Brief Answer:
don't loose hope yet, chances are still there..

Detailed Answer:
Hello XXXX, Welcome to HCM,
I've gone through your query and understand your concern for your wife,

First of all, extremely sorry to hear all these your going through for such a long time..

Now from your description, it seems that there's some advanced stage of metastasis with a suspicion to spread to liver..

Please let me know few more details, i.e. the current list of medications, complete reports of the latest investigations done sp. the CAT scan and any blood investigations done (you can simply upload them at the reports section or alternatively you can e-Mail them to YYYY@YYYY and keep the Subject as ATTN:Dr XXXXXXX and I'll receive them)..

Let me know if there's any ongoing chemo-radiation at present or when last it last given..

Xarelto is a newer generation anticoagulants and generally quite safe option compared to the older conventional ones, please let me know why she was prescribed this(any blood clot/ heart rhythm abnormality or something else) ?

How is her latest hemogram, liver function and kidney function as well as coagulation profile status ?

Yes, as per your description the BMI of her is ~14 which is quite in the under-weight range..

Please keep monitoring the body weight every weekly and take a note of them, if you notice any rapid declining trend then that is cause of concern..

Good to know that the sensorium is intact, that's extremely important parameter, indicating that it's not in the dangerous range yet.. Please keep an eye on this frequently, it's extremely important that it remains so..there should not be any mind-fogging, certain development of weakness over any part of the body, excessive drowsiness etc. and if at all any of them noted then immediate hospitalization or visit to your nearest ER is advised..

I can understand that it's extremely difficult to maintain feeding if she's not been able to eat, but it has to be done as nutrition maintenance is extremely important at this stage to combat with the ongoing catabolic state, so I'd request you to consider other options for providing nutrition.. under strict medical supervision, placement of naso-gastric/naso jejunal tubes for long term feeding, it'll be really helpful, and it won't be painful as it's done under local anesthesia, just counsel her beforehand that it's necessary to bring back some strength and most importantly proper nutrition for fighting against the long term disease process..she has to be agreed on this, if you can't make her agree, please seek help of your paramedical-nursing attendants, as it's extremely important at this point..

Once it's placed, seek out a dietitian for preparation of the proper diet chart to ensure high protein-mod calorie-high fiber diet chart preperation along with formula feeding solutions (several advanced options available in this regard starting form Protinex powder etc.)..

Being able to walk, talk, well preserved sensorium are all positive signs that she's gonna make it for those another 10 days..but as I've mentioned proper nutritional replacement has to be started without further delay..

Be extremely cautious so that someone accompanies her to the wash-room, be vigilant for any signs easy bruising over any body part, sudden onset development of any swelling, any reddish urine/motion , any abrupt vomiting, any excessive blood tinged sputum/cough, sudden onset fever- if at all observed needs immediate hospitalization for aggressive management..

I've tried make it as simple as possible for you to understand regarding what to do in between these 10 days,as well as for long-term future, please let me know if any further queries..

Don't loose hope yet, even though it's in the advanced stage, but still with proper nursing, adequate nutrition, timely monitoring and follow-ups- certainly the quality of life can be improved to quite an extent..

My Best Wishes..

Take Care
Kind Regards

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