My wife and I are trying to care for her 93 year old mother Alma who lives in her home about 1 mile from here. She has a pacemaker which is about 8-10 years old. She has been on Coumadin but she is getting stubborn about taking her medications. Says she feels better without them. However she has complained twice within the last 7 days that she has woke up in the middle of the night with breathing problems. Her doctor retired 1 year ago. Should we take her to the emergency room?

Of course your MIL must be seen by a doctor asap! I agree with others, take her to an Urgent Care Facility if that's easier. She needs to be evaluated without delay and before a disaster occurs. After that, she needs to be set up with a new primary doctor for regular visits. I suggest you set up cameras in her house and you can monitor her by phone from your house. I wish you the best.
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Reply to NYCmama

An oximeter is a device that measures oxygen saturation and heartrate. It's put on a finger and is very easy to use. You can purchase one at most drug stores or Wal Mart, and they are relatively inexpensive. It might be a good tool to have on hand.
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Reply to melsharpe

Where we live, there is a service called "Dispatch Health" that will send an EMT or Nurse Practitioner and tech to your home where they will examine you, order meds if necessary, treat you, and diagnose you. You don't even have to leave your living room! I have used this service for Mom twice now. I tried to call them yesterday (before, I always got a same day visit) when Mom fell and possibly sprained her wrist, and they could not see her until two days later! Guess people are finding out about this fantastic service and they have more patients than medical personnel to answer the calls. I know there are other companies that provide this same service. It is so much easier and more convenient to have someone come to you than go through the hassle of getting to a crowded doctor's waiting room.
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Reply to texasrdr22

Brandi, does she have a remote transmission device?  My father's cardiologist was given (loaned) a device which connected to a phone and with another connection transmitted data to his cardiologist.   This was in lieu of in person visits.  

The cardiologist could interpret the data and make determinations on his cardiac condition from that data, w/o Dad having to go in for an appointment, which he also did, but not as often given the remote transmitter.

This would allow the cardio's office to determine if the interruption in anticoagulation therapy is affecting your MIL's cardiac condition.  

Is she refusing to take all meds?  Or just Coumadin?  Can you narrow it down to which meds are affecting her disposition?   Perhaps they could be changed.    D'c' ing or interrupting a Coumadin regimen is very frightening for someone who really needs it.

Did anyone take over practice of the cardiologist who retired?
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Reply to GardenArtist

How is her INR level being monitored?

Does she have home testing equipment or does she go to a lab?

If she isnt taking this med consistently, she is at risk for blood clots, stroke and other disasters.

I agree that down the road she needs a geriatrician but right now I would start with an ER to test her INR (this is based on the fact that Urgent Care centers here in NYC lack the capacity to do that testing (DH is on Coumadin).
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Reply to BarbBrooklyn

I was amazed and thrilled when my LO’s very good nephrologist retired and recommended a practice that was solely based on different aspects of geriatric care.

Because of that really productive experience, I think that in your situation I’d be looking for something similar.

An emergency room where I am might not even allow her to register for care, and a walk-in might be even less likely. Someone her age needs a practice that is prepared to consider the whole spectrum embracing the issues of aging.

She also needs someone who will be familiar with all of her needs whenever she’s seen.
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Reply to AnnReid
lealonnie1 Dec 30, 2020
Where are you living that an Emergency Room 'might not even allow' a person to register for care???? DH would have died 3x already had that been the case here in Denver!
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Yes, take her to the ER right away. Urgent Care is no place that will deal with pacemaker issues at ALL. A pacemaker battery only lasts up to 10 years, and at the very least, it needs to be interrogated to see if it's working properly. That has to happen on a regular basis so she knows all is well with it! Shortness of breath is a hallmark issue of a pacemaker that's not working properly. My DH just went thru the exact same issue last month.

Good luck!
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Reply to lealonnie1

Has she not seen a doctor in a year? How is she getting refills on prescriptions?
If you think your mom needs to be seen by a doctor Urgent Care location might be better and possibly safe than the ER. If they think there is a problem that they can not handle they will tell you to take her to the ER. If it is severe enough they may even call for transport.
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Reply to Grandma1954

Dear "Brandi33,"

My FIL had a pacemaker. One of the symptoms of having a pacemaker that needs their batteries replaced is difficulty breathing.

Please take her to the emergency room or Urgent Care as "Grandma1954" suggested as soon as possible especially since her doctor has retired a year ago!

Best wishes to you all. -
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Reply to NobodyGetsIt
Midkid58 Dec 31, 2020

It's a $20.00 oxygen saturation measuring device that I think most pharmacies carry. 20.00 being the price and 02 meaning oxygen.

I'm going to get one for DH to wear and watch his O-sats (oxygen saturation) during the night. He refuses to wear his CPAP breathing device at night and I don't think gets 'good sleep'.
I am guessing that you mistyped Coumadin as comedian? That is not a drug to be played with; levels could be exceptionally irratic if not taken faithfully. If your Mom is not capable of taking medications she is likely not competent to be on her own now unless she has refused medications, and is on palliative care only and the MDs understand she would prefer to live alone on her own without medications until a natural death.
At her age this will come to a head in one way or another.
Awakening a bit breathless is not a problem if it passes quickly, doesn't happen in the day, and causes no appreciable change in O2 saturation. Next time she has this symptom have her call you, and go with the 20.00 O2 oximeter you put on the finger, measure her O2 levels. If she is above 90% by the time you get there she is likely fine.
Your question now, today, should be asked of her MD. I would say that they are unlikely to advise a trip to ER in Covid-19 times with only this short-lived and momentary symptom. However, you need also to tell the doctor that the coumadin is/may be being taken irradically. So what you are looking at now is a visit to an MD to discuss all of this.
Almost certainly your Mother is one of those who wishes to stay in her home to the end. So decisions will have to be made weighing safety versus risk quite soon.
Wishing you good luck.
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Reply to AlvaDeer
Brandi33 Dec 30, 2020
Thank you for your reply. I don't know what a 20.00 02 oximeter is or where you get one, but good advice. I understand what you are saying about the Coumadin, but she simply refuses to take any medications. We will do our best to try to convince her to change.
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