but all I can offer is hugggggs. Holding you and your family in love and light. Your DU family is here for you. Lean as hard as you need.

an ear.

Comforted by the support and love, but, feeling guilty about the inevitable burdens.
Day by day.
You are loved.

We all end up the same place.

We're all following right behind you.

You have the luxury of goodbyes. Many of us won't.

Thanks, Frasier! I've often wondered which is easier, both for the dying and for the survivors. My father died in 2001 after a long, slow illness. My mother died in 2002, in a shocking manner -- just alive and then dead, but she was 11 years younger!

I will certainly go much younger than she did, even - and yet... Maybe this is just about right for me. Enough time, and not too much.

My daughter went through this and continues to have occasional bouts of guilt. She was diagnosed with a very rare type of cancer two years ago. She feels guilty because her cancer took away her ability to have children, hence she feels guilty that I will have no grandchildren. She feels guilty because she is depressed and cross and not happy every time we are together. She feels guilty because we are the very last of our family - no siblings for either of us; grandparents, aunts, uncles all gone. She feels guilty that she may leave me all alone in my last years (I'm 72). None of the things she feels guilty about bother me in the least. What bothers me is that she wasted precious time on guilt. I gave her a project. I asked her to start a journal for me. I want her to write down her memories of our time together. Happy memories, sad memories, whatever impacted her. I am doing the same for her because it's possible I will be the first to go. My entries are relatively short but always end with telling her how much she means to me and how much faith I have in her to continue on her life's journey. I remind her that she is strong, smart, capable, kind, generous, and that however long or short her life may be, she has made a difference in this world. I know that her journal entries to me are very much the same. It's okay if you can't be there for your family right now. It's not your fault that you are working on the end of your journey. You can leave them with memories, wisdom, hope, confidence, laughter, and grateful tears that will strengthen them when you can no longer walk beside them. When my best friend of 55 years died, she selected a personal belonging for each of her family and friends. These were simple items, not anything expensive. In addition to the item, each of us received a letter in which she related what she most loved about us, how she felt we impacted her life, and, of course, what quirk of personality or habit we possessed that made her grit her teeth and bite her tongue. I read her letter many times each year, even though she has been gone for over a decade. Try not to focus on what you are unable to do for them now. Focus on what you can leave for them that will strengthen them and hold them up in the years to come. Leave something they can read over and over again knowing they will hear your voice as they read your messages. I send you much love and peace.

I will save and treasure it.

Part of my worry (and reason for wanting support among terminally ill) is what to "leave behind" --- I worry that some things could seem creepy or upsetting or make people feel melancholy?

But your words are wise and beautiful. Thank you so much!!

That is all you're in my thoughts

Just for saying that right now!

death was kind of wonderful when I look back. I had always been reserved around her because I was afraid of her criticism. After she had her stroke she couldn't talk anymore and so I started opening up to her. She didn't die for a few more years but I started talking to her a lot.

One day when she was in assisted living I decided to tell her all the good things I remembered about my childhood. Things like the vacations they took us on and the crafts my mom taught me. I remembered so many things and even though she could not talk she smiled; every time.

One thing I did not think of was to ask questions. Now I will think of something from the past and wish I could ask her more details. You can encourage your family to do that and it might be very nice.

It was an honor to take care of my mom in her last years. It certainly wasn't fun a lot but it left me with something special. Your loved ones will know that too.

from losing my parents, and from the ways they lost theirs.

I'm grateful that my daughter is making a true effort to see me as often as she can lately, not for any "special reason," which makes it even better, in a way.

I will encourage her to ask me questions. (I'm left with many I wish I'd asked my parents, too!)

Thank you for sharing your experience and giving me that advice.

I think with the time you have left with those you love, share your gratefulness, reassurances, love. Let them know that you need your time to cope with this as well. Nobody should feel guilt for their own mortality, this is not your fault. I hope you find the help and support you deserve.

You are exactly right. My daughter and distant loved ones are reaching out to me. I saw a quote recently from a Buddhist person, I think, suggesting that the people who love you are the ones who come when there's nothing left you can do for them -- that's my paraphrase.

I hope you are doing ok and have shifted your thinking from the guilt, please give yourself grace.

Biding my time and doing okay for the moment.

My son expreses those same feelings. I let him talk because that is what he needs at that moment.
I'm grateful that I have will have more time with him. I'm sure your family feels the same and understands.

She said, "I hope I loved him enough."

Those who live after you will suffer, surely, from guilt, particularly as you, although I don't know you, care for those who will live after you.

They may well wonder if they should have done this rather than that and go over and over what they might have done differently, not understanding that anything they do or say will always be wrong because nothing can ever be right about losing someone you love.

I was the one who broke the news to my father that he would not be cured because the rest of the family was in denial as was he. I vowed to be honest with him because of my acquiesce to the familial denial I knew was wrong when my mother was dying. (In my father's case, had a frank conversation with the oncologist based on my literature searches.) My guilt over my mother's case was somewhat assuaged when I realized I felt equally as bad about being honest with him as I did in lying to my mother and telling her we would beat it, although I alone in my family knew otherwise.

In these final days of your life, you are involved in love, and I hope, when my time comes as inevitably it will, I will have the wherewithal to be so myself.

I wish you peace.

Last edited Thu Aug 7, 2025, 11:15 PM - Edit history (21)

(This post and others need more work to be legible. But I will complete them another time. I have too much to do and am neither wealthy nor bright enough to gawk admiringly at Trump all day ;-/).


I lost my mother to multiple myeloma in Nov 2021 and am kinda over it finally. But it was hard.

My mom’s cancer story was odd. She was on 750 mg of this medication prescribed for diabetes Metformin for about a year and half at least. And then she saw this news story in 2020, (just around the time Covid was really starting to make itself felt) where some batches of Metformin were being recalled in the US due to high amounts of NMDA?
No NDMA.
https://www.ihs.gov/nptc/pharmacovigilance/medication-safety-resources-archive/2020/metformin-extended-release-nmda-recall/

Mom wasn’t even in the US and her brand was different. But that news story scared her, because we have lost a lot of people to cancer on her dad’s side (1 glioblastoma, 2 cases of breast cancer, 1 case of prostate cancer and my mom). So 5 cases in two generations.

And she was only pre-diabetic and figured it would be okay to stop using it. She didn’t tell her doctor. She had a good diabetologist, but it’s awkward to broach a news-story to go off meds so she stopped it sometime May 2020 end early June 2020. Her health deteriorated rapidly at that point.
She had complained a few times of tiredness and pain a few times maybe in previous years, but nothing very serious. She had vomited once in response to a Renerve?-a vitamin B injection.

But this was very rapid deterioration. She went from basically being fine to really ill by July 2020. Dad and I were shocked-she lost a lot of weight.
It is a silent cancer and only detectable by later stages I think. So maybe that is common.

Anyway our oncologist diagnosed it very fast and she started cancer treatment mid August 2020. We were lucky in finding an excellent oncologist-he was not just competent, he is also a really nice person.

Meanwhile I looked up PubMed to see how Metformin affects multiple myeloma. I was expecting to see a positive correlation between Metformin use and multiple myeloma. I think looked at all cancers more than multiple myeloma specifically. Can’t remember precisely. At any rate I was surprised to find many articles indicating that Metformin is considered to worst case have no effect on cancer and best case maybe actually check smouldering myeloma from progressing

Normally I am not much for sleuthing of that sort and I don’t second guess doctors (well okay reefer madness aside).

But it seemed odd that it was so soon after stopping metformin that she declined in health that rapidly. Could be a coincidence I suppose but what if it was not.

I was very close to my mom and couldn’t bear the thought of losing her. So I showed some of the articles to my oncologist and requested him to let her be on Metformin during her treatment. I also got her tested for lactic acidosis (one potential serious side effect of Metformin) on my own discretion. And it wasn’t an issue. I have all the lab reports somewhere. I really should organize them at some point.

My onc is pretty cool. He is a good scientist so not someone to jump enthusiastically on some sort of “Metformin Yes!” bandwagon because you show him a few studies. But at least he didn’t find it objectionable and there are other reasons Metformin is not the worst thing.
It’s a medicine without too many side effects.

So we started this course of treatment. And she was doing really well. I was her caregiver full time and used to ensure that she took all her meds. I got some support from Smart Patients which DUer Captain Queeg recommended. That was a good site. There was a nice lady called Jules on there.
I haven’t been able to stand looking at it after mom left us.

But she really improved after a slightly rough start where she needed a couple of blood transfusions. By Jan 2021 she was doing really well. We were so happy and relieved. Things finally seemed okay.
By around March or February of 2021 she was well enough that I let her start taking her own meds etc. I was a bit worried she might shirk on the meds. She is normally very rational but the cancer was sort of draining her and it was hard for her to keep stuff down, but you can’t shirk your meds so I used to ensure she took all of them…a rather grim lot too Acyclovir …I remember that one.

She was so well by March that she had started watering plants in the garden etc. So I thought I would let her start managing her own meds. She had stopped getting sick even the day after chemo. For MM it was this pretty standard regimen of Bortezomib, Dexamethasone and I can’t recollect the rest but I kept a dairy I plan to scan at some point. We followed everything to the letter. None of that Apple Cider Vinegar dreck (couldn’t watch that thing ..scary damn show..not only that scammer Belle Gibson..that other woman refusing cancer treatment and she’s also based on a real person who refused cancer treatment and died. Scary messing with cancer like that. Cancer is not “hysteria”).

I generally trust doctors and our oncologist did everything he could to make life easier for us including recommending this really useful home healthcare checkup lab. That was so helpful during covid. He is awesome - overworked but so competent and thorough regardless and always so cool. My mom was very fond of him.

But it’s to be expected that doctors in general are overworked in these parts- we can’t train and educate oncologists at the rate at which people pop out babies.

Anyway, things seemed to be going well, but sometime in July or August of 2020 maybe she started getting sick again after the chemo. I was distrait with some stuff I wouldn’t bother with today in August. But mom was okay. Though it was worrying that she had started getting sick again.

But by October she started doing really badly again and in November it drastically accelerated and then she told me that she had halved her Metformin dose around July-August (roughly) just around when she started getting sick again. And she stopped it entirely sometime in Sept-early Oct (she was not sure).

She did it of her own accord. Not sure why.
It’s silly..she always hated taking it because for some reason it’s this bitter and large pill rather than something like a gel capsule that goes down easily. And since I had requested our onc to put her on it, she saw it as in no way a necessary part of her treatment. She had this feeling it was just some whim of mine.

I had this hunch that whether it is outright beneficial or not, sometimes when you get on some medications it’s better to stay on them. And I have at least 3 data points indicating the mom responded to it in a positive way. There’s also a person to person variation probably.

I am myself cautious about outright any specific claim where it is related to science or medicine when it has not been rigorously verified enough to be a part of any gold standard of care and is only being explored as an adjunct. (As an aside, I am wrapping up a correction to some old work where the original model I had in mind for analysis of an experiment struck me as inadequate and I have come up with what I consider a better analysis. I’ll see..)

I didn’t have the time or energy to parse all literature about Metformin and Multiple Myeloma. So since I couldn’t really assess the quality of the papers, while I did feel she shouldn’t go off it, I didn’t know enough to be that sure what the right thing to do is.

When I found out I started her on it immediately. But then I took her to the hospital and they didn’t want to put her on it. She left us a few weeks later.

I was pretty devastated. I felt guilty and still do, because had I continued to give her meds I would have noticed immediately when she started getting sick again. But more than guilt, it was just painful to lose her and think that it was possibly preventable had I known that she went off it.

I don’t know if Metformin helps or not in the end. But i do suspect that once you go on any medication that at the very least has some effect on cancer, you should not go off it suddenly.

These are some of the papers I found on it later. Many of them are from China, but though Xi Ping is a douchebag, I see no reason to be more suspicious of science coming out of China than of any science to the extent that it depends on the quality of the specific paper. In general there does seem to be an indication that Metformin has an anti myeloma effect. But I did find at least one paper arguing the other way and I have not been able to go over these papers and assess their quality. But the real world dynamics of caregiving are not that black and white and mom definitely seemed to respond well to Metformin and badly to going off it. So in conjunction with the rough trend shown by these papers, I did feel she should have stayed on it and by now i have stopped having this sense of savage regret that I didn’t she had gone off it so I could have prevented that:


This is a basic research paper on Fission Yeast that I think is my best bet re a simple model for understanding the anti-proliferative mechanism behind Metformin’s general anti-tumor action:

https://www.nature.com/articles/s44324-024-00048-9
Reversal of metformin’s anti-proliferative effect in fission yeast efr3 and dnm1 (DRP1) mutants with elongated mitochondria

These refer to different cancers and indicate a positive effect net that Metformin has wrt checking cancer:

https://www.sciencedirect.com/science/article/pii/S1347861317301147
Effects of metformin on proliferation and apoptosis of human megakaryoblastic Dami and MEG-01 cells. Liang et al. 2017

Metformin Antagonizes Cancer Cell Proliferation by Suppressing Mitochondrial-Dependent Biosynthesis. Griss et al. 2015.
https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.1002309

Metformin - its potential anti-cancer and anti-aging effects. Podgorica et al. 2017.

These refer to different cancers and indicate potential negative effects to be cautious about wrt use of Metformin for cancer:

This one is related to lung cancer and indicates why you have to understand the specific mechanism of action beyond a rough correlation. Things don’t always line up as neatly as you wish they would wrt human health. More broadly it is what helps a type of huckster (the Apple Cider Vinegar type) to confuse people anecdotes and sketchy use of statistics:

https://pubmed.ncbi.nlm.nih.gov/35740881/
Metformin Induces Resistance of Cancer Cells to the Proteasome Inhibitor Bortezomib

These are specific to Multiple Myoma and indicate a positive effect net that Metformin has wrt checking cancer:

https://pubmed.ncbi.nlm.nih.gov/36762777/
Metformin attenuates multiple myeloma cell proliferation and encourages apoptosis by suppressing METTL3-mediated m6A methylation of THRAP3, RBM25, and USP4
Chen et al. 2023

Reduced Progression of Monoclonal Gammopathy of Undetermined Significance to Multiple Myeloma in Type 2 Diabetes Mellitus: Will Metformin Never Stop Its Pleasant Surprises? Stella Papachristou , Djordje S Popovic , Nikolaos Papanas (2022)

Metformin inhibits IL-6 signaling by decreasing IL-6R expression on multiple myeloma cells
Ameet K Mishra, David Ding (2019).

This review says that low dose Metformin prevents progression of myeloma from MGUS to MM, but higher doses have adverse effects. I can’t access it to see what the doses are.
Repurposing Metformin in hematologic tumor: State of art. Min Hu , Yan Chen , Tao Ma , Li Jing. 2023

The Risk of Multiple Myeloma Is Reduced in Metformin Initiators: A Retrospective Cohort Study in Taiwanese Patients with Type 2 Diabetes Mellitus. Chin-Hsiao Tsen. (2022).

This one shows, quoting from the abstract:
“Co-treatment with the anti-diabetic agent metformin suppressed GRP78 and enhanced the anti-proliferative effect of bortezomib.”
Molecular chaperone GRP78 enhances aggresome delivery to autophagosomes to promote drug resistance in multiple myeloma. Malek et al. 2015.

[iObesityasaPossibleRiskFactorforProgressionfromMonoclonal Gammopathy of Undetermined Significance Progression into Multiple Myeloma: Could Myeloma Be Prevented with
Metformin Treatment? Dantas De Cunha Junior et al. (2015).

Metformin and chidamide synergistically suppress multiple myeloma progression and enhance lenalidomide/bortezomib sensitivity. Mao et al. (2024).

Metformin confers sensitisation to syrosingopine in
multiple myeloma cells by metabolic blockage and inhibition of protein synthesis. Vreken et al. 2023.

Influence of metformin on HIF‑1 pathway in multiple myeloma. Kocemba‑Pilarczyk et al. (2020)
To quote from the paper:

Results: Our results showed, for the first time, that metformin inhibits HIF-1 signaling in MM cells. Moreover, we demonstrated the effect of metformin to be mainly oxygen dependent, since the HIF-1 pathway was not significantly affected by metformin in anoxic conditions as well as after application of hypoxic mimicking compound, ­ CoCl2. Our data also revealed that metformin triggers the growth arrest without inducing apoptosis in either normoxic or hypoxic conditions.
Conclusions Taken together, our study indicates metformin as a promising candidate for developing new treatment strategies
exploiting HIF-1 signaling inhibition to enhance the overall anti-MM effect of currently used therapies, that may considerably benefit MM patients.

Metformin Inhibits Multiple Myeloma Serum-induced Endothelial Cell Thrombosis by Down-Regulating miR-532. Gao et al. (2022).

“Conclusions: Metformin played an inhibitory effect on MM serum-induced HUVEC thrombosis, suggesting that metformin could serve as a novel antithrombotic approach for MM patients.”


This one’s more about the general association between diabetes and mm:
Diabetes mellitus and multiple myeloma; common features of two distinct entities
et al (2022)

This was the paper that I really wanted to take a better look at as it goes the other way (in common parlance..too weary to put it
professionally). It’s the only one I have seen so far that explicitly indicates that.

The antidiabetic drug metformin acts on the bone microenvironment to promote myeloma cell adhesion to preosteoblasts and increase myeloma tumour burden in vivo
Beatriz G et al (2021)



I’ll update this post with the entire list including the one that explicitly indicated went counter to this. Those are the ones that strike one the most.

I was thinking indifferently that I really should read them at some point after I am done with this paper I am completing.

Anyway I am fortunate in having mom’s oncologist as my oncologist now..I do preventive care to some extent within reason and so I went to him for a preventive check up last year and so far nothing except something called a TR3 nodule to keep an eye on.

But I have been putting off a colonoscopy..
I will get around to it. I don’t drink anymore (or very rarely-can’t remember the last time I had a drink. Maybe Fall 2024?). However I used to drink sometimes and heavily (society you know ;-/..or not) so I really should get around to it.

Life feels like one endless colonoscopy session most days, so I have been shirking that one ;-/.

First, I'm so sorry about your Mom. It is NOT your fault!! Please do all you can for your own health.

There are a lot of studies showing Metformin as a virtual miracle drug for some cancers, in some cases, for some patients. I'd read about it on a cancer forum, looked up the studies, and sent links to my doctors. They wouldn't prescribe it for my cancer, and I don't fit the profile. On the contrary, I have tended to be 'under' weight if anything, and I've had trouble with hyPOglycemia... but there is commonality with high blood sugar.

If cancer is a metabolic disease (as it seems to be), hyPO and hyPERglycemia do the same thing, because in hypoglycemia, blood sugar spikes before it crashes. This is a problem I inherited that my mother, her brother, and all of my sisters have had to manage (although no doctors ever took it seriously because it isn't diabetes -- and by the way, we ALL got cancers of various kinds).

There is an herbal supplement - Berberine - that does much of what Metformin does, although it's tricky because I don't want to lower my blood sugar, but just level it.

Please check in soon and let us know how you are doing!!

Last edited Mon Aug 25, 2025, 05:32 AM - Edit history (1)

(I will compose a more detailed reply later today. Leaving this as a placeholder. )

I do feel guilty. I am scientist by training so I am cautious with any position on things without a better fleshed out model and mechanism.

But Metformin unambiguously seemed to be a drug of the type, where having gone on it once, it was a bad idea to go off it. Her cancer seemed sensitive to it.

There’s a doctor whose writing I rather like. He explains it well here:

https://www.salon.com/2025/05/20/dont-fight-uncertainty-embrace-it-2/

As a physician, I’m used to uncertainty. Most medical problems transpire inside the body, hidden from view. I can’t touch the clot in a patient’s coronary, or see their stroke in the same way I can see a flat tire. At work, I can rarely be totally certain about anything. That’s just the nature of medicine. As Canadian physician William Osler said, medicine is “a science of uncertainty, and an art of probability.” But it’s also the nature of the world. I can’t personally verify the weather in Tucson, or general relativity, or the reality of climate change, either.

Instead, I weigh and consider a constellation of indirect information, and make a judgment about what I think is likely true. To do this, I’ve been taught to think in probabilities, as Osler suggested, because probability is a yardstick for uncertainty. Physicians and scientists everywhere are trained to think this way. But this kind of thinking, called Bayesian inference (after the English mathematician and clergyman Thomas Bayes), is something that can benefit everyone. Especially in a time when the basic facts of what’s real, and what’s not, have come into question.

I am not a doctor and my field in science is far removed from cancer. But as a care-giver, I had a feel for how my mother was responding to treatment. I learnt odd factoids from the experience of taking care of my parents, such as that antibiotics like furantoin can increase your creatinine levels..

The grey areas of human health can be hard for people to navigate under scrutiny and when liability rather than care of quality is the main concern in healthcare related settings. This was the end or perhaps middle of the pandemic (Nov 2021).

She had an excellent oncologist. He is mine as well..i really like him. But the hospital had deteriorated over the course of the pandemic. My doctor left soon after and is at a different hospital now. Just the year before her hospital was pretty good. By the time she passed away it was this busy, invasive place with an overall diminished quality of care. It was a sense impression but distinct.

I am doing okay. I sometimes try to feel more remote from everything and that works for me. My mom would have wanted me to progress as far as I could in my work and after a long and dreary break I am trying now.

Bruce’s Spider would be weary by now ;-/…
I still like science and facts so..cautious optimism I guess.

Thank you

Optimism is good! And it sounds like continuing on in your work is a way of honoring your mom, for you. That might be an important connection even as you feel "remote" from other things, as you said.

Keep taking good care of yourself and check in!

An uphill task…but I persevere ;-/.
I have ended up taking a long sabbatical but onward and upward is my motto.

(The Citadel is a good book I would recommend to any young scientist or doctor who needs inspiration in a frustrating and low rewards profession.
It is old enough that it isn’t like our present day influencer and personal experience selling cottage industry of fluff.

Unless you are Anthony Fauci (whose biography or story would be worth reading or listening to) I agree with Hamilton Nolan that writing/journalism etc are not narcissism. The only good (and rare) journalist whose soul is on display, Yasha Levine, fulfills an important function only because society is deprived of people to trust and look up to outside establishment figures like Fauci and Lina Khan. This doctor Clayton Dalton pulls it off. But usually it’s part of that same industry commodifying every last bit of human experience and unacceptable. Everything should have a non-redundant function to be of value imo. I agree with Warren Hern that human output is mimicking tumors sadly and I want to contribute non cancerous output ;-/).