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Suggest Treatment For Pneumonia, Atrial Fibrillation And Bed Sores
Question: My Mom is 104 & had a major stroke abt. 2 mos. ago. P 2 swallow tests, they said it ALL was going into her lungs. That if we let her eat, she fill-up & develop pneumonia. I put her on Hospice for palliative care & we started letting her eat. She is eating abt. 50% of her meals, her vitals are w/in normal range, there is no congestion... (Before we put her on Hospice, the monitor showed A.fib.--we believe that is the reason for the stroke--she has a high-normal pulse & prob. is still in a.fib)She has developed some edema in her extremities & on her affected (L) side & developed bed sores on her coccix 7 R.heel (stroke left her L.side paralysed). I am thinking of taking her off hospice & being more aggressive in Tx-ing her bed sores & maybe trying to tx. the a.fib too. The Hospice nurse says this is just what happens & acts like there is no way to treat them. I am not sure Hospice is worth 'doing'. Am I missing anything here??
Brief Answer:
Decide firmly what exactly you want for her.
Detailed Answer:
Hi
Greetings from Dr Divakara P
Thanks for posting your query.
See Hospice is a different kind of care given to patients for whom recovery from the disease is not important or possible. In hospice the motive is to make the patient comfortable to deal with her disease and not for the cure.
While actual treatment is totally aimed at curing or controlling the disease.
So first you need to be very firm in what you want for her . If hospice is what you wanted then don't think of treating Afib or bed sore or anything.
But if you intend for a cure then go ahead and get her evaluated with further test.
For bed sore it requires dressing with saline gauge and if there is any infection then antibiotic cream has to be applied. I would recommend to consult a surgeon for the bed sore.
For Afib with fast rate she needs to be put on medication that brings down the heart rate like beta blocker or amiodarone. Take a cardiologist consult.
Also make sure her nutrition is taken care either through oral feeding or feeding through nasogastric tube.
Hope these points were helpful to you.
Any clarification feel free to ask.
Regards.
Decide firmly what exactly you want for her.
Detailed Answer:
Hi
Greetings from Dr Divakara P
Thanks for posting your query.
See Hospice is a different kind of care given to patients for whom recovery from the disease is not important or possible. In hospice the motive is to make the patient comfortable to deal with her disease and not for the cure.
While actual treatment is totally aimed at curing or controlling the disease.
So first you need to be very firm in what you want for her . If hospice is what you wanted then don't think of treating Afib or bed sore or anything.
But if you intend for a cure then go ahead and get her evaluated with further test.
For bed sore it requires dressing with saline gauge and if there is any infection then antibiotic cream has to be applied. I would recommend to consult a surgeon for the bed sore.
For Afib with fast rate she needs to be put on medication that brings down the heart rate like beta blocker or amiodarone. Take a cardiologist consult.
Also make sure her nutrition is taken care either through oral feeding or feeding through nasogastric tube.
Hope these points were helpful to you.
Any clarification feel free to ask.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
That is what I am trying to decide: "What I want" or rather, what she wants....
I am not a fan of Hospice. I think it limits your choices. I only put her in Hospice BECAUSE of the Dx., & esp. the rather grim results of the swallow-tests--I was led to believe that as soon as she took anything orally her lungs would begin filling up. I thought her demise was imminent. However, p 6 weeks of oral intake, I wonder abt. the validity of those tests. It seems to me that if the food was going into her lungs, we would know by now--w/o any further testing. Her breathing would be rapid & congested--there would be a fever--don't you think? She has no underlying conditions--hypertension, known heart or lung disease, metabolic disorders or the like.
She is not being forced to eat. She is participating in eating in a limited way, by holding a cracker or toast in her 'good' hand & taking a few bites as she is fed by attendants. She is drinking a (thickened) Ensure-type supplement daily & wants (& is getting) her AM cup of coffee w/cream daily.
Her speech is cleared up so that she is able to make basic needs known: cold, hungry, stop!(when she is being fed), etc. But, she is either incapable or unwilling to engage in conversation, so I am not sure how she is thinking. In the past she said she did not want any extraordinary efforts; breathing or feeding tubes, etc., to keep her alive but she also wanted to be kept comfortable. Would wound-care & a pill for to try to control her A.fib be considered "extraordinary"? Or, would it be helping to keep her comfortable??
I am not a fan of Hospice. I think it limits your choices. I only put her in Hospice BECAUSE of the Dx., & esp. the rather grim results of the swallow-tests--I was led to believe that as soon as she took anything orally her lungs would begin filling up. I thought her demise was imminent. However, p 6 weeks of oral intake, I wonder abt. the validity of those tests. It seems to me that if the food was going into her lungs, we would know by now--w/o any further testing. Her breathing would be rapid & congested--there would be a fever--don't you think? She has no underlying conditions--hypertension, known heart or lung disease, metabolic disorders or the like.
She is not being forced to eat. She is participating in eating in a limited way, by holding a cracker or toast in her 'good' hand & taking a few bites as she is fed by attendants. She is drinking a (thickened) Ensure-type supplement daily & wants (& is getting) her AM cup of coffee w/cream daily.
Her speech is cleared up so that she is able to make basic needs known: cold, hungry, stop!(when she is being fed), etc. But, she is either incapable or unwilling to engage in conversation, so I am not sure how she is thinking. In the past she said she did not want any extraordinary efforts; breathing or feeding tubes, etc., to keep her alive but she also wanted to be kept comfortable. Would wound-care & a pill for to try to control her A.fib be considered "extraordinary"? Or, would it be helping to keep her comfortable??
Brief Answer:
No need to aggressive treatment.
Detailed Answer:
HI
See here the choice is always yours , I can just show you what are the pros and cons of each path.
In my personal opinion , as per her past wish that she should not be put on any feeding tubes I would recommend to continue same kind of Hospice care with slightly more attention towards the bed sore management. There is no need to actively treat her to make her totally normal ( because that may not be able to achieve and in the process of achieving we will be troubling her )
So there is no need to actively treat her for her condition as her food intake is quite OK. The only thing that needs attention is bed sore and for that you take a Surgeon's consultation. Frequent changing of position, alternate day saline gauze dressing , using a water bed all these can help in recovering from bed sore and prevent further occurrence of bed sore.
Rest there is no need to actively evaluate or treat Afib or for her swallowing problem ( which actually is showing some improvement )
Hope this information helps you.
Any clarifications feel free to ask .
Regards.
No need to aggressive treatment.
Detailed Answer:
HI
See here the choice is always yours , I can just show you what are the pros and cons of each path.
In my personal opinion , as per her past wish that she should not be put on any feeding tubes I would recommend to continue same kind of Hospice care with slightly more attention towards the bed sore management. There is no need to actively treat her to make her totally normal ( because that may not be able to achieve and in the process of achieving we will be troubling her )
So there is no need to actively treat her for her condition as her food intake is quite OK. The only thing that needs attention is bed sore and for that you take a Surgeon's consultation. Frequent changing of position, alternate day saline gauze dressing , using a water bed all these can help in recovering from bed sore and prevent further occurrence of bed sore.
Rest there is no need to actively evaluate or treat Afib or for her swallowing problem ( which actually is showing some improvement )
Hope this information helps you.
Any clarifications feel free to ask .
Regards.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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