What are symptoms of congestive heart failure?
My Aunt is 96. She had a procedure in the hospital that replaced the generator in her pacemaker. She was in and out in one day. Prior to that she had had a flu that had caused congestion in her lungs, but we were about two weeks out after the flu before the procedure and she was recovered and approved for the procedure.
A few days after the procedure she ran a small temp. It went up to 99.9 and then went down. Her temp was 99. something for two days. They had given her an antibiotic after the procedure to prevent infection.
8 days after the procedure, she had a coughing fit and spit up a great deal of flem.The day after I took her for the one week check on the generator replacement, she went into a delirium for two days and two nights..
The incident with the flem happened during the delirium and scared the facility people silly. They thought she was dying. The doctor told me she was close to the end, but didn't say why he thought so. It scared everyone as her fingertips turned blue and she was choking. She was sent to the hospital and the doctors found absolutely nothing wrong with her. Two nights later I'm sitting here listening to her breathe. She is breathing noisily and she coughed several times today revealing congestion in her lungs. When she went to bed she was on her back and after she fell asleep for about 20 minutes she sat bolt upright and I asked her if it was hard to breathe and she said yes. She breathes easier on her side, but it's very noisy.
Last night she vomited in the bed, and I'm thinking she was getting flem in her throat and it triggered her gag reflex.
I don't know what is going on. The doctor said we were near the end, but he said that two years ago. I don't want my Aunt to suffer, she has a DNR, but still can be treated with antibiotics. Her lungs were clear on the x-ray at the hospital yesterday. Her vitals are good. Her BP was a bit high and has been running high since the procedure.
Is this congestive heart failure? She wears compression stockings, but has a history of swollen legs (not swollen if wearing the stockings). Hypothyroid, She has very few medicine.
Does anybody find this familiar? The assisted living facility was so scared, they pretty much asked me to move her. I don't want to do that if I can avoid it, but I don't feel safe with her here. They are well meaning, but there isn't anything they can do if she needs help in the night.
What was disturbing was the RN at the hospital said the paramedics told him that the facility was trying to force my Aunt onto hospice. I pay for private caregivers to be with my Aunt 12 hours a day when she is well and she is OK by herself at night. When she is ill or weak or recovering I have someone here 24/7. They are not burdened by her care at all. My private caregivers are companions, and the facility provides the services they are paid for...showers, meds, dressing, etc. but the delirium and the choking incident are scary without medical professionals to help.
My Aunt has memory problems, but she is sweet, humorous and loved by everyone. does anyone have a sense of what is going on? I'm afraid her lungs will fill and empty in that scary way again. I don't want her to suffer. I don't want to make a decision to shorten her life if it's not necessary. I can let go if it's time, but how do you know when it's time. I took my aunt to the beach for the day last month. We had a great time. We went out to dinner the night before her procedure. She has a huge appetite and loves to eat. She walks very little, remembers almost nothing, but is in a good mood and enjoys her days. She loves to sing. She has had three hip fractures and two replacements in her nineties and is incredibly resilient. she has pain from the last replacement and doesn't walk except in the apartment. When she had the flue a few weeks ago I was told her lungs are expanded.
I asked the nursing home where she did rehab three times if they had room for her, but the community is short of CNAs and they have a cap on residents. Apparently that is happening everywhere in this area. It will be weeks before a bed is available.
I have no one to really help me decide. my brother is out of cell range in the southwest somewhere.

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I appreciate this answer vstephans. Thank you. My aunt believes you live and go forward until you die. Only God decides when that is, and your duty is to live until it happens. I am trying to advocate for that. I do need to make that known to the doctors. My aunt did not want me to have to make a decision about her dying and so her advance directive is to follow the recommendation of the doctors. But it's not easy to hear the doctor say it's past time to withhold treatment and let her go. Her doctor wants to change her POLST to indicate no treatment at all. I have no wish to hasten my aunt's death or to prolong her life into suffering. I don't believe there are any medicines to reduce the load on the heart. We now have no indication that her lungs have fluid. Her breathing is clear and she is sleeping well. The noisy breathing I heard when I initially wrote was not present last night. Her oxygen is 93-94. She is in good spirits. I do know her pacemaker works 1% of the time and she is not considered pacemaker dependent, but one time out of a 100 beats is every other minute. That seems like a lot to me. I will ask the cardiac people about the "shortening factor" and "ejection fraction". I really would like more information.
Aside from the thyroid and bowel care, vitamins and omeprazole, I think there is a small dose of Lasix and that's it.
You're right, I need more information. And I need to communicate more specifically. Thank you.
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Twinflower, it sounds like you want to be sure there is really nothing they can do to extend her life short of a heart transplant, and make sure she has her thyroid tuned up, her infections treated, oxygen when she needs it, and morphine only if she can't be comfortable any other way.

Left-sided heart failure causes the fluid build up in the lungs because the blood returning form the lungs to the heart is the oxygenated blood that the left ventricle has to push out to the rest of the body. The leg swelling can happen just because of hypothyroidism, problems with veins in the legs, general fluid overload, or in heart failure due to the right heart not being able to pump our all the blood returning from the body into the lungs because of the pressure building up in them. The right side of the heart can fail on its own, because something else is causing lung problems, or because the left side fails. You may want to ask the doctors more specifically what her cardiac function actually is, in terms of "shortening fraction" and "ejection fraction" and what medications they are giving to try to reduce the load on the heart. If her heart function is really low, almost any stress on the body such as a procedure or an infection, or even too much sodium at a meal or two, can push it further into decompensating...she did real well to make it through the flu.

Make sure they understand that you and she both assess her quality of life as positive and your goal is not to just let her go as easily as possible. Assumptions can be made, and if they had not even checked her heart, they may be assuming you would not want it treated if the in fact has any CHF (congestive heart failure.) I hoe this is all not too technical to be of any real help, but again, you probably have to make your goals more explicit with the physicians and make it clear that you want to understand what is going on, what's reversible and treatable, and what isn't! Hugs!!
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thank you Jeanne, the bed is a good idea. She actually owns an electric bed but doesn't think it's comfortable. She is now using her double bed. I will find out if I can rent one. If it helps I can purchase one.

Her oxygen was fine at the hospital yesterday and she breathes fine sitting up. She has never been diagnosed with CHF or asthma or any lung problems. She has no swelling in her arms. or anywhere if she wears her medi-peds. Aunt understands hospice to mean you are dying imminently We had hospice a year or so ago, and my Aunt was very upset. that they were here. Her symptoms improved and she went off hospice within a few days. It was very premature. But I learned that she is scared of them. To her it means the end has arrived and she is dying. I don't want to scare her if that's not true. However there is nothing stopping me from discussing things with them. And I probably should. Since we already did an intake, there is no paperwork and I have access.
You have been very supportive of me and I thank you very much. I don't know what I'd do without the kind help I receive here.
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Would she be more comfortable sleeping in a hospital bed that could have the head raised a bit?

Could the doctor be more specific why she is "at the end"? And whether she is experiencing congestive heart failure?

My husband lived with CHF for decades. His symptoms included a lot of swelling in the legs and ankles.

I think if I were you I'd talk to a Hospice representative. I don't believe that hospice shortens one's lifespan. My mother was on Hospice 3 months and was dismissed from the program as she improved so much! I believe the extra attention she got actually helped extend her life! My husband died on hospice, but his last weeks were made more comfortable by the knowledge and caring of the Hospice nurses. So I suggest a discussion with Hospice, even if you decide not to use their services yet.

Your aunt is very lucky to have you as her advocate. Hugs to you!
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