GI Bleed in the very old, options?

Is the person on Coumadin? Years of use causes internal bleeding. With my Dad, they never found the source but stopping it slowed the bleeding. Hopefully if the person is on any kind of blood thinner they would stop it. No fish oil.

How are things going, Hope?

Ask for a consult with a Palliative Care Professional. Quality of life is their main concern.

Thanks. I will use many of those questions verbatim:)

We are here another night. Will talk to GI in the morning. Any other advice is welcome.

I have no insight on this situation other than a vague recollection of similar bleeding experienced by a relative, several years ago. I don't recall the conditions well enough to offer any knowledgeable advice.

I think you're on the "right track" though - get more information, assess the situation, but don't make decisions until you have all the facts.

I wouldn't rely too much on the look on the nurses' faces, especially with a succeeding round. They might just have inherited some followup work from the previous round and not been in a particularly good mood. They're trained to keep their emotions in check as to patients' conditions though.

I think you can kind of "generalize" your path forward from this statement you made:

"She is already in decline, dementia, weak." The questions would be how serious is the bleed, can it be stopped/repaired/contained, and if so, and what are the likelihoods of success, or repeat, and/or of less positive responses? How invasive would the procedure be? What will happen if the surgery isn't done, and what are the options for the consequences of that?

And, the age-old question, what would the doctor do if this was her or his mother?

Make sure that you and any visiting family or friends take enough down time for yourselves that you feel refreshed if you have to make any decisions.

Thanks so much for that. The GI NP thinks it was residual from yesterday because this was her first bm since yesterday. If her next hemoglobin drops significantly they will do a bleeding scan but no scoping. I very much appreciate the input on the bowel thinning. I would not have known that. It will help in communication and decision making. I’ve had to become an expert on so many health issues in the years of caring for them, but not much by way of the GI system. So, I wasn’t sure what “heroic” measures means on a GI level.

This stuff is very challenging. We have activated PoA. We just moved them to memory care a few months ago (y’all may remember my calls for help with the move, lol.) It has been going well. But FIL is beside himself because she is not in the facility (when he remembers). They are both in their 90s with significant Alz/dementia. It seems like the need to make tough choices is unending.

Looks like one more night in the hospital. Very lucky though... she has no pain and the staff here has demonstrated a much higher awareness of dementia issues than I have experienced before. It is such a relief to not have to explain everything in great detail.

My SIL is a GI doc. HE says that caring for the very elderly is really tricky--as we age, our skin gets thinner, right? Well, the bowel linings also get very thin. Many GI's won't even treat a heavy GI bleed if it's got be done invasively. He says it is very frustrating, but he's had to opt out of procedures that would "cure" a younger person, but would likely hasten the death of an elderly person. Your gi will likely do ultrasound and perhaps something very minimally invasive to see if they can find the source of the bleed.

The doc won't do anything "heroic" . Talk to them before your mom goes in for any tests. If someone there has POA, is she bad enough that you'd need to put that in action?

I'd be reluctant to OK ANY procedures beyond keeping QOL...septic shock from a perforated bowel is a horrible death. I hope you can keep your MIL in relative comfort.