Untreated DVT

[Jenasaurus]

My mum has secondary cancer in her lymph nodes following ovarian cancer, she also has alzeimers and is in a nursing home. Her recent ct scan showed a pulmonary embolu and a DVT she was prescribed blood thinning injections. The home have said she is refusing to have them and so they have changed her to tablets but is also refusing to take these. I am obviously concerned and don't know what to do to help resolve things. Can a patient with alzeimers be forced to take blood thinners or is that cruel, I am very anxious and worried about what will happen and if she will suffer without them

Im guessing given the unique circumstances no one can relate, hence no replies. I looked on the cancer forums and posted there too but they are also slow moving so will wait until tomorrow and speak to the oncologist. Would have done this anyway but wanted some reassurance or advice from anyone who was facing or experience of similar

I work with dementia patients and you could ask the nurses to push for covert medication. The medication may not be suitable however and the MDT involved in your mums care may decide it is not in her best interest.

I wish I could help but I don't know the answer, does she have the capacity to know what will happen if she refuses?

My sister has power of attorney and makes all mums decisions. we recently had to complete an expression of wish form for end of life choices but that was just not to give life saving intervention, like in the case of cardiac arrest not medication to help her live pain free. My sister saw her yesterday and told me about the blood thinners and asked me to check today when I see mum if they have managed to get her to take any. My DS said he thinks it may be my DMs choice not to take them, but I don't believe she knows what they are for or the role they play in keeping her well. I am seeing her in an hour so will check up but its hard and confusing when she makes choices like this but other choices are made for her.

Depending on your mum's situation, if she is very poorly with her Alzheimer's and cancer she may be coming towards the end of her life and it be a case of focussing on medication to make sure she is as comfortable as possible day to day.

I don't think it sounds as if your DM is able to make a capacitous choice not to take the blood thinners. However it would be unlikely that they would be something given as covert medication, unlikely say pain relief.

Is she under a palliative care team? I think they should be having a more leading role as if it is getting to the point she can't manage her medication, putting her through more scans feels unfair to her and this should be the point that the oncologist maybe backs out and focuses on quality of life rather than more tests and appointments.

this is her last scan, her oncologist said unless requested or something else changes she wont have any further scans. She was unable to complete her course of chemo as she developed shingles and now has a blood clot, she has stopped eating and I know its her bodies way of shutting down but in other ways she is still there, My sister said she played snakes and ladders with her yesterday and mum enjoyed it, despite not knowing who my sister was (and my mum won) she also went for a little walk in the grounds of the home so is mobile. Its just confusing as one moment it looks like she is preparing to go and the next she has bounced back, thanks for the responses, it does help

The thing is, the nurses cannot force someone to take medication regardless of capacity unless there are multiple professionals involved in the decision. It is seen as abuse. Covert medication (giving medication disguised in food/drink) is quite a rare occurrence now and only agreed if it is absolutely necessary. They will try every option prior to agreeing to it.

Can you contact the gp and ask for a meeting with gp, yourselves and nursing staff to discuss covert medication.
The nursing home should have it's own policy on covert meds and it usually includes such a meeting to discuss and weigh up the options.
They can look at rationalizing all your mum's tabletsn working out if there are some can just be discontinued to increase the likelihood of her taking others and if covert is agreed upon then they will come up with a plan usually with advice from pharmacy as how best to do this as different tablets/capsules can it can't be crushed or mixed with different things such as milky drinks or fruit juice.

Good luck

The snakes and ladders sounds lovely.

Those are the important things, taking one day at a time and medication that is making her feel better right here and now.

Her GP and Palliative Care Nurse are the important professionals right now, making sure she is on as little medication as possible, in ways she can manage to take eg painkilling patches and ignoring anything else that gets in the way of her spending time walking round the garden or making her life as easy as possible.

The worst case outcome would be a fatal pulmonary embolism and your mum is at very high risk of this.
However, only you and her doctor can decide if she understands this and chooses to accept it.
Others have articulated the arguments around it very well, but I think you were wanting a simple statement of probable consequences of not treating the DVT.

Thanks for all the responses and thank you endoftelinefinally to your honest and frank response which I kind of already knew, weirdly enough if you google what happens if you leave a DVT untreated nothing comes up!

Thing is for a lot of people absolutely nothing will happen. For some of them their DVT will get bigger and they will have a more and more painful leg. For some they will have a pulmonary embolus - and for some of those it won't be symptomatic. And for some it will and it will make them short of breath and be distressing. And for a very very small number the pulmonary embolus will be the cause of their death.

For your DM, who has cancer as well, it may be hard to tell what is happening because of the DVT and what is deterioration because of the cancer itself and it is usually better to focus on managing symptoms rather than thinking about individual whys and wherefores.

Does that make sense?

yes it does make sense AnnaMagnani, thank you for replying. I have just visited her and she seems very thin, she has a croaky voice and a chesty cough but otherwise seems to be without pain. I took her for a walk and she patted a dog and we then went back, had a cup of tea and played cards, she struggled with the rules for the game snap, which was hard to see as she was an excellent bridge player less than 2 years ago, its such a cruel illness isn't it