Hi There My Mother In Law Has Been Advised She

Posted on Mon, 8 Oct 2018

Question: Hi there my mother in law has been advised she is on palliative care,with an EF of 19%, ICD which has had the defib part turned off in Feb this year, she is diabetic, with readings of 20+ most days, she has also been diagnosed with vascular dementia, she also has kidney failure, where her kidneys have been deteriorating since Feb considerably. Palliative doc has advised that she has poor survival, and may not be here past the end of this year. She recently had a blood test for her kidneys showed that her creatinine levels have gone to 400 from about 240 and then went down again to 240, so that may be dehydration, however, she is also complaining of itching on all her body and really bad eyes feeling sore and heavy. She is not very active, and on the bed most of the time, however, at times she does venture out to church etc. due to her vascular dementia, she has turned quite rude, but cannot put her into a nursing home due to our culture of keeping the parent at home. Can you advise what does her health look like overall? she has a kidney specialist appt coming up on the 3rd October to advise further. The doctor has also stopped her asprin, Apixiban, statins, VD3, Calcium as she is on palliative care.

Answered by Dr. Dr.Dorina Gurabardhi (2 hours later)

Brief Answer:
Health condition is very complex, palliative care and regular follow ups are needed.

Detailed Answer:
Hello dear,
welcome to ‘Ask A Doctor’ service. I reviewed your query and here is my advice.

I am really sorry to see that the health condition of your mother in law is so complex.
In my opinion the most problematic diagnosis in this case is kidney failure and low fraction of ejection due to heart failure.

Kidney failure can be maintained under control through dialysis. Regular measurement of creatinine and azotemia levels should be done.
Low fraction of ejection can be maintained under control through medications or pacemaker.
Both diagnoses should be followed by a cardiologist and a nephrologist.

Palliative care is very important in this case to relief the symptoms and stress of a serious illness.

I would also suggest healthy foods,avoid salt and walking.

Her health should be maintained under control through regular follow ups and prescribed medications.

Hope I have answered your query. Let me know if I can assist you further.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr.Dorina Gurabardhi (2 hours later)

She has been told by the palliative care team that they would not consider dialysis as he heart and body would be too weak also she has had a triple bypass 20 years ago as well as 5 stents and 2 heart attacks. So heart is pretty damaged. We have been told she may not be here by end of
the year but she does not know this. What does he survive prognosis look like with all of these complex conditions? Could it be end of the year or this is unpredictable as it depends on person to person. Palliative care is important for her as it is symptom control because at the moment she wants to eat all the time and she goes to urinate frequently which is probably the sign of her diabetes and kidney failure.At least we know we need to start putting things in place for her.Thank you.

Answered by Dr. Dr.Dorina Gurabardhi (1 hour later)

Brief Answer:
Life expectancy is unpredictable and changes from a person to a person.

Detailed Answer:
Hi again dear,

So sorry to hear about the situation.
I see through your response that you had already tried all the alternative treatments. In this case, palliative care is the only remaining therapy.
This therapy can help in relieving the symptoms.

It is very difficult to precisely give you a response about life expectancy in this situation. It depends on many factors and it is changing from person to person.

But, I agree with your doctors that life expectancy in this case is very short.

Hope it helps.
Lots of good luck wishes,
Do take care of yourself through this as well.
Dr.Dorina Gurabardhi

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Above answer was peer-reviewed by : Dr. Raju A.T