Paul had converted to Normal Sinus Rhythm last evening. He had a pretty calm night, no significant changes until this morning. When I got there this a.m. he was up in a chair, had eaten breakfast, then the telemetry indicated he'd converted back to Atrial flutter, HR 160's.
Shortly afterward the RN comes in to get BP's, tells me he is in A-flutter again, then gives a bolus of Amiodorone, and a half liter NS with 18cc's (don't know the dose) Amiodorone currently going at KVO.
Doc came while I was there. (Gee- imagine that!) Chief concerns are that DH continues in and out of A-Flutter, with risks of embolus. Doc says consider decision weighing risks of coumadin vs risks of bleeding. DH isn't always steady, and bleeds easy anyway (thin, fragile skin). Concern is a fall leading to cerebral or other internal bleed. Plus, coumadin would require frequent PT checks and I don't want to be carting him around to do that. I plan to choose no coumadin.
Doc says scans show no liver issues, no ascites, prostate issue may be just BPH as the PSA blood test was OK. (Hmm! A urologist told me that false highs occur with trauma to area such as a cath. And he has one in now?). I would not consider a TURP. No how, no way. Worked enough with those on med surg. Sis also worked in urology office 11 yrs and knows what I mean.
I talked to my kids just to let them know, and they all seem to understand.
So, its just another couple ingredients to add to our Alzheimer's Soup!
SO what will they do, just let him have the A-flutter? Is that the same thing (or a lesser thing) as A-fib? Any word about when he would come home? Or to a "rehab" ??
I think you are right not to use the Coumadin. Charlie was already on Coumadin when he was diagnosed with the PSP and the FTD. At that time the doctor said that we needed to make the same choice, risk of stroke or risk of a fall causing internal bleeding. At the time, I decided to stay with the Coumadin. But, not only did it mean monthly trips for blood work, I panicked with every little bump or fall he had for fear that he was bleeding internally and I didn't know it. Finally, after his little midnight stroll where he go outside and fell and banged himself up so badly I nearly had a heart attack, I said enough is enough and we took him off of it and I do not regret it.
DH has always bled too easy. Thursday a.m., before going to the doctor he stumbled on our stairs and bumped his wrist while catching himself. Didn't break the skin, or it would have been a real mess. He still has that deep red/purple bruising under his skin. He's had so many IV's started since his admission, and although he is NOT on coumadin or heparin he still bleeds alot at the sites when one is discontinued. Right now he has two in because his antibiotic (UTI) and the antianxiety meds couldn't be given through the same one during the amiodorone (antiarrhythmic) infusion. When I went back last night they had both his hands/forearms wrapped in guaze mits. Poor DH. Just doesn't know what to make of it all.
I'm especially fortunate the hospital is able to keep a sitter in the room to keep an eye on DH. He wants to get up a lot. He has had ativan IV which I knew about, and I heard the aide mention he had Haldol yesterday. He is "seeing things" and confused, but still pleasant and cooperative. I just know he'd fall and bleed, or pull out his cath and IV's and bleed A LOT!!! if someone wasn't right there with him. Yep, I'm feeling blessed right now.
New Realm, A lot going on, glad that you have the option of a sitter being with him so that you can get a few hours of rest. Thanks for letting us know whats up. Hang in there. TandP's. Rk
Every time I read "bolus" I think of the giraffes. That's what the keepeers call their cud. I took friends around the zoo today - gorgeous day!! - and the husband had just had a "debriding" I think he called it to stop a-flutter. He was fine and said he didn't have to be fully knocked out.
we were told by the pharmacist that Amiodorone (Pacerone) that was started in the hospital could increase the effect of Risperdal, and the pharmacist thought DH takes a high dose (no, I don't think so). He takes 1.5 mg am and pm. This is the first the neurology office has learned of DH's hospital admission and new diagnoses so the nurse is consulting the Neuro. I'm waiting on a call back from either the nurse OR the doc. I'm interested in hearing what he thinks. Looking up on the puter I didn't see anything specifically saying an antiarrhymic could potentiate and antipsychotic.
Anyway, DH is incredibly antsy, and hates that indwelling catheter. I want to be able to give him something and know its safe. They gave ativan and haldol IV in the hospital. We use Xanax at home so I've given him 2 and he's finally dozing off. He kept the HHA on her toes today. I was lucky to get her since I just called the agency when DH got discharged yesterday. She was just super.
Diana-does your husband have the catheter because he can't pee without it. They are such a source of infection and bladder irritation. Is it permanent? Haldol is an awful drug to give. Aren't you glad you can control the situation now. Good luck. Nora
his bladder was so greatly over distended, due to "obstructive Uropathy," that the urine backed up to the kidneys and caused a degree of kidney failure that will hopefully resolve itself. Because of that he could not have some of the scans they wanted to do with contrast. Doctors say his prostate is most likely causing this. A urologist mentioned TURP, which I refuse to consider. Upon discharge the PCP mentioned the possibility of a laser procedure. I would be willing to hear about that. Other than that I will NOT consider invasive surgery, especially if it can be managed by routine straight cathing. I have had to straight cath myself on an off for many years due to neurogenic bladder, and in my nursing career so it is a very simple basic treatment to me.
My wife has to take Coumadin because of her history of TIA's and mini-strokes. We have her INR levels checked almost every week. This drug cause a lot of bruising and and bleeding under the skin. She hates all of the bruising and the appearance of these under skin bleeds. But it is necessary to keep a close check on the INR level with Coumadin and adjust the doseage as needed. A lot of the things we do for our loved ones are based on our perception of adding to their quality of life. Sometimes it is so hard to decide what must be done medically for them. It seems like many of these procedures only add to their discomfort and increase their agitation.
DW is also dealing with end stage kidney disease, this limits some of the procedures such as MRI's with contrast, heart cath's and other procedures that use iodine and other substances. The Iodine puts a very heavy load on their already failing kidneys and is just not appropriate for them.
I becomes so hard to make these difficult decisions, it seems like some time we are d***ed if we and d***ed if we don't. But in my opinion if it adds to their quality of life we must do what we have to do.
I used to take my Mom in for frequent PT/INR's when she had to be on coumadin. She began throwing clots after abdominal surgery for cancer. It was difficult for her to have to go back and forth so much. We live semi rural so I also don't like to have to take DH into town so often.
DH's doc told me to consider which I felt was the safest choice for us because where we live we have many stairs. To get in to our tri level home from our upper driveway we have to go down exterior stairs made of rail road ties, and NO hand rails, to get to the front door. From the lower driveway we have exterior stairs up to the deck. DH is now a greater fall risk than before, and he has already had a couple falls. It is odd that DH is already an easy bleeder, but his doc says if on coumadin a fall could easily cause him to bleed to death.
I do still have mixed feelings about whether it would be more humane to allow the possibility of strokes, or take the risk of a hemorrhage.
We are fortunate that our townhouse is one level and is "stepless". DW has a very difficult time with changes in elevations, she had one bad fall down a short flight of steps at church, thankfully only four steps. It did so much damage to her skin, multiple skin large tears on her arm. This happened before she was on Coumadin, if she been on Coumadin I'm sure we would have had major bleeding problems on our hands.
I can certainly understand how steps can be a hazard. I find that I really have to grab hold of her and guide her down any change in elevation. You also need to be aware of those elevated booths in some restaurants, they are only one step but can cause a nasty fall. My DW fell off of one of these litle elevated steps. I am even very cautious of curbs and make sure I guide her up or down any change in elevation, no matter how small it is.
Her balance has really been affected by the combination of AD and her bad back. I have had to caution my daughter and granddaughters to be very careful with her when she is out shopping or eating with them.
We're lucky that our next-door neighbor is a retired welder. He was happy to make some wrought-iron rails along the sides of the front walk steps. He was going to put them on the back steps as well but it's too hard for my husband to maneuver the inside pantry there with his walker, so I said forget it.