DEAR DR. ROACH: I was advised by a doctor at a reputable hospital to put my mother in hospice for congestive heart failure. She also has multi-infarct dementia. That was a year ago. Her vitals have been checked twice a week since that time and are always good. Her oxygen level also is very good. We have never had to use the furosemide medication for water retention. I am starting to think she might not have needed to be in hospice. During her third re-evaluation, a new doctor changed her hospice diagnosis to emphasize her dementia. I am her caregiver and do get some things from hospice that are helpful, but I have spent a year believing my mother was going to die very soon — maybe for no reason other than a doctor in an emergency room recommended hospice. — H.S.

ANSWER: Hospice is a philosophy of care that emphasizes reducing suffering and improved quality of life over treatments intended to be curative or disease-modifying, and it is appropriate when the harms of disease-modifying treatments outweigh the benefits. Eligibility for hospice requires the patient’s attending physician and the hospice medical director agree that the person’s life expectancy is six months or less. However, physicians are frequently unable to make accurate predictions about length of life, and your mother’s situation of being in hospice for a year or more is not that uncommon. It may seem counterintuitive, but patients often live longer in hospice than comparably ill patients who do not choose hospice. In the specific case of congestive heart failure, hospice beneficiaries lived 100 days longer in hospice than those who were not in hospice.

My experience with my own patients in hospice, and in fact with my own family members, has been universally positive. I have found that physicians usually refer to hospice too late in the course of the disease. While I understand that you may feel misled in your expectations, I would urge you to consider that her life has been both of better quality and of longer duration than it might have been had you not chosen hospice.

DEAR DR. ROACH: I fell over a year ago and got a Staph infection in my knee replacement of 14 years. They opened the knee, cleaned out the infection and put a port in my arm for IV antibiotics three times a day. How long can I be on this antibiotic? The problem is that I need a shoulder replacement, and they won’t consider it until they take out the old replacement and put in a new one. Otherwise, I’m in pretty good health. What is your thought on this? — W.F.

ANSWER: Infections of prosthetic joints are very dangerous and difficult to treat. Six weeks is the usual minimum treatment for a prosthetic joint infection. Often, the old, infected joint needs to be removed entirely during the treatment.

Because the bacteria infecting the joint can go into the bloodstream during treatment, it is essential to avoid putting in any other hardware until the infection has completely cleared. It has been my repeated experience that patience is of great value in this situation.

READERS: Diabetes has become epidemic in North America. The booklet on it provides insight on its diagnosis and treatment. Readers can order a copy by writing: Dr. Roach — No. 402, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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