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Thread: Mom with Spinal Stroke--help!

  1. #1

    Mom with Spinal Stroke--help!

    Hi,

    My mom has renal cell carcinoma (kidney cancer) that has spread to her spots on her bones, specifically her spinal column that caused a compression fracture at her T5. Her right kidney was removed 8 months ago and she is responding well to chemo (it is not progressing and showing some signs of healing) however, this type of cancer is not curable.

    A little over 2 weeks ago, her back pain became significantly worse and they took another MRI and saw that the compression fracture was in fact compressing the spinal cord. They decided to do back surgery to relieve the pressure but because of the type of cancer and its tendency to be very bloody during surgery, they decided it was necessary to do a spinal embolization prior to surgery.

    When they did this, it paralyzed her from the waist down and they have told us she had a spinal stroke. They moved her to ICU and pumped her with steriods and pushed her blood pressure up to try to push blood back to the spinal cord.

    2 days ago they moved her out of ICU and the doctor over the rehab program came in today and told her he is not willing to do rehab on her if she chooses to continue chemo as it would make her too weak. So a choice, chemo and you can't walk or walk again but die from the cancer. He fears damaging her back further.

    She is in Arkansas, a state with 2 million people total and I am in Orlando, FL. They do not have an speciality rehab programs for SCI but rather a general rehab facility (this is at the state's largest hospital).

    In Orlando, through the Orlando Health network, we have MD Anderson Cancer Center and the Rehab program hear is accredited in SCI and is one of their speciliaties with a partnership with the Shepherd Center in Atlanta. So, we want to move her here.

    She is 60 years old, never been sick, worked 2nd shift in factories her whole life and we believe she deserves another opinion and chance, despite her age...

    Any support, suggestions, advice, reality checks are appreciated.

  2. #2
    I am so sorry to hear about this. This is quite a difficult decision to make. I think moving her to Orlando would be wise. I know that in Miami they have http://www.miamiproject.miami.edu/Page.aspx?pid=183.

    I wish you the best.
    T-7 Complete
    "If you don't like something, change it; if you can't change it, change the way you think about it."

  3. #3
    Quote Originally Posted by sstaneart View Post
    Hi,

    My mom has renal cell carcinoma (kidney cancer) that has spread to her spots on her bones, specifically her spinal column that caused a compression fracture at her T5. Her right kidney was removed 8 months ago and she is responding well to chemo (it is not progressing and showing some signs of healing) however, this type of cancer is not curable.

    A little over 2 weeks ago, her back pain became significantly worse and they took another MRI and saw that the compression fracture was in fact compressing the spinal cord. They decided to do back surgery to relieve the pressure but because of the type of cancer and its tendency to be very bloody during surgery, they decided it was necessary to do a spinal embolization prior to surgery.

    When they did this, it paralyzed her from the waist down and they have told us she had a spinal stroke. They moved her to ICU and pumped her with steriods and pushed her blood pressure up to try to push blood back to the spinal cord.

    2 days ago they moved her out of ICU and the doctor over the rehab program came in today and told her he is not willing to do rehab on her if she chooses to continue chemo as it would make her too weak. So a choice, chemo and you can't walk or walk again but die from the cancer. He fears damaging her back further.

    She is in Arkansas, a state with 2 million people total and I am in Orlando, FL. They do not have an speciality rehab programs for SCI but rather a general rehab facility (this is at the state's largest hospital).

    In Orlando, through the Orlando Health network, we have MD Anderson Cancer Center and the Rehab program hear is accredited in SCI and is one of their speciliaties with a partnership with the Shepherd Center in Atlanta. So, we want to move her here.

    She is 60 years old, never been sick, worked 2nd shift in factories her whole life and we believe she deserves another opinion and chance, despite her age...

    Any support, suggestions, advice, reality checks are appreciated.
    sstaneart,

    The first and the most important decision is whether your mother will undergo chemotherapy. As you point out, because of the multiple metastases, this cancer is not likely to be curable by the chemotherapy. Chemotherapy will prolong her life. It is possible that additional therapies will appear during the period that may be more effective and it is also possible that she will belong to that small fraction of people where chemotherapy results in a prolonged remission. However, the more realistic hope is that the chemotherapy will postpone progression of the cancer for a period of time. Achieving the best quality of life during this period should be the goal. For obvious reasons, the length of the period is important. For example, 6 months is different from 6 years. So, when you and your mother talk to the oncologist, you should obtain estimates of the time and engage in realistic planning concerning what she wants to spend that time doing. If the time is longer than expected, that is cream on the pie.

    Second, the decision of whether or not to undergo rehabilitation and locomotor training will depend on whether or not your mother chooses to undergo chemotherapy and how she responds to the chemotherapy. If she decides to undergo chemotherapy, she should not be doing intensive locomotor training while she is receiving chemotherapy. Please note that she should get rehabilitation (i.e. range of motion, standing, and other activities that does not require intensive training) during and after the chemotherapy, just not the intensive locomotor training. Choosing to do chemotherapy postpones the decision for locomotor rehabilitation until it is clear how she is doing and what she is able to do.

    I do understand what you are saying, i.e. that your mother is being forced to choose between length of life and walking. However, I suggest framing the decision in another light. The decision should based on what your mother wants to do with her life in the time that likely remains. Please understand that if she doesn't undergo chemotherapy and engages in locomotor training, it is not clear that she will regain walking. Also, in the coming months, other factors, such as pain and renal failure, may also assume a more dominant role than the spinal cord injury.

    Wise.

  4. #4
    I am so sorry about your mother!

    Unfortunately, spinal cord damage from metastatic tumors of the cord and spine are common with renal, bowel, prostate, breast and lung cancer. They tend to be fairly late mets, and are not good prognostic signs for survival of the cancer.

    In my experience, people who have paralysis due to metastatic lesions do best to get home and made as comfortable as possible, rather than trying to drag them, often in fairly severe pain, through a comprehensive interdisciplinary rehabilitation program. We also do not admit these patients but will provide consultation to their primary care team (usually palliative care) for the SCI related issues. I would not to haul her across country to a program that very well may make her remaining life miserable. If her chemotherapy effects a cure for her cancer, once she has recovered from the chemo, she could be reconsidered for an acute rehab stay.

    I would also not recommend sub-acute (nursing home level) rehab for her. A home program would be best, that can be adapted to her needs and the stresses of her cancer and chemo, and it would allow her to be in her own home with her own family around her.

    She may still be eligible for some services from the Arkanasas Spinal Commission, so I would still recommend contacting them and asking for a case manager to be assigned.

    (KLD)

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