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Yup.
(3)
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Hoping mom got some rest, Barb

Will you be making the round trip again today?
(3)
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No words, just (((hugs))).
(5)
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(((((((Barb)))))) Such a distressing time. Poor mum. Prayers for all of you.
(5)
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More oy. The tramadol doesn't seem to be covering mom's pain, she looks dreadfully uncomfortable/in pain/miserable. We've inquired about morphine. Hand with the IV ( the wrist that's NOT broken) feels hot. I tried feeding her some soup today, but it didn't seem to go down, so we're back to ice chips and lemon ice. Thanks for asking. Just sort of holding my breath.
(6)
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Scary about the medic alert bracelets! Thinking of you and your mum. Update us when you can.
(4)
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Now That is scary! I understand if it's a MedicAlert necklace that happens to be hiding beneath your clothing. But a bracelet? There goes believing how helpful those bracelets are.

I'm just checking in to see what's the latest. Keeping vigil with you along with the other AC posters. Take care.
(4)
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The other reason I really would rather she not be in hospital--they've always screwed up her meds there, no one knows her and one of us REALLY would need to be there around the clock. And I never trust hospitals to actually READ the DNR/DNI/MOLST. In my experience, they "save" folks and ask questions later. Exactly what you want for a young healthy patient. Exactly what is not wanted for my poor mom.

While I'm rambling, my brother told me that in the ER the other night, when they were splinting mom's arm, one of the docs said, "oh, and we moved her watch and jewelry to her right arm". My brother looked at him and said "jewelry?" Yes, some sort of bracelet, the doc said.

"You mean her MedicAlert bracelet?" (the one with all her med conditions, etc.)

Well, yes. The one they didn't look at.

A couple of years back, my husband got taken to the local ER; as I was telling the ER nurse all of HIS medical conditions and meds, the nurse looked down sternly at my mostly passed out hubby. "Mr. S", she said, "you really should be wearing a MedicAlert". Before I could explode, he mutely raised his right arm with the clearly marked bracelet on his wrist.

Oh. Well......yes, like that.
(8)
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CM, if I read my brother correctly, he was repeating something that his wife had said, because it was followed later by "and without someone else in the room" (mom has a roommate, nice quiet lady who is rehabbing and who is always out at an activity). Mom seems blissfully unaware of anyone else's presence, including mine.

I was so glad that I was able to talk to brother at work yesterday; I usually get both of them on the phone and my sil is built very differently from the way we are. When her dad was dying of a dozen different ailements, her younger brother was jumping up and down on the chair in the hospital room screaming "fight it, Poppi, fight it" (I'm not exaggerating; they really resist dying, these folks.)

I pointed out to my brother that at the NH, mom is surrounded by folks who love her; everyone in the place stopped by yesterday, every aide, nurse, Father, two nuns, just to check in. When I mentioned to her nurse and the APRN that we wouldn't want to send mom to the hospital for the pneumonia, they looked at me like I had three heads and the RN murmured, "no hospital, Barbara, no hospital". I'm frankly of the opinion that the fall that she suffered was far less traumatic that the two way ride to the ER in the ambulance, and the experience of being in the ER and having tests, questions, etc.
Thanks for the good thoughts, Countrymouse; as you say, this is will come out as it's supposed to. b
(6)
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?????? is spot on, BB - no one has ever been "more comfortable" in a hospital, it's just not what they're for! Perhaps what he really means is "nearer the big shiny expensive machines," and I sympathise, because it is an instinct to rush one's loved one to the highest-tech centre one can think of.

Poor mother. But it sounds as though they're doing a good job of keeping her comfortable and not frightened. Hoping for the best outcome for her, whichever way that may go.
(3)
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Oh crap, Barb

Hope the drive home wasn't too exhausting
(2)
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Thanks for all your thoughts and prayers. They are keeping me buoyed. It's a 90 minute drive each way and fortunately I have a wonderful audiobook from the library to distract me; it's called The Fortunate Ones, author's last name is Umansky.
(7)
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Barb, thanks for the update. Sounds like it's kind of a wait and see situation at this time.

Make sure you get plenty of downtime for yourself although I know that's hard to do in a situation like this.
(4)
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Thanks for the update, Barb. My heart goes out to you. it is a difficult time. I am glad your bro came around to not sending her to hospital. The feedback about the smiles was good to have. No matter how prepared we think we are for a situation like this, we never are ready for it. The Levaquin will keep her more comfortable and her will and body will decide if she can go on. I am sorry she looks miserable. (((((((hugs)))))))
(4)
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((((Barb)))) I know we can't help, but I wanted to send a big hug to you.
(7)
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Oy. Mom has pneumonia. They are starting her on Levaquin and will set up a saline drip to try to protect her kidneys.

She looks totally miserable, but is still able to eat lemon ice and take drips of juice.

Talked to my brother earlier, glad I did. He was thinking that mom would be more comfortable in the hospital (???????)

We talked it through and he thinks that letting her be is a good thing. He said, " you know, if SIL were involved in this discussion, she'd be arguing for the hospital " ( i know, I know. He also told me that the smiles that they've been reporting to me are a figment of SIL'S imagination.

Just oy. Well see what happens. Mom has fought through several falls, pneumonia. What happens depends on her will to pull through this.
(10)
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Barb, how was the visit yesterday? Your family have been in my thoughts.
(2)
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Barb,
I will start praying for God's will for your Mom, and that there will be no more suffering, no more pain, and no more tears, dear one.
(4)
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Peace and love to you and your family.
(3)
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Such a difficult time. Big (((((((hugs))))))
(4)
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I think it'll be a bit easier to assess the situation when you visit tomorrow, and speak with the staff.

I'll be thinking about you and hoping that the visit brings some sense of resolution, or movement to it, for you and your family.
(5)
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I'm going to practise magical thinking and bring a dress :)
(6)
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Anytime day or night, Barb

You have friends in all time zones here

Let us know how mom is after your visit tomorrow

Hugs
(4)
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This is the complication. I know what mom explicitly told me when I was growing up, and later as an adult, about keeping folks with compromised minds and multiple medical conditions live with feeding tubes, breathing tubes, pacemakers and other measures. She taught me the phrase "pneumonia is the old person's friend"--her mother died of gangrene--we were PRAYING for her to get pneumonia, believe me.

If I were managing this alone, I would have turned down the pacemaker two years ago. My mother, in her early old age, would have been horrified to be kept alive in this condition. But I don't make these decisions myself.

And my brother is certainly correct; at the time that mom's heart started to fail, she was able to express her opinion and it was "yes, I want the pacemaker".

This time, I don't think she's got the capacity to chose one way of the other and we ARE going to have to make the call about what to treat.

Thanks for listening to my ramblings. It really helps to write this stuff out.
(7)
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Thanks for all your input. Just got an email from SIL; mom has now been in bed since she returned from the hospital on Wednesday night; eyes closed. Smiles when told a funny story.

I'll be up there tomorrow to see what there is to see.

Yes, I've heard pneumonia called "the old people's friend".

These decisions don't fall on me entirely; my two brothers and I make these decisions jointly. Thanks for all of your support!
(6)
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You Barb, will do what is best for your Mom.
I am for comfort care at end of life.
Sorry that she is declining, and these hard decisions fall to you.
(4)
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Barb, I've only seen gasping for breath when associated with oxygen deprivation, or the oxygen hasn't been turned on, or isn't getting through, or there's been exertion and the lungs haven't yet caught up. This has been other than in cancer situations though. So I don't have the experiences to be really unsettled by this, but it doesn't frighten me as I've had anaphylactic type reactions from food additives.

As to pneumonia, in my experience the presentation has been one of coughing, lots of congestion, weakness, debilitation and general decline. We go through pneumonia generally a few times per year. The last two times have included sepsis, which scared me as I had always thought of it as being fast moving and frequently terminal, especially with older people and co-morbidities.

It was also complicated because a donkey's posterior of an internist and a similar anatomical resident were obnoxiously abrupt, rude, and totally unprofessional in advising my father that he shouldn't consider resuscitation in the event of cardiac failure, and further they would be cracking his chest in order to do that. In their infinite wisdom, they both advised that he had already "lived long enough," "is 98" and had a good life (how they perceived that I don't know).

I tried to replace them but they refused and challenged my efforts. I still plan to write a complaint letter to the hospital; they were both totally unprofessional.

I raise the issue b/c of the attitude by some physicians that it's just time to let go - don't expect them to want to do CPR on a 98 (almost 99) year old person. So we didn't get the treatment we would have with a younger person. And that's a consideration when deciding how to proceed.

I've been thinking about pneumonia and if there's anything I could share in terms of your mother, and I guess I'd have to say it would depend if it's in both lung lobes, how much oxygen has to be turned up to stabilize her breathing (8 liters is as far as we've gone and that's kind of "freaked me out"), whether or not the pneumonia and/or sepsis can be resolved, and whether or not oxygen weaning will be present in post-pneumonia recovery.

I wonder if the next bout will be severe enough to require 10 liter flows of oxygen, and what the prognosis would be at that time.

The weaning is I think critical, because being on 6 or 8 liters of oxygen significantly compromises mobility. That mobility compromise drastically changes one's daily outlook.


When on an 8 litre flow rate at home, and going out for doctor or other trips, the little portable concentrators can't be used b/c they don't have the capacity for liter flow that high. E-tanks have to be used; they're more klutzy. And even then, I've been advised by the DME supplier that an E-tank which normally lasts 6 hours will only last about 2 (I don't remember specifically) hours. I began taking 2 tanks, one primary, one for switching in the event of longer trip duration, and one as backup in case one of the others failed.

I had to create a special carrying area, braced and cushioned (even though the tanks aren't delicate) for the tanks in the trunk of my car. Add the rollator, extra cannulas in case one or more failed, and the back seat of my car filled up as well. I could see hunkering down at home becoming a pattern. So did my father.

Plus hauling the equipment aggravated a back injury. This changed my outlook on trips, even short ones, and I really began to dread them.

This also changes travel, movement, flexibility and freedom issues. You need 2 E tanks just to go to a doctor's office, one as backup in case something happens to the first (which it did to me). Everything becomes so complex on a higher level, especially if oxygen weaning isn't part of the rehab protocol.

At that point, frustration really sets in, and just the basics of breathing become more complex.

I think that would be a time to evaluate options. Lessening value to life can come from co-morbidities, and disasters like cancer, but it can also come from complex challenges just to getting through a day without dragging tubes around, tripping over them and worrying about falling, running out of oxygen if the car breaks down or is in an accident, and more.

I could see how it changed my father's and my outlook. And it wasn't at all positive.
(4)
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I am with you on not sending her to the hospital. I want to avoid that for mother too. It is too traumatic. If antibiotics make her more comfortable, I am for them - on that basis - as part of comfort care.

Let us know how she is.
(5)
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Barb, I'm sure you know a lot more about pneumonia than I do, but I've read that it used to be called the old peoples friend. Do you feel your mom has enough quality of life left to make it worth fighting for?
(5)
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I don't know Katie, we've come right up to line a couple of times and mom bounces back.

About treating pneumonia. Had some time to think about that. We won't send her to the hospital ( Heck, i wouldn't have sent her to the hospital after this fall, would have asked them to x-ray wrists with portable and ordered splints in house. Going to the hospital via ambulance is a big part of the trauma now). The last bout of pneumonia took two rounds of antibiotics to cure, one via IV. But she recovered.
(5)
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