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Sunday, December 8, 2013
Life Expectancy Range
My Mom has had type 2 diabetes for the last 25years without watching what she ate. she is about 100 to 150lbs overweight, 66 years old, has had 1 toe amputation, 5 years ago contracted necrotizing faciitis, lost an entire leg, it also caused acute kidney failure and congestive heart failure. She made pulled thru after 5 months in the hospital. She has had several eye surgeries, she now has Kidney failure goes to dialysis 3 sometimes 4 days a week. Wound clinic once a week for a sore that wont heal up. December she had a further amputation on the remaining foot, September she fell and broke her hip, Dr. told us dialysis leaches out the bones and makes them brittle. She is on some many medications for heart, diabetes, kidneys, etc. We have made a spread sheet that we carry with us. Most doctors will not give us a straight answer on anything. She still does not follow the diet rules very well at all. I have a couple questions:
1. What is the life expectancy range at my mother`s age and condition?
2. Dialysis causing bone loss was a new fact we had never been told. What else does it cause or where do I find the answers?
I think that the reason your doctors have not given you a straight answer is that they honestly cannot predict the future for your mom. She has, as you know, several things going against her, including her age, weight, heart failure, kidney failure, and inability to follow her diet. She has already experienced several of the complications of poorly-controlled diabetes, including heart disease, kidney disease, poor circulation (resulting in amputations), and eye problems. If she has high blood pressure, high cholesterol, or is a smoker, these things will further increase her risk of diabetic complications. Although it is not possible for me to accurately predict how long your mom will live, I can say that, in my clinical experience, patients with the history you've described tend to have life expectancies somewhere in the range of several months to perhaps a couple of years.
The major risks that she faces at this time are those of a heart attack, a stroke, or a life-threatening infection. Things that she can do to improve her quality of life -- and possibly to increase her chances of survival -- include: following a diabetic and renal diet, keeping her blood sugars and blood pressure under good control, taking all her meds faithfully, restricting her fluid intake in order not to gain too much weight in between dialysis treatments, keeping her feet and skin scrupulously clean to avoid infection, and not smoking.
As for the relationship between dialysis and bone disease: if patients do not follow their diet and take their meds while on dialysis, they may develop high blood phosphorus levels, low calcium levels, and very high levels of a hormone called PTH (parathyroid hormone). PTH in large amounts can be very destructive to bones, causing them to dissolve and weaken, and increasing the risk of fractures. If your mom takes medications called phosphorus binders (for instance, Renagel or Phoslo), she should be particularly careful to take them as prescribed to keep her phosphorus levels under control. This will help to keep PTH levels from rising and may reduce the likelihood of another fracture. Also, be aware that other reasons for her to have low bone density may include inactivity and diabetes itself.
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University