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Suggest Treatment For Swollen Ankles And Feet
Question: my 92 year old dad has liver (diagnosed in May) and bone mets (found 3 years ago and treated with Radiation) from Thyroid Cancer, he is confined to his recliner 24 hours a day, only moving to use the commode which is beside the recliner. He has Congestive Heart Failure and a Pleural Effusion which is drained twice weekly of about 1200 ccs each time. The fluid has recently become more red in color from a yellowish. His feet and ankles are swollen in the last week, quite significantly. His appetite is diminishing but he still eats small meals. How long does he have.
Brief Answer:
It is very difficult to predict with certainty.
Detailed Answer:
Hello,
I am Dr Dhananjay Chavan, MD. I am a geriatric psychiatrist.
We know statistics about average survival of various cancers depending on their grade (how malignant the growth is) and stage (how advanced and widespread it is). However, these are essentially just averages. For example, if mean one year survival of a particular cancer is just 10%, one would still not know whether you are in these 10% or not.
Each individual even in the group of same cancer type varies considerably in length of survival.
In your father's case: he is 92 and has at least three conditions that can be fatal. He is refusing treatment. All this makes him even more vulnerable for many additional conditions that can also be life threatening.
He may suddenly collapse due to a sudden exacerbation in cardiac failure or an added complication such an myocardial infarct (heart attack), stroke or severe infection leading to multi-system failure. This sudden decline and demise is a real possibility if he is not cared for in an intensive care set up.
In such a case, you should prepare yourself and your father's near and dear one's about the possibility of an imminent demise.
If your father has refused all treatment (I assume that means medications and hospitalization but not pleural tap since he is allowing draining of the pleural effusion), it is reasonable assumption that he is prepared himself for his death. You may ask your father about any wishes he may have including his immediate comfort such as room temperature, clothing, type of food he prefers or even if he wants to listen anything in particular. If he is a religious person, you may discuss that aspect with him and his priest.
To answer your question again, it is not possible to give an estimate. He probably has weeks to months rather than months to years.
There are times when such a prediction is possible. For example, if a person is on certain life supports such as artificial respiration or medications to keep his heart pumping when his lungs are not functioning adequately on their own and heart is not maintaining adequate blood pressure on its own. In such a case, removal of these life supports can lead to death immediately.
I hope I have answered your question. If you have any further queries, I will be happy to help.
It is very difficult to predict with certainty.
Detailed Answer:
Hello,
I am Dr Dhananjay Chavan, MD. I am a geriatric psychiatrist.
We know statistics about average survival of various cancers depending on their grade (how malignant the growth is) and stage (how advanced and widespread it is). However, these are essentially just averages. For example, if mean one year survival of a particular cancer is just 10%, one would still not know whether you are in these 10% or not.
Each individual even in the group of same cancer type varies considerably in length of survival.
In your father's case: he is 92 and has at least three conditions that can be fatal. He is refusing treatment. All this makes him even more vulnerable for many additional conditions that can also be life threatening.
He may suddenly collapse due to a sudden exacerbation in cardiac failure or an added complication such an myocardial infarct (heart attack), stroke or severe infection leading to multi-system failure. This sudden decline and demise is a real possibility if he is not cared for in an intensive care set up.
In such a case, you should prepare yourself and your father's near and dear one's about the possibility of an imminent demise.
If your father has refused all treatment (I assume that means medications and hospitalization but not pleural tap since he is allowing draining of the pleural effusion), it is reasonable assumption that he is prepared himself for his death. You may ask your father about any wishes he may have including his immediate comfort such as room temperature, clothing, type of food he prefers or even if he wants to listen anything in particular. If he is a religious person, you may discuss that aspect with him and his priest.
To answer your question again, it is not possible to give an estimate. He probably has weeks to months rather than months to years.
There are times when such a prediction is possible. For example, if a person is on certain life supports such as artificial respiration or medications to keep his heart pumping when his lungs are not functioning adequately on their own and heart is not maintaining adequate blood pressure on its own. In such a case, removal of these life supports can lead to death immediately.
I hope I have answered your question. If you have any further queries, I will be happy to help.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you, I do understand that he is terminal, we were told 3-6 months in May. He takes his regular medications for blood pressure etc daily and is of sound mind. He does know he is going to die and is comfortable with it. I guess I am trying to figure out if they new swelling in his legs and now red colored fluid in the Pleural space are symptoms that point to more imminent demise. He is under hospice care and still at his home with family care givers, not a medical facility. I recognize that you cannot pinpoint an exact time.
Brief Answer:
Yes, you are right. Can't pinpoint an exact time.
Detailed Answer:
Hello.
Yes, you are right. Based on what medical science knows today and based on your input, it is not possible to pinpoint an exact time.
If he is of sound mind at this stage, it means he is not in delirium. Oftentimes, when things start deteriorating in extreme old age, delirium sets in wherein a person's consciousness is impaired; he becomes disoriented, distractible and may also hallucinate. Doesn't happen in every case but it is common and is a pointer.
Well, if you do not have any clarifications, you may close the discussion and rate the answer. Wish you good health. Take care.
Yes, you are right. Can't pinpoint an exact time.
Detailed Answer:
Hello.
Yes, you are right. Based on what medical science knows today and based on your input, it is not possible to pinpoint an exact time.
If he is of sound mind at this stage, it means he is not in delirium. Oftentimes, when things start deteriorating in extreme old age, delirium sets in wherein a person's consciousness is impaired; he becomes disoriented, distractible and may also hallucinate. Doesn't happen in every case but it is common and is a pointer.
Well, if you do not have any clarifications, you may close the discussion and rate the answer. Wish you good health. Take care.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Could you possibly comment on the color of the fluid pleural effusion and sudden swelling if the legs and feet.
Brief Answer:
Spread of cancer or trauma can cause reddish color
Detailed Answer:
Earlier serous (light yellow) color of effusion fluid could be explained as due to heart failure. Change in color to red may indicate that cancer has spread or there has been some kind of trauma.
Sudden swelling of legs and feet can be due to various reasons including worsening heart failure, kidney disease, lack of protein in body, some kind of obstructive pathology in abdomen that is affecting drainage from both feet etc.
Hope you get enough rest as caregiving can be very stressful.
If you do not have any clarifications, you may close the discussion and rate the answer. Wish you good health. Take care.
Spread of cancer or trauma can cause reddish color
Detailed Answer:
Earlier serous (light yellow) color of effusion fluid could be explained as due to heart failure. Change in color to red may indicate that cancer has spread or there has been some kind of trauma.
Sudden swelling of legs and feet can be due to various reasons including worsening heart failure, kidney disease, lack of protein in body, some kind of obstructive pathology in abdomen that is affecting drainage from both feet etc.
Hope you get enough rest as caregiving can be very stressful.
If you do not have any clarifications, you may close the discussion and rate the answer. Wish you good health. Take care.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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