End of life...

Scopolomine dries up secretions.

I'm so sorry you're going through this; glad hospice is wonderful.

(((Big hug segoline))). A year ago I was in your shoes & looking for this sort of information so thank you for sharing, I know there others out there looking for this information too. I hope this transition is easy & peaceful for your mom.

Actualky barb, this is compounded for a specific purpose in end stage. I questioned it because of.

I want her released from this prison. I want her at peace.

Hugs!

May her passing be peaceful and may The Lord give all of you strength and grieving mercies during this time.

I am so glad you are having a good experience (if you get what I mean) with Hospice.
The emotional support I got was just as important as the support I got for my Husband.
Hold her hand
Tell her you love her but...
Let her know you will be all right.
((Hugs))

I will tell you something funny. Somewhere, somehow, since she is on comfort meds only now. She actually could have decided, I will show you! And gotten up to prove it.

That part of our family is part mule, frankly. God love her, she is not going out with a whimper.

Although this is kinda black humor, you take it where you find it. Ok mom. You do you. And I am your champion all the way.

Ok so for educational purposes in end stage. The skin gets mottled due to lack of blood flow. It is not painful. The skin may feel cool to touch.

The scopolomine formulated for end stage dementia is not same, for example as that used in treatment of ALS.

There's other stuff thrown in there so they shouldn't call it that, but they do. It is designed to increase secretions and offset death rattle. I wish I did not know this. Alas I do.

Thank you.

Sego; I don't doubt that your hospice folks know what they're doing (I'm just an inveterate corrector and goody two shoes and generally annoying person--my brother will tell you that).

Be well and be strong, my friend. (((((hugs))))))

You're good barb. No harm. No foul. Thank you

I'm sorry you are going through this, it is so hard, but the most loving thing you can do, your being there with your Mom as she transitions to the next life. I've been in your shoes 4 time now, seeing all 4 of our parents til the end, and I am So glad you are happy with your Hospice team! We had Great Hospice support with 2 of our parents too, and it made things so much better for everyone.

The end stages can go on for a bit, so be sure to rely on the Nurses if you have any questions as they are phenomenal at what they do. I hope you are getting some rest, and are taking advantage of others offerings of their time, running errands and food stuff, your being able to get out for an hour or 2 now and then is so important for your own health. Hospice can get you a volunteer to sit with your Mom so you can get a little ME time once and a while, as it is exhausting work caring for your LO at this stage.

Again, I am So sorry, I am sure that it is her time to go, it is difficult when you are agonizing over the long goodbye. I pray that your Mom is pain free and is resting peacefully. Remember to take care of yourself! HUGS!

Oh Segoline, her end is near.

This is exactly what my mom’s hospice nurse told me.
I lived 4 hours away. Mom’s hospice nurse called me @ 8am to let me know that the nurse thought her time was near because her lower extremities began to mottle. I was there by 3pm; she passed 12 hours later @ 3am.

While I know this is hard, I am hoping you have made arrangements for her to be transported to a funeral home. We had mom’s funeral pre paid.

Spend these last days speaking to her, tell her you love her and that it is ok to go. I did on my mother’s last day, and thanked her for being the wonderful mother she was.

There is something divine about the dying process. For me it felt like a connection to the universe or to God if you believe. Some deaths are not as peaceful; thank heavens you and your family made the decision to bring in hospice to provide your mother with a peaceful death.

Those days were hard, seeing my mother failing, knowing death was imminent. I myself felt relieved when my mother had passed - her suffering was over. She was with my dad and all her brothers & sisters (she was one of 11). She was whole again.

My Mom was in a room by herself at the end. The NH staff let me stay with her & just kept her door shut. Don’t be surprised if your mother passes when you stepped out or fell asleep. My mom passed while I was asleep in the empty bed next to her. I fell asleep listening to her labored breathing (not gasping, just agonal breaths). I woke up immediately when that noise ceased, looked over and she was gone. She chose when to go and didn’t want me to see it.

My thoughts and prayers are with you today.

Scopolamine is scopolamine is scopolamine. If she's being given scopolamine, they are trying to control the secretion of saliva, which helps with what's called the "death rattle" that can be distressing for those keeping vigil at the bedside. Scopolamine also slows gut motility and reduces secretion of irritating stomach acids. It prevents vomiting. At end of life all those things are good to keep her comfortable.

Mottled skin means her extremities are probably cold to the touch. Keep her warm both physically and emotionally, Seg. Her end is near. Peace.

So I clarified today. The hospice nurse was talking to me from inside her closet. I was talking from inside my bathroom. From national news, you must know Oklahoma besieged by tornadoes. We all need a nap.

Communication got sketchy. Faded out.

Yes it dries up everything. The scop.

Well the bed sore is no longer a nickle size. We talked to hospice from the facility and they explained it was a Kennedy Terminal ulcer

Kennedy Terminal Ulcer: the "Ah-Ha!" Moment and Diagnosis
Authors
Joy E. Schank
Keywords
Pressure Ulcerend-of-life careKennedy Terminal Ulcer
Issue: Volume 55 - Issue 9 - September, 2009

Abstract
The Kennedy Terminal Ulcer is an unavoidable skin breakdown or skin failure that occurs as part of the dying process. Research is limited but the literature suggests that Kennedy Terminal Ulcers are typically pear-shaped, red/yellow/black, similar in appearance to an abrasion, and tend to occur suddenly in the sacral/coccygeal region not long before death. In this case study, one resident of a long-term care facility suddenly developed a full-thickness ulcer. The ulcer did not respond to treatment and the resident died 6 weeks following ulcer development. Another resident, admitted with a full-thickness ulcer, also did not respond to standard measures of care and general skin failure was observed. She died after 5 months. Research about end-of-life phenomena such as skin failure is needed to help clinicians, caregivers, and patients understand what is occurring and facilitate the provision of optimal and appropriate end-of-life care. 

Hospice is pretty matter of fact about this.

((((((hugs)))))) segoline. Prayers for peace.

Thanks for that info segoline. My MIL developed a bed sore in her sacral region 6-ish weeks before she died, sounds like it was a Kennedy terminal ulcer. She didn’t go on antibiotics or anything, she did use a special ointment, and she started receiving baths 3x a week once the sore was discovered. I think prior to that, her home health aid was coming only once a week.

Hope you’re hanging in there during this difficult time.

What is quite disturbing to me is its prognosis and rapidly it has grown. The prognosis is awful. Complete ulcerated and black backside. I dont want this for my mother. No one puts a pet or a frigging farm animal through this. They intervene out of compassion.

I going to think about this for 24 hours and talk to hospice and my sis. I am ready I think for the morphine to start. Think of me what you will.

@worriedincali

Antibiotics would not have helped. Nothing does. So I talked to hospice. My compromise is increasing pain meds to every 4 hours. My sister told me they already were. They weren't. Prn.

So I am good with this today. She is on opioid and valium. She was actually more with it due to being taken off all that other crap, but asked me why is this happening.

Why does my hand stick. My backside hurts so much. Why is that. Well mom, we are going to take care of it.

This is a nightmare.

I'm so sorry you and your Mom are going through this, Segoline. It's very similar to what my mother went through before she died last July. I stayed with my Mother the last few weeks of her life and did everything I could to make her comfortable, and that's all you can do. All any of us can do, sadly. Sending caring thoughts to you and to your Mom.

Thanks everybody for your kind words. You want to do something immediately. Stop this NOW. Quite often, in life, with many things, the best thing to do is nothing. This is not one of those times. But a compromise was in order. And I think I found it per reply above. Post my conversation with hospice, an RN went to see her. Eyes on. Eyes on ulcer. Meds changed pronto. Not only every 4 hours, but prn on top of. My mom is more lucid since stopping all of these other meds. The psych meds included. The consequence though is she asks what is happening and why. I want her at peace. Like I said, I am good with this today. I might want a different aggressive scenario in a few days.

Fot anyone in this stage of things, I feel for you. And you have my heart.

And I cannot emphasize enough how responsive this hospice is. Holiday weekend. Call back in 5 minutes. RN call back in 10 mins. Physically going to see our mom, check ulcer, change meds. 1 hour.and callback within same time

Gosh they are good.

Yes, Sego; time for morphine, I think. ((((hugs)))))). And more ((((hugs))))))))

@barb, this is my compromise right now.not to say I won't change it.

I tried to talk to my sibling last week about bed sores in end stage. She said she did not want to know. Today, puts on big show. Because she has an audience of her DIL who is RN and son.

This is what I deal with and have, as DO MANY OTHERS. So while she was napping. I changed some things. And it was for best. For my mom. She called me when she awakened. I did not take the call.

I am good. I did well today.

Please Segoline, consider Barb’s advice regarding Morphine. It’s hard but if you were to list your mother’s most important need now it is for pain relief. If she’s off her psych meds her anxiety may be inching back.
Try to Stay ahead of this. Just a suggestion.

Sego, what is your hesitancy about morphine? They are NOT going to give her a fatal dosage. They are going to keep her calm and pain free. (((((Hugs))))))

Please don't be afraid of giving your mother as much pain medicine - morphine included - as is prescribed by the doctor, or ask for more if you feel it's not enough to control pain. Pain is easier to prevent than to relieve, and severe pain is difficult to manage. Get ahead of any pain now, and you will be providing her with the comfort care she needs and deserves. Peace, Seg.

I have no hesitancy about morphine. I will talk to them further about its use. Her pain and anxiety meds were prn. That's great if she articulate, not so much if she can't.

So the change is every 4 hours and prn.

Good reminder to stay ahead of pain. Thanks all.

Segoline - I totally agree. We had no hesitancy about morphine either. If the prescribed amount wasn't keeping her comfortable, we gave her more. She was within days of death, after all. No other consequence was of more importance than keeping her comfortable. Glad you are doing what you can to keep your Mom comfortable at the end. You'll feel better, afterwards, having done that.

Oh. My. God.

PRN and my mother.

To the nurses " No, dear, I'm just fine".

Then she would call me or SIL or brother. "I'm writhing in agony!" Or we'd come to visit and she'd be weeping. I'd get the nurse, stay outside and she'd tell the nurse she was FINE!!!!!

In this way, folks who are caregivers to those with dementia are driven, slowly but surely, to insanity.

We made everything by the clock AND PRN. My mother was no longer a reliable reporter of pain.