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How To Relieve Swallowing Problems After Stroke?
Question: My 85 year old mother suffered a hemorrhagic stroke 7 days ago. She seem to rebound after being "asleep" for 30 hours; she was sitting up, getting up with assistance to toilet, eating & sipping, recognizing people, smiling, could respond with grip on both sides...
Suddenly, a 2nd bleed 4 days ago and she lost all ability to respond; no eyes opening, no vocalizing, no swallowing, very little mobility, some rigor in neck & upper body. Doctor & family agreed to stop all fluids, and not to feed. She receives only a small dose of Morphine every couple hours, not enough to keep her under.
Today, day 5 after the second bleed, day 3 without any fluids, she is opening eyes, vocalizing, moving arms and legs, grimacing, swallowing, pursing lips to suck on swab...and I swear she focused right on my face and had one little tear fall. Terribly, dramatic, I know...
My question is: should we restore fluids to ease some of her discomfort? Is it possible she is trying to heal
my sisters want to help ease her passing, but I get the sense when I am with her that she is fighting to stay.
Yes, fluids? Or, no
XXXX
Suddenly, a 2nd bleed 4 days ago and she lost all ability to respond; no eyes opening, no vocalizing, no swallowing, very little mobility, some rigor in neck & upper body. Doctor & family agreed to stop all fluids, and not to feed. She receives only a small dose of Morphine every couple hours, not enough to keep her under.
Today, day 5 after the second bleed, day 3 without any fluids, she is opening eyes, vocalizing, moving arms and legs, grimacing, swallowing, pursing lips to suck on swab...and I swear she focused right on my face and had one little tear fall. Terribly, dramatic, I know...
My question is: should we restore fluids to ease some of her discomfort? Is it possible she is trying to heal
my sisters want to help ease her passing, but I get the sense when I am with her that she is fighting to stay.
Yes, fluids? Or, no
XXXX
Brief Answer:
Read below
Detailed Answer:
I read your question carefully and I understand the situation you are in.
Medically speaking if the aim is to help her survive she must be given something, if not fluids a nasogastric tube can be inserted and fed through that. Otherwise her passing away will take place sooner or later. The aim of a nasogastric tube is not only feeding, but also preserving intestinal mucosa. If one is not fed for several days, thinning of the intestinal walls takes place and bacteria residing in the intestine enter blood stream. So not simply fluids but feeding as well.
Of course there is the other point of view, whether she will ever be able to lead a life of some sort of quality after two bleeds. With the limited regenerative abilities of a 85 years old she probably won't. But whether that means you should let her pass away....that is more of a personal judgement of yours rather than a medical one, I could understand both points of view.
What I can say is that if she has resumed opening her eyes that means that she probably has overcome the death threat due to cerebral edema and compression, it is now more a question of palliative care, she's much more probable to die from immobilization complications like infections, deep vein thrombosis and pulmonary embolism, bed sored etc. That might happen even if she's restored to full care, naturally even more probable if she's not.
I hope I was able to make my point clearly, I know it might sound confusing. Feel free to ask more questions.
Read below
Detailed Answer:
I read your question carefully and I understand the situation you are in.
Medically speaking if the aim is to help her survive she must be given something, if not fluids a nasogastric tube can be inserted and fed through that. Otherwise her passing away will take place sooner or later. The aim of a nasogastric tube is not only feeding, but also preserving intestinal mucosa. If one is not fed for several days, thinning of the intestinal walls takes place and bacteria residing in the intestine enter blood stream. So not simply fluids but feeding as well.
Of course there is the other point of view, whether she will ever be able to lead a life of some sort of quality after two bleeds. With the limited regenerative abilities of a 85 years old she probably won't. But whether that means you should let her pass away....that is more of a personal judgement of yours rather than a medical one, I could understand both points of view.
What I can say is that if she has resumed opening her eyes that means that she probably has overcome the death threat due to cerebral edema and compression, it is now more a question of palliative care, she's much more probable to die from immobilization complications like infections, deep vein thrombosis and pulmonary embolism, bed sored etc. That might happen even if she's restored to full care, naturally even more probable if she's not.
I hope I was able to make my point clearly, I know it might sound confusing. Feel free to ask more questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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