Nursing home question

goldenbuckeyeMay 26, 2006

I have durable POA and medical POA for my Mom. Does the Dr. at the NH have to honor my request to discontinue a medication if it's for good reason? She takes Celebrex twice a day for arthritis but it increases the chance for heart attack and stroke and she's already high risk. I'm very concerned because last weekend her oxygen level dropped to 82 and they put her on oxygen for about 3 days. They also said she had a respitory infection and put her on an antibiotic. I think her heart caused her oxygen level to drop and I think she had a TIA (mini stroke) because Sunday she was confused, weak, couldn't even hold her mug of water (spilled it all over her bed) and couldn't stay awake. Monday she didn't even remember me being there with her on Sunday but she was pretty well back to normal except I think she has dementia. Her short term memory is very bad.

Her Dr. at the NH is also the medical director but I don't care much for him. He seems to have this ego problem that so many doctors have. Everybody says this is the best NH around but this Dr. makes me wonder how bad the others must be!

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Start at another level besides the top.

What I'd do is start with the nursing supervisor and express your concerns. And make a list to cover all that's on your mind. The Celebrex would be low down on my concerns, actually, but the change in her behavior on Sunday is IMHO a bigger deal. Lines of communication go both ways, up and down, and you are the one to keep the lines open from your side. But don't even worry about talking to the doctor right now. You need to talk to all the hands-on people and express your concerns.

And yes, ask if Celebrex is the appropriate medication, and if they think that there is a greater risk for this particular patient. Remember that not all patients have the same reactions to drugs, and also that in ALL medications there is a risk-assessment process. Anything, from Aspirin to Zinc, has side effects or potential interactions, but we look at each patient and whether this drug makes a difference that helps and at what cost of side effects.

When I was taking care of Mother, a number of times, I'd just ask the nurse who did medications questions and when I pointed out my Mother's reactions to something, the staff took action to make changes.

But don't worry about the Dr. at this point. You need to start your comnmunications lines at a lot lower level. If you just go to the top, you might make the staff, who are indeed skilled, feel like you are complaining about them, and also ignoring their potential to take care of the problem on another level.

My Mother was in the NH for 6 weeks, and I guess we only saw the doctor twice, and the rest of the time, we dealt with changes in meds or concerns about reactions with the immediate staff.

    Bookmark   May 26, 2006 at 9:57AM
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You also must weigh things. Which is worse for your mother, the pain and stiffness of arthritis? Or the slightly increased risk of heart attack or stroke? You could take her off her medications and she could still have a stroke or heart attack. In her condition, things are going to go wrong. I would hope that keeping her pain free would be as important as trying to prevent what may be inevitable anyway.

Something is happening. There is no doubt about that. Talk to her nurses. Ask if they have witnessed other changes that may or may not be connected to her medications. Do some homework as to what may be causing the problems. Then, you will at least have more than just a feeling as to what is the problem.

If she had a respiratory problem, the oxygen drop would have caused some of the problems that you mentioned. Once her brain is getting the oxygen it needs, she should be more alert. She has to be able to breathe well to get the oxygen into the blood for the brain to use. In this case, the heart is most likely still pumping well, but it's the lack of oxygen in the blood that is the problem.

But above all, remember that stress from pain can cause problems in the elderly. Especially depression. It's easy to want to die when everything hurts and even eating is painful.

    Bookmark   May 26, 2006 at 1:08PM
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"...have durable POA and medical POA for my Mom. Does the Dr. at the NH have to honor my request to discontinue a medication if it's for good reason?"

If you have a valid medical power, and your mother is either incompetent or is competent but chooses to cede the power in this circumstance, the Dr's choice is either to work with you -- that is, follow your instruction -- or resign from the case. He is a professional with his own rights and priviledges and may decide your chosen course of action is something he cannot be a part of. However, your mother's rights/priviledges via herself or through the power she has given you prevail over all others in matters of her own being. Only a court can decide otherwise, which they almost never do.

    Bookmark   May 26, 2006 at 5:28PM
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You have the right to refuse a medication without having further medical treatment withdrawn. That's in the patients' bill of rights. Whether that will happen or not in reality... I can't say. Doctors are the new Mafia...they make offers we can't refuse. The doctor in this case is obviously on the take, but in charge. Try to talk to him rationally about removing the medication. You could complain to your insurance company or Medicare. There the ones that are going to have to pay, especially if this junk causes a heart attack. Doctors are immature, your Mom is more than likely to receive repercussions though if you complain.


    Bookmark   June 25, 2006 at 11:13PM
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I am going through the procedure for placement of my husband and I have the papers I need to control things. The living will does not cover Do Not Resuitate or the right to with hold live prolonging drugs, nor can I just request it. The nursing home said the doctor has to put it in "doctor's orders"

    Bookmark   June 29, 2006 at 8:13PM
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