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Fortunately when she passed out she came to and was indoors and she had no injuries. This was her first fall.

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Hope you get her to compromise and at least go to a doctor. She's probably afraid she would be admitted if she goes to the ER.
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Pasa18 Oct 16, 2019
katiekat2009, you are correct. This was exactly her fear. The ER doctor wanted her to stay overnight for observation but we declined the hospital stay. She did not want to sit in the guerney, so she got the transfusion while sitting in the wheel chair. Although we left the ER around 2 am, I realized we were lucky this time to take her back home.
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Sorry, I was too late to the conversation.
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Why do you want to take your mother to the ER? Whatever for?

I should take her back to the person who did the recent blood tests, which was presumably her GP/PCP. You want the continuity of personnel and thought process to be sure your mother will get the most appropriate treatment.
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Pasa18 Oct 16, 2019
I reached out to the forum but did not have time to explain until a bit later. Sorry, I was a bit anxious. The primary called on a sunday and said she had been calling every half hour. Had this been thought out in retrospect, an appointment to an IV center would have been a smoother experience than taking a 96 yr old to the ER.
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She can also have pernicious anemia which is common in the elderly. People are given B12 injections usually monthly in their PCP’s office to treat this.
If she has received several transfusions fortunately red blood cells provide RBC & are loaded with ferritin (iron). Iron is the building block for red cell production and a person can receive a lot of iron from a blood transfusion.
Good luck to you!
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Red blood cell transfusions tend to be given to patients with severe iron-deficiency anemia who are actively bleeding or have significant symptoms such as chest pain, shortness of breath, or weakness.

Transfusions are given to replace deficient red blood cells and will not completely correct the iron deficiency. Red blood cell transfusions will only provide temporary improvement. It is important to find out why she is anemic and treat the cause as well as the symptoms.

See if her doctor and your mum would consider intravenous (IV) iron. It’s generally used to treat iron deficiency in patients who do not absorb iron well in the gastrointestinal tract, patients with severe iron deficiency or chronic blood loss, patients who are receiving supplemental erythropoietin, a hormone that stimulates blood production, or patients who cannot tolerate oral iron. Usually they refer to a hematologist to supervise the iron infusions. IV iron comes in different preparations:

Iron dextran
Iron sucrose
Ferric gluconate
Large doses of iron can be given at one time when using iron dextran. Iron sucrose and ferric gluconate require more frequent doses spread over several weeks. Some patients may have an allergic reaction to IV iron, so a test dose is advisable before the first infusion. Allergic reactions are more common with iron dextran if so they can switch to a different preparation. Severe side effects other than allergic reactions are rare and include urticaria (hives), pruritus (itching), and muscle and joint pain.

It’s hard watching loved ones make choices you wouldn’t, I hope your doctor friend can help.
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Pasa18 Oct 15, 2019
All in all it turned out good this time. The family friend was convincing and she agreed. I didn't think of the IV option which I had many moons ago. The IV iron was later recommended by the ER care coordinator. This would have been preferable to the 12 hour wait and procedure time yesterday in ER. Mom wanted to leave by the time she got to a room and the doctor came. I recognized this tantrum and knew she needed to eat and stick to her routine, I ran to the cafeteria again and got her hot food which calms her down. The whole capacity issue came up because by 5 pm her sundowners was kicking in and she claimed she was there for the podiatrist only. She tried scooting out of the room in the wheelchair. After the food kicked in she was more cooperative, but it was almost a no go. Since it was her first transfusion, it took four hours to see if she'd tolerate it and another 2 hours for the second run. She refused to stay overnight for observation and we made it home in the wee early hours.
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So, if your mom is competent, pose to her the choice: "mom, your doctor says you need a transfusion or to sign off on getting Hospice services. Which call would you like me to make?".

I understand that this is not the choice that YOU would like her to make, but it is HER choice.
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Pasa18 Oct 14, 2019
Yes, as her primary caregiver I have to respect her wish.
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The great thing about anemia is that it just makes you sleepy. As long as she doesn't fall, she can curl up in a ball and slip away in her sleep. It really is your mom's choice. Can you be this blunt with her? To me, dying in my sleep would be my preferred route - no pain but just slipping away. Please talk to her honestly about her wishes and let her choose her journey.
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Pasa, I'm assuming her anemia is based on iron deficiency?   If so, does her diet include iron rich foods?    I obviously can't offer an opinion on hospice, but I've had iron deficiency anemia for decades.  I can always tell when my count level is low.

Since meat is a good source but expensive now, I found a substitute in broccoli, which I use in salads along with spinach.   It makes a world of difference.

Do you think you could get her to include either  meat or some iron rich foods, if this is the cause?

Or do you think that she's made a determination not to
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Pasa18 Oct 14, 2019
I think it took so long to get the results the doctor did not say the cause. However, yes I have tried to vary her diet to include iron rich foods. I was anemic for sometime and know the signs which I recognized. I tried nutrition and supplementation, however there is a time when only a transfusion does the job.
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I didn't get a chance to elaborate the details. The primary is recommending she get a transfusion or hospice. I noticed she was getting weaker a couple of months ago and when she refused to go into seeing her primary, I called medicare to see if home health would be covered and then asked her primary. I wanted her blood lab done by a visiting nurse. So by the time a nurse came and the doctor coordinated with the home health nurse, they felt she was doing great for 96. Relative to maybe other 96 year olds, but for her the change to me was apparent. The home health nurse drew blood on maybe the third visit a couple of weeks ago which was a relief because she didn't want to leave the house. However, the results did not come out because the blood coagulated and the blood lab needed to be redone which pissed me off and didn't instill confidence in my mom. (I'm not medically trained but a relative who is a nurse said there is an anticoagulant in the vial). I had to convince my mother to be cooperative and we went in for blood work after she had the fall and the paramedics incident this week. Her primary called this afternoon every half hour until she reached me and told me mom needs to be seen in ER. I was on my way out for a walk after clearing her garden and cleaning her home. I went back in and loaded the wheelchair and waited until she finished lunch to tell her she needed to go into ER. She won't cooperate and is refusing a transfusion. The grand kids, all now between age 19-35 responded to my text informing them and they stopped by today and they have not been able to convince her to go in. A old family friend who is an ER doctor said he will stop by to talk with my mother. Hospice is next. She is at a critical level where an iron supplement will take too long.
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CarlaCB Oct 14, 2019
Thanks for clarifying, PA. It sounds like your Mom may be near the end of the journey, although without knowing her diagnosis it's hard to tell. My mother went through many transfusions as well as multiple rounds of iron infusions before we ended up where you and your mother are now. Either hospital, or hospice. The last time, she left the hospital AMA and went home with hospice. She died at home a few weeks later under hospice care, with my sister and me with her 24/7.
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I had the exact same reaction as Lymie. When this was happening to my mother I was in contact with her primary doctor and she would advise me whether the numbers were concerning enough to require hospitalization. My mother was found to have a gastric bleed due to ulcers, which were corrected endoscopically during her hospital stay. She remained anemic, though, and was ultimately found to have a blood cancer, which she chose at 87 not to pursue treatment for. Her doctor told us that if Mom refused to be hospitalized when her counts got really bad, she (the doctor) would be sending hospice to her home the next day, and that is what happened.

That said, if your mother passes out again, I'd call 911 and have the paramedics talk her into going to the hospital. My sister and I did that a few times too.
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Lucky she didn't hurt herself. Why do you think she needs to go to the ER? She may need an iron supplement. Has anyone talked to her doctor?
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Pasa18 Oct 13, 2019
Yes, I elaborated above.
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What is her primary recommending? I assume this is the doctor who ordered the bloodwork?
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