New questions and family crisis see post #9

[DisMomme]

NEW QUESTIONS AND FAMILY CRISIS SEE POST #9
My grandfather is in the hospital. He was a little disoriented last week and took a fall on Wednesday. Saturday I got the call that they had transported him to the hospital. He was lethargic and unresponsive. The doctor basically said he's given up on the will to live there's nothing I can do, he has a DNR. He just lost his wife last month so the doctor was quick to believe he was just depressed and lost his will. My mom said to take him to the hospital. He had a fever and an infection that they believe he has had all week.

The hospital gave him antibiotics and by Saturday night he was awake and alert though unable to speak. Long story short, he is still in hospital but cannot swallow.

Hospital Drs believe his epiglottis has failed and he has pneumonia now due to inhailing food & drink into his lungs. SO, what happens now?? He has an IV now and is not allowed to eat or drink. As I stated earlier, he has a DNR and does not wish to have any tubes. Can an epiglottis be fixed??

He's 91 but up until last Wednesday he got himself up and dressed every day. Shaved and bathed by himself and was very active. He read the newspaper daily and was very up to date on current affairs. I understand the DNR and I know he doesn't want to be on machines but to think that a simple infection that went undetected by his doctor may be his downfall is infuriating to me.

Sorry this is so long. I guess I needed to vent. Does anyone have any idea what I should expect for him next?

 

[mommasita]

I honestly have no clue. Have you spoken to the Dr's and/or staff? I know when it was my grandmother, the nursing staff spelled everything out for me, and I was very happy.

I will send giant hugs and keep your grandfather and your family in my prayers.

 

[quasar4legs]

So sorry for your family, this sounds like a very distressing situation.

I don't know if it can be fixed but as Mommasita suggested the doctor should be able to give you some idea of treatment options/prognosis etc.
Perhaps you could ask the nursing staff to arrange an appointment for your family to speak directly with the doctor.

I shall keep your precious grandfather and the rest of your family in my thoughts.

Quasar

 

[Puccaw]

You obviously care for him very much. It sound like what has happened is that your Grandfather's gag reflex has become negligible. The gag reflex is what causes the epiglottis to open and close which is what prevent food and fluid from entering the lungs. Unfortunately that cannot be resolved, the option would be a GI tube put in through his Gastro-Intestinal tract which at 91 would cause more pain and suffering than any positive outcome.
Hope that this helps, sorry that it wasn't brighter news. ((hugs))

 

[DisMomme]

Thank you all for your prayers and support. Grampy passed at 4AM today. My mom & I were with him. It was peaceful and I am glad he is no longer in pain.

Unfortunately that cannot be resolved, the option would be a GI tube put in through his Gastro-Intestinal tract which at 91 would cause more pain and suffering than any positive outcome.
Hope that this helps, sorry that it wasn't brighter news. ((hugs))

This was exactly what the hospital staff said when I got down there. (I live about an hour & half away). I know it was the right decision to not do the GI tube. He would not have wanted that, he loved eating too much! He was comfortable and not in pain at the end.

Thank you for letting me ramble in my original post. I love my Grampy very much and his decline was very quick. I was shocked by it but am at peace with him no longer being in pain.

 

[quasar4legs]

So sorry that you have lost your grampy and I am sure that it was a comfort to him to have you and your mum with him during his final hours.


Thinking of you and your family

 

[mommasita]

I am so sorry for your loss

Continue to post anytime. We are all here for you

 

[Pea-n-Me]

I am coming late to this post, but I wanted to respond in the hopes it might give you a little more peace about the situation. I'm sorry to learn of you grandfather's passing.

At that age, it's not uncommon to see this type of fast decline, especially after an event such as losing a spouse - for many reasons. I don't know his particular situation, but things we see are that the spouse who passed was taking care of the surviving spouse more than anyone had realized, depression, altered habits such as meals and toileting (often leading to urinary tract infections and very common in the elderly, urosepsis, resultingly leading to mental status changes leading to falls, etc), especially in people living alone, even when family comes to help out, low level aspiration due to swallowing defects which can lead to pneumonias, falls, confusion, etc. It can truly be a downward spiral and happen very fast.

There are accidental falls, but often when an elderly person falls, there are many issues below the surface going on, unfortunately.

But to answer your original question about what happens next, for those who may also be wondering, generally if a person's mental status improves with treatment of underlying causes of decline, then swallowing studies are done to see if the person can swallow safely, and under what conditions, in order for them to be able to eat again. Specialists run the tests and imaging is used. Results may come back that the person is aspirating so he or she is unable to eat at all. (And these can be repeated again after a period of time, if necessary.) Or it may come back that they are ok to swallow thickened liquids, but not thin liquids, so in that case a thickening agent may need to be added to liquids. Or it may come back that the person is ok with soft solids, etc. There are a number of possibilities.

Sometimes, when the mental status is such that the person either cannot be awake enough to swallow safely, or is permanently altered, then the decision about whether or not to place a feeding tube would be dependent on what the health care proxy, or person themselves if they have advance directives, wants in that situation. It is almost never an easy decision.

To give you another perspective, as a family, we needed to make this decision when my aunt lost her swallowing reflex in late stage Alzheimer's. But in that particular disease, reaching that point is considered terminal, even though the person's body may still be fully functional, as in her case. Since the thought of letting her essentially starve to death was very difficult to imagine, we did consider the option of placing a feeding tube, which they would have done, albeit reluctantly, had we pushed the issue. We ultimately and with great difficulty decided the greater kindness would be to not place the feeding tube, and she passed away peacefully several days later.

With that said, there can be times where a feeding tube is a temporary situation while the issue causing the swallowing difficulties (or undernutrition, ie the person is safe to swallow, but unable to eat enough calories on his own to sustain his body's needs, especially in the setting of illness) resolves. So the short answer is, it just depends. But generally people think of feeding tubes as being "the end", and that isn't always the case.

 

[DisMomme]

Thanks everyone for your prayers and answers about my Grandfather. I am at peace that he is at peace now.

This year just keeps getting worse though.....My MIL is now in the hospital. She had her Mitral Valve repaired in her heart. It was supposed to be "routine".

The doctors cannot get her blood pressure to stabilize. They have her in an induced coma-like state hoping her body will heal itself. They put in a balloon pump(?) to help her blood pressure. They also gave her blood and increased her IV fluids. Blood pressure is now stable but low and only with the help of the pump, without it the doctor told my DH she wouldn't last 15 minutes.

My questions...how common is something like this after valve repair? We were under the impression that this was a relatively low-risk option. What are we looking at in terms of time? For blood pressure to stabilize and for recovery from surgery? Everyone is afraid each night to leave the hospital. Do people recover from a set-back like this after heart surgery? She is 70.

Please say another prayer for my MIL. She is extremely religious and I know she will appreciate the prayers or kind thoughts you send her way.

Thanks
~Kim