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when is enough enough
My Mother is 75 and has had a shunt in her brain since 1979 since than she has had lung cancer in 200+ which resulted in a lower right quadrant lobectomy radical radiation and the cancer has spread throughout her body  she also presents with diabets and high blood pressure she had shunt failure this past december she has been thriough several hospitals some neurosurgeons did not want to deal with it but at the insistance of a family member they attem[ted to remove the old shunt and replace it with the knowledge that it may due more damage than good ad the request of family member the old shunt was removed and another put in since then the new shunt failed and the old shunt shattered she is now awaiting surgery because of an open wound and new shunt failure she is hospitalized in icu on a ventilator and has a lung infection and infection in the brain... are thes lifesaving procedures or since there is abnormal brain activity and a low level of conceiousness due to siezures and to much stress on the body I think/// at what point would a docter not continue treatment and what could the outcome be


This discussion is related to VP shunt removal.
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Dear Concerned,
I'll try to give you my thoughts on this, to sort of organize this thing.  If she's had a shunt since 1979, I wonder if it is still needed.  Could be the best thing would be to let that go, IF the docs think she no longer needs it.  I mean, for all I know, she needs it even after all these years.

So, let us say she does not need the shunt.  This simply leaves closing the wound there.  But if she does need the shunt, then the docs will of course need to try to get another one in, which I do not think is out of the realm of possibilities...they got one in, so they can get another one in, is my way of thinking.  In either case, shunt or no shunt, the area's infection has got to be cleared up, and is, in and of itself, a danger to her life.

Now, on the lung cancer and her current lung infection, once again the infection has got to be cleared up.  So, let us say both the skull and lung infections clear up.  This means she will be back like she was before this shunt routine.  Could be she will feel worlds better, not suffer too much damage from the shunt procedures, and what you have left is a person who still has lung cancer that has spread throughout her body, I believe you reported.  You did say something about seizures, I am assuming she did not, that you just thought maybe that was why she was doing so poorly.  But if she did have seizures, then once she wakes up, the doctors can decide if they did her any lasting harm...therapy can help this, depending on profound the injury to her brain might have been.  This is a disturbing thought and significantly would affect her quality of life, which if she has a directive concerning not wanting to live with poor quality of life, it should be respected.

I am assuming that she is receiving some sort of cancer "control" type treatment, perhaps some sort of chemotherapy, to hold at bay the cancer she has in her body.  You might therefore ask her oncologist physician to weigh in on what her prognosis is, as to length of survival and so forth, with her cancer. Let us say he says they can continue her current cancer treatments for perhaps five years, and she will be able to function as before until it finally is no longer controllable by chemotherapy or whatever treatment she is receiving for cancer.  But if he says she's only got six months, that also will carry a lot of weight when considering how much more this poor woman has to go through.

This means (a) if infection in skull and lungs are treated successfully and she wakes up and is coherent, (b) any seizures did not do significant permanent damage, (c) her cancer control outlook is for five years, then I'd hang onto your mother until she recovers as stated in (a), (b), and (c), and bring her on home and THEN she can continue to be treated for high blood pressure and diabetes.  While 75 years old sounds old, particularly in a cancer patient, it really is not.  Many people of varying ages suffer from the conditions of cancer spread, diabetes and high blood pressure and live many, many years.  But I do see her as in crisis right now, with infection the MAIN difficulty, which is not a small difficulty, AND she is a cancer patient, which her oncologist is the only one who can determine if she will live comfortable for however many years that seem acceptable.

But if at any point her skull and lung infection does not clear, or the seizures have ruined her brain, or her cancer outlook is dismal, or she does not wake up, well, I am sure the physicians at the hospital where she is now will let you know that things have gone out of control and she is likely to die as a result of the combination of all her health issues, and I imagine they would recommend she be taken off the ventilator and let her pass naturally.  You can ask those doctors if they take her off the ventilator, will she die shortly thereafter, or is there a possibility she would live on in a semiconscious state and in a lot of pain, which is not acceptable.  So, the next question for the hospital docs is, if she would live on in pain, then eventually would any morphine-like drugs very likely bring on death, which would be the desired outcome.

I hope my thoughts and organizational notions can help you figure out the steps that may be involved in getting your mother back.  But of course the moment a physician says to you that the outlook is poor for your mother and it's cruel to keep her on a ventilator, then you and your family will need to ask those last couple questions I suggested in the last paragraph, and then let her go.  God bless you and your family and your mother, I think it is good you are looking into a worst-case scenario, particularly when she has two infections that have had a huge impact on her survival, not to mention her cancer spread situation, and I hope whichever way it goes, that you will fully understand what has happened and why she had to leave or if any weight should be thrown to the side of survival.  
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