Mom's not the healthiest person and past year has been one crisis after another, but this time I feel I should prepare for the worst.

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My mother was diagnosed with a DVT in March and admitted to the hospital, then was transferred to the SNF for physical therapy. Physical therapy was discontinued at the beginning of this month (May) because they said she had plateaued and wasn't making any progress (in order for Medicare to pay you have to show progress). The SNF kept her there under wound care coverage instead because she was not well enough to come home (and I had already decided I didn't want her back here at the house - it was just not a good situation for me or her). Last Friday I received a phone call from the SNF informing me that my mom's hemoglobin count had dropped to 6.7 and her white cell count dropped to near nothing, so they were transferring her to the hospital for treatment. They weren't sure what caused it - could be the coumadin causing a bleed somewhere (though they couldn't find where), could be any number of things - they didn't seem to concerned with finding out the "why", just trying to bring the numbers back up. During this time, she was so weak she couldn't even hold the phone up to her ear for more than a minute to talk to my brother & sister on Mother's Day. The hospital gave her a unit of packed red blood cells, which brought her count up to just over 8, and the next day her white cell count came back up within normal range. Her edema was controlled and her numbers all stabilized over a 4 day period, so they transferred her back to the SNF on Tuesday.

Ever since she then she has been extremely weak - all she wants to do is sleep all day and has absolutely no energy. I just got off the phone with her and she said the physical therapist was there with her, but she just couldn't do anything because she is so weak. I am really beginning to wonder if there is more to this than what they are telling me.

My Mom has a multitude of chronic health issues - congestive heart failure, diabetes, rheumatoid arthritis, etc. so she is not the healthiest person - really hasn't been doing well the past couple of years especially...it's been one crisis after another. This time feels different...and I don't know how to explain it other than I have a sinking feeling that I should be preparing myself for the worst, and I can't shake it.

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I went to Mom's wound care appointment with her on Friday - she was still pretty tired and weak. On Saturday I brought her a few things and when we arrived she was sitting up in her wheelchair watching TV (the first time I have seen her not just lying in bed in over a week). She said she felt a little better, and had gone to physical therapy earlier in the day - she had waved them off the previous 3 days. So now the dr. thinks she may have gotten some sort of virus OR the low blood count just took it's toll and now that it's creeping back up she's feeling a little better. We shall see....
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@Eyerish - lol - i didn't take it that way at all - no worries! ;)
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Thanks for the responses. I forgot to add that the edema is also exacerbated (sp?) by low albumin - her protein count has been low for quite some time, in spite of protein supplements. (Also forgot to add chronic renal disease, stage 3, to her list! that plays a role in there somewhere.) Her hemoglobin has been low ever since 2005 (rectal cancer with subsequent chemo and radiation damage to the marrow) - she had been seeing a hematologist who was keeping a handle on it with Procrit shots - it's been between 8-11 for years, but the drop last week took everyone by surprise. She's always got so much going on with one system or another - I am really surprised, to be honest, that she's even still with us - that just shows how strong-willed she is I guess!

I agree 100% that caregiving isn't over just because your parent is in a SNF - I've been making near daily trips just to make sure she's got everything she needs,etc - I just never seem to get RESULTS when I ask questions from the nurses/doctor - always the "i'll check on that & get back to you..." type of answers. Guess it's time for me to ramp it up and insist on answers.

I do have to say though, that since Mom has been gone from my house that I have felt immense relief from the stress I had when she was here. I feel like I am her daughter once again, and I have noticed a huge (positive) difference in the way she treats me also.
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^^^^ Didn't mean to sound like a snooty know-it-all. My dad's blood counts were real low at one point too.
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A normal hemoglobin count is between 13-17 so your mom's count is very low and could indicate a bleed, as they told you. When there's CHF the heart fights to keep fluid away from it so the fluid tends to settle in the extremities but it can also settle in the veins. This causes the veins to bulge and they can break, causing little bleeds.

With CHF the heart has difficulty beating through the fluid and so it has difficulty pushing the blood with enough force to reach the extremities. This causes low blood pressure which can make someone very weak.

Rectal bleeding can happen because there's pressure there from sitting and during bowel movements. When my dad's blood counts were low the SNF didn't do a whole lot to fix them but he was in a rapid decline and everyone knew it.

It's been my experience that SNF's aren't real aggressive in treating age-related decline (ARD). If you think they need to be more proactive you're going to have to advocate on behalf of your mom, try to get the Dr. on the phone and find out why (s)he isn't treating the source of the low blood counts and are only treating the symptoms.

People don't realize that once our loved one goes into a SNF the caregiving doesn't stop. We have to yell extra loud and more often in order to get our loved one's the care we think they need. We may not be giving hands-on care anymore but the caregiving is far from over.
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Ah, Purple dear, how hard for you! (And for Mom, of course.) Hospital stays take a lot out of the elderly. She may gradually return to her baseline as she recovers from the trauma of the hospital.

Or it is possible that she is in a serious decline. Can you have a frank discussion with her primary care doctor regarding her prognosis at this point? Ask if it is time to bring in hospice, for example.

Let us know how this progresses. We'd like to make the journey with you!
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