Labs indicative of congestive heart failure were 3 times normal range but nothing was said and no meds were given. NT-proBNP 1,352.0 with normal level is less than 450.0. Thanks for advice.
How emergent was the surgery? With a BNP that high she is in heart failure. The shortness of breath would be a clue but some heart failure can be more rapid. She needs a cardiologist and will need more meds
Short of breath walkihg short distance, swollen feet - this is my LO too. Now added achy legs with walking.
I'm thinking along the lines of Quality of Life. What does she really like to do in her day? Can she still do that? Would investigation, medication & treatment improve her symptoms? Would there be negatives?
I met a man just last week who refused 'water tablets' & 'those tight stockings'. Didn't want to be up & down to the toilet & couldn’t manage donning the stockings alone (plus wouldn't pay for RN visits). He choose to carry on just as before, without them.
Not saying your Mom should! Just weigh up all the medical options but also lifestyle; what is needed for a good life at 90.
Heck, I was sent home from the ER with the diagnosis of a possible ulcer when the numbers on the test that determines pancreatitis was over 10,000 and normal is 300. That happened again a week later, and that's when they decided to have a GI doctor look at me. Surprise--my gallbladder needed to be removed.
Keep in mind, doctors specialize in their specialty, and PCPs only know a little about a lot of things. Sometimes we're the ones who have to point out the obvious, so a surgeon who isn't versed in cardiology or a PCP who's looking only at surgical notes needs to be nudged by a "Hey, what's with these cardiology numbers??"
Good for you for advocating for the patient. Keep pushing to find out what those labs are about.
Thank you! And I never really thought about it like that! But your absolutely right about gathering knowledge of each of them. Sorry you were sent home with a bad gallbladder!! Thankfully you had it removed before it got really bad!
Usually a surgeon will not operate unless a cardiologist gives the OK. Thats even with people who seem healthy. What was the surgery Mom had? If you are concerned, have her PCP go over the labs. Maybe the thought is...for her age she is pretty healthly. Maybe her CHF is beyond medication. Usually, though Lasix is given for water retention. Maybe blood pressure meds too. Medicare allows you to go to a cardiologist with no referral.
Upon discharge, the only prescriptions given are those of the attending doctor, in this case the surgeon. He may prescribe something for the pain. But if there were not precriptions concerning Moms CHF before the surgery, the surgeon is not the one to prescribe them. Usually discharge papers say to see PCP within a week or two. Thats when u discuss the labs and medication needed or PCP refers Mom to a cardiologist. Which is who I think Mom should be seeing for your piece of mind. The cardiologist will probably run his own labs.
Thank you! I didn’t know she could go straight to cardiologist on Medicare - that’s great to know! You’re right, they gave her pain meds and an antibiotic- hip replacement!
No dr has ever mentioned CHF. They say she’s in good health. I did go with her to her physical last year. And asked dr to check her legs because one is always swollen down to her foot and her shoe is tight. He looked at it snd said she’s fine just needs to move more. I insisted that’s not normal and he insisted she was fine.
She is 90 and has dementia. Had the surgery a few months ago. I’m one of her co-POA and live out of state. She is always short of breath just getting to the phone. I asked for her medical records and saw this alarming lab result. I was visiting for one of her follow up appointments and primary dr said she was doing well so I thought everything was fine. So now looking at this high level I am concerned why nothing was done. I have her pharmacy records and keep track of them bc she takes small doses of Xanax and I want to make sure it’s not filled too often. There is no medicine on it for CHF nor any medication for it in her medicine cabinet. Just not sure who to call about? Her primary at call a cardiologist? She has never seen a cardiologist before so May he confused if I take her to one- if she realizes.
If I were in this situation, I'd call the primary physician first and ask them to check those old lab results, describe her symptoms, ask them to do updated lab or other assessments. Once that is done, they can refer to cardiologist. But given her age and dementia, someone is going to have to go with her to her appointment(s). I'm not sure you could go directly to a cardiologist, but would likely need a referral from the primary.
If patient can't remember what was said to them, usually discharge papers will give information about needed followup and any referrals that have been made. Even for people with no cognitive issues, it's good to have someone else present when the discharge nurse is going over discharge paperwork so everyone is clear on what needs to be done post discharge. That's a time to ask questions if you have concerns. It sounds as though you have access to the patient's lab results, so I presume you have some kind of authorization (POA or HIPAA) and can ask about this on behalf of the patient. If patient is still hospitalized, ask to talk to the attending hospital physician or surgeon about recommended follow up for CHF.
It was a few months ago and she’s home now. Yes I’m one of her medical POA. I talked to dr after surgery and before discharge about rehab and physical therapy. Asked if everything else was ok and he confirmed she was in good health. Just wondering if there’s any way that elevated lab result could be from pain.
With a BNP that high she is in heart failure. The shortness of breath would be a clue but some heart failure can be more rapid. She needs a cardiologist and will need more meds
I'm thinking along the lines of Quality of Life. What does she really like to do in her day? Can she still do that? Would investigation, medication & treatment improve her symptoms? Would there be negatives?
I met a man just last week who refused 'water tablets' & 'those tight stockings'. Didn't want to be up & down to the toilet & couldn’t manage donning the stockings alone (plus wouldn't pay for RN visits). He choose to carry on just as before, without them.
Not saying your Mom should!
Just weigh up all the medical options but also lifestyle; what is needed for a good life at 90.
Keep in mind, doctors specialize in their specialty, and PCPs only know a little about a lot of things. Sometimes we're the ones who have to point out the obvious, so a surgeon who isn't versed in cardiology or a PCP who's looking only at surgical notes needs to be nudged by a "Hey, what's with these cardiology numbers??"
Good for you for advocating for the patient. Keep pushing to find out what those labs are about.
Upon discharge, the only prescriptions given are those of the attending doctor, in this case the surgeon. He may prescribe something for the pain. But if there were not precriptions concerning Moms CHF before the surgery, the surgeon is not the one to prescribe them. Usually discharge papers say to see PCP within a week or two. Thats when u discuss the labs and medication needed or PCP refers Mom to a cardiologist. Which is who I think Mom should be seeing for your piece of mind. The cardiologist will probably run his own labs.
will call and get her an appointment!
Most folks need clearance from a cardiologist for any type of major surgery.
Are you Healthcare POA and/or on HIPAA forms? Have you asked the hospitality and or surgeon about how the heart issues might be addressed?
What does "follow through" mean to you?
Is the person currently in the hospital awaiting surgery? Is the surgery for the injury or something else?
I would make sure that this person's primary or cardiologist is looped in about all of this before the surgery by calling them yourself.
Need more info: how old is this person? Are you their MR or MPoA or guardian?