Mom is 90 years old. She has afib on Coumadin, qhypertension, several previous bowel obstructions multiple hospitalizations in less than 2 yrs. She was last in hospital for slightly elevated cardiac enzymes and urinary retention along with lymphedema and trouble breathing with wheezing and sent home on O2 and lasix. Primary took off lasix couple weeks ago but now the swelling has increased again and she needs O2 all the time and was given a nebulizer for the next 30 days.
my question is what could be causing all this? She cannot exert herself at all. Doc put her back on lasix because of the swelling wheezing and low O2 says. The lasix is exacerbating other issues like not having a BM in 3+ days (which she is obsessed with) and she seems dehydrated. Urologist advised more fluid intake for the urine issues which should help the constipation but so far not. Everything is a catch 22 situation. He wants her electrolytes and kidney function checked as her BNP for lung fluid came back normal and to check her afib. The echo they did in hospital said her heart was strong. So no CHF?? Could this be kidney failure? What could be causing the breathing issues and excessive swelling if not heart failure?
Very few of her body systems are working well, if at all. Her lymph system isn't working anymore. Her lungs aren't working to the capacity that they once were able to. So, not only is someone probably having to stick her at least 3 times to get ONE full blue top for her PT/INR (and I'll bet that's Q3xW), but also BMPs, CBCs, BNPs, which also has to be a FULL tube, and now LFTs to boot? What's next, Blood Gasses? Blood gasses are Painful! If she's really dehydrated, I'm telling you, as an EXPERT, seriously, I'm an expert...venous blood draws are torturous for her.
I wish more Physicians would have serious conversations with family of elderly patients. Sorry to be such a jerk, but every day at work, I wish I could take a family aside and say to them, "For What?"
Are you hoping they can return her to her 20 year old self? Or her 89 year old self? Are you hoping to keep her alive another 10 years? If so, FOR WHAT? What is SHE being forced to endure while this quest to prolong her life/death goes on? At this point, it's prolonging her death. Harsh, yes, I know. But that is the reality of it.
At least ask them if they can put her on Eliquis or something other than Warfarin so she doesn't have to have that PT/INR drawn several times a week. Maybe there's a reason they can't. I don't know. Or maybe, it's just time to put her on Comfort Care and let her not have to be poked and prodded every day for whatever time she has left. Maybe, if she can communicate well, Ask HER what she wants. Be sure what she says isn't because she's tying not to break your heart. I would bet my hat, if this serious conversation were to happen with her, you would find out that she doesn't want all of this, because, exactly what I said. For what?
Have some conversations with HER, if you can, and a serious conversation with her doctor about whether or not this is all for naught and if it wouldn't be better for her Comfort and happiness to just let God do what He does.
The rest is likely: she’s 90 with multiple hospitalizations. She isn’t going to bounce back easily from that and her body is old and it’s getting wonky.
I'm no doctor but probably your Mom's aged heart cannot keep up, drugs or not. This causes a domino affect of other problems, as you are seeing. Elders often have so many other peripheral health issues from their advanced age.
If I were you I'd research hospice so that you don't have to do it in a crisis like I did: the ER/hospital where my Aunt was taken hadn't release her medical records so she couldn't get approved for hospice during the evaluation. When she had the stroke she should have already been approved for hospice but wasn't so back to the ER where I had to get on my broom and make an angry scene because the only reason she was there was because of their admin incompetence. Then they finally immediately approved her for in-hospital hospice (which I do not recommend due to there being no hospice-trained nurses). In-home hospice -- which was my Aunt's wish -- takes 2 days to set up (including getting the O2 ordered/delivered). Facility hospice can be quicker as long as beds are available.
I'm so sorry your Mom and family are going through this distress. Please have tempered expectations for any "recovery". Plan for the worst but hope for the best. May you receive peace in your heart as you advocate for her.
Please consult with mom's docs.
I am so sorry for all that you are going through.
We could not possibly guess at any of this, and again--I say that as an RN.
Wish I had a definitive answer. It's trial and error and a guessing game even for doctors I'm afraid.
Best of luck to you!
Lasix can ruin the kidneys, it depletes our system of all the vital electrolytes and minerals. It is helpful but a hard drug.
My dad had problems with it and his new cardiologist had him weigh himself every morning and only take the Lasix when there was a 2 to 3 pound increase in his weight. He had him take a low dose potassium when he had to take the lasix, he also took a magnesium, multi B, C and probiotic daily. It worked great.
I would encourage you to ask the doctor about working with the meds and not an all or nothing approach.
Did they refer her to a Pulmonologist? If not, you should request one. They will tell you what is going on with her breathing.
Prayers that you find the right path forward for all of you. She is 90 and has had a long life, I hope it was a good one and she will be remembered lovingly, by many, when her time comes.
The young people today need to care deeply for the elderly and their ailments, because it is the only way to ensure their longevity in the near future. If they don’t care more now, who will care for them?
people used to have more respect for the elderly, but today, so many young people see the elderly as just a problem or in the way.
I love that you care and want to help.
I would suggest a quality olive oil with high polyphenols, and have her take one teaspoon at night. It should help with the constipation. She can also get extra liquids from fruits like watermelon 🍉, and veggies like cucumber 🥗. This should help with the dehydration. She needs to get movement into her life, even if bedridden. She will thrive if she feels important, loved, and has a reason to live and not feel sick and lonely. Maybe she can play catch with a soft, easy to catch ball. Watch things on tv that she really enjoys.
Although, it may be true that her heart has weakened too much at this point. I believe in miracles, and that giving your all can possibly really help her. Just asking for help on this forum was a very loving act. She is so fortunate to have you. 🙏
Hypertension - she probably needs a combination of medications: diuretics to pee off extra fluids as well as keeping to a fluid intake of a certain amount daily.
GI issues - To keep her bowels moving (more activity would help with this too), she needs a Miralax-style laxative... and probably more movement in her day.
UTI/Kidney issues - To prevent UTIs, keep her bottom parts clean (wipe front to back and change dirty/wet undergarments promptly). Have her drink about 2 liters of water-based fluids (caffeine doesn't count) every day. This amount can be her limit that will work with her hypertension issues as well.
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