We would like some information about where to go as we have not been able to get the information from the medical community that we need in order to make the right decision for our dad.
Our father is an 83 year old man who is trying to decide whether to go home on hospice or to have the dual surgeries: free flap surgery and debriding of his head wound.
The facts:
Cancer history – has had numerous basal, squamous and melanoma over his head, neck, back, chest, arms over the past 30 years; lost left ear to sqamous cell carcinoma in 1980, lost major portions of the top of his head and neck muscles –front and back- in ‘86 & ‘87 followed by three, six week rounds of radiation at that time which resulted in little skin covering the top of his head and significant loss of healing ability on the top of his head. Over the past year an open wound on the top of his head has gone from slightly larger than a silver dollar to about 4" x 3". As of November, dad has suffered some kind of brain irritation resulting in what looks like seizure activity. His seizure-like, or tremor, activity (doctors have been unable or unwilling to definitively call them seizures) has increased dramatically over the past couple of weeks. He is now on seizure medication which is, for the moment, controlling this activity.
Over the past two or three weeks we have seen a rapid deterioration in our father’s ability first, to walk, to eat by himself, to speak, basically to function independently. Incredibly, the doctors are not sure whether he has had a stroke and the symptoms did not come on all at once, they came on gradually.
He has been in the hospital for the past two weeks. While he had a cat scan in November which was clear, the MRI that he had ten days ago and the cat scan that he had three days ago show some darkened area that the doctors have said is either cancer (tumor) or an infection from the very large wound on the top of his head.
Early in this hospital stay the doctors suggested our father be transferred to UCLA for two surgeries: the debriding of the wound and free flap surgery to transfer muscle from his abdomen to the top of his head in order to cover the wound. So, for most of dad’s hospital stay we have been under the impression that he was waiting for a bed at UCLA. However, during this time, he has been losing strength and functions (as mentioned above) and we found out today that the infectious disease doctor and the internist believe these surgical interventions are too risky for our dad. They state the risks as being: dying while in surgery, being in a permanent vegetative state, permanently on a ventilator, etc. Dad’s neurologist is not so certain that the surgery is the greater risk. We will hear from the neurosurgeon tomorrow. All this is further complicated by the fact that our dad has weak kidneys and atrial fibrillation.
Until the past month, Dad was pretty strong.
Our questions are these:
- Is it too early to be thinking about hospice at this point/ is the free flap surgery a real option for our father?
- Are there any free flap surgeons out there that can give us information on whether this surgery would be useful for a man with all of these conditions?
- BOTTOM LINE: Do the risks outweigh the potential gains of the surgery?