Emphysema? for any Med Professionals. (Sorry PopDaddy) Long Post. Update 6/7/04

[4cruisin]

My fil (79 yo) was hit by a car last Sunday. No major trauma except for broken collarbone, many bumps, bruises, scrapes and a deep gash in his head requiring many stitches. However, his hospitalization has brought to the forefront a diagnosis of stage 3 emphysema. The man smokes 3 - 4 packs of cigarettes a day and although dh and I knew he had lung issues, it seems as the pneumonia he developed as a result of the hospitalization has weakend him even more.

So, here is my question. Dr. has recommended he use O2 at home which fil refuses to do. He will not quit smoking. He is on 4 liters of O2 in the hospital and at rest his saturation level runs in the very low 90's. With any exertion, the level drops into 70's to 80's. He has no other chronic disease such as heart (bp is fine for now) or diabetes, etc. The nurses have told us that the prognosis is not good and the resp therapists are very concerned. The dr told my dh this am that he does not see any real problem and thinks my fil should be able to return home to his original condition after a short stay at rehab for pt. My dh and I are realists and know that anything can happen at any time. If you are a rt or med professional, what do you think? All my dh's siblings are looking at him for answers and he does not want to scare them but he is telling them that they should definetly prepare for the worst and say everything they need to to fil.

TIA,
Nancy

UPDATE:
Thank you so much for the replies, good wishes and prayers. FIL was moved to a rehab facility Friday. He did walk about 50 ft Saturday am with the therapists. O2 is down to 3.5 liters so the pneumonia is clearing up a little with antibiotics. Dh is not convinced he will totally recover or be able to go back home. I would feel terrible to see him spend the rest of his days in a nursing home if it is not necessary. I know this will be a very difficult road. We went through this 3 years ago with my dmom and she never smoked in her life but spent half her life in smoke filled bingo halls and ended up dying from pulmonary fibrosis..not a nice death. I guess I just needed to hear other's experiences with emphysema and continuing to smoke.
Again, thanks for all the replies. I feel very fortunate to have friends here.

 

[phorsenuf]

My MIL has emphasema. I don't know what stage it is tho. She is pretty much on oxygen all the time. She has a tank she carries with her all the time. If she sits, she's ok but if she does any walking at all she has to use the oxygen.
My guess is if he decides to continue to smoke and refuses to use the oxygen, then prepare for the worse. However if he quits and does use the oxygen then he'll do ok I would imagine.
Sorry I can't be of any real help, but I hope he will recover ok from his accident and will decide to quit smoking.

 

[year2late]

OK, a few issues.

He got pneumonia so that is (hopefully) temporarily worsening his chronic condition - emphysema. Unless he sustained other injuries you haven't mentioned, he should be able to eventually get back near his baseline.

Evaluation of chronic emphysema is difficult to do if your only frame of reference is during an episode of pneumonia. Chances are, after being in the car accident, he was taking more shallow breaths due to pain (or whatever) and one of the usual hospital bugs took hold.

He needs to get over the pneumonia and follow up with a good pulmonologist in your area. Pulmonary rehab (like physical therapy for the lungs) can be very helpful for some. A good pulmonologist should have be able to optimize your FIL condition with a variety of inhalers. Go with him and make sure he is being taught the correct way to use them. I am an ICU nurse and my mom has emphysema - it never ceases to amaze me how people misuse their inhalers.

This website may be of help...

EFFORTS

But if he doesn't quit smoking now, optimizing his condition will be next to impossible.

 

[Piglet]

My Step Dad has emphysema and is currently in the hospital now after having respiratory distress on Wednesday. His O2 was 74. He normally runs in the low 90's. He has been on a ventalitor 3 times but continues to smoke even while being on oxygen 24/7 Nothing we say or do will make him stop, so it is just a waiting game. He can no longer walk (just a few steps) and uses a scooter or wheelchair all the time.

I am very close to my DSD. It is very hard for us to continue to see him get worse and worse, but we can not make him stop smoking. So frustrating when we catch him sneaking around and finding out he has people that goes and buys him cigs. His doctor is very frustrated that he continues to smoke and is constantly on him about a living will. My DSD wants to do everything he can to save his life except stop smoking.

I guess the point of all this is to give you our experiences and to say I will be praying for your FIL and your family. In the end it is all up to them. If you have any questions, feel free to PM me. My DSD has been living like this for quite a few years (like 5 or more).

Melinda

 

[AZKathy]

If O2 is brought home, for goodness sake don't let him smoke around the O2! Ka-boom!

 

[4cruisin]

Thanks for the replies. The pneumonia was a result of shallow breathing because of the pain associated with his injuries plus the fact his lungs are compromised. He is very stubborn and I know he will not stop smoking and is very uncooperative. My mother died from pulmonary fibrosis 3 years ago (she never smoked) and she was very cooperative with the medical professionals and with us as well. I'm walking a fine line because I do not want to interfere with the in-laws...they are not too fond of me and the feeling is mutual. I guess I was just wondering if this is going to be a long haul because my dh is already starting to stress out trying to deal with his family and talk sense into his father. I do not want this to affect my dh's health, he has some minor heart issues himself.

Piglet, please tell me your sd does not smoke near the oxygen. I'm sure you all know how explosive that is. I know how sad it is to see someone so ill. Thanks for your good thoughts and prayers.

Thanks for all your support.

Nancy

 

[Piglet]

4cruisin - yes my SD does smoke while wearing oxygen. He knows that it is dangerous, but I guess he doesn't care. It is so frustrating. We can't get it through to him that he is hurting so many other people besides himself. My DD will be so heart broken when the time finally comes for him to pass on.


Meinda

 

[HoneyPooh]

Prayers for your DH and family. My mother passed from Emph and it was a terrible way to loose a loved one. The worst part was that her last words to me were "I'm sorry" because she knew that she had brought all this grief on us of her own free will. But, people will make their own decisions and sometimes they don't fully see the effect on those around them until it's to late. With my mother she did fairly well for about a year after diagnosis but then she contracted a cold from a flu shot. She went into the hospital on Christmas morning and died on January 26th.

 

[tar heel]

Smoking while using oxygen -- YIKES. A patient at the hospice I used to work for did that and set herself on fire. Serious and very painful injuries. Both the hospice team and the medical equipment company (which was supplying the oxygen) warned the family that they could no longer provide services if the smoking continued b/c it was a safety hazard to their employees. She chose not to quit.

Piglet -- You do realize that you and your other family members are also in danger, right? Open fires around oxygen can't be taken lightly.

 

[Piglet]

I totally realize this - what can I do??? He doesn't smoke in his house or around people he will go outside in his scooter and hide to smoke. He also will go for a drive and smoke.

We have told him it is dangerous and have begged him to stop. You can't make someone stop smoking!!!!

Melinda

 

[AZKathy]

All smokers will eventually quit one way or another.

I say this not out of meanness but from first hand experience. My DF, such a marvelous individual, smoked and had mild emphysema. One Christmas, he got pneumonia and finally succombed to the terrible illness two weeks later. This happened six years ago and I still hurt loosing my wonderful father. Okay, here I go gettin misty eyed still...........<a href='http://www.smileycentral.com/?partner=ZSzeb008' target='_blank'><img src='http://smileys.smileycentral.com/cat/4/4_9_7.gif' border=0></a>

 

[Disney Doll]

There is not a heck of a lot you can do. As you said, you cannot make him stop smoking, nor can you make him use oxygen at home.

My best recommendation would be to make sure his affairs are in order, make sure you know what he wants from a medical standpoint as far as life support and leave him be about the smoking, oxygen, etc. He made his choices, and now he will live with the consequences of those choices. Tell his other children to say what they have to say to him, and prepare yourself, your DH, and your children for the day when he will pass away, because it is probably coming sooner as opposed to later.

The day will come when he will not be able to breathe, you'll call the ambulance and he'll either get better or not. Unfortunately, my guess is that this accident has been the catalyst for the beginning of the end. Pneumonia in someone with emphysema is diffcult at best to treat, they never fully recover(especially if they are non-compliant with treatment), and he will end up having multiple relapses & multiple hospitalizations.

My prayers for you. You have a tough road ahead.

 

[Micca]

DBIL passed away from it. It was awful. I will hope for the best for you and your loved ones

 

[luv2nascar]

my grandmother died from emphysema and congestive heart failure
she finally gave up smoking in her final months when it was way too late
she lingered for months on oxygen and in and out of the hospital
it really is an awful way to go
I have never smoked nor will I after having seen that
praying for your family

 

[Pop Daddy]

I try not to do my 'long post ' thingie if it involves health

 

[720L]

My Grandma died last month from lung cancer. She had C.O.P.D. , chronic bronchitis, asthma and emphysema. She was diagnosed with that about 6 years ago. A year ago in August she was diagnosed with lung cancer. She smoked even after being diagnosed with the empysema, but when she had to go on oxygen full time she quit. I know how frustrated you are because he won't quit. I think some people are just so addicted to the nicotine they can't stop.
I would guess if he wants to walk around the house, he will find he has to have that oxygen on. I'll pray for you and your family.

 

[4cruisin]

Update is attached to original post.

 

[Dan Murphy]

Just know, Nancy, you and family are in my prayers, good thoughts. Do hope he is comfortable.

 

[DebbieB]

My aunt has it and she continues to smoke, although not much lately. One time my mom, aunt and their other sisters went to Olive Garden to celebrate a birthday and my aunt was highly insulted that they would not seat them in the smoking section because of her oxygen! She wanted to just leave but the others persuaded her to stay by saying they will go outside to smoke after dinner (my mom was the only one out of the 4 who is a non-smoker). My aunt saw her husband die from the same thing, she continued to puff away....