mother in law in hospital Declining

[Hound dog]

It has been a hectic several days to say the least.

To some extent, I may have stumbled upon the reason behind mother in law's frantic phone calls to us that have been driving us absolutely nuts over the past couple of weeks. And some of the reason she has been acting out of character.

It started Sat morning. husband and I already planned a visit to mother in law's because we had to pick up some things for her at the store. No biggie. I sit down to have my morning coffee and the phone rings. And of course it's mother in law. Now after a week filled with up to 18-20 phone calls per day......Let's just say a few cuss words sailed out before I picked up the phone. She was asking if we were coming. (she knew we were coming) So I explained to her that as soon as I finished my coffee we were heading out. Not 10 mins later she called again. I was tempted not to take the call. But husband had walked into the kitchen, so instead I handed the phone to him. I could tell by how he acted and such that mother in law was pouring it on rather thick and started to get ready to leave. More than a bit miffed at husband that he'd told her we'd be right there.

*Note- husband also has a tendency to exaggerate and be a bit dramatic*

On our way there (not 10 mins later) husband calls mother in law on his cell and hands it to me. Ok, so now I'm really miffed. And he tells me to tell her to pull her nurses cord. mother in law answers. It's evident she confused, her voice is very weak and keeps trailing off. I told her to pull the nurses cord. (which is attached to her recliner) I repeated it several times and not once did she seem to understand what I said. So I gave up and told husband to hurry.

When we arrived she was sitting in the recliner slumped over. She looked terribly pale. I went to her and asked her what was wrong. She didn't seem quite right. But she said her stomach hurt and her legs were numb. So I asked her the general questions while checking for fever ect. Then she said her heart felt fluttery and started telling me to call 911. So I took her pulse and b/p. Strong and steady. B/P normal range. She was adament about 911, so I called them. husband headed to the nurses desk to tell them what was going on.

Paramedics arrived. mother in law had already lost consciousness on me once. She told the medics the same thing she told me. B/P was normal for them too. But mother in law lost consciousness 2 more times while they were assessing her. Since the rooms are so tiny, with medics help they "walked" her onto the stretcher. First thing I noticed was that when they swung her legs up mother in law didn't cry out. She always cries out, it is excruciating for her legs to be moved like that let alone touched. This told me her legs had to be numb. And I informed medics of that.

husband and I hop into the car and head for the hospital. We noticed the medics seemed to be doing nothing. But we decided to just meet them there. Came to find out after they got to the ER, mother in law had lost consciousness 2 more times and each time came back confused and combative. Hence the delay in starting out.

At ER mother in law was confused. She couldn't complete sentences, used the wrong words, did not complain once about anything. Most importantly her legs which are always in severe pain due to the broken hip in march and the severe arthritis. She continued to pass out. Each time I noticed her blood O2 levels dropped into the upper 70's lower 80's. When she came out of it the levels would pop back to normal. Her B/P was 145/45. Bottom number NOT good.

Labs said she had low sodium. ER doctor wanted to blame all symptoms on the low sodium. I didn't buy it. mother in law has been admitted twice over the past year for low sodium (same level by the way) and never displayed these symptoms. Medic also didn't buy it. He thought she might be having TIA's. ER doctor did admit her. Fam doctor finally got notified and he over ruled ER docs treatment of sodium via IV, but did admit her

While waiting for a room. mother in law seem to rally around. She started to seem like herself again. Except the demanding thing was there.....bit paranoid.....and seemed to think she was the only patient in the ER. Still out of character, but not as bad as when she came in. Twice though she tried to get out of the bed and we had a heck of a time.

Sunday she was terribly confused. She thought she could just get out of the bed and walk down the hall. Hard time keeping her in bed to wait for assistance. When husband went back in the afternoon.....evidently the nurses had let her sit in the wheelchair and he caught mother in law trying to go down the hall.......she was leaving. (confused) Monday wasn't much better.

Tuesday she was getting back to herself a bit. With a bit of paranoia thrown in. Pinned the doctor when he came for rounds and wouldn't let him leave the room til she got her medications.

Wednesday she was much better and wanting to go home.

Today when I went up this morning she seemed ok. We chatted. Then she sent me home cuz she wanted to nap. I went up with husband tonight. mother in law was uncomfortable in the bed and asked to sit in the chair. She did well getting up and in the chair. But complained of terrible dizziness. As she sat there she grew more and more confused, became unable to use the correct words, then couldn't even finish a complete sentence, then got so confused she tried to get up and walk off. Nurse and I got her back into bed.

Then I had one of those AHA! moments. Sitting upright mother in law begins to get confused, it grows worse the longer she is in the postiion. Once she lays down it seems to dissapate over time. I mentioned this to the nurse who was going to make note of it for doctor.

Not sure what it means. Can't say I've seen it before, because in all my work with the elderly I've not seen it. I don't know if it's a circulation issue or blood O2 issue. I do know that mother in law had surgery to clear blockage in her right carotid artery. The left carotid artery was also quite blocked at the time but after the intense pain the first time around she refused to have surgery on the left. I wonder now if that blockage is giving her this problem.

If it is I don't know what we'll do. She will refuse surgery. (can't blame her) But I worry that she won't be surpervised enough at the assisted living in case she becomes confused.

Oh, and fam doctor is having her see a psychiatrist. Happens to be my psychiatrist. He believes mother in law to be severely depressed. I don't doubt she's depressed. But I think I understand why she is now. With this going on she's been thinking she is going crazy. Poor woman.

Am going to do my utter best to catch fam doctor and speak with him tomorrow. It has been a mighty long week. sigh And I feel mighty guilty for thinking mother in law was becoming needy and demanding.........when it actually was a symptom of something serious going on.

 

[susiestar]

Saying prayers for mother in law.

Please don't beat yourself up. It is hard to catch these things. She WAS being needy and demanding, but for reasons you did not know.

If the professionals who take care of her did not catch it how could you catch it over the phone?

I hope and pray they figure this out. she sounds, overall, like a really sweet lady.

Gentle hugs to all of you.

 

[Wiped Out]

Lisa,
Saying some prayers for your mother in law. Be gentle with yourself, it's amazing to me that you, not the doctors had that AHA moment. You are amazing!

 

[Marguerite]

You seem to have a good handle on it.

TIA definitely sounds possible especially with the dropping oxygen levels. But also in consideration, especially with the low sodium, is postural hypotension. It's possible to have acombination.

Surgery - it needn't be invasive in any major way, they can do a lot of amazing things these days with stents and catheters. The people who need tihs sort of thing the most are often the worst surgery risks, so the non-invasive options are often the best.

I hope they get her health sorted out. Yes, depressio definitely is an issue, but subsequent to, as you've suggested. First treat the other health issues, THEN work on the depression (what's left of it).

Marg

 

[Fran]

Poor m i l. It must be an awful feeling to be confused and out of sorts. Hopefully they will come to understand why she has symptoms that fluctuate so frequently.

 

[tiredmommy]

Two thoughts: pay close attention to her medications (something may have changed) and have her carotid arteries checked. {{{Hugs}}} I went through something similar with my father.

 

[hearts and roses]

Sending hugs and support. I hope the Docs listen to you and investigate further. It's so odd to me how docs dismiss with a wave of the hand the aged's health issues and simply state things like, "Well, she's old". My mom's doctor did the same thing before she ended up having 5-bypass surgery! Let us know how it goes.

 

[everywoman]

Hugs and support. It sounds a lot like my mother in law before her major stroke. Have they done a brain scan? Could it be a bleed?

 

[DaisyFace]

Lisa--

I will keep your family in my thoughts and prayers.

Yes, I think you are on to something with your theories about blocked arteries. I've seen that in the elderly myself. It can be non-symptomatic....and yet will cause them to become confused, faint....and then when they revive they yell at you that there is no way they could have possibly fainted. in my opinion....Scans of the head and neck are definitely in order.

I am also so disappointed that not one person in that nursing home was aware of mother in law's condition. They have a patient that is fainting and no one noticed? That's not right...

((((hugs))) and support. Stay strong.

--DaisyF

 

[klmno]

I'm sorry to hear this Lisa. I hope the doctors can help her soon. I will keep her and your family in my thoughts.

As far as feeling guilty- stop beating yourself up. You still addressed her needs and spoke with her when she called, so you have nothing to feel guilty over. It's perfectly understandable that you questioned (doubted) what was going on when this pattern with her started but now you understand. You've been a good daughter in law!!

 

[DammitJanet]

I think Marg is onto something with the hypotension or I think there is even another word for it...argh...my brain isnt working this morning. They do some kind of tilt table test for it. I will probably remember the word later...lol.

 

[Hound dog]

Thank you for the good thoughts and prayers.

Marg you may be on to something. But mother in law is 94 yrs old. Surgery she won't consider in any form. However I might be able to talk her into those scans if doctor does order them. "might" as one never knows, those scans are really uncomfortable for her cuz laying on her back is painful.

Didn't catch the doctor this morning. I swear that man is next to impossible to catch. Or it could be he's avoiding me. He doesn't like it when I tell him he's wrong about something. Last time we had quite a row over mother in law's DNR orders........I won, and he didn't like the fact I went over his head. The man has major Ego issues. And it's not just me, sister in law worked for himf or years........and she said his ego is one of his main problems. Like to drove her crazy.

Of course he may be thinking along the same lines as we are because most of this hospital stay is strictly to he can keep a close eye on her, like he's expecting something to happen in the near future.

I just feel bad because I didn't figure out what was going on sooner. I'd suspected mother in law was having TIA's that may have been making subtle changes to her personality, hence the demanding and neediness. But I just didn't realize it was something like this.

No wonder the poor woman thought she was loosing her mind and crying all the time. Sheesh, been there done that with the Traumatic Brain Injury (TBI) myself. Scarey thing when your brain won't cooperate with you and you seem to be the only one to notice.

I go up to hospital everyday to make sure her nursing staff knows she is not normally confused or senile. Because at 94 yrs, that's an almost automatic assumption for them to make.......and they might miss something significant by making that assumption. Thankfully her doctor does know that she is sharp as a tack under usual circumstances......and was the friday before this came to a head. He'd seen her first thing in the morning....and she had only been up in the chair a few mins. So the confusion hadn't taken hold.

I believe whatever is causing the problem is growing worse, as the effects of sitting up develop faster than they did leading up to last weekend. Perhaps a large stroke is on the horizon. If it is I pray it is enough to let her pass swiftly and not linger. She is ready to go. And a stroke leaving her in a vegatative state is mother in law's worst fear.

I'll be going back with husband this evening. This morning she was in bed, so seemed to be normal. This afternoon she'll want to be in a chair.....and I want to see if the theory holds up.

Hugs

 

[Lothlorien]

I hope docs can figure out what's going on. Dealing with someone who is so confused like that must be hard on all of you.

 

[mrscatinthehat]

Sending hugs out to you.

beth

 

[witzend]

Poor gal must be terribly confused and upset. I know I would be. It is somewhat encouraging that it comes and goes and that you might be able to duplicate the symptoms given the right conditions. Keep your hopes up!

 

[Marguerite]

Janet, the only terms I could find were "postural hypotension" which is also sometimes called "orthostatic hypotension". It's basically where your BiPolar (BP) is OK while you're lying down or even maybe sitting (especially semi-reclining) but when you get up, it suddenly drops, often to the point of fainting (or at least feelnig faint). This can happen a bit for most people, especially when getting out of a hot bath, but it becomes a problem where it causes dysfunction. It's a matter of extremes.

Treatment can be as simple as taking extra salt on board.

DL, a couple of thoughts. On top of what I mentioned above, your mother in law needs to be assured that opening her up is not even necessarily going to be suggested. She can relax a bit there. Because even if doctors want to fix things, there are many ways they can do it without having to open her up. At her age they will want to avoid a general anaesthetic or surgery if they can. But at her age she is still entitled to quality of life, and a sudden change like this indicates a problem that could well have a simple fix.

If her carotids have gunged up, they could cause symptoms like this. There could be other causes of course, but Doppler studies on her carotids would be a good start - again, non-invasive. It's just ultrasound over the throat area.

If her BiPolar (BP) is normal, I doubt she'd headed for a stroke from a bleed-out. The worst risk I suspect would be a blockage of flow from the carotids plus a clot breaking off and causing a blockage in the brain.

Thinking of this scenario - carotids blocked up a lot, plus BiPolar (BP) on the low side plus low salt. SO when she stands up, the blood flow through the carotids, sufficient when lying down, has more to pump against to get through the blockage and so she faints.

I need to think about the BiPolar (BP) reading - the low diastolic with normal systolic (ie wide pulse pressure) I think also indicates blockages in major vessels.

It depends on a lot of things, but there is a lot they can do to help her without having to cut her open. Diet is a really good start - low fat (especially low trans fat, low saturated fat) and increase in mono oils. Ease back on carbs, introduce more fibre (especially psyllium fibre and other soluble fibre) and more fresh vegetables, as raw as she can stand it. Summer is a great time for salads anyway.

Of course, in any kind of institution the quality of food often isn't too good. And a common health problem for older people is poor nutrition especially various vitamin deficiencies. You can get some weird symptoms.

Was she ever a smoker? Does she still smoke? That could also be a factor.

And if the doctor does insist on surgery, it's still not so risky - I had an elderly female relative who had her cataracts done when she was 95, then had a mastectomy a few months before her 100th birthday. She left the hospital after 3 days, to come back to her retirement hostel. She walked back in as if she'd just been taken for a lovely Sunday afternoon drive.

My mother had blocked carotids as well as clots in other places. She began having TIAs when I wasstill in my teens. I wasalmost 40 when a clot moved form her leg and went to her brainstem, causing a blockage (and therefore stroke). She was determined to overcome the handicap. And that was worst case scenario, it took decades to occur.

If BiPolar (BP) is up, you risk a blood vessel rupturing. If there are a lot of clots around, you risk one of them moving. If you are low in salt, your blood viscosity is affected and that can cause lower BiPolar (BP). But there are also other factors - there are sensors to Co2 levels and BiPolar (BP) levels in the carotid arch, so depending on where clots are, it can have a strong effect when the danger is not as bad as it at first seems.

I suspect the first step will be Doppler studies on both sides. Meanwhile they'll be doing blood chemistry.

Keep insisting that this apparent dementia, especially episodic, is very recent and unusual. They don't know her in the hospital and you're right, they may just assume she's a crazy old lady.

As for how you deal with her - tell her that something has suddenly gone a bit haywire for her, YOU think it could be something simple that can be easily found and shouldn't be too invasive to fix, but to not let it upset her too much, you are there for her and will make sure the hospital staff treat her with respect.

A sudden recent problem is far less likely to be unfixable or nasty. She's OK a lot of the time, she's only confused when she's fainted or similar. So it's not dementia. ANYONE would exhibit confusion under these circumstances. Anxiety could make it worse.

Basically - reassure her, but don't pre-empt the doctors, make it clear what you think, rather than second-guess the medicos in case what they tell her is too different. You don't want the doctors' advice undermining yours, not until you get to talk to them!

Marg

 

[Hound dog]

Marg..........I'd love to have you stand next to me when I'm talking with doctor Ego.

I know mother in law is insistant that nothing, absolutely nothing, be done to prolong her life. But doctor Ego released her today with no warning after she passed the evaluation given by psychiatrist.

doctor Ego is determined not to listen to a word I say.

On one hand I understand, because I understand mother in law's position on the matter. Her quality of life is nearly zero. The severe arthritis and broken hip (that won't be repaired) makes living a nitemare. But on the other hand it would be nice, or would've been nice to be certain of what we were dealing with before releasing her back to assisted living.

mother in law went into full blown anxiety when she discovered she was to be discharged at 6pm. husband and I were majorly POed as we had not been told so were not prepared for her to be discharged. I had made big plans with the grandkids this evening to take them to a movie. husband had to get to bed early for work in the morning.

So we talked to the RN, who called doctor Ego. Much to our shock, doctor Ego appeared in person to appease mother in law. Told her that if going home tonight caused her anxiety he could change it to morning. Explained to her the hospital wouldn't like it, but he could smooth it over and it would be ok. mother in law then changed her mind and decided to go home as all plans were made. So doctor Ego goes out to follow her wishes...........and he barely got out of the room and mother in law had husband chase him down to tell him she wanted to go in the morning. By them it was too late. Transport ambulance had been called and were on their way.

So.....I got a wee bit ticked. mother in law had a perfect opportunity to go home in the morning like she wanted and threw it away. She knew I had plans to go to the movies with the grands at 7pm. And instinct told me she was going to try to weedle me into spending the night with her. (and I knew if I did it once, it would be a long term thing) I called easy child and told her to pick me up at the hospital. Told husband he could settle his mom into her room.

husband was furious, but would not make a scene at hospital. (evil of me I know) mother in law understood and was ok with it. I kissed her, told her I loved her, reassured her the staff at assisted living would take good care of her......and high tailed it out of there.

Evidently husband survived getting his mom settled back at assisted living, cuz Nichole said he was home by 7:30 pm.

I'll check on her tomorrow. But I knew with the way her anxiety is right now......if I'd have skipped the movies and went with her........she'd be expecting similar behavior in the future.

I've no doubt the staff where she is will be checking on her regularly as hospital advised them of the situation. If mother in law needs them, she can pull her cord which sets off the staff's beepers. doctor Ego told us and her that she can return to the hospital without hesitation if she feels it necessary.

On a good note......psychiatrist gave her an anti anxiety medication....half dose due to her advanced age. So that ought to help some at least.

Somedays I feel like I'm caught on a Merry Go Round.

 

[KTMom91]

I'm so sorry, Lisa. Sending hugs and lots of strength.

 

[susiestar]

Sorry you have had such a difficult time. I am glad you were able to take the grandkids to the movie as promised. You are problem right about staying the night.

You are the one who pays attention to what she is experiencing. She wants you there as a security blanket. While understandable, it won't stop the things you must do and want to do. Life has to keep marching on.

I hope a solution is found quickly and that it is something that is affordable.

What had husband's panties in such a bunch? That he had to do something with HIS mother? I would be pushing even more stuff onto my husband if he pulled that. He may not be capable of loving soemone else, as you posted in another thread, but that doesn't get him out of doing what needs to be done. Heck, even my dad had to take care of his mom sometimes. She was in the dining room where the hospital bed was brought in. We lived halfway across teh country and came back to help her and give my aunt time to take a vacation. My dad helped with the aspects of her care that she would let him help with.

You may have to push husband to pull his share of the load. It doesn't pay to be too nice. It just gets more stuff dumped on you.

Hugs, and I hope the next few days are much easier.

Keeping you all in my prayers!

 

[Hound dog]

Susie husband was miffed cuz it made his bedtime later. Although since Nichole told me he got home at 7:30......he didn't get to bed that much later. In his defense he gets up at about 4 am. Understandable but one nite with 45 mins of less sleep wasn't going to kill him.

He has been carrying at least half the load. Because I make him. He doesn't like it.....but doesn't grumble...well too much anyway.

The people around me are finding out that I'm no longer everyone's helper person. lol I don't mind helping people, especially family. But no more killing myself to do so. Nope, not gonna happen.

Learned just a few mins ago during one of husband's bathroom runs that mother in law had a reception commitee to great her when she arrived at the assisted living. They had missed her and been worried about her. By the time she got to her room she had a whole crowd of staff waiting to see her and check her out. lol mother in law really is a very lovable sweet person. And I'm sure this reaction from the staff eased her anxiety a great deal as I didn't receive a phone call from her tonite.

But I'll be going over there tomorrow to pay her rent and any other bills that have come in.........and also to see how she's doing. I have a feeling staff will be doting on her for several days at least.