when to remove the tube feed /or not

Nurses General Nursing

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my grandmother was diagnosed with [color=#0000cc]amyloidosis

of her spine in 2007

in 2008 the pea sized tumor grew to the size of a

grapefruit then a foot ball

they operated on her prone side (face down )

the doctor found the mass spread to her breast and was traveling up her brain

she survived the surgery

but was paralyzed from the hips down

and has deteratied since feb 2008

she is now on tube feed

she cant take in food or water she gets nauseated

they have her on 4 of dilladid every 4 hours

as needed due to her screaming in intense pain

my question is we realize now that she no longer has control of bowl, urine and other functions

and cant eat , and now the tube feed is making her sick and residual of 200 cc is coming out of the tube

we are preparing her for hospice

and my dad refuses to reduce her tube feed

thinking it will kill her

is this correct

or i figured since the body is shutting down

and the brain is in confusion and her output is very little it would be less pain and suffering on her

she gets bloated and gassy and cries out in pain

from it

her body wont absorb it anymore

but we dont know how to let her go

peacfully and humanly

she sleeps 21 hours of the day

and her dementia and pain is intesnse

please can you offer advice

for us

shes 90 years old

i dont want to see her suffer anymore

leah

her granddaughter

:scrying::cry::redbeathe

Specializes in critical/truama/alchol drug rehab.
hi leah,

you sound like a loving, sensitive granddaughter who only wants comfort for your grandmother.

i'm not sure i'm understanding why your dad wants her to remain on the g-tube?

is it because of guilt/fear that he would be causing her death by letting her 'starve'?

or is it related to some family dynamics involving unresolved anger, hurt?

clearly, the feedings are causing your grandmother more anguish and pain.

her body is trying to die.

she and it are ready.

these feedings are keeping her alive artificially.

she will not feel hunger, i can promise you that.

and, if she becomes dehydrated, her body will release endorphins which will serve as a natural analgesic.

another important consideration, is that she very well could be experiencing mental pain as well as the physical.

truly, there is work to dying.

much of this work is resolving the unresolved.

if there are outstanding tensions, now is the time to put them to rest...

that everyone needs to let grandma know that she is loved and valued.

this is NOT the time to hold onto grudges.

your dad needs to focus on his mom and her well being.

right now she is suffering.

you may want to remind him (privately) that you will not allow your grandma to suffer because of him.

you need to advocate for her, and let dad know that you mean business.

this is your grandmother's time and no one should be detracting from that.

i believe you know what i'm talking about, and also believe you know what you need to do.

you have excellent instincts.

so yes, the fdgs are adding to her pain...

as is possible/probable constipation.

i'm pretty sure the tumors are starting to obstruct her.

and yes, the ativan could be causing paradoxical agitation but it could also be the tension from your family.

haldol would be an effective alternative.

hospice needs to get involved immediately so they can do what they do best.

and more than anything, your family needs to redirect all their energies to your grandmother's best interests.

letting her suffer is inexcusable.

many hugs to you, honey.

and give your grandma a great big hug for me.:redpinkhe

leslie

How sweet of you

God bless you too

thanks

leah :heartbeat:heartbeat:heartbeat

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Specializes in long term care Alzheimers Patients.

Hi Leah

I just want to let you know my thoughts and prayers are with you. I have tears in my eyes as I read your posts. You are a wonderful kind granddaughter, and will make a wonderful nurse. I hope your dad listens to what hospice recommends, he needs to do waht is best foe your grandmother. Please keep us posted

Love debi

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Specializes in ICU.

would your dad keep a dog alive like this? i doubt it. he has to love his mom enough to let her go. technology can keep her "alive" for quite a while. would he appreciate being kept alive like this? what goes around, comes around. perhaps being blunt like this will give him something to think about for in his hour of need, you will be making the decisions...is this the lesson he wants to teach you? the example he wants you to follow when things are on the other foot?

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Hi Leah,

Continue to look to the Lord for your peace and strength. Your father cannot comprehend right now due to his own pain and denial. For now, let go and wait for hospice team to assist. Very soon, your father is going to need you more than you know. He has tons of vultures and critics at this back right now. Just be there for him, show him you are on his side, hug him and let him know how much you love him.

What a loving granddaughter you are. You love her deeply, hear her cries for Jesus and know her wishes. I WILL pray for peace and strength for you and your family. For your grandmother, I pray for her peace and will celebrate the day the Lord calls her home. It's all in His time, not ours.

God bless.

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Specializes in critical/truama/alchol drug rehab.
Hi Leah

I just want to let you know my thoughts and prayers are with you. I have tears in my eyes as I read your posts. You are a wonderful kind granddaughter, and will make a wonderful nurse. I hope your dad listens to what hospice recommends, he needs to do waht is best foe your grandmother. Please keep us posted

Love debi

God bless you and thanks for the support

leah:heartbeat

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Specializes in Emergency.

As the body begins to die, kidney function decreases, GI motility decreases, and GI absorption decreases. In essence, feeding her is making her situation worse. It's also thought that IVF exacerbates the "death rattle" when patients are dying because the patient is fluid overloaded. You can bring her comfort by stopping the feedings and limiting IVF as appropriate.

I'm sorry, but your grandmother is dying. You can help to give her a good death but you have a very difficult job ahead of you - which is helping your father realize that death is just around the corner. She needs permission to pass and she may be having nightmares because of the guilt she bears because she is dying and your father doesn't want to let her go. She may feel guilty about leaving him behind.

Please let your father know that stopping the feedings is not killing her. She is dying because of the cancer. Insist on him facing what is on the horizon and help him realize that he needs to help her pass with the least discomfort as possible. Perhaps her pain control needs to be more aggressive also - dilaudid 4mg every 4 hrs doesn't seem like a lot for someone dying of cancer. Is a PCA pump with oral pain lozenges for breakthrough pain an option? If she appeared more comfortable, would your father feel more comfortable about withholding feedings?

Again, help your father give your grandmother a good death. A death free of guilt, free of pain, and surrounded by loved ones...

Best wishes to you.

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