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continue full dose of diuretics?
My 93 year old father has has very little (about 10%) heart function for very many years now. He had a major heart attack at around 65 and lost much of his heart tissue then. We are amazed that he has been able to continue as long as he has. He lives with one daughter and spends a lot of his time sleeping but gets up and walks to the kitchen for breakfast and occasionally for other meals, although most often it's just a solid breakfast and a few bottles of Boost and small snacks the rest of the day. He is usually fairly alert, although it is sometimes hard to tell because he is so very hard of hearing. He enjoys some time at his computer most days, reading and visiting with family and friends, and watching over his financial accounts. His meds include: captopril 25mg, furosemide 40mg, digoxin 0.25mg, warfarin 5mg, pravachol 40mg, metoprolol 50mg, aspirin 81mg and Spironolactone 25mg.
He picked up a probable cold last week while getting his pro-time done, and developed a sore throat on Thursday, and today is very weak and not very alert. We are kind of used to him getting extremely weak and foggy whenever he picks up a virus over the last few years, but it keeps getting more extreme with advancing age. This time he is too weak to get out of bed at all (legs like jello), too foggy to realize when he needs to urinate, and too unaware to realize when he has wet himself or to follow instructions. It's very difficult for my sister to change his adult diaper when he can't stand or help much. Between that difficulty and the fact that he's so tired that it's probably going to be very hard to get him to drink much (although he did eat dinner last night and had a Boost this morning), we are wondering whether it would be safe to reduce (not stop, just reduce) his dosages of diuretics - both to avoid dehydration and to avoid excessive urination. His doctor is completely unreachable today, and none of us think the ER would be appropriate for help. Does anybody out there have knowledge about this kind of thing? Thank you!
He picked up a probable cold last week while getting his pro-time done, and developed a sore throat on Thursday, and today is very weak and not very alert. We are kind of used to him getting extremely weak and foggy whenever he picks up a virus over the last few years, but it keeps getting more extreme with advancing age. This time he is too weak to get out of bed at all (legs like jello), too foggy to realize when he needs to urinate, and too unaware to realize when he has wet himself or to follow instructions. It's very difficult for my sister to change his adult diaper when he can't stand or help much. Between that difficulty and the fact that he's so tired that it's probably going to be very hard to get him to drink much (although he did eat dinner last night and had a Boost this morning), we are wondering whether it would be safe to reduce (not stop, just reduce) his dosages of diuretics - both to avoid dehydration and to avoid excessive urination. His doctor is completely unreachable today, and none of us think the ER would be appropriate for help. Does anybody out there have knowledge about this kind of thing? Thank you!
I will add to Flycaster's comments, sometimes a hospice service can provide in-home services. People tend to think of hospice as "a place where you go to die," but in my own state of Arkansas, it's almost all in-home services. If there is a hospice in your sister's area, maybe using them would provide a way for your father not to have to move again.
In most cases like this, Hospice is recommended. Sometimes people don't want the end of life help, but in my experience with four loved ones, they were able to complete their lives with class and dignity. I have Congestive Heart Failure and have made sure my family will empower Hospice to keep me comfortable when my time comes. I learned this from my father who was what could be called a country doctor, and felt strongly people should leave the world as painless as possible. Blessings.
Thank you! Yes, I'm truly shocked too by the poor quality of medical care available in North Las Vegas. My sister had a very hard time finding ANY doctors who would take on a new Medicare patient when we first moved him out there 6 or 7 months ago from his solo home in Florida. Today she tried both the doctors she did finally find (one cardiologist and one primary care) and neither one had anyone on-call, just a recorded message saying what their normal office hours were and no way to contact them outside of office hours. We were very worried about exposing him to even more illnesses during a long wait in the ER and were planning to just watch closely until tomorrow, but he did get a little worse and she did have to call 911. He can only walk a very short way when he's well, and in his current condition he couldn't walk at all and she couldn't lift him to get him into his wheelchair or into the car to drive him. We hoped that if he arrived by ambulance like that he would at least not have a long wait to be seen once there, but no such luck. It was hours anyway, but at least he didn't have to sit in a waiting room chair the whole time like on other ER visits. We would love to have a doctor we could reach 24/7 for him, but haven't been able to find anyone like that in North Las Vegas. I'm going to keep my fingers crossed that my sister will encounter a physician via the hospital now who can provide better care. They've admitted him for an IV antibiotic and an overnight stay. We may have to try to move him again, to my place in California, where there are many excellent doctors available, but I'm not sure if he'd survive another move. Thanks for your help.
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I'm kind of shocked to hear that there is a medical doctor who doesn't have anybody on call when he's unavailable. I thought that was standard nowadays -- that anybody practicing clinical medicine is obligated to make arrangements for an on-call doctor. Even solo practitioners have to do that. They usually share call with a clinic or with one or more other solo docs.
The danger in decreasing your dad's diuretic is that fluid could build up on his lungs and cause him to have trouble breathing, and he could go into crisis. He's on the diuretic because his heart can't move enough fluid, and that won't change. Were he clearly dehydrated already, that would be one thing, but your post indicates you are concerned only that he might get dehydrated as time goes on.
I understand the concern about taking your father to the ER, but if his overall condition gets any worse, or if your sister has too much difficulty keeping him cleaned up, then the ER might be your only option. When you do talk to the doctor, I would get his input on what you should do in a future situation such as this. In my opinion, your father is too frail for you not to have a doctor that you can call 24/7. Good luck.