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We received call from NH saying MIL hemoglobin *(red blood cells) was critically low & that they called for ambulance. My huband and SIL went to ER to meet it.

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My Mom is 87. She has a history of GERD and takes protonix is daily. She has other medical conditions including COPD. Last March she past out in my arms while standing in the kitchen. (she also had taken her oxygen off which did not help matters). Basically she had low red blood levels and we ended up faced with a similar situational yours. They told us having low red blood levels can be caused by a couple of things one is your body isn't making enough which could be caused by a slew of reasons. The other is that you could be bleeding somewhere in the body internally, also a ton of causes. We could not have a colonoscopy done due to her medical condition. She did have a camera pill study completed which was negative for any bleed in the upper stomach. A colonoscopy would have helped but she cannot tolerate it. So they treated her with biweekly shots of ARANASP to build her red blood. It started to work after a couple of sessions but then her levels dropped again. After that she received iron infusions on a weekly basis for about 6 weeks which seem to help and has kept her stable. It's very important to have regular blood work done to make sure it's at a normal level. At the age of 90, I personally wouldn't put her through lot of vigorous tests. If they find something what will be the plan of action? How will she be treated? Paliative care may be the best way to go. Only you know the answer to that. Prayers to you.
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I missed the last part of this post somehow. Just FYI i have had 25 colonoscopies in my lifetime as I have ulcerative colitis. Through my research I found that there are other procedures, including a test call the fecal immunology test which is as effective in diagnosing problems. There have been great strides in using MRI scans and CT colonography (a type of xray) however these still require the prep, just not the anesthesia. If what you are looking for is bleeding (not polyps) there are other tests too. What the colonoscopy is best for is a person who is expected to have polyps (as they can be removed during the same procedure) or someone who needs a definite diagnosis (like chrohn's or colitis) to base future treatment on. I would have recommended looking into these others had I known there was some controversy here. Maybe this will help someone in the same position in the future.

Angel
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Utzie, I'm so glad the procesure went well. What were the results? Were they able to find the source of the. blood loss?
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Colonoscopy done. MIL is fine...happy to be eating solid food, even tasteless hospital fare. Light stuff, of course. Also, I'm taking the "Kick Me" sign off my back- this is my last post on this forum.
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I can only assume that Babalou is correct in thinking that MIL's doctor must be thinking in terms of being able to deal with the bleeding as part of the same procedure. For the love of Mike, surely otherwise, given the no surgery no chemo agreement, they wouldn't put the poor lady through this?

Utzie, can a family member be there to call a halt if need be?
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I think it's crazy to give this 90 year old woman a colonoscopy. She's going to s**t her brains out and not know why. Without sedation the colonoscopy is going to be super painful...if she remains still enough for them to even get it done. Sedation in a 90 year old has its own list of risks including confusion and dehydration. What a mess. Utzie - I suggest you talk to your husband and ask him whether or not his mother ever would have wanted this much intervention.
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Let's remember that Utzie is the DIL and in a position of "no power". Sounds as though the elderly mom's daughter (utzie's SIL) is running the show. Yes, it's a stupid thing to do this procedure. This is what happens when you don't decide on palliative/hospice measures soon enough. Just my opinion.
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Who does a procedure on someone with low hemoglobin? Whats with that?
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Not even to speak about the fragility of the lining of the intestines! One last chance at the big bucks for a procedure!!! I agree with Veronica.

Maybe you should delay at the very least-get a second opinion. If the patient is too frail for surgery-she is too frail for colonoscpy-makes sense?
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PS This is another case of "I studied medicine on line and you can too" Real diplomas from out credited college $350 each.
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I am just throwing up my hands in horror here. Why find out if the bleeding is coming from the colon if everyone agrees that M/L is too frail for surgery/chemo.
If that much blood has been lost and it is coming from the colon it would be pouring out of her rear end! What do they plan on doing stuffing her up with Tampax. This borders on elder abuse. They plan on force feeding her a gallon of noxious fluid tonight, letting her suffer the inevitable diarrhea and then in the morning subjecting her to the actual colonoscopy which hopefully won't be too uncomfortable. However given her age and condition they will most likely be pretty sparing with the sedation because of the risks involved.
The POA and the rest of the family need to be lined up and given a gallon of the prep,then made to stand in line for ONE toilet.
I can't write anymore I am so incensed.
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Thanks for the update. Will they be able to remove the polyp during the colonoscopy, or will there have to be a second procedure? I understand that you are not sriving this bus, but with a person of that age who is frail I worry about the electrolyte imbalance/ that might be caused by the prep.
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The colonoscopy is on for tomorrow of MIL. SIL agrees with MD that it's necessary in order to see if the colon is where the blood loss is occurring. If there's a polyp (she has a history of benign polyps) or cancer causing bleed. My husband agrees. I don't know if they tested her stool. I think we all agree that chemo, surgery is out. There is a DNR in place.
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God bless you, your mom, and family during this difficult time, Utzie.
And a blizzard-snowmaggeden on top of all that.
Just, be safe as possible.
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I agree about asking what the colonoscopy is for. Is she strong enough for surgery, if the results say that is called for? If not, then what is the purpose. I have read that the American Cancer Society does not recommend cancer screenings for people who have a terminal illness like dementia.

When my great aunt became ill, she was in her late 80's and not strong enough to undergo surgery or chemo. (She had had radiation treatments the previous year on her face for cancer.) Her doctor believed cancer had returned somewhere else in her body, but did not recommend a colonoscopy, since she was so weak and would not be strong enough to have the cancer treated. She agreed.
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the transfusion were probably lifesaving in themselves at the time. I assume there is not a DNR in place. Do you really want these interventions in someone this age with dementia. I would not. Is there any evidence that she is bleeding from anywhere? Are they sure she has not done something like fracture a hip? It would not necessarily be obvious and you can loose a great deal of blood into the tissues when that happens. To me this is screaming Palliative/Hospice care. maybe she fell and ruptured her spleen. There are so many unknowns here and in the elderly the perception of pain is likely to change. Take your time.
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Utzie, thinking about you and your family today.
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I appreciate everyone's thoughtfulness and knowledge. Hopefully, we will know more tomorrow.
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pamstegman: and .. thanks for the prayers.
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My first thought was about the prep. She's had a few in the past but in her present condition, I can't imagine she'll hold it down or even swallow it.
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Yes they are tough decisions but a family meeting might be helpful with listing pros and cons of her desire for treatment/ wishes. Dementia is increased by lack of oxygen to the brain and that can be caused by low hemoglobin. Something to take into account .... Hope all works out
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I thought about this seriously. I wouldn't know which way was best, since she is in the NH with dementia. It would depend on how much she enjoyed her life now. These are some tough decisions.
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This sounds like over utilization of procedures. She needs palliative are rather than being poked and prodded and with dementia it's even more stressful on her
Give her love and her family around her with comfort
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Don't be (openly!) annoyed with DH: I'm sure he'd rather just not think about it, let alone discuss it. When we had a similar dilemma, I canvassed views from all close family members (didn't help - twelve people, fourteen opinions), and the one best qualified to give a clinically informed reply came back with "oh, poor Granny!"

Hope you get some sensible answers via SIL, and that meanwhile MIL is more comfortable now that she has a measurable red cell count :) Thanks for updating.
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Utzie, if it turns out she's not making enough RBC's, then they can give her a medication to help stimulate the marrow to make more. It could work if that is what your choose. Is her B12 and other nutrients okay? (I know it's too late to check now, since she received blood. Maybe they ran a panel first?)
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Countrymouse: Thank you. That is exactly what I asked my husband as I had to go to work today & did not see the doc myself. DH did not pursue this. SIL will speak to MD by phone 2moro. pamstegman: thank you -I will keep the faith. I hoped to get to hospital 2 moro myself, but we are expecting "snowmeggedon" here! When it "snows", it pours.
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Ask what the treatment will be if they find "something" during the colonoscopy? Are you willing to do that treatment?

Is she going to survice the prep for the colonoscooy?

What will happen if they do nothing? Is that an unacceptable outcome?

Good thoughts and prayers. But ask questions so that if it's time to stop treatment and keep her comfortable, you know it.
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Utzie50, I am sending prayers that you find useful answers. Keep the faith.
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Two things to think about for Monday:

1. What is MD looking for?
2. What does he plan to do about it if he finds it?

Unless there are clear answers to those questions, leading to likely, demonstrable benefit, putting a frail lady with dementia through a colonoscopy is not ideal. Don't be afraid to say enough.
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To give an update: MIL had endoscopy done this morning; results - negative for any bleeding. MD would like to do colonoscopy but not until Monday- to give her a break and us time to think about it.
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