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My mother in law was recently taken to the ER with severe back pain. A CT scan revealed what is believed to be some type of cancer in several vertebrae, plus one is fractured. Doctors say she needs a PET scan which must be done as an outpatient. She is unable to walk and is pretty much confined to a bed now, so she opted to go to rehab in hopes of getting better so that she could get the PET scan. That doesn’t appear to be working. Day 4 of rehab, she slept most all day and on day 5 (today) she doesn’t make sense when she talks, isn’t sure what time of day it is, or even what day it is. She is confused and will repeat everything you say.
She has COPD and is supposed to be on a bipap machine each night, but she hasn’t used it in at least a month.
Is the build-up of CO2 causing her erratic behavior or has the cancer spread to her brain?
Should we insist that her regular physician come see her in rehab?

Yes, the facility is aware of the bipap, but it's PRN. They say she refused help with it the first night and they have not offered to assist again.

I was able to get her on it for about 10 minutes this morning, but that's all she would tolerate. She's even letting her breathing treatments (DuoNeb)sit on the table. She used to be adamant about getting them every 4 hours.

Her O2 ranges from 84 to 98, depending on which finger you can get a reading

We don't now if this is how she wants it or the CO2 is clouding her judgment.
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Reply to leelaw
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Either one or both may be responsible for the erratic behavior. If there is cancer in the spinal area it is also possible that it is from metastases from another primary area of cancer, and cancer in the spinal column may more easily spread to the brain. You will have to await testing on all these matters to get any answers, and you may never have complete answers. I sure do wish you luck and am sorry for this diagnosis.
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Reply to AlvaDeer
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Looks like rehab is not working. If Medicare is paying for her care, it will stop if she cannot participate in therapy. If she is private pay, she is wasting her money. I would insist she be taken to the hospital. If the facility will not call an ambulance than you do it. Rehabs are not prisons, you have rights. Rehabs are limited in what they can do concerning care.
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Reply to JoAnn29
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You will not know about brain cancer unless there is a scan. High CO2 causes sleepiness and non compliance with bipap, figures in. Low oxygen levels cause loopiness and shortness of breath can cause shortened sentences. Vertebral cancer can be a beast.
You have a couple of choices here. There are mental status changes in a COPDer. The needs emergency evaluation and an arterial blood gas, a type of lab test that is done in a hospital. A doctor visit will not help and the APRN on site may not be aware of her changes. She is in rehab but you can insist on a visit to the ER. OR You request hospice.
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Reply to MACinCT
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Is this the elder that you state in your profile is in independent living? Does she live alone?
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Reply to CTTN55
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Sweet of them to order an investigation they couldn't carry out.

Did they scan her head, or only the bit of back she told them was hurting? What other investigations did they do?

Yes, insist that a qualified medical practitioner comes to see her in rehab to take a full history and carry out a full assessment. Now. Yesterday. As soon as possible.

[seeing red on your and her behalf, sorry].

PS Build up of CO2? What build up? Put a pulse oximeter on her finger. If you get a startling reading, put it on her toe. If it's still a worry, jump up and down and make a fuss. Bi-paps are helpful but if her oxygen reading is low that won't be the big factor.
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Reply to Countrymouse
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Is the rehab aware of the order for the bipap?

I would talk to the Director of Nursing and review what meds she is on to try to figure out why she is sleeping so much.

Hace her tested for a UTI, which can cause behavioral symptoms.
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Reply to BarbBrooklyn
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I am so sorry that you are struggling with this situation. I wish you peace as you navigate your way through this difficult time in your life.

Please take your mother in law to the doctor. She may be confused due to a UTI or another medical situation. I hope her confusion clears up soon.
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Reply to NeedHelpWithMom
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