10% lung capacity

[phorsenuf]

My MIL is currently in the hospital. She has COPD and emphysema. We were told she has 10% lung capacity left and she is fighting an infection in her lungs. They were giving her morphine which in turn just totally zoned her out and was pretty much sleeping all the time and not eating. My SIL (who lives near her) told the Drs. yesterday no more since it seemed to be working against her.
We have been waiting to hear back from the Dr as we keep getting 2nd and 3rd hand info. We live about 13 hours away.

For anyone who has been in a similar situation, or works in this field, what are your thoughts? What do you think we should expect? How long can someone possibly last on just 10%?

 

[firecracker725]

My MIL is currently in the hospital. She has COPD and emphysema. We were told she has 10% lung capacity left and she is fighting an infection in her lungs. They were giving her morphine which in turn just totally zoned her out and was pretty much sleeping all the time and not eating. My SIL (who lives near her) told the Drs. yesterday no more since it seemed to be working against her.
We have been waiting to hear back from the Dr as we keep getting 2nd and 3rd hand info. We live about 13 hours away.

For anyone who has been in a similar situation, or works in this field, what are your thoughts? What do you think we should expect? How long can someone possibly last on just 10%?

Speaking as someone who has been in the situation of caring for a parent from a long distance, I can state emphatically that your DH should be on his way there if he wants information and to participate in the decisions being made. Honestly, she probably should be sleeping, and you shouldn't worry about eating at this point. Does anyone here have power of attorney?

 

[phorsenuf]

Speaking as someone who has been in the situation of caring for a parent from a long distance, I can state emphatically that your DH should be on his way there if he wants information and to participate in the decisions being made. Honestly, she probably should be sleeping, and you shouldn't worry about eating at this point. Does anyone here have power of attorney?

We were up in NH for my sons college graduation when all this happened. We just got home last night so we are figuring out how soon we can get there. He was going to talk with his boss today about taking more time off. Of course this is when everything at work is blowing up. Never fails. His sister has medical power of attorney. My husband and sister do not get along so she wouldn't listen to him anyway regarding his opinions. All we keep hearing is they haven't seen the Dr (for the last 2 days?), and one person says she's doing poorly, yet another says she's getting better. Hoping the Dr will call him today. It's so frustrating.

I'm doing laundry and getting ready myself so we can take off quickly if needed.

 

[StitchesGr8Fan]

My dad has been functioning at 20% for 10 years now. He gets chronic lung infections and we think every one is going to do him in. I would say have someone at the hospital asking lots of questions, and be cautiously optimistic.

 

[AntePrincess]

We went through this two years ago with a loved one and are going through it again with another, so first of all .

I'll be honest with you, our first loved one died of it and it was a very long, drawn out sort of death, but there were complicating factors out the wazoo (brain hemorrhage/bleeding stroke, crippling arthritis, and general weakness, concluding with pneumonia). Our current loved one in these straits is almost 90 and also generally weak. I'd say everything depends on your MIL's underlying condition and age. If she's getting on in years and coping with other difficulties, this might not be the big one, but she is unlikely to really recover from it later on.

It all depends on what the doctors say. If they indicate you should prepare for the worst, I think it would be a good time to have the family have a talk, ideally with a hospital or hospice counselor present. My best advice, if anyone has a POA or can otherwise speak for your MIL, is to get a DNR. There is nothing worse than watching a loved one 'brought back' to prolong their dying for six months instead of letting them go. I refused to step in and do anything more than comfort family members when the first relation began to decline, and I regret it though I don't know what I'd do differently this time around. I am just an in-law in both cases, I thought I wasn't close enough to put my foot in, but I was close enough for the first loved one for him to tell me repeatedly that he just wanted to die, that he didn't want to be seen in the condition he was in, etc.

Anyway, just my 2¢. It really varies.

 

[Jaya]

My father hovered between 16-18% for almost 10 years and lived a full and happy life. I think it was his great love for life and family that kept him going -- the doctors didn't know how he stayed alive that long. He had to lay down and rest a lot and he knew his limits but most people didn't know there was anything wrong with him - he never complained. He would occasionally have an episode and the docs would have him at death's door and wham! three days later, he'd be out of the hospital and back to "normal". It was that will to live that kept him alive and active. His mother was the same way....bad heart and docs said she shouldn't be alive but she lived almost 20 years with a heart that was barely beating and she had a good, active life. I'm sure hoping I follow in their footsteps.

 

[phorsenuf]

She's been on oxygen 24/7 for a while now. When we talk to her she always said she was doing good. In fact we were taking her to Las Vegas and the Grand Canyon this summer (her bucket list), but now when we talked to our BIL, who lives near her, he said he can't imagine she could have even gone. She needs help bathing, can't clean her own house and can barely go 15 feet without stopping to rest. He said it was wishful thinking on her part. So obviously she is far worse off the she has led us to believe.
She lives in a progressive assisted living home and has her own apartment. My SIL is now thinking there is no way she will be able to go back to that. I just hope this doesn't cause her to give up.

 

[xbmomma17]

I want to start out by saying that I am not a doctor, so with that in mind, my opinions are based on research and experiences.
I lost my Grandma about nine years ago to emphysema, it was terribly painful to watch. I can definitely empathize with your current situation. I agree with everyone else so far about getting someone there that will ask the questions that you want answered. Poor communication, on your SIL's part, can be very frustrating when you are miles away. If the family should be there to say good bye, you also need to know that.
Questions that I would want answered include: Is she currently intubated? Why was she on morphine? What are her chest x-rays showing?- improvements or decline? What therapies are being done to help her get stronger? Does she have pneumonia or a different lung related infection?
To be perfectly honest with you, morphine is typically used for extreme pain management and palliative/hospice care. It will depress the central nervous system, hence the respiratory system, and reduce her drive to breathe. I would be concerned that she is being properly monitored with an end tidal CO2 monitor, not just pulse oximetry, as well. Most hospitals do physician rounding at least once a day, especially in ICU areas, which is where I would suspect your MIL might be.
Someone else talked about DNR status, and I have to agree with that as well. Although you never want to lose loved ones, watching them survive on a ventilator because they are indefinitely unable to breathe on their own in heartbreaking. Obviously there are many other factors affecting this situation, but I would suggest that your husband get there and ask your questions directly instead of getting the second hand info.
Also, there is a great website called caringbridge.org that allows families to keep in touch when a loved one is in the hospital. It is like a blog site.
Good luck & your family will be in my prayers.

 

[minkydog]

My thoughts are this: She is hospitalized with a lung infection and only 10% lung capacity. Eating is the least of her problems. Your husband needs to go NOW. Sure, she could rally. She might even get better. It's possible. But not probable. He won't really know until he gets there and talks to the doctors himself. I wish you the best.

 

[phorsenuf]

I want to start out by saying that I am not a doctor, so with that in mind, my opinions are based on research and experiences.
I lost my Grandma about nine years ago to emphysema, it was terribly painful to watch. I can definitely empathize with your current situation. I agree with everyone else so far about getting someone there that will ask the questions that you want answered. Poor communication, on your SIL's part, can be very frustrating when you are miles away. If the family should be there to say good bye, you also need to know that.
Questions that I would want answered include: Is she currently intubated? Why was she on morphine? What are her chest x-rays showing?- improvements or decline? What therapies are being done to help her get stronger? Does she have pneumonia or a different lung related infection?
To be perfectly honest with you, morphine is typically used for extreme pain management and palliative/hospice care. It will depress the central nervous system, hence the respiratory system, and reduce her drive to breathe. I would be concerned that she is being properly monitored with an end tidal CO2 monitor, not just pulse oximetry, as well. Most hospitals do physician rounding at least once a day, especially in ICU areas, which is where I would suspect your MIL might be.
Someone else talked about DNR status, and I have to agree with that as well. Although you never want to lose loved ones, watching them survive on a ventilator because they are indefinitely unable to breathe on their own in heartbreaking. Obviously there are many other factors affecting this situation, but I would suggest that your husband get there and ask your questions directly instead of getting the second hand info.
Also, there is a great website called caringbridge.org that allows families to keep in touch when a loved one is in the hospital. It is like a blog site.
Good luck & your family will be in my prayers.

Thank you for all this. I'll try to answer what I can. She is not intubated nor in ICU. She went to her Dr on Wednesday and her Dr said he lungs were clear then come Friday she's in the hospital with a lung infection. I believe they were giving her morphine to keep her calm because she gets panicky. My husband talked to her on Friday and she seemed ok, but maybe slurring her words a bit. My husband chalked that up to the morphine. Saturday she couldn't talk with us, she was too out of it. On Sunday she didn't even remember why she was there. When my husband told her, she said "well that was days ago". He talked with the floor nurse and she said she was up and eating and doing better.
I don't believe they have done any tests on her. I just really feel nobody is being very proactive on her part, which is driving me nuts. Getting info from his sister is like pulling teeth. So aggravating! I do not know if she has a DNR or not, but I know that she is not on any type of life support. She's not at that point.


Just talked with my husband and he got a message from his sister that they are probably going to move her to ICU as she is laboring to breathe. That's all I know for now. Said he'll read me the message when he gets home. Yes, she keeps him up to date with a text versus calling. Seems to me we should be thinking about heading that way.

 

[minkydog]

Thank you for all this. I'll try to answer what I can. She is not intubated nor in ICU. She went to her Dr on Wednesday and her Dr said he lungs were clear then come Friday she's in the hospital with a lung infection. I believe they were giving her morphine to keep her calm because she gets panicky. My husband talked to her on Friday and she seemed ok, but maybe slurring her words a bit. My husband chalked that up to the morphine. Saturday she couldn't talk with us, she was too out of it. On Sunday she didn't even remember why she was there. When my husband told her, she said "well that was days ago". He talked with the floor nurse and she said she was up and eating and doing better.
I don't believe they have done any tests on her. I just really feel nobody is being very proactive on her part, which is driving me nuts. Getting info from his sister is like pulling teeth. So aggravating! I do not know if she has a DNR or not, but I know that she is not on any type of life support. She's not at that point.


Just talked with my husband and he got a message from his sister that they are probably going to move her to ICU as she is laboring to breathe. That's all I know for now. Said he'll read me the message when he gets home. Yes, she keeps him up to date with a text versus calling. Seems to me we should be thinking about heading that way.

I agree. It sounds like she is steadily going downhill. If she does not have a DNR, don't be surprised if they go ahead and intubate her. I'm really sorry for you all.

Just wanted to speak to the texting--everyone approaches end of life stuff differently. When my dad was dying, I couldn't handle phone calls much so I did a lot of texting. Believe it or not, I totally forgot to call one of my sisters. She knew he was sick, but since she doesn't call or text, I somehow just let it slip my mind. I have 3 other sibs and none of them thought to call her either. So when my dad died, she was totally out of the loop. I was horrified when I realized what I'd done, but there was no taking it back. After that experience I came to see how each of us dealt with his death in very different ways.

 

[phorsenuf]

I agree. It sounds like she is steadily going downhill. If she does not have a DNR, don't be surprised if they go ahead and intubate her. I'm really sorry for you all.

Just wanted to speak to the texting--everyone approaches end of life stuff differently. When my dad was dying, I couldn't handle phone calls much so I did a lot of texting. Believe it or not, I totally forgot to call one of my sisters. She knew he was sick, but since she doesn't call or text, I somehow just let it slip my mind. I have 3 other sibs and none of them thought to call her either. So when my dad died, she was totally out of the loop. I was horrified when I realized what I'd done, but there was no taking it back. After that experience I came to see how each of us dealt with his death in very different ways.

His sister said he CO2 levels were slightly elevated and so they were going to try some medication and if that doesn't work then they would move her to the ICU and mask her (?). I sent a message to his sister asking more pointed questions. The texting thing bugs me because it doesn't give my husband (or I) and opportunity to actually discuss what's going on.

 

[AntePrincess]

She's been on oxygen 24/7 for a while now. When we talk to her she always said she was doing good. In fact we were taking her to Las Vegas and the Grand Canyon this summer (her bucket list), but now when we talked to our BIL, who lives near her, he said he can't imagine she could have even gone. She needs help bathing, can't clean her own house and can barely go 15 feet without stopping to rest. He said it was wishful thinking on her part. So obviously she is far worse off the she has led us to believe.
She lives in a progressive assisted living home and has her own apartment. My SIL is now thinking there is no way she will be able to go back to that. I just hope this doesn't cause her to give up.

I think it's very common for older relatives to sugarcoat their real condition, they don't want to be a burden even though their loved ones wouldn't necessarily feel that they were.

My thoughts are this: She is hospitalized with a lung infection and only 10% lung capacity. Eating is the least of her problems. Your husband needs to go NOW. Sure, she could rally. She might even get better. It's possible. But not probable. He won't really know until he gets there and talks to the doctors himself. I wish you the best.

I agree that now is the best time to see her. It doesn't sound very good.

His sister said he CO2 levels were slightly elevated and so they were going to try some medication and if that doesn't work then they would move her to the ICU and mask her (?). I sent a message to his sister asking more pointed questions. The texting thing bugs me because it doesn't give my husband (or I) and opportunity to actually discuss what's going on.

Good luck with the medication. As for your SIL, can you call her? Will she pick up? Everyone deals with these things differently, she may not even realize you feel differently about texting. (I sympathize with her a little on this one, I'm terrible on the phone and would rather write things out, especially when I'm stressed. I'd probably be sending mile long emails in her shoes.)

 

[xbmomma17]

If her CO2 is going up, one of the first non-invasive treatments that should be done has to do with a positive airway pressure machine (PAP). I have ever heard of a medication that brings down CO2...but now I'm going to have to look it up... Many people use similar devices at home to help them with obstructive sleep apnea, like a CPAP or a Bi-level PAP (as BiPAP is a trademark name). I would make the guess that they will try the Bi-level on her to help bring down her CO2. Numerous settings will be entered into the machine, as hospital ones are slightly different then home units. The most important will be the IPAP and EPAP- they stand for Inspiratory Positive Airway Pressure and Expiratory Positive Airway Pressure. These numbers represent the amount of pressure that she must breathe against during her regular breathing. The extra pressure will actually allow her (hopefully help her) to take larger breaths. She will be "flushing out her CO2" with those larger breaths. This type of non-invasive treatment has been proven to reduce the amount of people getting intubated in respiratory distress situations. I hope that all made sense and I truly hope that it works out well for your MIL.

 

[phorsenuf]

If her CO2 is going up, one of the first non-invasive treatments that should be done has to do with a positive airway pressure machine (PAP). I have ever heard of a medication that brings down CO2...but now I'm going to have to look it up... Many people use similar devices at home to help them with obstructive sleep apnea, like a CPAP or a Bi-level PAP (as BiPAP is a trademark name). I would make the guess that they will try the Bi-level on her to help bring down her CO2. Numerous settings will be entered into the machine, as hospital ones are slightly different then home units. The most important will be the IPAP and EPAP- they stand for Inspiratory Positive Airway Pressure and Expiratory Positive Airway Pressure. These numbers represent the amount of pressure that she must breathe against during her regular breathing. The extra pressure will actually allow her (hopefully help her) to take larger breaths. She will be "flushing out her CO2" with those larger breaths. This type of non-invasive treatment has been proven to reduce the amount of people getting intubated in respiratory distress situations. I hope that all made sense and I truly hope that it works out well for your MIL.

I have no idea what the medication is, I'm going to try to find out today. I sent a message to my SIL last night asking if any xrays or tests have been done. She's had a couple xrays and she has some fluid in her lungs but she does not have pneumonia, but does have bronchitis. I guess the mask my sister was referring to must be the CPAP. She said it can only be given to her in the ICU.

What causes CO2 levels to elevate and how high is too high? What impact will it have on her if it continues?

 

[abdmom]

CO2 is produced by all functions of your body. You breathe for 2 reasons: to bring in oxygen which is required for metabolic functions as well as to blow off CO2 which is the product of metabolic functions.

Elevated CO2 levels mean that she is not breathing enough to blow off the CO2. Normally your brain tells your body to breath fast enough and deeply enough to keep the CO2 levels stable. It's rather dangerous as giving oxygen to someone who has high CO2 can make the CO2 levels even higher. wikipedia High CO2 levels can cause respiratory arrest.

 

[ChiCat]

If her CO2 is going up, one of the first non-invasive treatments that should be done has to do with a positive airway pressure machine (PAP). I have ever heard of a medication that brings down CO2...but now I'm going to have to look it up... Many people use similar devices at home to help them with obstructive sleep apnea, like a CPAP or a Bi-level PAP (as BiPAP is a trademark name). I would make the guess that they will try the Bi-level on her to help bring down her CO2. Numerous settings will be entered into the machine, as hospital ones are slightly different then home units. The most important will be the IPAP and EPAP- they stand for Inspiratory Positive Airway Pressure and Expiratory Positive Airway Pressure. These numbers represent the amount of pressure that she must breathe against during her regular breathing. The extra pressure will actually allow her (hopefully help her) to take larger breaths. She will be "flushing out her CO2" with those larger breaths. This type of non-invasive treatment has been proven to reduce the amount of people getting intubated in respiratory distress situations. I hope that all made sense and I truly hope that it works out well for your MIL.

Bipap can work in respiratory distress but works well for shorter time spans as the mask has to be fitted tightly across the face which can cause skin to break down (sores), also most hospitals don't have humidifiers that work with the machines (these are typically not sleep apnea machines) which can be very drying. Also some people don't tolerate the machines, drive 75 miles down the highway and stick your head out of the window and try to breathe, it feels the same way. However if her co2 is high enough she may be out of it where she won't resist the machine. Sorry I did not have time to read all the posts.

I've seen people in an outpatient setting living with 15% capacity but even at that a lot of doctors worry that if they had to go on the ventilator they would not be able to come off.

 

[ChiCat]

I have no idea what the medication is, I'm going to try to find out today. I sent a message to my SIL last night asking if any xrays or tests have been done. She's had a couple xrays and she has some fluid in her lungs but she does not have pneumonia, but does have bronchitis. I guess the mask my sister was referring to must be the CPAP. She said it can only be given to her in the ICU.

What causes CO2 levels to elevate and how high is too high? What impact will it have on her if it continues?

A lot of hospitals have that policy for cpap with respiratory distress, that they need to be in an icu. That's because they need to be closely monitored, what if the mask fell off or she vomited in the mask? It's for patient safety, floor nurses have more patients so they can't watch patients as closely as an icu nurse.

 

[ReneeA]

It may not be the morphine making her loopy if her CO2 level is at all elevated. With raised levels, it will cause confusion and lethargy.

 

[Nancyg56]

When my Mom was in stage 4 emphysema, she was given morphine to help her breathe. I cannot remember the reason, but my sister is a respiratory therapist and she worked with the pulmonary Dr to manage the medications. I just remember that she needed ativan and morphine because she got extremely anxious when she could not find her breath. It was awful..