Bladder Cancer Complications: Seeking Answers for Sleepiness and Hematuria

Issues related to bladder cancer?

Hello, my mother has bladder cancer and is undergoing chemotherapy and radiation therapy.
She was hospitalized on May 1 due to a drop in electrolytes and has since been in a state of excessive sleepiness and unable to speak.
Additionally, the issue of hematuria has not been resolved.
The attending physician has not been able to determine the cause of her excessive sleepiness and inability to speak.
Initially, it was suggested that it might be caused by hydronephrosis, but due to her persistent state of excessive sleepiness, she could not undergo anesthesia for surgery.
Therefore, nephrostomy tubes were placed on both sides to drain the hydronephrosis, but her excessive sleepiness and inability to speak remain unresolved.

What should I do now? Should I consider transferring to another hospital, or should I continue to stay in this hospital and allow the attending physician to keep searching for the cause? Also, her urine continues to have blood, and the doctors are controlling it with hemostatic agents.
As soon as the hemostatic medication is stopped, the hematuria returns.
What should be done about this situation?

Zhang Liqing, 50~59 year old female. Ask Date: 2017/05/27

Dr. Chen Jiansheng reply Urology

It is advisable to communicate with the primary physician and discuss the concerns you have.
If they are unable to address your issues or if their suggested approach is unacceptable to you, then consider transferring to another hospital.
Wishing you all the best.

Reply Date: 2017/05/27

More Info

I'm sorry to hear about your mother's condition. It sounds like she is facing significant challenges due to her bladder cancer and the complications arising from her treatment. Let's break down the issues you're facing and explore possible steps forward.

Understanding the Symptoms
1. Sleepiness and Inability to Speak: These symptoms can be concerning and may stem from several factors, including:
- Electrolyte Imbalance: Since your mother was hospitalized due to low electrolytes, this could contribute to her lethargy and confusion. Electrolytes are crucial for nerve and muscle function, and an imbalance can lead to significant neurological symptoms.

- Medication Side Effects: Chemotherapy and other medications can cause fatigue, confusion, and other cognitive issues. It's essential to review her medication list with her healthcare provider to identify any potential side effects.

- Underlying Conditions: Conditions such as dehydration, infections, or metabolic disturbances could also lead to these symptoms.
2. Hematuria (Blood in Urine): Persistent blood in the urine can be a result of:
- Tumor Bleeding: The cancer itself may cause bleeding.

- Treatment Effects: Chemotherapy and radiation can irritate the bladder lining, leading to bleeding.

- Kidney Issues: If there is kidney obstruction or damage, this could also contribute to hematuria.

Next Steps
1. Communication with Healthcare Providers: It is crucial to maintain open communication with your mother's healthcare team. Discuss your concerns about her sleepiness and inability to speak. Ask for a thorough evaluation to rule out any reversible causes, such as electrolyte imbalances or infections.

2. Consider a Second Opinion: If you feel that the current medical team is not adequately addressing your mother's symptoms, seeking a second opinion from another oncologist or a specialist in palliative care may be beneficial. They can provide additional insights and treatment options.

3. Monitoring and Management of Hematuria: Since her blood in urine is being managed with hemostatic medications, it is essential to monitor her closely. If the bleeding persists or worsens, further evaluation may be necessary, including imaging studies or cystoscopy to assess the bladder.

4. Assessing the Need for Transfer: If you feel that your mother's needs are not being met or if her condition is deteriorating without a clear plan for management, it may be time to consider transferring her to a facility with more specialized care. This decision should be made in consultation with her current medical team.

5. Supportive Care: Given her current state, supportive care is vital. This includes ensuring she is hydrated, managing pain, and providing emotional support. Palliative care specialists can help improve her quality of life by addressing symptoms and providing support for both her and your family.

Conclusion
Your mother's situation is complex, and it is understandable to feel overwhelmed. The key is to advocate for her needs, ensure that her symptoms are thoroughly evaluated, and explore all available treatment options. Don't hesitate to ask questions and seek clarity from her healthcare team. Your involvement is crucial in navigating this challenging time.

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