Bladder cancer in the elderly

About a month ago during a routine checkup, Dad’s bladder cancer was found to have come out of remission. On the bright side of this less than cheerful news, the tumors were small and the surgeon thought they might respond well to a new type of in-surgery chemotherapy treatment. So, Dad’s surgery was scheduled for what would be the 18th of September.

However, the surgeon sustained a sports injury a couple of weeks back, and won’t be able to operate again until October. Although it isn’t particularly customary in medicine, Dad’s doctor transferred his case temporarily to his colleague so Dad could have his surgery this Friday. I thanked the colleague profusely, and left a Thank you card for Dad’s regular doctor, at the pre-op appointment this morning. Then, we rushed on to get Dad’s pre-op tests worked up before heading out to lunch at a café nearby.

We will find out the pathology report in October at the follow-up visit. Until then, Dad will have a chance to rest and heal.

Here’s a few resources below.

I found a great resource from the National Cancer Institute: http://www.cancer.gov/cancertopics/wyntk/bladder

The National Cancer Society published a nice guide on caring for cancer patients at home:

http://www.cancer.org/acs/groups/cid/documents/webcontent/002818-pdf.pdf

And one specifically for bladder cancer:

http://www.cancer.org/acs/groups/cid/documents/webcontent/003085-pdf.pdf

Here’s a few bladder cancer factoids:

  • Bladder cancer affects over 74,000 people each year in the US, and has a 20% mortality rate. Most of the patients are elderly men.
  • Most people have a transitional cell cancer (TCC). Transitional epithelial cells line the bladder and allow stretching of the bladder when it fills.
  • Med techs screen urine samples for transitional cells. The bladder normally sheds a certain number of transitional cells daily. Too many transitional cells, or cells that have an abnormal appearance, on a urine screen is a red flag for us med techs and we report it out as an abnormal result for the doctor to follow up on.
  • Bladder cancer can cause the same symptoms as a urinary tract infection (UTI). Therefore, if an elderly man is experiencing symptoms of a UTI, it is best to seek treatment to rule out the possibility of bladder cancer.
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Falls in the Elderly

Nearly 2 weeks ago, Dad took a spill getting out of the car one evening. At the time, the only thing he appeared to have injured was his pride. By Tuesday of this week, however, a bruise the size of a small pancake had appeared on his hip. I took him to Urgent Care, and happily, the X-ray was negative for a break.

But the bruise kept growing. By yesterday morning, the bruise had grown to the size of a football, leading me to wonder if this was old blood continuing to make its’ way to the surface, or a seeping vein that refused to seal off due to the use of NSAIDs. Dad was understandably in pain and had been having mobility difficulty, necessitating help nearly every night this week. So, I threw on a t shirt and skirt, and drove Dad to the ER for evaluation.

The ER doc said the bruise was impressive, but of course, not the largest he had ever seen. He felt it was old blood continuing to come to the surface, and said the bruise might grow a bit larger before it resolved itself. We were in and out of the ER in just over an hour, which might be a record.

Before we left the ER, I got some good tips from an RN on how to help Dad transfer better to prevent falls. As a med tech, I have a strong background in medicine, but not much clinical training. The nurse said she thought I would have made a good nurse, which is a huge compliment because lab techs are generally not very high on the clinical totem pole. But, I pointed out to her that I was learning to solve problems on the fly instead of being trained and experienced. I told her that if there was a manual, I would read it, or if there was a class available, I would take it.

This brings me to the point that fall prevention in the elderly is desirable, but caregivers also need to know what to do when a person ends up on the ground. Searching the web, I found some free resources that seemed promising.

First, is a fall statistics and prevention for healthcare professionals on the CDC’s website. Interesting to me in this set of webpages is a guide on how to develop a community program to prevent falls. However, the guide mostly focuses on fall prevention inside the home, which is most of what I have seen elsewhere:

http://www.cdc.gov/HomeandRecreationalSafety/Falls/Index.html

Here is a training article about teaching an elderly person how to get up after a fall, assuming they are ambulatory and not injured. This seems like a good class for a PT clinic to teach to the elderly and caregivers:

http://physical-therapy.advanceweb.com/Article/Teaching-Fall-Recovery-Skills-to-the-Elderly.aspx

I hit pay dirt when I found an entire set of training videos for the elderly and caregivers on

http://www.youtube.com/user/CAREGIVERSTRAINING

Finally, the NY Times wrote up a nice article on predicting the possibility of recovery after a fall. This article helps both elderly patients and their families know what kind of recovery to realistically expect after a fall, and what to ask a physician about the patient’s prognosis.

http://newoldage.blogs.nytimes.com/2013/11/15/predicting-a-falls-aftermath/?_php=true&_type=blogs&_r=0

Additionally, if your locality has a caregiver support program, a caregiver counselor may be able to line up training classes for you. The Washington state DSHS website has this info:

http://www.altsa.dshs.wa.gov/caregiving/training.htm

Advance training for caregiver duties may be desirable, but isn’t always possible with a sudden increase in responsibilities and a hectic schedule. However, it is nice to know that there are many resources available on the Internet and locally.

Surviving the emotional aspects of eldercare

Yesterday, Dad was having a rough day emotionally. After a few frustrating attempts to improve his mood unsuccessfully, I had an Aha! moment. So, I switched tactics and said this:

“Focus on the positives in life. Focusing on the negatives doesn’t fix anything.”

The aging process brings on many changes, not all of them welcome. While we may have more wisdom with life experience, we also have more aches and pains. Additionally, diseases such as Alzheimer’s and Parkinson’s, cause dementia and depression that are not completely alleviated by medication. These changes cause restrictions in our activities that we were once able to do freely. Understandably, people resent these restrictions, feel sorry for themselves, or experience a host of other emotions.

For more detailed information on dementia and depression in these diseases, here are a couple of links for publications and resources:

http://action.apdaparkinson.org/p/salsa/web/common/public/signup?signup_page_KEY=8130

http://www.alz.org/care/overview.asp

Responding empathetically to these feelings in our parents requires patience and a willingness to change our personal perspectives. Because many of the conditions that occur with the aging process are incurable, and can only be treated somewhat effectively, it can be difficult for both the parent and caregiver to experience.

Here is a nice, short publication from the WA state DSHS on the emotional aspects of caregiving:

http://www.altsa.dshs.wa.gov/caregiving/documents/Emotional%20Challenges%20of%20Caregiving.pdf

Know your resources.

If you are overwhelmed and cannot cope with the emotional aspects of caregiving, get help immediately. If you are suffering from severe depression from the strain of your caregiving duties, see your doctor. Remember, if you don’t take care of yourself, you won’t be able to take care of your parent.

If your employer has an EAP program, that may provide you with valuable benefits for free. Alternatively, your health insurance company may have resources you can access, such as an in-home assessment for your parent to determine what assistive devices they need. These services are confidential and usually provided for free.

Although you may not be familiar with the social services network, there are a wide variety of resources available to caregivers from a patchwork of government and private charities. Because family caregivers provide such a huge amount of valuable caregiving that would otherwise bankrupt government resources to provide, support is available at free or sliding scale rates to caregivers and the elderly.

Every state and county has a different set of similar websites and services. A quick check on the Internet should start to give you an idea of what is available. If you live in King County, WA state, Senior Services is an excellent resource for free and sliding scale respite care and other forms of assistance to caregivers. Here is the link:

http://www.seniorservices.org/

If you live in WA state, the state DSHS website contains a huge amount of resources. Even if you or your parent do not qualify financially for assistance, DSHS might still be a good resource for recommending support for your situation. Here is the link to the website:

http://www.dshs.wa.gov/

Everyone has a unique way of finding balance and inner peace. This can span from engaging hobbies, socializing, exercise, religious activities, or just sitting and thinking. Here are a couple of links I’ve come across looking for inspiration:

http://www.becomingminimalist.com/happiness-now/

http://bemorewithless.com/light/

Finally, here are some of my favorite cheerful thoughts for those days that drive you buggy. Feel free to make a list of your own and post them somewhere handy, or even memorize them.

  • Medicare provides access to healthcare and durable medical equipment that might otherwise be unaffordable to those on a fixed income.
  • We have clean, running water from taps, and municipal sewer systems that keeps us healthy and protects us from diseases like Typhoid.
  • We have access to abundant food from 24 hour grocery stores and programs like Meals on Wheels.
  • Our roof doesn’t leak.
  • We have family, friends, and community who love and care about us.
  • Flowers bloom in the springtime.
  • Tomorrow will be a better day.
  • Everything is temporary, even the worst of times end.
  • From Monty Python- Always look on the bright side of life! (Whistle a few bars of the tune).