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My teacher ( a mathematician with reputed papers to his credit) is seriously ill and bedridden in India. He is 76 years old and is suffering from Rheumatoid Arthritis. He is left with no money but some compassionate people are taking care of him (I am in U.S, and my teacher is in India). He is unable to move or sit. He doesn't want to eat much. The care giving volunteers are advised by doctors to make him sit for half an hour or more which he finds very painful. He cannot sit for more than two minutes. He does not have appetite and so does not want to eat much. He cannot handle varieties of food and so is getting bored of eating oat meal every time. If he doesn't sit after eating, he throws up. Whenever I talk to my teacher, he is requesting me to ask them not to compel him to sit or eat. His hemoglobin is very low (4). He is still active mentally and keeps up to date in Mathematics and talks to me about Math.
What can I communicate to the volunteers? Any suggestions?
Thank you,
Vasu

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Thank you GardenArtist.
Vasu
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Ask medical doctors in India. I am not a medical professional.
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Painful sitting, bloody diarrhea, very, very low hemoglobin.... I can't help wondering if he has intestinal issues or even cancer in the organs surrounding his pelvis. He's losing blood from something.

Hopefully when he gets to a larger city the doctors can find a source of the bleeding, which could be causing the difficult in sitting.

I wish you and your friend as well as all his supporters the best of success in helping this gentleman through this difficult time.
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Thank you Veronica for your advice. The doctors in India are capable as you mentioned. But where he is now is a small town and so no equipment. There are not many volunteers to help him. Frankly, speaking I am not confident about any service in India since the service providers (of any type) are very committed. But there will be one or two hospice at Madras which is a big city. I am checking through some of my elderly relatives to find one such.
I want to share with everyone who gave advice that my friend is now eating some solid food and he likes it. He did not throw up.
His speech was clear. I hope he continues to improve.
I will update about his condition for few more days.
Thank you all for your adive and concern.
This is a great forum.
Vasu
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Vasu, I know that indian doctors are very well trained ,mostly in the British tradition and have met many who are extremely skilled so would have no concerns about their treatment and advice. I do not have knowledge of local Indian customs but can understand the desire to keep feeding your teacher because most people are anxious to keep their loved ones strong and healthy. This of course includes eating, getting out of bed and exercising. There comes a time at the end of life when it is kinder not to insist on these things.
As far as sitting up to eat is concerned that advice is given to try and stop the vomiting after meds by allowing gravity to help the food move through the digestive system.
The head of the bed can be easily raised by placing blocks of wood or even piles of books under the head of the bed and using pillows to make an 'armchair" for him to rest against.
You can arrange blood transfusions but if the cause of the bleeding can not be controlled they will have little effect. Drugs to control the pain and nausea are the best way to go.
Do you think he could tolerate being moved to a hospice in another city? It will be very painful to transport him.
Are there enough volunteers with sufficient knowledge to continue to care for him in his current location. At this time his needs are very simple. He needs to be kept clean, have his position change frequently gently. Food of his choice can be offered and fed to him if he is too weak to feed himself. The bed linens have to be changed and washed daily. Above all he should be allowed to make his own decisions and that includes whether to eat or not and where he wants to die. It is unfortunate that the family has abandoned him but he does have people willing to care or him rather than having him lying on the street to die. A truly heartbreaking situation but you and others are doing the best you can to help him.
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Thank you very much for explaining term leg work. I am looking for some more volunteers at India to share the burden.
Thanks,

Vasu
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I'm sorry for any confusion. The phrase "leg work" means the ability to do errands, meet with people or any other activity involving physically doing something. You are here so you need someone who can do the physical things for you there, your ally.
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He has his wife in India and son in Britain. Both of them do not want to take care of him. We called his wife and left message for his son. I know my teacher from my college days when he was also young. He was and is a gentle person focused only on Math research. All his latter students also attest this. Something went wrong and he is in this situation.
I have my mother who is 80+ and is living alone. She is not very mobile. These are the problems that complicate this issue. My doctor friends advice me to ask him to go for blood transfusion and endoscopy for his bloody diarrhea. Of course, they gave this advice as friends and with a disclaimer since they have neither examined the patient nor gone through his medical records.
Thank you for your response and concern,

Vasu
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This man is in India. Things maybe different there. Does he have family? If so contact them and tell them ur concerns. You, as a friend, cannot control his situation. Do u have family still in India who can checkin on him?
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BillsLiz,

Can you please tell me what is a leg work? Is it massaging or gentle movements?
He developed bed sore because of lack of movement. Now, bed sore has almost healed.

Thanks,
Vasu
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Could an auto jack under the headboard raise the bed sufficiently to simulate sitting?
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Thank you everybody for your valuable suggestions.
1. I am checking for Hospice like facility in a city. There are difficulties because even in hospice someone has to visit him otherwise quality of service will deteriorate and he will feel lonely. Even though, he has no one to visit after we put him in hospice, I think that is the only option. We all will take up the expenses.
2. In Indian culture, compelling someone in this condition to do things is very much accepted and expected. People will blame for not being a caring person if we don't do what we think is helpful for such a condition. Doctors' advised the volunteers to make him sit. This is purely cultural and as everyone mentioned leads to hardships to the patient.
3. I will request the volunteers to try different kinds of food and puree the food.
4. Meditation is a good idea and it is easy to do. I will suggest this too.
5. I will also request them to do some pain management.
6. His low Hb count is due to RA I believe and we are planning to take him to a city for blood transfusion.
7. I am not sure if doctors ruled out restrictions in his esophagus or stomach issues that may cause him to throw up. They advised the volunteers to make sit while eating.
8. A bed that can be raised and lowered is not available in that place. We are planning to move him soon to a bigger city. We will get such a bed. An useful suggestion indeed.
9. I will get him a wheel chair too when he becomes capable of sitting.


I click the "Report this post" in one of the answers. I did not know what it was meant to do. If it reported the answer as spam, I sincerely apologize. All answers were helpful.

Thank you all for the kindness you have shown.
Vasu
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Doing this long distance is very difficult. You need to establish an ally in India who can do the leg work needed. I also have debilitating RA and I'm a personal chef. When it hurts to move every second of every minute is hell. One person suggested pain management. This is critical. Get your ally involved in working with a doctor. Meditation, as well as medication, can be very helpful and it's free. The saying "use it or lose it" is the honest truth. I know from experience. Attitude is everything. Eating may be an RA issue also. He may have RA in his mandible joint (jaw). I could only eat soft foods for several years because I couldn't chew anything. One person suggested raising him with pillows to eat. Raise the bed instead. Starting a meal already miserable is a negative experience for everyone involved in his meal. Finally, if the food is delicious he will be more interested in eating even if it's only a small amount. India has incredible spices available. You can meet with a nutritionist or a chef, go over all his dietary issues and develop several recipes that you can send to your ally. The ally can gather the ingredients and teach the recipes to the good Samaritans helping your teacher. Cooking techniques are different in different countries so what's devised as a recipe here may be unheard of to those actually cooking for him. Depending on what his food issues are, there are several vegetables or grains that can be over cooked so they can be mashed. For example, mashed carrots can add cumin, thyme or saffron for savory and cardamom, cinnamon or nutmeg for sweet. Good luck and bless you for being such a good friend.
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Vasu, he should contact the nearest Hospice center in India. They will help him.
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I agree with ferris1. Permit him to live -or die- with his dignity and self-respect intact.
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Communicate to his volunteers your friend has the mental capacity to make decisions for himself and to honor HIS wishes. No one has the right to "compel" another to do something. This is his life. My best to him.
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If your teacher is of sound mind, and from your description he most certainly is, then he must tell his volunteer caregivers that while he appreciates their good intentions he requires them not to move him into a sitting position. To lay hands on a person who has specifically told you not to is technically assault; and I'm reasonably sure that would be true in India too, where, after all, the law and legal system are very highly developed.

To solve the reflux problem, his caregivers could instead raise his upper body on pillows and assist him to eat in bed, allowing time after he's eaten before they adjust his position again. It's a fairly simple, mechanical problem - gravity's the key!

Hb that low, I'm sorry to say, indicates either serious complications of his RA or additional, also serious, health problems. Can you speak to one of the volunteers yourself and request that somebody take on the role of advocate for your teacher? His wishes must come first.
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Can he see a doctor to check for restrictions in his esophagus or stomach issues that may cause him to throw up? Perhaps a change in diet is helpful, I.e. puréed foods high in protein. My 91-year-old mother doesn't like to to chew, so I purée her breakfast and dinner. Breakfast is whole milk yogurt fruit, nuts, oats. Dinner is soup made from vegetables, broth, protein (textured vegetable protein or meat) and beans. Lunch is a soft boiled egg and soft bread with cheese or peanut butter. Eating slowly may help. Perhaps he can sit up for a few sips, take a break and continue. Namaste.
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If pain is preventing him from moving and sitting, the doctor needs to work with your teacher on pain management. If pain cannot be better controlled, he should not be compelled to sit up. Individuals have a right to make their own decisions and participate in their treatment plan. They have a right to not follow recommendations. I think one of the most important considerations is to focus on your friend's quality of life--what is important to him.
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Can you get advice from a rheumatologist in the U.S., then convey it to the volunteers and your teacher? Do you talk on Skype? That would help you communicate with everybody face to face.
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WOW~Big issue here......attempting to be involved with all this from the US to India.
I am at a loss to advise you in any way.
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