Feeling uneasy--my "nurse" radar is going off

[minkydog]

My 76yo has been having some problems lately. Recently she was having palpitations so she had a lot of tests, echo, stress test, etc., which revealed atrial fib, so they started her on coumadin and cardizem. She was already taking something for blood pressure(can't remember at the moment!), so the added cardizem has dropped her BP into the 101/60 range. (In addition, she takes meds for diabetes, thyroid, neuropathy, and some asbestosis.)

Apparently last week she started passing blood in her stool--a lot of blood. They did some blood work and her Hgb had dropped from about 11 to 9. Yesterday she called me to tell me things arent going so good(I live 400miles away.) She felt faint and woozy when she was out with friends. They revived her and then she drove them home. She went to her doctor where they took more blood. Now her Hgb is 8.1, her BP is 88/40, and she continues to pass dark blood. Today she went in to be transfused 2 units packed cells.

I've been a nurse for 32+ years, but my experience is nearly all pediatric. Mother was also a nurse for about 20 years, mostly in L& D. Between us we have the ability to recognize when something is wrong and then do something about it. I am really concerned about the rectal bleeding and her faintness--she says when she stands up she nearly always feels nauseous and fainty. I'd really feel better if they'd do a colonoscopy on her. But she doesn't want me to come down there--she says she can still drive because she only feels faint now and then! I reminded her that if she feels faint while she's driving through an intersection she could run over someone's child! ACK!

She did agree to call one of her lady friends to go to the doctor with her today. You know how little old ladies are. They love nothing better than sitting around a doctor's office trading aches & pains. I'm still waiting to hear how it went.

 

[rkandmjsmommy]

The coumadin can cause bleeding, such as rectal bleeding, and if she is losing that much blood and on b/p meds that can cause her B/P to go low which can cause the woozy faint feeling! She needs to have ALL her meds looked at
good luck

 

[ChrizJen]

First, why has she not been admitted?!?!?!
That would be my first question! She needs to be monitored and have tests run.
And secondly, if this were my mom, I don't care what she told me. I would probably be on my way to her. This sounds like at the very least something that she's not taking seriously enough. Loss of blood/low blood pressure could be causing an altered mental state.
If you can make the trip, I would go. Make her take it more seriously.
It could be just a bad combination of meds. But she needs to get to the bottom of it.

Good luck!

 

[minkydog]

First, why has she not been admitted?!?!?!
That would be my first question! She needs to be monitored and have tests run.
And secondly, if this were my mom, I don't care what she told me. I would probably be on my way to her. This sounds like at the very least something that she's not taking seriously enough. Loss of blood/low blood pressure could be causing an altered mental state.
If you can make the trip, I would go. Make her take it more seriously.
It could be just a bad combination of meds. But she needs to get to the bottom of it.

Good luck!

I wish I could go down there. I don't think she's taking it seriously, either. My DH is leaving tomorrow to see his mom who is 89 and failing, so you know, I have to stay here and hold down the (considerable) fort. She's supposed to go back on Monday for follow-up bloodwork. If it's still not good, then I'll probably go down there and see if I can jack things up a bit. fortunately, my younger sister lives within 30-40 minutes of her and has checked in with her every day. There are 4 of us girls, so we can tag team

Nurses are their own worst patients. Mother is not aging well--she's fighting tooth and nail to not lose any scrap of independence, so that means that sometimes she won't admit when somehting is wrong. She's scared to death that someone will take her keys away and send her to the nursing home. Believe me, she's a long way from that. But with her it's black or white--full independence or full dependence, nothing in between. I've been trying to get her into a scooter chair for 3 years, but she won't even consider it because she thinks it will stifle her mobility. Hello! Mom! If you'd use a scooter you could walk your dog, go shopping with your teenage GD, etc. *sigh* It's hard being the oldest daughter.

 

[doxdogy]

My father did the same before he passed away. Would never tell us anything going on with his health. Thankfully, when he started having blood in the urine from his coumadin, my brother was in town for a visit and staying at this house. He called me and we tagged teamed him and he went to the doctor. Which led the the diagnosis of bladder cancer in the very early stages. Sometimes I wonder if he had gone to the hospital the night he broke his leg, he would still be here. I can definitely feel your frustration.

 

[Serena]

Yeah, someone is not taking this seriously. Her docs need to look at this.

I'm hoping they get her sorted out and better quickly and you don't have to worry any more.

 

[lovemygoofy]

I'm no where near a medical expert but with the feeling faint and the heart palps and stuff I was thinking she could be anemic. I know that I'm pretty anemic and have some of the same issues minus the bleeding.

 

[minkydog]

My father did the same before he passed away. Would never tell us anything going on with his health. Thankfully, when he started having blood in the urine from his coumadin, my brother was in town for a visit and staying at this house. He called me and we tagged teamed him and he went to the doctor. Which led the the diagnosis of bladder cancer in the very early stages. Sometimes I wonder if he had gone to the hospital the night he broke his leg, he would still be here. I can definitely feel your frustration.

Yeah, mother is becoming more secretive about her health. Several times she has kinda off-handedly mentioned stuff--like, she can no longer feel her feet. Like, she doesn't check her blood sugar more than once or twice aweek. She doesn't want us to know EN-EE-THANG. Sometimes she'll let me know after the fact that she went to the doctor and they found______. Mother is mentally clear so I know it's not anything dementia-related. She just doens't want anybody to know her business for fear that it will all be taken away from her. I know she must be scared--if I was passing lots of dark red blood I'd be very scared! She's trying to "not scare" me, like I wouldn't know what dark red blood means, or heart palpitations, or numb feet.

oh, now ya'll have me going. I think I will go down there next week. It's my birthday--she'd probably like that.

 

[diznygirl]

Will she listen to you if you phrase it in a way that telling you everything will enable you to keep her independent longer?

Hubby's parents did the not tell us anything thing. Drove us nuts! We could have helped. Instead we were allowed in during the last two months of his father's life when his mom finally asked about life insurance! I immediately turned around and told my parents to tell me everything. We can't help when we don't know. And we want to help.

 

[minkydog]

Will she listen to you if you phrase it in a way that telling you everything will enable you to keep her independent longer?

I think she would. If I go down there next week, after DH gets back, I will bring up my concerns. She showed me her closet a few years ago and said,"When I die, all the information is up there." ummm, okay...first i have to dig through the 40 years of crap you have stored on top of it..

Actually, that's one of my other concerns, that her house is outstripping her energy and ability to care for it (not to mention her checkbook!) She talks about moving into a senior apartment, but she doesn't want to throw anything away--she has a 2000sq ft house packed to the gun'ales. I've tried to help her go through stuff, but in the end she wants to keep it all. I have to literally wrest the trash out of her hands! This is one feisty old lady.

Seriously, though, I need to sit down with her and listen to her plans. I need to see her advance directive, find out who her medical and financial powers of attorneys are, get all her credit card and bank numbers written down, computer passwords, et al. I don't think any of my sisters has done that yet and she'll probably pooh-pooh me for wanting to do that but I think it's important.

 

[Disney Doll]

It is important for you to know what your mother desires as far as her health care is concerned in the event that she cannot speak for herself.

In terms of the current situation:

The Coumadin is the mosy likely candidate causing the rectal bleeding. Truthfully, up my way, little old ladies who are rectal bleeding, feel dizzy and faint with a Hgb of 8.1 get admitted, put on a cardiac floor with 24 hour telemetry and would have the million $ cardiac & GI work up. Frankly, she's danger to herself and others...your concerns about her driving through an intersection feeling faint and killing someone are well-founded....she could do that. I understand independence...I have an 81 & 83 year old myself....but it only takes you so far when others are being endangered.

 

[minkydog]

The Coumadin is the mosy likely candidate causing the rectal bleeding. Truthfully, up my way, little old ladies who are rectal bleeding, feel dizzy and faint with a Hgb of 8.1 get admitted, put on a cardiac floor with 24 hour telemetry and would have the million $ cardiac & GI work up.

Yeah, that was more in line with my thinking. Here you've got a 76yo lady who has underlying chronic illnesses and recently acquired a-fib who suddenly has lost a lot of blood and feels faint. I woulda thought they'd put her in the hospital, too. I'm still waiting to hear how things went. I try to think that no news is good news, ya know?

 

[Serena]

No news, isn't good news with her. As you have already said, she won't tell you unless you make her. I'd call and find out.

 

[Ohiodislover]

Was she taking a daily aspirin before the coumadin was prescribed? Or Ibuprofin. I have patients ALL the time who were started on coumadin and not told to stop the other blood thinning meds, or were told but didn't realize, etc.

What was her most recent INR?

 

[monkey68]

Yeah, that was more in line with my thinking. Here you've got a 76yo lady who has underlying chronic illnesses and recently acquired a-fib who suddenly has lost a lot of blood and feels faint. I woulda thought they'd put her in the hospital, too. I'm still waiting to hear how things went. I try to think that no news is good news, ya know?

Is it possible she refused to be admitted? At my hospital, that would also get you an admission into either ICU or at the least, telemetry for blood transfusion (symptomatic anemia) and monitoring. Does she get her INR checked when she's supposed to to be sure she's not taking too much?

 

[minkydog]

Was she taking a daily aspirin before the coumadin was prescribed? Or Ibuprofin. I have patients ALL the time who were started on coumadin and not told to stop the other blood thinning meds, or were told but didn't realize, etc.

What was her most recent INR?

Just talked to Mother--She got her blood with only a few glitches. Apparently they didn't get the message that she's allergic to latex until she was on her second unit. It sounds like it was a bit of a circus. On the upside, she does feel better, less short of breath and more alert--that's what a few extra red cells will do for ya.

I asked her if she was takng any advil or aspirin--no, she was taking solendac(sp?) and lyrica, She stopped the coumadin a week ago. Her protime was 4.7 last Wed but now it's 1.7.

I told her that I really had thought they would keep her for observation tonight. She said they might have, if they had known she was still passing "a little" blood. She says the doctor's office called and told her to start taking a baby aspirin every day. WTH?? NOnononononono, no baby aspirin, mom! Did the doctor tell you that? No, some "nurse" did. Turns out her regular doctor is out of town--apparently the covering doctor isn't on top of this either and that's probably why she isn't in the hospital for all this. I'm pretty upset. But I did get her to agree to go to the ER if she feels faint at all, passes more blood or experiences more palpitations. And I made her promise NOT TO DRIVE! She has agreed not to drive--she got very fainty feeling walking into the center this morning and I think it really frightened her.

Arrgh! taking care of elderly parents is as bad as taking care of teenagers! They're every bit as oppostional!

 

[Serena]

Yeah, it must be really frustrating as it is, without being so far away.

 

[Pea-n-Me]

Up my way, too, she would definitely be admitted and either chemically or electrically cardioverted. People who have new AF have a better chance of going back into a normal rythm and staying there than someone who has chronic AF, so I'd think her chances would be good and then she wouldn't need anticoagulation. (BTW was she having her blood drawn on schedule when she was on the coumadin?) Meds with her will be tricky because of her asbestosis.

I hate to say it but if it were my Mom, she'd be admitted, through the ER if necessary. I don't have to tell you a massive GI bleed could be fatal. Did you say if she lives alone? How reliable would she be if she began bleeding heavily at 3am? Or not realizing that melena was blood? (I know you said she's a nurse, but stranger things have happened.) The other thing that could occur (and often does when systems get out of whack) would be a rapid AF which would certainly buy her an admission.

Good luck. I can sympathize.

ETA

She felt faint and woozy when she was out with friends. They revived her and then she drove them home.

She may be orthostatic. Your sister may need to be firm with her about driving until this is squared away, unfortunately.

 

[npmommie]

It is important for you to know what your mother desires as far as her health care is concerned in the event that she cannot speak for herself.

In terms of the current situation:

The Coumadin is the mosy likely candidate causing the rectal bleeding. Truthfully, up my way, little old ladies who are rectal bleeding, feel dizzy and faint with a Hgb of 8.1 get admitted, put on a cardiac floor with 24 hour telemetry and would have the million $ cardiac & GI work up. Frankly, she's danger to herself and others...your concerns about her driving through an intersection feeling faint and killing someone are well-founded....she could do that. I understand independence...I have an 81 & 83 year old myself....but it only takes you so far when others are being endangered.

Up my way, too, she would definitely be admitted and either chemically or electrically cardioverted. People who have new AF have a better chance of going back into a normal rythm and staying there than someone who has chronic AF, so I'd think her chances would be good and then she wouldn't need anticoagulation. (BTW was she having her blood drawn on schedule when she was on the coumadin?) Meds with her will be tricky because of her asbestosis.

I hate to say it but if it were my Mom, she'd be admitted, through the ER if necessary. I don't have to tell you a massive GI bleed could be fatal. Did you say if she lives alone? How reliable would she be if she began bleeding heavily at 3am? Or not realizing that melena was blood? (I know you said she's a nurse, but stranger things have happened.) The other thing that could occur (and often does when systems get out of whack) would be a rapid AF which would certainly buy her an admission.

Good luck. I can sympathize.

ETA
She may be orthostatic. Your sister may need to be firm with her about driving until this is squared away, unfortunately.

I second what pea and dis doll said.

also the lyrica can cause abnormal bleeding and also dizziness especially in the elderly because of how they metabolize the med.
good luck, I think you should call your moms doctor yourself and discuss getting her admitted.

 

[minkydog]

Up my way, too, she would definitely be admitted and either chemically or electrically cardioverted. People who have new AF have a better chance of going back into a normal rythm and staying there than someone who has chronic AF, so I'd think her chances would be good and then she wouldn't need anticoagulation. (BTW was she having her blood drawn on schedule when she was on the coumadin?) Meds with her will be tricky because of her asbestosis.

I hate to say it but if it were my Mom, she'd be admitted, through the ER if necessary. I don't have to tell you a massive GI bleed could be fatal. Did you say if she lives alone? How reliable would she be if she began bleeding heavily at 3am? Or not realizing that melena was blood? (I know you said she's a nurse, but stranger things have happened.) The other thing that could occur (and often does when systems get out of whack) would be a rapid AF which would certainly buy her an admission.

Good luck. I can sympathize.

ETA
She may be orthostatic. Your sister may need to be firm with her about driving until this is squared away, unfortunately.

Pea, I appreciate what you're saying. Believe me, I've thought of all that and more. Mother just started coumadin about 2 weeks ago and they drew her first protime last week. She probably is having some orthostatic hypertension from time to time. All I can do is tell her of my concern, though--she's legally competent to make her own decisions. And if she won't share things with me there's not much I can do. I live 400 miles away and we have our own family health issues. I worry that she lives alone, but she has neighbors and friends who live near and check on her every day. If she gets up in the night, faints and hits her head on the corner of the dresser, well...not much I can do. She will not go to the ER. Flat out, will not. She did say she would go if her symptoms continued--and I tried to educate her a little more about how all this stuff works--but she won't go. One of her grandchildren is due to arrive there in 4 days and she WILL NOT go to the hospital. she's making me crazy.

You and I know what's going to happen here. Something bad is going to have to happen to get her to recognize the gravity of her situation. I wish I could just drive down there and shake some sense into her.