Please help. Just found this on my dad's back.

[sprigatito]

My dad's partner died of cancer a few days ago, he and I were with her when she died, and I've brought him home with me until the funeral (and probably permanently). He's got Alzheimer's and his partner was his carer. He's been looking pained and twisting his shoulder, he said it's just a spot, but I made him show me his back and found this. It looks just like the squamous cell carcinoma he's had removed before, only it's enormous. He's lost weight and is pale and more vague and breathless than usual, but I thought it was just grief

This is really fucking bad, isn't it? He survived stage 4 lymphoma in 2017 and has a heart condition. I have a doctor calling me back from 111, but should I just take him to A&E?

And thank you it's so helpful to have someone to talk to.

I'm the same!
Have to be in control of everything.
Must have answers to things immediately.
Want quick action.

And suffer with severe anxiety, and catastrophise things. I'm autistic. Are you? Your dad is, so you might be.

My eldest is autistic, and it's been a long series of "oh....fuck" revelations when I look back at my own childhood 😂 I am pretty certain I am. And it really doesn't help when one needs to respond "normally" to stressful things.

Ha!
I was diagnosed in my 60s.
It helped to make sense of my whole life.

It’s super frustrating. But looking the situation objectively - there’s only one outcome for elderly people. It’s a question of when not if. You can’t make yourself personally responsible for keeping him alive - it’s very stressful to give yourself that role - I tried and I had to stop.

I understand the feeling of urgency, but you may need to step back and say what will be will be. Because you can’t speed the NHS unfortunately.

It’s true it could metastasise but that process may already have started before you even found the lesion, and the lesion could itself be a metastasis. Even if it hasn’t metastasised, that doesn’t mean another won’t spring up somewhere else, or that his lymphoma won’t return.

Sorry everything is so tough.

Just a suggestion but my Mum with dementia at the point of irrational decisions could be easily distracted by a small glass of wine.

Not necessarily drinking much, more I suspect the ritual and connections to relaxing in the evening and not dashing off home on trains or fretting about things.

Obviously that may not work with his painkillers.

He can't have alcohol while he's on the antibiotics, but that's a really good idea for when he finishes them. He'd love a glass of wine in the evening and it would be a really good distraction when he starts sundowning and agitating to go home.

@Mirabai I've read your last post several times this evening, it really struck a chord. I am trying to keep him alive through sheer force of will, and it's driving me crazy. Tomorrow I am going to try and take a couple of hours to do something I really enjoy, and not think about cancer or what's ahead. Thank you.

I've redone the dressing tonight and it's ulcerated further, it's got a really deep hole in the middle now. Have upped his pain killers, and if it turns hot or he gets a fever we'll go to A&E.

You can get some really quite convincing non-alcoholic wines and beers these days.

Earlier this year I was staying with some relatives of DP, and the elderly father was in the earlyish stages of vascular dementia. He was prone to falls and on various meds that weren't great with alcohol, but his family and carers offered him a glass or two of alcohol-free wine (he thought it was the real stuff) every evening to keep up his usual routine, and that seemed to work for them.

Not sure what antibiotic your beloved Dad is on OP but maybe having a small drink is ok in moderation.

interactions

I think most antibiotics are safe to drink on now.

As long as it isn't Metronidazole, that one makes you really sick. Others are usually fine.

The risk is mainly it increases the chance of an upset stomach, and antibiotics can cause that on their own.

Hi OP, I'm sorry for your predicament. My DH has secondary cancer that has metastasised in his bones and he has a few large lumps like this, with more smaller ones seeming to appear in a regular basis. One on his back is huge but non painful, but a large one on the back of his head is extremely painful. We were told at first it was a cyst but it's now been confirmed to be a cancerous lesion. In DHs situation it is running deep and they will not excise it. They have however offered some radiotherapy which will hopefully help relieve some pain. My DH had his appointment this week to prep him for radio treatment on his head, and the first treatment will take place in about 10 days time.

He did however have to consent to the treatment, and I don't know how advanced your DFs dementia is to do this? He may also have to have an MRI or CT scan first so they can get a proper look at the tumour (if it's confirmed as this) and how deep it is. Would he be able to manage a scan?

A very difficult time for you and I empathise completely.

I'm so sorry about your DH and what you are both going through . I have a suspicion that my dad's lesion could be a metastasis from lung cancer, based on where it is and his other symptoms, but I am far from an expert and there are lots of other things it could be. Whether he has capacity to consent to treatment is tricky, he might well have the ability to make an informed decision in the context of one conversation where everything was explained, but he might forget it an hour later or change his mind.

I think he'd be fine with a scan though, and will push for that and blood tests when we see the dermatologist.

It's certainly possible that the lesion is a secondary from lung cancer, OP. The weight loss and cough are suggestive

A CXR will be useful.

Is your dad likely to keep still enough for a scan?

Yes, I think he'll manage that. He tends to be very compliant for doctors, he saves his orneriness for me 😂

@sprigatito Mental Capacity is question specific, not a generic term or state. So for your poor dad, a MC assessment would need to be carried out and the question would be something like “does name/dad have the capacity to make an informed decision about having treatment for cancer (or other)”
He would need to show he understands and can retain the information given to him about it, and the crucial bit is, can he retain that information long enough to make an informed decision.
It may be that he can only retain the information for 5/10 mins and then forgets what he said but as long as he can understand and make a decision that will be fine.
It doesn’t need to be a social worker that completes the MCA, a doctor, nurse, OT or other health professional can do it.
Hope you dad is not in too much pain, he is lucky to have such a lovely caring daughter. Do look after yourself as well though, you have had a tough time. 💐

@AdmittowearingCrocs that's really helpful, thanks for explaining it. I think dad will probably be very involved in any decisions in that case, his understanding in the context of a single conversation is very good.

WARNING: gross description of wound!

Is anyone medical around to answer a couple of questions? My dad's lesion has changed and I just want to know if I'm caring for it properly until he's seen on Wednesday.

A couple of days ago it developed a hole in the middle, this has now become really deep and it's leaking quite a lot of slightly brownish, mostly clear fluid. There are also a few white and yellow bits of matter. The edges of the ulcerated bit are sort of crumbly, like the flesh is liquefying. I can't see the bottom of the ulcer as it is so deep - should I be trying to clean inside it? So far I'm just changing the dressing every day and leaving it be, but I've just done today's change and the gauze pad was soaked. I did think his back felt a bit hot, but there's no horrible smell and he doesn't have a fever. Any advice on how to manage it for the next few days would be appreciated (and sorry again for how unpleasant it is)

Again, I really think A&E

I think I agree that a&e may be the best option here. What a worry! I'm so sorry.

You shouldn't be changing his dressing imo, I know it's Friday so too late now but they should have arranged a dressing change with a nurse at the GPs or arranged a community nurse visit to get a hcp to do it. I'd really advise against A&E, maybe the walk in centre again Sat a.m? and perhaps they can arrange wound care with your practice until his opa. Good luck.

I’m so sorry you’re in this situation. I agree A&E and you and your father shouldn’t have been left without this support in the first place. The referral pathway is one thing but wound care support is entirely another that the GP should have guided you on.

The doctor we saw at the walk-in centre told me to change the dressing, I bought some the same as the one he'd put on it. If I didn't change it surely it would get infected really quickly, given that it's now soaking the pad within a day?

I'm not going to take him to A&E on a Friday night, the wait last Friday was 10 hours (the app hasn't been updated since then!)

Just feel like I've been left to deal with this without any support or real advice apart from "wait until the 5th of June" 😞