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Advice for dear old dad - 7/15/2007 4:32:18 PM   
velvetears


Posts: 2933
Joined: 6/19/2006
Status: offline 		my dad had a series of strokes over the last few years. He has never recovered 100%, most affected has been his balance and use of his right arm is now clumsy - speech as well but thats much better - he's not as quick as he used to be, he's 77 and living on about 30% capacity of his heart - has a defribulator/pacemaker on it. He is also an insulin dependant diabetic who will find any hidden pastry in the house.

He's exceptionally lucky to even be alive.  Now to my question. He is a VERY stubborn old man who will not adhere to doctors advice or just plain good comon sense to improve the quality of his remaining years. He really needs to use his walker 100% of the time but won't and he's fallen i would say in the last 2 years 30 times?? 

He's injured himself but never broke a bone or had a head injury yet.  He recently fell (3 to 4 days ago) and is in the hospital, his ribs hurt yet they are not fractured but they found a hematoma on his spleen and he has pneumonia.  i was told the first day he needed surgery or he could die, and now i am told there is no need for surgery as this hematoma is healing.  i know ruptured spleens can be very dangerous and one can die from blood loss. 

My common sense tells me if he continues to fall, which he will, won't it eventually rupture? So why not remove it anyway?  Once a spleen is injured, isn't it always vulnerable?  i cannot get up to the hospital as my car is in the repair shop or i would be up there getting first hand info from his doctors. i am getting this info from his wife (NOT my mother) and she's a complete scatterbrain and doesn't have a mind for anything at all remotely medical.  His doctors will only speak to her and they expect her to relay the info. To give you an idea of what i am dealing with, with her, she informed me he had amonia.  i said what was he doing with amonia, i didn't understand. She said she had no idea but he was being treated with antibiotics for it - that's when i realized she meant pneumonia - so any information from her i cannot rely on in the least.  i have looked up ruptured spleens and hematomas on the spleen on google and i get a sense it's nothing to be trifled with.  i know i can't expect "medical advice" but maybe someone out there has had a similar experience with an elderly loved one who can give me some kind of advice or insight?  i will be on pins and needles if he comes home knowing he will eventually fall again as he is left alone most of the day while his wife is at work. 

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RE: Advice for dear old dad - 7/15/2007 5:15:54 PM   
SeeksOnlyOne


Posts: 2012
Joined: 5/14/2007
Status: offline 		the only advice i can offer is maybe ask his wife if you can join them at the talks to the dr.....offer it in a way of being helpful-4 ears hearing the info is better than 2........explain to her he is your dad and you want to be involved.....

i went in the room for every appt my mom had.......when the roles begin reversing, child becoming more like parent and parent more like child....it is a helluva adjustment.......good luck and get as involved as you can in his health care as soon as you can.

_____________________________

it aint no good til it hurts just a little bit....jimmy somerville

in those moments of solitude, does everyone sometimes think they are insane? or is it just me?

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RE: Advice for dear old dad - 7/15/2007 6:05:35 PM   
Sinergy


Posts: 9383
Joined: 4/26/2004
Status: offline 		 
I have two control freak parents who are two of the most depressingly obtuse and self-absorbed people I have ever known.

It is their E-ticket ride.  If they choose to not pay attention to your advice, do something stupid, and get their ticket punched, you can avail yourself of a therapist to gripe to.

Getting yourself emotionally involved in their self-destructive urges will only bring you down, and not help them at all.

Sinergy

p.s.  Always remember what Tyler Durden said "On a long enough time line, the survival rate for everybody drops to 0"

_____________________________

"There is a fine line between clever and stupid"
David St. Hubbins "This Is Spinal Tap"

"Every so often you let a word or phrase out and you want to catch it and bring it back. You cant do that, it is gone, gone forever." J. Danforth Quayle


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RE: Advice for dear old dad - 7/15/2007 7:07:06 PM   
DSwriter


Posts: 39
Joined: 2/14/2007
From: New Hope, PA
Status: offline 		Can't help you with the spleen question. The ones you should be asking are his doctors.

If i it were my father and he was in the hospital i'd find a way to get there.

Bus.  Taxi.  Rent a car.  Walk. There is always a way.

As far as when he gets home - can you check into some sort of home nursing care?  Or pay someone - like a babysitter - to keep an eye on him during the day?

(in reply to velvetears)
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RE: Advice for dear old dad - 7/15/2007 7:08:49 PM   
CuriousLord


Posts: 3911
Joined: 4/3/2007
Status: offline 		Death is a horrible subject. I've lost my father already, so I know it's something that no loving family wants to have to consider. I've thought about it a lot in the years since. Hell, I turned 21 not long ago, and my own mortality is still bugging me.

In the end, I think he has to live if he's going to live. He's going to have to go along. I'm.. afraid everyone will pass on. But if he's stubborn, and persists so well- it seems he's maintaining his identity in life, not letting it defeat him. Medically, it may be not be the best for him, but is confining one's actions much better?

I suppose my point is just, if he's living the way he wants- to the greatest degree that circumstance allows- maybe it's not so bad.

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RE: Advice for dear old dad - 7/15/2007 7:34:49 PM   
HaveRopeWillBind


Posts: 514
Joined: 7/15/2006
Status: offline 		Velvet,
You have father/daughter dynamics working against you. For all of your life he has been the one to give advice and he isn't likely to reverse that role at 77. You need some other authority figure to intervene, most likely his doctors.
I agree with DSwriter, you need to get to the hospital any way you can so you can talk to the doctors and get straight information yourself. How about asking his wife to pick you up and bring you along? Once you have good info from the docs you could ask them to intervene on the walker issue.

Either that or you have to threaten to shackle his ankles together so he has to use a wheelchair if he won't use the walker.

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RE: Advice for dear old dad - 7/15/2007 8:07:58 PM   
maybemaybenot


Posts: 2817
Joined: 9/22/2005
Status: offline 		With your Dad's cardiac history, repeated strokes and diabetes he is a very high surgiccal risk. Unless it was imperitive that the spleen be removed < or any other surgical procedure> the MDs are going to treat medically first when ever possible. When you weight the risks of doing surgery vs. treating medically and safely, your Dad is much better off not going under the knife.
Will he re injure his spleen with another fal ? Perhaps, depends how he falls. It is not a given that he will re injure it.

Non surgical intervention for traumatic sleen injuries has been gaining consenses as the " way to go" when rupture has not occured

I would suggest that you try and get to the hospital and talk with the MDs and the Case Manager for your Dad's case. SOunds like he would benefit from a short term stay in rehab. I suspect they will be advising this anyway.

As for Dad's non compliance: well..... it will probably never change. As a nurse and a daughter who has a similar parent, I find all I can do is to educate about the potential complications, the benefits of complaice, but ultimately it is their decision.

Like SeeksOnlyOne, I go to all my parents MD appts and I fill their pill boxes weekly. I cook most of their meals for the the beginning of the week on Sunday and take them over in freezable containers, my brother in law does the same for the end of the week. My sister and I have a schedule to check in on them and we clean the house every Sunday. We have hundreds of
" checks and balances " in place and they still do it their way. It definately is tough to watch your parents fail and become the parent yourself.  And I will admit that some of their non compliance is a non issue for me. Me and my siblings do the best we can, but we cannot become the medical police. I still want to enjoy them, not be their adversary. It's hard to find the balance,  and it takes some letting go of our own fears.

                           mbmbn

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Tolerance of evil is suicide.- NYC Firefighter

When tolerance is not reciprocated, tolerance becomes surrender.

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RE: Advice for dear old dad - 7/15/2007 10:10:52 PM   
velvetears


Posts: 2933
Joined: 6/19/2006
Status: offline 		Seeks - i am usually involved and have taken him to all his appointments (which are many) as his wife works and i have had the free time.  The problem with the hospital is that the doctors will talk to me if i happen to be there when they make the rounds - which means i have to get there 7 am and stay till - whenever?? They will only return calls to the contact person, which is his wife - understandable as if they didn't have this rule they would have to call every daughter aunt uncle that showed concern. Unfortunately shes not a reliable source to then relay it back to me in any sensible way, she doesn't know the questions to ask etc...  i usually do that and have been there 100% of the time throughout all his past hospitalizations, it's just this past week i have lots of stuff on my plate as well as the car problem. That will be resolved monday - so i should be up there monday night for sure.  Shes afraid to drive at night, or anywhere in nj or near the city and to be quite frank i am afraid of her driving, i would have to take my youngest so going with her is out of the question. 

Sinergy - i understand where you are coming from and mentally am prepared for the inevidable.  i still want to do all i can, if i can to help.  i don't think of death in this situation as a big tragedy, which might be a big factor in my dads non compliance - he's going out on his terms not anyone elses.  

DSWriter - i know this and am frustrated by their policy.  i am going to do my best to get them while he is at the hospital. He is in a remote area and busses aren't an option.  i start a new job in the next few days so time is going to be a difficult factor.  Unfortunately his insurance doesn't pay for home nursing but i think he has the option of staying permanently in one - he was in one for a long time (8 months) but he wasn't happy at all as he was always a very active on the go man - it's hard for him to adjust to what these strokes have taken from him. 

Curious Lord - sorry you lost your dad at such a young age.  i think it's emotionally hader when we are younger - i lost my best friend at 12, my grandma at 15, and nursed my mom through 4 months of grueling cancer till she died, i was 37.  This might sound odd but i feel accepting now at this stage of my dads life.  i think your point is very valid when you say hes living life the way he wants and to the greatest capacity he can which is why i don't argue or yell at him like his wife does, i just encourage him to do the things he needs to do and remind him he's loved - which is all i can do.  He hates the confinement and i know it has to be like a hell to him, so his stubborn independance at the cost of falling all the time doesn't shock me, just frustrates me as i don't want to see him break a hip and if he survives surgery be confined to a wheelchair.   He's talked about death and in his own way i think he's telling me he ready. 

HaveRopeWillBind - i will definately try to get the docs to one more time explain to him the importance of #1 - using the walker 100% of the time, #2 - take all his meds every day and on time #3 - stay away from sweets to monitor his diabetes.  His wife threatens, it just doesn't work.  i just figure accept hes going to fall and be practical and tell the doctors that given that factor we all can't change, should the spleen be removed since it appears he's already injured it. 

mbmbn - thanks for the info - i suppose they are taking everything into consideration and treating it the safest way taking all his medical factors into consideration. In 7 years since the date of his defrib/pacemaker he will have to have a new one installed. i was very worried about him going under the knife then - this was just last winter but the doctor assured me people in worse condition then him and older then him have that surgery and do well.  i didn't think he was going to survive, but he did  - his doctor neer had any worries.  Maybe they can't do surgery because of the pneumonia right now?  i also read that when you loose your spleen you are more susceptible to pneumonia and other types of illnesses as your immune system is compromised thereafter.  i sympathize with you going through a similar situation with your own parents.  It is not easy.  And you are right - the non compliance will never change.  i finally insisted he use a pill box as he takes about 20 pills a day - i fill it up and have made a chart for his wife to do it for when i am not there. She has serious issues with following directions and being able to comprehend so if i am not there we do it over the phone as i have a copy of all his meds and know what each one looks like and when it is taken dosage etc.  She's getting better at making sure he takes them but its something i had to drill into her brain - that hes alive only because of these meds and by allowing him to not take them is going to kill  him.  She doesn't understand what its like to work with the elderly (shes 27 years younger then him) - you have to take charge and distract them while you are basically making them do what you want - you don't argue with them and demand. 

Thanks for all the replies and advice - it is apreciated.  i will be up there by tomorrow night and finally get to talk to the medical professionals.



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Religion is for people who are scared of hell, Spirituality is for people who have been there

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RE: Advice for dear old dad - 7/15/2007 11:24:41 PM   
BitaTruble


Posts: 9779
Joined: 1/12/2006
From: Texas
Status: offline 		If your dad gives his permission, you absolutely can speak directly with his doctors and get the first hand information which you seek. Talk to your dad. Tell him your concerns and that you just want information because you get scared when you're left in the dark. I went through something very similar recently and my dad is one of my very best friends and not knowing is the worst feeling. 

I wish you bright blessings and wellness for you and your family.

Celeste


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Rock, paper, scissors."

He laughed. "You are the wisest woman I know."


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RE: Advice for dear old dad - 7/16/2007 4:41:24 AM   
SeeksOnlyOne


Posts: 2012
Joined: 5/14/2007
Status: offline 		and a couple of more thoughts.....

mom was stubborn as a mule......it paid off in many ways-she took her self off many meds and learned about herbal treatments....this enhanced her life for her last 9 years, and she educated her drs quite a bit, whether they liked it or not.....

but as she got more forgetful, it was some days a chore for me to remember my sweet nature.....i could go over there and take her groceries, ask if i could look through her rx's to see if any needed refilling, only to be fussed at that she knew when she needed rx's.....fast forward 2 days to a call 1 hour before the pharmacy closed, where she needed one of her meds right now because she was smothering.....

it was a mind game, a control thing, and i would cuss as i ran to the pharmacy....but i did it every time and was smiling when i got to her door........ok not every time was i smiling-lol....

my point is.....its frustrating as hell, for us and for them.....i just know she gave up most of her life to care for me when i was little and it seemed the right thing to do for me to take care of her when i could.

when youre ready for a cry, check this out....
http://parentswish.com/site01/big.html

and again, good luck to you.....


_____________________________

it aint no good til it hurts just a little bit....jimmy somerville

in those moments of solitude, does everyone sometimes think they are insane? or is it just me?

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RE: Advice for dear old dad - 7/16/2007 5:00:24 AM   
KMsAngel


Posts: 17415
Joined: 4/13/2007
Status: offline 		this may seem somewhat morbid, but considering you're saying you think your father may be telling you he's ready for death, it would seem like a good idea to check into whether he has an advance directive. particularly since his wife doesn't seem the type to be able to make any decisions for him without help. I did a quick google and came up with two links vy quickly:

http://www.noah-health.org/en/rights/endoflife/adforms.html
http://www.mindspring.com/~scottr/will.html

not living in the states, i can't really give you any closer contacts.

it may or may not give you some peace of mind in regards to knowing how he feels about his health and could inspire some good talks with your father.

best wishes for his health
Angel

< Message edited by KMsAngel -- 7/16/2007 5:01:02 AM >

(in reply to SeeksOnlyOne)
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RE: Advice for dear old dad - 7/16/2007 5:40:03 AM   
SeeksOnlyOne


Posts: 2012
Joined: 5/14/2007
Status: offline 		here in the states, if you go to the hospital for x-rays, they ask if you have a living will.......and they will help you with it for free......mom had one and it saved me many hard decisions.........

_____________________________

it aint no good til it hurts just a little bit....jimmy somerville

in those moments of solitude, does everyone sometimes think they are insane? or is it just me?

(in reply to KMsAngel)
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RE: Advice for dear old dad - 7/16/2007 5:58:26 AM   
maybemaybenot


Posts: 2817
Joined: 9/22/2005
Status: offline 		This is just a guess:  I would guess that your Dad's internal defib. was put in under local anesthesia or conscious sedation. This is the preferred method for high risk patients. A splenectomy would require general anesthesia, besides the obvious complications, the diabetes can have a severe impact on healing and the chance of post op infection, abscess etc are very high.

If you are not your Dad's Healthcare proxy, you can have your Dad sign a letter stating that

I, "Dad " give my Mds and their designess permission to speak to my daughter Velvetears about any and all of my medical conditions and subsequent treatments "

Once your Dad has signed that and it has been given to his MD, you can call the MD or call the hospital and get a call back with updates if you are unable to make the trip or if you have been there for hours and no MD was present during your visit. Make sure you keep copies and give it to be put in his chart on each hospitalization. You can also speak to the nurses, who will generally give you a thorough update on what is happening.

Just one other suggestion, if you haven't already done this. Let the MDs know that Dad is non compliant. They need this info to accurately treat them. I do this in front of my parent not behind their backs. I have found that the MDs often times can present it a little better than we daughters and sons can, and information is better processed and taken a bit more seriously from an MD. It hasn't changed the whole picture, but there are some things my parent was non compliant with, that are now OK. The down side of being the adult child who has to start parenting the parent is that to your parent, you are and will always be the child. So often times simply by them being the parent, you are automatically not as * wise* as they.

                                 mbmbn

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Tolerance of evil is suicide.- NYC Firefighter

When tolerance is not reciprocated, tolerance becomes surrender.

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RE: Advice for dear old dad - 7/16/2007 6:19:51 AM   
mnottertail


Posts: 60698
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quote:

ORIGINAL: velvetears

my dad had a series of strokes over the last few years. He has never recovered 100%, most affected has been his balance and use of his right arm is now clumsy - speech as well but thats much better - he's not as quick as he used to be, he's 77 and living on about 30% capacity of his heart - has a defribulator/pacemaker on it. He is also an insulin dependant diabetic who will find any hidden pastry in the house.

He's exceptionally lucky to even be alive.  Now to my question. He is a VERY stubborn old man who will not adhere to doctors advice or just plain good comon sense to improve the quality of his remaining years. He really needs to use his walker 100% of the time but won't and he's fallen i would say in the last 2 years 30 times?? 

He's injured himself but never broke a bone or had a head injury yet.  He recently fell (3 to 4 days ago) and is in the hospital, his ribs hurt yet they are not fractured but they found a hematoma on his spleen and he has pneumonia.  i was told the first day he needed surgery or he could die, and now i am told there is no need for surgery as this hematoma is healing.  i know ruptured spleens can be very dangerous and one can die from blood loss. 

My common sense tells me if he continues to fall, which he will, won't it eventually rupture? So why not remove it anyway?  Once a spleen is injured, isn't it always vulnerable?  i cannot get up to the hospital as my car is in the repair shop or i would be up there getting first hand info from his doctors. i am getting this info from his wife (NOT my mother) and she's a complete scatterbrain and doesn't have a mind for anything at all remotely medical.  His doctors will only speak to her and they expect her to relay the info. To give you an idea of what i am dealing with, with her, she informed me he had amonia.  i said what was he doing with amonia, i didn't understand. She said she had no idea but he was being treated with antibiotics for it - that's when i realized she meant pneumonia - so any information from her i cannot rely on in the least.  i have looked up ruptured spleens and hematomas on the spleen on google and i get a sense it's nothing to be trifled with.  i know i can't expect "medical advice" but maybe someone out there has had a similar experience with an elderly loved one who can give me some kind of advice or insight?  i will be on pins and needles if he comes home knowing he will eventually fall again as he is left alone most of the day while his wife is at work. 


Same situation with my dad pretty much, who has durable power of attorney?  If there is no administrator now, you might point out to him that mom can't do the duty when he goes so she will need an advisor slash caretaker.

You can tell him, (I had some hell of a fights with my father) that if he is gonna be falling all over and you can't be there, he is going into a nursing home, the thing with my dad was that he was strong, wanted to control every bit of his life, but in a quiet private moment, we had a talk and he admitted that since his strokes he knew there was something wrong with his thoughts.  Well, in any case, we never had any problem talking about death, ignoring it don't make it go away.  You may couch the conversation in such a way that he can see the benefit to your mother to have home health care.......at least pop in once or twice a week.  maybe go to assisted living, place, becasue if he falls and nobody is around, will mother be injured trying to get him picked up, or is he gonna die in the middle of the hallway?

Ja, I know-------but like that.

Ron 

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RE: Advice for dear old dad - 7/16/2007 1:14:51 PM   
LightHeartedMaam


Posts: 296
Joined: 5/12/2007
Status: offline 		I JUST dealt with my stubbon, 85 yr old Geman father about this very issue this weekend.
He's getting frail and now uses a cane as he. too, is unstable on his feet. 

He is living alone in a tri-level home.  He told me he was thinking about getting one of thos medical alert pendants for emergencies.  That's all I needed.  I research the very popular one and the rest on the internet and consumer reports. The one I chose is a $29.95/mo- no contract, offers a wristwatch type  device as well as a pendant. I'm having it sent to him and billed to me.  If you want to know which one I got, feel free to email me here.


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RE: Advice for dear old dad - 7/18/2007 5:49:48 AM   
velvetears


Posts: 2933
Joined: 6/19/2006
Status: offline 		Bita -  always was close to my dad too and have always overseen his care in the last 10 years.  He moved away about 5 years ago which has made it difficult for me to keep in as close contact as i would have liked.  i used to be able to pop over whenever i wanted, now its over an hours ride. Thanks for the well wishes.

Seeks - My dads stubborn in a passive agressive way. He won't say i will not do x - he will nod say yea and then just not do it.  i go to the docs with him and tell the doctors all the time, and he usually tells me on the way out - now why did you tell him that it's not true, i laugh and ask him who he's kidding and hopefully something will get through to him.  Like taking his meds same time every m orn and evening - he was skipping them, not taking them as scheduled... finally the doctor told him the meds were literally keeping him alive and if he was copliant he could live a dozen more years.  Without these meds his heart could not function at all. He's pretty good on the meds now.  We get then through the VA so they are mailed to him, after we have an all day appointment starting at around 9 till 5 - grueling day. but only maybe 3 times a year.

mbmbn - i am pretty sure he had general anesthesia, it took him a long time to wake up and i remember them telling us there was a complication from the anesthesia.  But other than that he did remarkably well.  i always inform the doctors, nurses etc hes non compliant.  When he was in the assisted living facility i told them, in front of him to keep an eye out cause he will get out of bed and not use his walker. He fell while in there too.  i can't tell you how many times i have caught him and wrenched my own back, not fun. 

Ron - his wife has everything tied up that way - shes very controlling and posessive, which is why she moved them away 5 years ago, to get him further away from me and his other daughter.  Now thats he's incapacitated she needs my help and has actually argued with me that i should do more.  i do what i can and don't feel guilty about it. She's looking to sell their home, which is a ridiculous place - drivway mountain goats would have trouble geting up so winters are impossible, if there is a lot of snow forget it i don't visit. my dad told me much the same about his thinking capacity after his strokes, he knew he couldn't think as clearly.  It changed him in significant ways - he can't really write, and he will cry at the drop of a hat. i never in my life once saw my dad cry till after these strokes. He's always been very warm and friendly but not an emotional man. He would be caring and pragmatic, logical in his approach and show his concern - but never tears, ever.  Not sure if it's depression - maybe, so they have him on a very low dose anti depressant. He has fallen and stayed on the floor for hours. i have gone there without  calling first - just on a gut feeling once and he told me get me to the hospital i think i am having a stroke - so i did. His wifes daughter, soon to be son in law and their baby live there but they won't lift a finger to really help him.  They are close some of  his doctors but won't take him - makes no sense to me, and everyones afraid of driving into NJ (where the heart specialist is), just ridiculous.  It has caused many a fight between his wife and them.  i basically try to ignore it, i won't talk to them and when i visit i try to take my dad out and bring him somewhere - thats getting harder.  i have talked about death and asked him if he was afraid to die - hes not and we both talked about it just being a transition - i told him when he goes to wait for me on the other side - in a light hearted way, he pretty grounded that way.  He knows he doesn't have all that many years left.

LightHeartedMaam - How odd - i always call him the stubborn old german - his own dad was the same way when he got older and i tell him hes becoming just like his father. Maybe its a german thing lol.  He needs a pendant but what i don't get about them, cause my aunt had one was if they go off they call the contact person and expect you to go see if they are ok - i was an hour from my aunt and i said well if she had a heart attack shed be dead by the time i got there??? Made no sense to me - would make better sense to keep a cell phone near you, which is what my dad does - not that he would make the darn call though

Update: Talked to everyone - all arguing lol.  The docs and nurses agree with me about the assisted living - at least for a while till he's stronger. Wife is adament no - says her daughter is there to take care of him, she tells the doctors this so they can give him a release plan - i tell htem point blank the daughter will not take care of him and that his wife is just saying that to get him released. She actually asked me once to lie and say i would care for him so they would release him - we argued and i told her i would not lie and tell the doctors i would do something i cannot - if he fell and died i would be liable and he would be dead - he went into the assisted living home that time.  i am stepping back this time a bit because i can't fight this battle. If she wants him home and is willing to lie and he dies, so be it.  She told them as she always does and never follows through that she will get home nursing care - a nurse comes in for half hour checks BP and meds and leaves - not the level of care he needs.  If he goes into the home she will loose his pension, thats the bottom line.  All i can do is inform the doctors and let it be -hope for the best and pray.

< Message edited by velvetears -- 7/18/2007 5:52:54 AM >

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Religion is for people who are scared of hell, Spirituality is for people who have been there

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