Hospital Blues

golddustSeptember 24, 2012

Mom is in hospital with a kidney stone and low heart rate. Tomorrow she will have the stone broken up with a lazer and will come home Wednesday or Thursday.

The Dr. Thinks her low heart rate (30 beats per minute verses the normal 60 to 100) is due to her memory medication so we will pull her Namenda and check her heart rate down the road. She may need a pace maker.

The challenge with memory loss and medical interventions is always a struggle. The truth is, we are now her death panel. I'm thinking the pace maker should be done because low heart rate can affect her circulation.

It's crazy that memory pills can slow heart rate. Good blood flow to the brain seems important for function. What do I know...

She isata hospital 50 miles away and the daily visits and lack of sleep are taking its toll.

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So sorry Goldie. I hope she is soon home and over this. My aunt had a pacemaker put in around age 80 and is now 92. She had by-pass surgery in her mid-70's! She's not been in the best of health in the last couple of years, but no more heart troubles. A fairly minor (if there is a minor operation) procedure and it worked very well for her.


    Bookmark   September 24, 2012 at 3:47PM
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50 miles? That's gotta be tough! I hope Mom gets better quick! For her and you!


    Bookmark   September 24, 2012 at 4:18PM
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" The truth is, we are now her death panel."

You lost me here. Isn't this your MIL who moved in? I didn't realize she was so sick.

Can't the doctors do the pacemaker now, keep her drinking LOTS of fluids to protect the stones from the kidneys and then do the zapping?

I was hospitalized for kidney stones too, and until I had the surgery they kept me on a ton of water. That completely got rid of the pain.

Will she have a stent? Lovely memories I have. Not. lol.

For your own well-being, can't you all take turns staying with her? At least try to take a day off and get some sleep & eat something healthy.

Keep us informed, I know you have a lot on your plate right now.

    Bookmark   September 24, 2012 at 4:37PM
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So glad they can zap the stone with the laser! Dh has had that done a couple of times. He has also passed the stones...a big ouch! Last time he was in so much pain, I had to drive him to the ER. (Lithotripsy beats passing the stone.) Watch her spinach intake (I know, strange) is said to contribute to causing stones.

Great that they made the connection with the meds and the heart condition.

Hope you can catch up on your rest, Golddust. Hope your MIL is home as soon as planned so you can skip the commute.

Will be praying for best outcomes for your MIL's heart, her kidney stone, and her memory issues. Praying for strength, peace and comfort (and helpers!) for you.

    Bookmark   September 24, 2012 at 4:56PM
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Bumblebeez SC Zone 7

I'm so sorry she is going through this. Do research namenda carefully, I decided against it for my Dad although it was recc'd if I wanted him to have it.

    Bookmark   September 24, 2012 at 5:02PM
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Does anyone remember the thread here about end of life issues? Someone posted a link to an article written by the son of an elderly woman with chronic medical problems. One thing I took away from the article is that medical personnel making decisions/recommendations regarding treatment base them on whether the patient can survive the procedure, not necessarily whether the procedure is in the best interests of the patient. And he made the point that once the person is in the hands of medical personnel, things happen without your having the option to refuse them.

I'm not suggesting that this is applicable to your MIL's situation now, but it would be a good article to read given your reference to being her death panel.

    Bookmark   September 24, 2012 at 5:22PM
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I'm sorry that your MIL is having so many medical problems right now, Golddust. Sadly, at this age, one medical problem seems to precipitate at least two more. My heart goes out to you and your family, as I know how much stress and upheaval it can cause. My advice is to share visits with the rest of your family. Not only does this help to keep you all a bit saner and more rested, but too many visitors or too long visits can wear out the patient, which is never a good thing at that age. And, a patient's family that is well-rested is a boon to the patient and to the staff because they make better, quicker decisions when necessary.

    Bookmark   September 24, 2012 at 5:25PM
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I am sorry you are all going through this. I know how tough it is to take care of an elderly parent in your home. My thoughts are with you all. c

    Bookmark   September 24, 2012 at 5:54PM
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Thanks everyone. Oakley, it is her memory that is fading fast. That makes every decision we make that prolongs her life complicated.. Graywings hit the nail on the head. I participated in that thread about end of life issues and read a great article in Time mag as well. Just trying to be mindful of the big picture.

I'm doing nothing today. It is almost 3:00 and I'm still in my pajamas. Well, almost nothing. My DIL and I are texting back and forth. Her beloved Grandma has been transferred to Hospice and she is trying to deal with dynamics of her family. I told her to watch Brene Brown's tape on vulnerability. She loved it and called her Aunt. She wants everyone to watch that tape now.

    Bookmark   September 24, 2012 at 6:04PM
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I'm glad you took a day off ! I hope things go better soon, take care.

    Bookmark   September 24, 2012 at 8:54PM
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cyn427 (zone 7)

An entire day in pajamas is a great day, imo! Hang in there-you have difficult decisions ahead, but you always seem to make the right ones. I have no doubt you will do the same now. You are so kind and loving, but you also seem very level-headed and wise. No doubt you will be "mindful of the big picture" and chose well, if not easily.

    Bookmark   September 24, 2012 at 9:44PM
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((((((((((((((( hugs )))))))))))))))))))

    Bookmark   September 24, 2012 at 10:31PM
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So sorry that you are having to deal with this. I read that Time magazine article too. It certainly prompted some thought. I also recently read an article by Dr. Ken Murray titled "How Doctors Die" about the limitations of medication and the end of life choices choices that doctors make for themselves. It too was very thought provoking!
It's such a tough subject to face and yet one that none of us can avoid! You are very caring and undoubtedly will make good decisions that are in your MIL's best interests. Oh that we could all be assured of such care when we are at that vulnerable stage of our lives!

    Bookmark   September 25, 2012 at 12:06AM
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Interesting article, sis3, especially the stats about CPR:

A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life.

Here is a link that might be useful: How Doctors Die

    Bookmark   September 25, 2012 at 8:54AM
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graywings - Thanks for posting the article. I read it recently and found it fascinating and more than a little disheartening.

About twenty years ago my otherwise healthy grandfather had prostate surgery at age 89. I don't know the details but do know that he was very stubborn. If he wanted that surgery, by God, he was going to get it.

Anyway, he came home from the hospital and the family was there to greet him. He sat down in his favorite chair and had a heart attack. The paramedics were called but my Grandmother wisely told them not to intervene and to just make him comfortable.

If he was still in the hospital the whole process would have been much more difficult and traumatic. And he still probably wouldn't have survived.

    Bookmark   September 25, 2012 at 9:38AM
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Gold; I'm so sorry that you're facing this. How old is she? IMO; as you know; it will not be an easy decision on what to do with a pace maker. My neighbor from the old house lost his 82 year old lady friend "G" 2 years ago; she actually had one a few years (2-3) before her heart gave out totally. She was in a hospital; they could not save her.

I know nothing about pacemakers; so I'm not sure what happened in G's situation; but it did not save her in the end. The "complication" with your MIL is her memory; how bad is it & how bad can it become? I know that for me personally; I would not want to live like the mom in the article I linked to from the post you mentioned (link below) because it was a similar situation.

Not an easy decision; I hope & pray her children make the choice that everyone can live with.

Sis & graywings thanks so much for the link. I'm going to bump my post on elderly care & when to say enough to add it so that if anyone else looks for it; they're together.

Here is a link that might be useful: Elderly care & when to say enough

    Bookmark   September 25, 2012 at 1:54PM
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Wait a minute, I need to stick up for the benefits and success of CPR!

My DH is alive today because of prompt CPR and administration of an AED (Automatic EXTERNAL Defibrillator- you may have seen those decals with a red heart and lightning bolt at various public places around your town).

Last January 23rd he had just started his regular work out at his Y when he went into a sudden cardiac arrest (not a heart attack, but a full arrest) and quickly became unconscious. Luckily for him, on the next elliptical machine was a CPR trainer (RN at a local hospital) who recognized at once what had happened. The Y staff had had training on their new AED just 48 hours before. The CPR trainer started CPR compression immediately while another bystander started rescue breathing. The Y staff deployed the AED and it took two shocks to restart my husband's heart.

But it did, and he survived with no residual heart or brain damage. In fact he was joking with his rescuers when the ambulance arrived.

I am the luckiest gal in the world that it all worked out so well. But it did work out because there were trained and willing people - and the necessary equipment - at hand.

I think that broader-based CPR training and increased availability of AEDs would go a long way to improving the odds of survival for out of hospital arrests. And there could be more people who go on living afterward, like my DH, in very good health.

My DH now has an internal defribrillator (ICD).

Of course, this is a different circumstance from CPR in the context of other severe illness when "merely" restarting a heart may not be the best thing.

Did you know that modern CPR doesn't involve mouth to mouth contact anymore, just chest compressions? It's much easier to learn and perform. The Red Cross, and the American Heart Assoc. will teach you.

The people who saved my husband told me that they had never done anything that gave them more satisfaction and happiness. In fact more than one said it was a life-changing experience for them.

And needless to say it was a life-altering gift from total strangers for both my husband and I.

And, now, for Golddust re a pacemaker: My husband's ICD is an oomphier version of a pacemaker. (Basically it's intended to pack a much bigger wallop, if needed, but doesn't do anything on a day to day basis. In fact since January, it's done nothing, I'm very happy to report!) The surgery to insert it was not that big a deal. It took less than an hour to do. He was out for it all, and recovered with no pain, or discomfort. The incision healed nicely, though he has a residual scar and a little bump where the device is (just below the collar bone on the left side.) It is monitored at home by a device hooked up to the phone line, which phones in a report every couple of weeks. You need visits to the electro-physiologist/cardiologist a couple of times a year to have the device checked and reams of data downloaded. It can easily be adjusted externally (no additional surgery needed to change heart rates, for instance). And since we have already broached the topic of end-of-life care, it can also be turned off externally if that is an issue for some reason. A pacemaker (unless it is also an ICD) wouldn't deliver any heart-re-starting jolts. The batteries for pacers and ICDs generally last about 10 years before needing replacement, which is a very simple little procedure, not involving changing out the device. Your MIL's cognition may improve if her circulation is assisted by a pacer. In fact her whole physical well-being and organ function would likely be improved if her heart rate is raised to a more effective rate. If she has a pacer, she will have to give up chainsawing (as if!), but she could still drive, use a microwave and an induction cooker, etc. She wouldn't need to take blood thinners just because of the device, if that's a concern. With a pacer to sustain her HR, some drugs that she formerly might not have been able to take will become possible.

I hope you and your MIL, and your DH, of course who must be quite worried about his Mom, are doing well and all home soon.



    Bookmark   September 25, 2012 at 2:04PM
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roselvr I am glad that you and graywings too found that article interesting. I confess I have avoided reading about the subject in the past but DH and I are now at an age when it has to be faced, either because of loved ones or our own mortality.

    Bookmark   September 25, 2012 at 4:57PM
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I know that I personally do not want to live longer if I have Alzheimers. If you read the post I made a few months ago; that woman's story is my biggest fear. I do not want to live like that & I hope that my hub & kids remember it if the time comes. My dad felt the same way; also did not want artificial life support that he would not come off of. We had a through marriage MIL that was in nursing that gave us a copy of an advanced directive written by the nurses in her hospital. We knew if they did not want it; neither did we. My dad knew that I could make the tough decisions if they needed to be made.

My heart goes out to anyone in this situation.

    Bookmark   September 25, 2012 at 5:25PM
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It can take a long, long time to die from Alzheimer's. My wonderful 88 yo mom has had to live in a nursing home for the past seven years because of it. She has no health problems, takes nothing but a multi vitamin. Her loving spirit and sense of humor remain, but she knows no one, and she is fully aware of her situation in the moment she thinks of it. It is terribly sad.

Years ago, long before her diagnosis, she signed an order to DNR, as have my husband and I. We might like to think we can choose the way in which we will die, but in truth we cannot. Some us us live in terrible circumstances - dementia, paralysis, depression - for many years without any need for medical interventions or medicines simply because parts of our bodies or minds fail, but not the engine that drives the whole.

Living, and dying, are complicated, unless you are lucky and die in your sleep.

    Bookmark   September 25, 2012 at 6:27PM
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Sending healing prayers you way for your Mom.

    Bookmark   September 25, 2012 at 11:57PM
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I am glad you have had a day to rest. Caregiving is so difficult and exhausting. Praying for you and your MIL.

    Bookmark   September 26, 2012 at 4:06PM
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I'm late seeing this, but am hopeful your MIL is doing better now. Sorry that you and your family are going through this; I've always been a nurturer but I'm rapidly learning that being a caretaker is much different and harder in a large variety of ways. Glad to see you took some time for yourself, can you provide an update as to how she and you are doing?

    Bookmark   September 26, 2012 at 6:24PM
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Mom came home Thursday eve. She was so weak it took two of us to get her in the house. They removed the kidney stone and sent her home with a cathidor and home nursing. She had a nurse come Friday and she will come again tomorrow.

I can see her slowly building strength back but a week in the hospital takes a toll. I'm cooking her the things I know she loves to eat. She is keeping me very busy. We've had a couple bathroom challenges. After the gagging reflex settled down, I cleaned her up. The second time I was almost unphased. The strong antibiotics can be hard on the bowels.

Today is her real birthday and we are planning to take her to dinner if she is strong enough. Her big celebration is three weeks away.

    Bookmark   September 30, 2012 at 11:43AM
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Thank you for the update. Hope things continue to improve for her.

    Bookmark   September 30, 2012 at 12:12PM
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Gold...2 things. Your MIL needs to have the probiotics so that the diarrhea settles down asap. Her electrolytes can get out of whack really fast. Get her the liquid drink immediately.

Also be very careful of the contamination with a catheter and the diarrhea. It is VERY easy for the bowel movement to creep up the tubing when cleaning the patient and also just when they are sitting in the stool before it is caught. E coli will cause a terrible urinary tract infection. Increase her fluids and get some of the cranberry concentrate capsules. These actually work as the cranberry causes a particular coating on the lining of the urinary tract and prevents the bacteria from adhering..think teflon ! Good Luck and if I can help with any problems let me know. I was a Home Health RN for 13 years. I have seen and done it all in rural AL. c

    Bookmark   September 30, 2012 at 4:15PM
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Thank you, Trail. The Home Health Nurse was here during the first disaster so hopefully we did everything right. The second did not compare. She has not been battling constant diarrhea, more like loose stools once per day. I'm giving her Greek Yogurt smoothies with bananas.

Making her drink water, water, water so her urine stays pale. Luckily I can see what color it is because of the cathador.

Will have DH run get the cranberry pills STAT. Thank you so much! It feels great to have your support. Will also have him pick up some pedalite.

    Bookmark   September 30, 2012 at 5:13PM
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Gold, I hope things calm down for you soon, and MIL will improve greatly.

Does she have a urinary catheter or a stent?

Did they give her a pacemaker?

    Bookmark   September 30, 2012 at 5:23PM
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DH had to go in to work for awhile today. After I finished posting the last post I phoned him.

Me: Can you do me a favor on your way home? My girlfriend, Trailrunner, is a nurse. She said we need cranberry concentrate pills and some pedialite for your mom. Can you grab some on your way home?

DH: Sure, no problem. Be home in a half hour.

The funny thing is, he doesn't even flinch when I use your screen names anymore. Your screen names are now common to him.

    Bookmark   September 30, 2012 at 5:25PM
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I'm glad to hear that your MIL is back home again. Please continue to keep us posted, Goldie.

    Bookmark   October 1, 2012 at 10:28AM
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I'm glad to see that Lynn has also adopted the name I use for you - Goldie! Just suits you!!

Hope she continues to improve.

    Bookmark   October 1, 2012 at 11:41AM
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You are such a treat...and your MIL is one lucky gal. You tell your Home Health RN that I am so glad she is there for you all. I loved my work every single day and made well over 15,000 visits in the 13 yrs I worked . It is a wonderful job and meets a need for patients and families that nothing else does. We see and hear things the Dr's never ever encounter and are privy to what really happens in a patients life. I have been able to solve mysteries that never would have been solved without someone being there in the home and seeing and hearing everything that goes on. I should write a book ! Keep us posted. c

    Bookmark   October 1, 2012 at 11:47AM
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Elizabeth, our wonderful home nurse, came at 8:00 this morning to remove Mom's cathador. My job is to get her to drink lots of fluids to see if she can pee on toilet. Trail, she was very impressed that I was giving her pedalite. I told her you gave me that advice.

Apparently she (and you) have seen it all regarding care givers. She told me there were some she would love to kill or have them follow her around so they could see what a good caregiver does and how they treat the patients. Home nurses are very special people. I could easily become friends with her.

She is impressed with our set up for Mom. Loves our stair lift. She wants our shower for herself. It is 4' x 7' with lots of safety bars and a shower chair. That makes me feel good.

Trail, you should write a book. It would be helpful to people like me.

    Bookmark   October 1, 2012 at 12:55PM
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Thanks for the credit :)

Elizabeth sounds wonderful and you are in good hands. If your MIL doesn't pee soon you will have to call LIz back and have her re-insert the catheter..hopefully your MIL has had it a short enough time and won't have a problem urinating. Keep up the good work. I retired in Sept 2003. Seems like a lifetime ago. I stopped working to take care of my Mom. Life happens doesn't it ??? (( )) to you and your family. c

    Bookmark   October 1, 2012 at 12:59PM
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I agree, Trail's advice is wonderful and spot on. She's one very wise lady! I have one sister and a good friend that are both home health care nurses and their practical, tried and true advice, as Trail's is, is invaluable.
I'd forgotten that you'd had a stair lift put in, Goldie. That has to be worth it's weight in gold for you guys!

    Bookmark   October 1, 2012 at 2:33PM
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Thanks for the update. I've been thinking about you a lot and was hoping things were on the mend and improving. Being a caretaker is hard work, so I know it hasn't been easy for you. Your MIL is really blessed to have someone who cares about her in such a giving way.

    Bookmark   October 1, 2012 at 3:14PM
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Hope your MIL feels better soon...and that you'll forgive me but my horrible schoolteacher brain won't let me resist blurting out that it's spelled catheter, not cathador :).

Unless, wait, maybe my vibrant middle aged mind (that thinks CC=country club) is blanking here. Is a cathador perhaps a term I just don't know about?

In which case I"m going with my best Rosanne Rosanadana: never mind...


    Bookmark   October 1, 2012 at 9:04PM
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Running, I knew I slaughtered that word. LOL! Spelling lesson appreciated. I like that school teacher brain of yours.

    Bookmark   October 1, 2012 at 10:55PM
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