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She had her pace maker replaced and av node oblation done so now she is in AF all the time and the pace maker is controlling the heart. She is just recovering from a bad bout of bronchitis. now her foot up to her ankle is swollen possibly the gout she has had the gout often. we have approached her before about selling the house but refused.

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If your mother is living on her own, it seems that palliative care is a bit extreme of an option. This assumes that her condition is terminal and that she will be given only care to make her comfortable not to help her condition (as I understand the guidelines.) Try the diuretic first and make sure her electrolite levels are good. My mother avoided diuretics even though she had AFib for over 8 years before her (unrelated) death at 104.If she stayed active, the fluid worked itself out.I also gave her hawthorne which increases the strength of the heart beat.
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When I asked my mother's PCP for a hospice evaluatuon he was very cooperative and that same day called a third party nurse from VNS to come over and do an evaluatiin for hospice. She advised hospice and then he called the Connecticut Hospice (my choice) and they sent a nurse to evaluate. She was accepted and has been receiving at home hospice since mid-November 2015. This is not 24 hour hospice, you should know. That wouldn't be available unti she was closer. But I intend to keep her home, anyway.
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Only her doctor can determine if palliative care is needed. Get her to a doctor who can give her an RX, "Lasix" for the edema.
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My husband has been A-fib on and off for the last 8 years. He has had 2 catheter ablations...the first one lasted 3 and a half years, the last one only lasted 8 months. It is hard to figure out what triggers it. He does not drink alcohol. They have him on medication,Tikosyn, and that regulated his heart beat.
As for palliative or hospice care, when I asked doctors and people in hospitals about that I got just blank looks, finally a NP strongly suggested hospice for Mom and recommended hospice evaluate Mom. Keep asking about it.
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You might talk to someone who is a volunteer for a hospice and see what they say about palliative care.
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FYI - My Dad is also in Afib - doctors have chosen to keep it that way since he constantly slips back into Afib, the process of getting him out of afib is harder on him than not. It could be stress that causes it, and some things can not be helped although I personally will continue to try to find the causes of his stress, it is psychological in nature. Could be that what triggers it is just a constant in his life. Sometimes it seems he does better when I am there, but life will not permit me to be there 24/7.
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Since she is having AFIB after ablation, Cardio Electrophysiologist is good place to go. At 89 years of age, she most likely is having issues with maintaining the homeostasis of water to sodium leading to Edema. Therefore setting electrolytes into state of imbalance as well. A full Cardiac workup is direction to take.
Living on her own would seem to have reached its end. In home Care or Assisted Living is best options.
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Why did they put he in AF rather than sinus rhythm?
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It sounds as though she is competent, so it is not your decision to make. You might start by having a conversation about advanced directives, there are several sites that offer advice on starting the conversation.

www.agingcare.com/articles/what-are-advance-care-directives-140690.htm
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An ablation and pacemaker should put the heart back into normal rhythm. For this reason and the swelling, I would also say to call her cardiologist right away.
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I would call her cardiologist and let him know about the swollen ankle asap..
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