF says no and ACOG says to have it but can’t explain any benefits to the exam). I agree with USPTF on that one and have been personally refusing pelvic exams on non pap years (usually every 3-5 years). </p>
<p>Thank you. I think it’s at least worth a conversation between the three of us, rather than auto-pilot annual screenings. Like, “Doctor, if you were to find cancer, what is the course and prognosis, what possible treatments, how hard would the treatments be on her?” If after that, she still wants the tests because they give her peace of mind, I guess I won’t put up a fuss. You’re right, rhandco, she is my mom. </p>
<p>This got me thinking because the last gyn visit, my doc said no need, since my last was fine. This is from my insurer. Pap Smear. Every two years from age 21 until age 65. Women aged 30 and over may have the test every three years if they’ve had three normal Pap smears in a row. (Include chlamydia screening for sexually active females up to age 25.)
Mammography. At least once every other year between ages 50 and 74. Women aged 40 to 49 and women older than age 75 should talk to their doctors about whether screening is appropriate.
Colorectal Screening Begin at age 50 and continue until age 75.
Discuss best method for testing with your doctor.</p>
<p>Hi all, checking in from the road. We went away for a few days and are now on our way to parentract weekend to see my freshman daughter. While I was gone it hit the fan. My sister also went across the country to visit her son. Mom has not progressed at all in rehab. They suspect that she just keeps saying her pain is a 10 to keep getting drugs and to not do therapy. They were going to just release her Friday buy with no family around they agreed to keep her until Tuesday. She seems okay going to a nursing home and is contemplating it to be a permanent move. In all honesty she just wants drugs and to be waited on.</p>
<p>eyemamom, hope you have a great visit with your daughter, and that your sister gets a good break visiting her son too.</p>
<p>A nursing home is not a fun destination no matter how many drugs the patient gets. It sounds like your mother has given up. How old is she? Do you think that a psych consult may be in order?</p>
<p>She’s 80. Her problem is her complete lack of mobility and back pain she’s had for many years. It seems this the her final straw. I told her an option could be to go for a few weeks and see if she recovers some. But most importantly to talk to her Dr and case worker about her options. She said right now she couldn’t be alone.</p>
<p>looking forward - your insurance company seems to be not up to date with the latest guidelines which is clearly “co-testing” for those over 30. Co-testing is pap plus high risk HPV. If co-testing is done, pap can go every 5 years. It makes me wonder if your insurance will pay if following current guidelines. </p>
<p>eyemamom - It certainly seems like your mom has made a choice. My FIL at 87, who died this past spring, made such a choice. He also chose not to rehab and go to a nursing home.Although he didn’t ask for pain medication, he chose to not get out of bed (if forced, he would be on the floor trying to get back to bed the minute someone’s back was turned), and stop eating. We told the staff to hold blood draws, medication that he didn’t want, and asked hospice to come in. It was a very peaceful death. </p>
<p>lasmas - Yes, I certainly understand peace of mind, but I think a clear statement such as “there is no chance of cervical cancer” with negative screening every year and no recent exposure to HPV may be appropriate. Breast cancer is a whole different story. </p>
<p>GT, will you give me a link, pls? And I’ll check. That chart was in conjunction with CDC. Ime, over the years, a doc can still run the charges through based on risk factors. I’d like to see. </p>
<p>I have mentioned to my ob-gyn the possibility of not having a Pap smear every year, but she still wants me back for a pelvic every year. At my age, (60) I don’t feel like that is necessary either. Seems like at some point the health insurance money should be spent on looking for heart disease and other ailments of the “golden years.”</p>
<p>Edit: I know ob-gyns have to make a living but I suspect they are guarding their livelihood as the population ages. Wishing they had gone into geriatrics…</p>
<p>We’re all unsure of what to do, would love to hear from the smart folks here. Mom was transferred to a snf doing some minor p/t. While in the hospital anytime a nurse would come by and ask her pain level, she would say 10. Then be drugged out of her mind. In the hospital rehab she kept saying the pain level was 10 and they basically just kicked her out because they thought she was unwilling to work and just wanted drugs. So off she is to the next place. They pulled back on the amount of drugs and now she’s really saying she’s in insufferable pain in her back. She isn’t moving much at all. A nurse tells her she thinks she needs a new doctor. I don’t think the doc is much good either and I think she’s either fed up or over her head dealing with mom’s back pain issues that seem to have no origin. Her osteoporosis numbers are apparently pretty high considering her age, she dx’d herself with rheumatoid arthritis, which the specialist said no, that’s not it. She’s just gone from one kind of specialist to the other looking for answers. However since she had heart surgery 30 years ago she pretty much just laid in bed whenever she had an ache or pain and stopped being active. She thinks but now we don’t know if she has fibromyalgia and spinal stenosis.
Let me say I don’t doubt she’s in pain. I couldn’t tell you how much. I don’t think someone on a pain scale of 10 lays in bed casually watching tv and talking to visitors.
Now everyone is scrambling to find an answer. I’m unsure if mom just wants to stay and bed, be waited on and get drugs or if she has any hope of ever being released again. She says she’s worse since she’s been in the hospital, but I wouldn’t doubt weeks and weeks of staying in bed would make you sore. Some other pt said she had more minor fractures.<br>
Even though my sister has medical power of attorney the doctor just doesn’t communicate at all.<br>
I don’t know how we even get her to another doctor, what kind to see, or what to do. </p>
<p>Does the facility have a staff doc or some who come oversee patients on-prem, separate from a personal doc? When in skilled nursing after heart surgery, my mother’s day to day was managed by a doc contracted by the place. He was eyes and ears and reported back to hers.</p>
<p>She could have one of the syndromes that can come from (or be exacerbated by) inactivity and its complications. That’s my guess for my mother. There are also pain specialists (or pain management specialists) who may consult. Even if all they do is review the files. </p>
<p>I don’t know. My mother is in the same cycle of inactivity leads to pain, she won’t commit to rehab, she lays around, the pain stays or flares up. </p>
And he was only 50. </p>
</p>