ask the doctor?

Question

My mom came home on hospice care today. 84 Yrs old, with a previously diagnosed aortic valve stenosis (AVS) that has become severe, congestive heart failure, now moderately severe chronic renal failure due to compromised blood flow from AVS. She developed a blistering rash, they think came from Lasix a couple of month ago and took her off diuretics. Also diabetic. I know, sounds BAD, but she was driving last week. Drs.now say there is nothing that can be done, and have her on comfort measure, oxygen, no diuretics. I struggle feeling like...are we accepting this verdict without enough research? Kidneys were fine until hospitalized and they tried to diurese her...created a lot of stress on her kidneys and creatinine rose to 3.9, but down to 2.9 without diuretics. But to do nothing? We live in a small town, but has been seen on best internist and another cardiologist who agreed with hospice. Just want to ensure I am not giving up too soon.

Answer 1

Excellently written question. I understand what you are concerned about. The internist and cardiologist agree with the hospice physician, which indicates that your mom is in a final cascade of systems settling down and shutting down. Nature packs a pleasant surprise for us at the end of life during that final cascade of organs and systems and loops and such settling down and getting ready to shut down. If that cascade of events if not interfered with too much, our bodies shut down in more peaceful and comfortable ways. For example, during that stage, our electrolytes can seem out of balance. But, they aren't really. And, to interfere with them too much can take away whatever benefit there is in that final cascade of comfort measures that our bodies give us. We are only just beginning to understand all the complicated sequences and relationships of that final cascade. But, we know for sure that more often than not, to do too much to try to get someone's body to appear to be functioning as it "normally" did before actually causes harm and discomfort. As much as we want to fight the shutdown, it's not wise to do so. Pain, on the otherhand, and other sufferings, can be well controlled with appropriate palliative care interventions and symptom management. Talk more about how to keep her as comfortable as possible with your hospice RN. And, don't hesitate to ask here throughout because the RN's who respond on Yahoo Answers are outstanding from what I've seen so far. I am sorry that you are having to face losing your mother. But, I am glad that she is facing the last weeks of her life with loved ones like you caring for her. Take good care of YOURSELF, too, throughout. Retired Hospice RN

Answer 2

Accepting hospice is a very hard thing to do. If you are really concerned see if you can get someone outside the area to look over her records.

This summer my mother was in remission from cancer at 59 she went to work in the family water softening business everyday. She was doing fine but began throwing up. We drove to the hospital because of a pain in her side. She was admitted for tests and 24 hours later we were in hospice even though she had been to work the day before. It was the hardest 5 weeks of my life. So I know it's a hard thing to face.

I can't help but wonder if another diaretic might help your mother. There are more diaretics than just Lasix. I'm not sure why they aren't trying one of them. Seek another opinion. Perhaps one outside the area. At the very least it will help you feel like you tried everything and that is worth your time. I would be happy to email you and keep in touch as you go through the time ahead. I learned a lot those 5 weeks and would be happy to help in anyway even if you just need to vent.

Say everything you need to say now while she is alert. She could go downhill very quickly you just never know. The biggest thing is make sure she knows how much your love her. And that you don't want her to suffer. Reassure her that you will miss her but you will be okay. Often Mom's hang on longer than they should because they are worried about you not themselves and you don't want her to suffer. The 5 weeks I was in the hospice with my Mother (I never left) I saw that sometimes people hang on longer than they should while others go when you least expect it.

My thoughts and prayers are with you.

Answer 3

I am so sorry for what you are going through. If you really want a second (or third or fourth) opinion, then you should get one. But with everything that your mother has wrong, combined with her advanced age, it probably is best to just make sure she is comfortable now. What is her opinion on this? Many people that know that their time is coming near its end prefer to stop treatments that are just prolonging the inevitable, especially when these treatments make them feel worse.
I am sorry if I sounded harsh, I don't mean to come off as unfeeling. I'm just trying to put this in the simplest way possible.

Answer 4

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Answer 5

The best answer I can give you is to ask your mother how she feels. People at her age tend to get better or worse on their own decision to give up. She may be tired. And trying not to make you feel bad. If you are concerned that she isn't getting the best care.
Take her to another Dr or two. To put your own feelings at peace.
Sometimes there isn't much else to be done but make her feel comfortable. I'm sure you feel very helpless and sad right now. Do the best you can. That's all you can ask of yourself.

Answer 6

That's a lot to deal with. If you are not sure that you are doing everything you can, you are entitled to a second opinion. See if possibly a larger hospital or physician in a larger town can help out.

My heart goes out to you.