Any Nurses out there that would maybe be able to answer a couple questions?

[DISNEYLOVER70]

Hello. I am coming to the DIS Boards to see if some one here can shed a little more light on my father's condition for me.

A bit of history on him:

82 years old
COPD
Diabetes
Had surgery on both sides of his neck for clogged arteries.
He is the oldest of 3 children and lost his other two siblings to heart conditions in their 60's.
They previously lived in Florida for the winters and last winter moved in with my husband and I (my husband is a contractor and built an apartment off the back of our home so they have their own private living space/entrance/etc).

He has been getting shorter of breath gradually I would say over the past couple years. Tires easily. I forgot to mention: because of all of the stress that has been on his heart over the years (stents, bypasses) he has an enlarged heart). About 4-5 weeks ago, his feet started to retain fluid. They got larger and larger and finally convinced him to go the doctor. They increased is lasik at home and finally admitted him to give him lasiks i.v. He was in our local hospital for two weeks with no improvement. Actually the fluid started going up into his calves. His regular doctor went on vacation and he had to see his "covering physician". (big jerk) I try not to be judgemental but this guy needs some bedside education. He came into my fathers room and told my father he was discharging him. here is how the converation went:

Dr.: i am discharging you tomorrow
Dad: You are? I have so much fluid and it is hard to walk (dad has fallen in hospital 3 times at this point from his feet being so big and his low blood pressure 70/45)
Dr.: I can not rationalize to the insurance company keeping you in this bed when there is nothing I or anyone can do for you.
Dad: Nothing?
Dr. : I am SURE someone has told you at some point in your medical history that you are dying. Your heart is practically non-functioning and your kidney function is failing. We increase the lasik to rid the fluid which in turn puts more stress on your kidneys and I have to decide which is lesser of the two evils "kidney failure or water retention"

My mother is 66 years old, has been undergoing chemotherapy for cancer she had in her colon that spread to her liver and now more recently to her lungs. She still has 2 more months of chemo to go (it is working though thank the Lord) and they want to send my Dad home basically to die.

So the social worker was able to get my dad into a beautiful new Nursing home facility in our home town for "rehabilitation" for 20 days. He has been there now for 6 days. The fluid is now all the way up to the top of his thighs and my mom says she sees the bloat in his stomach as well. He has been very tired, sleeps alot, but the PT says that he is "doing well" for his condition.

Last night I was giving him his evening foot rub and I noticed little blisters (clear) and his legs were literally leaking fluid. His bed sheets were damp from them. There were no "nurses" around to ask last night but I was wondering if this could be the fluid trying to get out of his body? Has anyone ever heard of this type of thing? And if the fluid isn't coming off, what is going to happen. One of my sisters told me that the fluid would eventually "drown him", is that even remotely true???

I am taking my dad to see his cardiologist on Monday (my mom has chemo that day or she would take him). I would like some intelligent questions to ask so I can have a better feel of where this is going. I know that I have been blessed to have my father as long as I have, but I am his 36 year old baby and I am selfish, I want him forever I have had a few friends of the family and of course that loser doctor tell me that this is the end, it is just a matter of time. But my Dad has pulled out of things before they said he never would. But this fluid is totally new to the equation. Any tips on what to ask the doctor of if anyone has seen this type of progression and the outcome, I would appreciate any info.

Thank you, and if any of you reading this are the praying kind, I would appreciate any and all of them. For my mother as well.

Renee

 

[Anne MN]

I could give you some questions to ask the cardio. I will PM you- less board space and TOO MUCH INFO for most people

 

[Annie68]

It sounds like he has 2 major issues right now, Congestive Heart Failure & End Stage Renal Disease. Has the option of dialysis been talked about? Have they tried anything other than the Lasix for the edema? There are many different diuretics/medication cominations that the Dr.'s use, depending on the patient's condition. I would recommend you scheduling an appt. with his physician, let them know it's a family consultation you need.

Usually before someone is sent home "to die", the Dr. discusses it with the patient & family, the patient decides that they want no further medical intervention, and a consult to Hospice is placed. Sometimes there is just nothing that can be done however, the patient's condition is too advanced, and then the physician has to explain to the patient & family that Hospice is the best choice in their situation . If this is the case with your Dad, it sounds like the covering physician assumed his partner had already discussed this with him. His bedside manner was unexcusable though.

Here is some information on Renal (Kidney) Disease; I will keep you & your father in my prayers.

Loss of kidney function leads to serious illness, affecting many aspects of physical well-being. The kidneys filter by-products of body chemistry and adjust the amount of liquid in the bloodstream. Many people have progressively diminished kidney (sometimes called "renal") function as they grow old, but usually this slow decline can be managed with diet and drugs. When the kidneys fail completely, you cannot live for long unless you have dialysis or a kidney transplant. A transplant that works relieves the person of kidney failure. However, transplants are not always available, appropriate, or successful. Dialysis is the name for the process of artificially replacing the main functions of the kidneys. Hemodialysis refers to filtering the blood through a machine; peritoneal dialysis refers to using fluid exchanges through the abdomen. Either procedure can be used to sustain life for years, but they do burden you and your caregiver, and each procedure has complications.

Sometimes a person whose kidneys no longer work decides not to continue or even not to start dialysis and to let death come from kidney (renal) failure. If you are considering this option, you need to know what is likely to happen. Usually, dying from kidney failure is fairly gentle and most symptoms can be suppressed. The characteristics of your renal failure and your other medical problems help to predict which symptoms may arise.

As the by-products of the body's chemistry accumulate in renal failure, these substances cause an array of symptoms. You almost always lose energy and become sleepy and lethargic, but you may find it hard to sleep at night. Over time, the typical patient just slips into deeper and deeper sleep and gradually loses consciousness completely. However, early on, mild confusion and disorientation are common, and usually require only reassurance as treatment. Sometimes, though, upsetting hallucinations or agitation arise. These can be treated very quickly with tranquilizers and anti-anxiety drugs. Certain minerals in the blood-stream can also accumulate and cause twitching of muscles, tremors and shakes, and even seizures. The tremors are usually of no importance to your comfort, but their onset can signal a need to prevent seizures. Medications to prevent or treat seizures are usually quite effective. Some patients develop mild or more severe itching before they become too sleepy to notice. This can be treated with creams, massage, erythropoietin, and antihistamines. Sometimes a fine white powdery substance covers the skin, but it is not the cause of itching and is of no importance. Appetite decreases very early, again to no one's surprise. The accumulation of acids in the bloodstream causes rapid, shallow breathing; this is not an uncomfortable feeling, and the rapid breathing is not changed by oxygen.

Many people with kidney failure pass very little or no urine. If you pass little urine, without dialysis you have to be careful to avoid problems with salt and water overload. Restricting your fluid intake to less than one quart of liquid a day will keep you from having much trouble. Fluid overload results in swelling of the body (edema), particularly of the legs and the abdomen. The excess fluid can also cause congestion of the lungs and the heart, leading to rapid breathing and shortness of breath. Sitting upright helps relieve the breathing difficulties, at least for a while, as it shifts the fluid away from the chest and toward the legs; it may be impossible for persons in this condition to lie flat. Oxygen and morphine may also ease any feelings of struggling to breathe.

It is important to know that persons with some urine output have lived surprisingly long times after stopping dialysis - sometimes for months. People with no urine output are likely to die within a week or two. If this is your choice, or the choice of someone you love, try to be sure that you have a doctor and nurse who are familiar with the problems that might arise. Make sure that medications to treat those problems are readily at hand, especially if you are in a nursing home or at home. In such situations, having a knowledgeable and experienced hospice team involved is often worth exploring, as they will make it their business to get you any urgently needed medications. You probably will have a kidney specialist by this point, and that doctor may be a real help both in making decisions and in keeping you comfortable. So, on the whole, when you have to die, allowing kidney failure to take its course is not generally a hard way to go. In years past, before dialysis, kidney failure had a reputation of being a gentle death.

Patients with fluid overload may present with blister formation, especially on the extremities. When the cause of the underlying edema is treated, the blisters subside. Blisters that form because of edema contain sterile fluid. Because of their thin roof, they usually break within a few days. Once the fluid imbalance is corrected, these blisters resolve without recurrence.If the blisters are located on a distal portion of the lower extremities, elevation of the legs can reduce the edema and subsequent blister formation.