Jump to content

when to remove the tube feed /or not

Posted

Specializes in critical/truama/alchol drug rehab.

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

She is in the process of dying. Removing the tube feeding will, if she is still digesting any of it, speed the process.

I believe that letting her go is the moral and kind thing to do. But your dad feels, for obvious reasons, guilt about doing that.

Have you contacted anyone from hospice to come and talk with him and the rest of the family?

I hope earle checks into this thread.

BinkieRN, BSN, RN

Specializes in Med/Surg.

That's an extremely difficult situation. Is your Grandmother able to communicate in any way? Can her doctor intervene in her behalf?

I'm sorry you're having to go through this. I believe your father is thinking more of himself, losing her, rather than what may be best for her. If I were she and I knew I was dying and I was suffering I would ask to be let to die. Hopefully the doctor will be able to intervene.

God Bless you, your father and your dear Grandmother

nrsang97, BSN, RN

Specializes in Neuro ICU and Med Surg. Has 19 years experience.

(((Leah))),

I am sorry that you and your family are going through this. Sounds like the thing to do now is to stop the feed because she isn't absrobing it anyway. This is a hard decision to make. However removing the tube feed will speed the process, but will ease some of her pain and discomfort as well that you have described. Have you contacted hospice? Maybe a meeting can be arranged with you and the rest of the family?

Prayers and blessings to you and your family Leah at this time.

angelwings777

Specializes in critical/truama/alchol drug rehab.

She is in the process of dying. Removing the tube feeding will, if she is still digesting any of it, speed the process.

I believe that letting her go is the moral and kind thing to do. But your dad feels, for obvious reasons, guilt about doing that.

Have you contacted anyone from hospice to come and talk with him and the rest of the family?

I hope earle checks into this thread.

dad is drving me and mom nuts

he finally decided to move her to hospice

and near our house

but he is the one that wont let go

and Gram cires out "i want to be with Jesus " why am i here "

it has been so stressfull for us

to make a long story short my dad doesnt have any of his famlies support

and they are lingering like vultures waiting for her to die

and dad hopes she will use up her moneys by keeping her alive long enogh

so he dont have to give a dime to the freeloaders

money is not everything

i think this woman that is 90 deserves to die with dignity

the whole frekking house has grams stuff here its a viritual shrine

and im going nuts from it

trying to grt through lpn school and deal with all this

and living with parents which i had to do in order to afford my schooling

just say a prayer for me

its gonna be a long haul :/

and the min i get that lpn degree

im off to Las vegas !

leah :confused:

chenoaspirit, ASN, RN

Specializes in Med/Surg, Home Health.

Well, I feel that when treatment is causing more pain than good, its time to stop. If the tube feeding is causing her to cry in pain and making her bloat, and you say she isnt absorbing it, it sounds like it isnt doing any good anymore anyway. Large residual can actually cause her to aspirate. I know this is very hard on you and your family. Ive been with many families when they had to make such a hard choice. But the family has to make the decision that they can live with. People can live for a long time without food. The main thing is to make her as comfortable as possible...meds to ease pain, turning her every 2 hours, fluffing pillows, and definitely providing her with GREAT oral care. I think the family needs to sit down with the doctor and have a long heart to heart talk about the pros and cons of all treatments involved. Then together the family should sit and discuss the options and decide together. God bless you, your family, and your grandmother.

to make a long story short my dad doesnt have any of his famlies support

and they are lingering like vultures waiting for her to die

and dad hopes she will use up her moneys by keeping her alive long enogh

so he dont have to give a dime to the freeloaders

Can you gently point out that by wanting to punish the vultures he is punishing his mother?

:(

angelwings777

Specializes in critical/truama/alchol drug rehab.

Well, I feel that when treatment is causing more pain than good, its time to stop. If the tube feeding is causing her to cry in pain and making her bloat, and you say she isnt absorbing it, it sounds like it isnt doing any good anymore anyway. Large residual can actually cause her to aspirate. I know this is very hard on you and your family. Ive been with many families when they had to make such a hard choice. But the family has to make the decision that they can live with. People can live for a long time without food. The main thing is to make her as comfortable as possible...meds to ease pain, turning her every 2 hours, fluffing pillows, and definitely providing her with GREAT oral care. I think the family needs to sit down with the doctor and have a long heart to heart talk about the pros and cons of all treatments involved. Then together the family should sit and discuss the options and decide together. God bless you, your family, and your grandmother.

thanks

she can verbalize that she wants to go home (heaven )

but she is now suffering from dementia

and the mass is goign to the brain now

and she forgets things

also why do dying people have nightmares ?

or is it due to the lack of oxygen in the brain ?

she tells me all these bad dreams

i was wondering if the atavan was doing that ?

or is it the pain meds

i want to tell the doc that she shoudl prolly be on a

med for her confusion

maybe haldol ?

thanks

leah

:banghead:

Leah, when did she get to hospice? The hospice peeps will figure this out.

angelwings777

Specializes in critical/truama/alchol drug rehab.

Can you gently point out that by wanting to punish the vultures he is punishing his mother?

:(

in my opinion hes hurting her more than they are

the hard part for me is Grandmother is a good christian

loving and kind

giving and dad is bitter and unforgiving

belive you me i have talked till im blue in the face

to him about it

its just so sad

i wanted her to be like the ones that just fall asleep and pass on peacfully

on a couch or somthing and it aint gonna happen that way

so i figure better have her sedated and no pain than comimg in and out

of pain and confusion

thanks

God bless you

leah :crying2::redpinkhe

angelwings777

Specializes in critical/truama/alchol drug rehab.

Leah, when did she get to hospice? The hospice peeps will figure this out.

she will be placed in hospice this week

thank God

so hopfully they can talk to the hard head :/

i have seen dying people

and i told my mom and dad i will not allow this to happen to you

if it gets like this

you get a whole different perspective on it when you work around it 24/7

i see people (et) tubed and knwoing that some are too weak and will be vent dependant the reat of their life

and that is sad :(

but it is a hard decision like you say it has alot of factors to take into

:cry::heartbeat:redbeathe

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

angelwings777

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

Debilpn23

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

mpccrn, BSN, RN

Specializes in ICU. Has 30 years experience.

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?

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.

angelwings777

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

kmoonshine, RN

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.

Guest
This topic is now closed to further replies.