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User
Posted 29 Nov 2024 at 22:51

Dear all,

I am outside the UK at the moment, supporting my dearest dad in the last stage of his fight against prostate cancer.

It has been an excruciating journey for us and I can only take small comfort in knowing that I have helped put in place some palliative care from a local hospice charity (with limited resources) that has been amazing in their help and support. Still, I have some questions that keep nagging at me...

Right now my dad's cancer has mostly metastasized in his bones, particularly the spine, hip and ribs. There were small tumours detected in his thorax and liver in the last scan in Oct. His urologist had been giving him false hope, so being told that nothing could be done in Oct was a huge shock to him, and it has been downhill ever since. We have not had time to have very many conversations before my dad went downhill and I know I will take years to get my head around this all....

He has refused to take his hormone tablets (apalutamide) for over a month. He had bad pain but we sorted him out with a microdose of fentanyl, taken via a patch (half a 12 mcg patch) every 3 days. Apart from thyroxin, he takes no other medication apart from daily laxatives to deal with the side effects of fentanyl. He seems comfortable and does not complain about pain. But since he was put on the microdose of fentanyl, he has refused to speak much at all. Gestures and nods/shakes his head to questions. Although he can use his arms and hands perfectly, he wants to be spoon fed. All this is taking a psychological toll on us because we cannot understand what he is going through.

The hospice just tells us to let him do whatever he wants. He has off and on bouts of confusion, and one incident recently where he seemed to be hallucinating and was so frightened we had to take time to calm him down. He dips in and out of sleep - mostly not very deep sleep - but since he rarely talks, and is confused more and more, I feel I have lost most of him already. Struggling to cope and understand. The hospice doc suggested that he is experiencing delirium and that this cannot be a side effect of fentanyl since he is on such a low dose. But we have noticed the dramatic personality changes (not speaking etc) immediately after being put on morphine - later switched to fentanyl - and am struggling to think it is entirely coincidental.

There have been no visits to the hospital since, no bone injections or blood tests and no way to ascertain where and how fast the cancer is progressing. Since he is on palliative care, their aim is to keep him as comfortable as possible, and as for the family, we don't really know what to expect, and I am living from day to day, experiencing a terrible roller coaster of emotions. He eats very little and does not drink enough, it has been this way for almost a month now.

I can't get the sense of pervading failure out of my mind, that I have somehow failed him in failing to find a better solution, to try and figure a way where we can communicate sensibly.... but I am fearful that we are already past that stage!

My dad feels angry with doctors, feeling that they misled and then ultimately failed him.

Worst time of my life, for sure.

I don't know if this sounds familiar to anyone here.

Ru - devastated does not begin to describe it

User
Posted 30 Nov 2024 at 23:21
I'm so sorry to read this but certain that you are doing all you can and most likely more. I recognise how your dad is behaving now from my past experiences with loved ones.

Many years ago I lost my husband to prostate cancer and I really wanted to talk about so much towards the end. It was only afterwards I realised how difficult and painful that would have been for him and that some things were best not discussed as there really wasn't much we could do, and it was best to just sit together peacefully. I know I always made sure my husband was comfortable and it's good that your dad's hospice are focusing on making your dad comfortable.

Even though he isn't talking, at least not coherently, I am sure he will be able to hear and will gain comfort from you talking to him. I reminisced about good times from the past and it was a safe, comfortable space to be in. It gives me comfort now to realise it was about all I could usefully do, although at the time it was all a bit of a haze. Just hold his hand and tell him anything you think you will regret not saying and I feel sure you will be helping him more than you know, and ultimately helping yourself too. It is a very painful time, I know, and I do understand his disappointment and the stage he is at now. Anger is very common at this stage, and so understandable. It does sound as though the drugs may be contributing to his delirium but an infection, not eating or drinking enough, and him simply struggling to come to terms with his current situation won't be helping either.

Regarding a possible urine infection, you will need to ask the hospice staff to test his urine. A urine infection would raise his temperature and it could make him confused, so well worth getting him checked out.

Do ask the hospice staff for any information you think might help. It's a difficult time and they might not be able to answer all of your questions, but worth trying to get some answers and understand a little more about the situation right now.

Remember to take care of you too, x

User
Posted 01 Dec 2024 at 16:25
You can't blame yourself for his prostate cancer and that is what has put him where he is.

He has bone mets so he may be severely anaemic especially if he has come off all treatment as even the cancers that were being suppressed will now be rampaging along with the tumors that have evaded treatment.

My own view on this after a similar experience with my own father is that he has decided his own fate and the best thing you can do for him now is make sure he is comfortable and unstressed and has access to escalating doses of pain killers.

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User
Posted 30 Nov 2024 at 01:13

Sorry for what you're going through.

I do wonder if he might have a UTI.

I recognise the feeling that you're already losing someone. My mother went through a couple of weeks of not much communication at the end. You are doing what you can, and knowing you're there and he's with people who know him is probably a big thing. You shouldn't feel that you're letting him down.

Edited by member 30 Nov 2024 at 01:18  | Reason: Not specified

User
Posted 30 Nov 2024 at 04:56

Hi Ru.

Seven years ago, I lost my dad to prostate cancer. It wasn't on his death certificate but I knew it was the main reason for his passing.

In 2009, when he was 79 years old, he telephoned me, and after asking how the family were, and chatting about the news and sport, he casually ended the call with,"Oh and I've got prostate cancer"

He later told me that he was having tablets, periodic injections, tests and check ups to try and control it. Like, prior to his diagnosis, I continued to call him and mum everyday and visited them weekly.

Knowing what I do now about the disease, I wish I'd dug deeper into how ill he was, but ashamedly I didn't. Anyway for the next 8 years he seemed to tootle along as usual.

It was only the last few weeks of his life that he nosed dived. He started to get lots of pains his lower back, pevis and legs. His appetite gradually faded and he lost weight. I took him to the doctors and his PSA was in the thousands. I took him for a scan and he was riddled with the disease. 

During the last week of his life, I moved in with mum and dad, to help them out. He'd become bed bound and I got help from Macmillan nurses. He always wanted to die at home but because he wasn't eating or drinking, and gradually losing the plot, I started making arrangements, to move him to a hospice. Me and mum were actually waiting for transport to take him there when he passed away. We were both relieved that his suffering had ended.

It is only now, because I know more about the disease,  that I realise how brave he was and I feel guilty that I never told him that.

I hope, that me and dad's story, reassures you that many of your emotions are totally normal. I share your sadness but be assured that you are doing your best for him.

Hugs to you both.

 

 

Edited by member 30 Nov 2024 at 05:02  | Reason: Typo

User
Posted 30 Nov 2024 at 12:24

Thanks for the responses. I'm really struggling with this. The stress has been very hard to endure.

Re: UTI

Interesting that you say that. He has been reluctant to have his diapers changed that often. He does sit in wet diapers for long periods. Again the hospice has told us not to do anything to upset him, so we relent and don't force him to do anything he doesn't want to.... eventually he does agree to be changed.

How do you tell if he has a UTI, take his temperature? Does it potentially cause confusion?

 

Edited by member 30 Nov 2024 at 12:26  | Reason: Not specified

User
Posted 30 Nov 2024 at 23:21
I'm so sorry to read this but certain that you are doing all you can and most likely more. I recognise how your dad is behaving now from my past experiences with loved ones.

Many years ago I lost my husband to prostate cancer and I really wanted to talk about so much towards the end. It was only afterwards I realised how difficult and painful that would have been for him and that some things were best not discussed as there really wasn't much we could do, and it was best to just sit together peacefully. I know I always made sure my husband was comfortable and it's good that your dad's hospice are focusing on making your dad comfortable.

Even though he isn't talking, at least not coherently, I am sure he will be able to hear and will gain comfort from you talking to him. I reminisced about good times from the past and it was a safe, comfortable space to be in. It gives me comfort now to realise it was about all I could usefully do, although at the time it was all a bit of a haze. Just hold his hand and tell him anything you think you will regret not saying and I feel sure you will be helping him more than you know, and ultimately helping yourself too. It is a very painful time, I know, and I do understand his disappointment and the stage he is at now. Anger is very common at this stage, and so understandable. It does sound as though the drugs may be contributing to his delirium but an infection, not eating or drinking enough, and him simply struggling to come to terms with his current situation won't be helping either.

Regarding a possible urine infection, you will need to ask the hospice staff to test his urine. A urine infection would raise his temperature and it could make him confused, so well worth getting him checked out.

Do ask the hospice staff for any information you think might help. It's a difficult time and they might not be able to answer all of your questions, but worth trying to get some answers and understand a little more about the situation right now.

Remember to take care of you too, x

User
Posted 01 Dec 2024 at 16:25
You can't blame yourself for his prostate cancer and that is what has put him where he is.

He has bone mets so he may be severely anaemic especially if he has come off all treatment as even the cancers that were being suppressed will now be rampaging along with the tumors that have evaded treatment.

My own view on this after a similar experience with my own father is that he has decided his own fate and the best thing you can do for him now is make sure he is comfortable and unstressed and has access to escalating doses of pain killers.

 
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