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Heart Disease (Expert Forum)
end stage chf
Answered by
Cleveland - OH
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end stage chf
by chbigdog, Jul 09, 2005 12:00AM
My father in law who is 93 has CHF, has a pacemaker for A-Fib and takes many medications for the above, as well as many other health problems. He is swelling with fluid, is losing control of his body functions, does not wish to eat (but will if we ask him to), has a very low intake of fluids, is talking to people (that aren't really there)is very confused and has SOB with exertion. His doctor is at the VA Hospital and is VERY difficult to reach, we have waited as long as two weeks for a response from the doctor. My F-I-L has a DNR order, he does not want to go to the hospital because he thinks he won't come home. I do not like watching him struggle with his breathing and since he is aware of what is happening to him, he is angry, embarassed and has begun to use profanity which is unlike him around our small children. He is definitely not himself, should we take him to the hosptial even though he does not wish to go, can we take him for comfort measures only? How would they treat him, can he be treated in ER and released, does it require a longer stay or is he ready for hospice?
Doctor's Answer
by Cleveland Clinic, Jul 09, 2005 12:00AM
, Jul 09, 2005 12:00AM
bigdog,
Sorry to hear about your father in law.
These are impossible questions to answer definitively. You do describe what sounds like a terminal state. In my years in medicine, these are usually the most difficult situations for physicians and families to deal with and vary for each individual and family.
It sounds like the most important thing for your father-in law is to make sure that he is comfortable. Even those with a terminal condition should never have to suffer even if they dont undergo resuscitative measures. My advice would be to look into a home hospice care program. Home hospice nurses are skilled in using analgesic and other comfort medications to help make patients with terminal diseases comfortable.
If you are having problems setting this up, and/or your father in law is uncomfortable and you are unable to reach your physician, an emergency room or the VA emergency room should be able to help give him medicine to make him comfortable. Make sure you discuss with them your expectations or his wishes exactly.
They may be able to give him something to ease his suffering, or ensure you that he is comfortable.
It sounds like you've already had end of life discussions with your father-in law which is fortunate as it should help make your descisions about which care pathways easier. These are always difficult on all family members involved and my advice is to continue to communicate among yourselves and with your father in law if able and look to those support systems that have been uselful to your family in the past whether that be each other, your faith, or something else.
good luck and best wishes.
Sorry to hear about your father in law.
These are impossible questions to answer definitively. You do describe what sounds like a terminal state. In my years in medicine, these are usually the most difficult situations for physicians and families to deal with and vary for each individual and family.
It sounds like the most important thing for your father-in law is to make sure that he is comfortable. Even those with a terminal condition should never have to suffer even if they dont undergo resuscitative measures. My advice would be to look into a home hospice care program. Home hospice nurses are skilled in using analgesic and other comfort medications to help make patients with terminal diseases comfortable.
If you are having problems setting this up, and/or your father in law is uncomfortable and you are unable to reach your physician, an emergency room or the VA emergency room should be able to help give him medicine to make him comfortable. Make sure you discuss with them your expectations or his wishes exactly.
They may be able to give him something to ease his suffering, or ensure you that he is comfortable.
It sounds like you've already had end of life discussions with your father-in law which is fortunate as it should help make your descisions about which care pathways easier. These are always difficult on all family members involved and my advice is to continue to communicate among yourselves and with your father in law if able and look to those support systems that have been uselful to your family in the past whether that be each other, your faith, or something else.
good luck and best wishes.
The docotor will not answer your question in this topic but inorder to get a post in the heart forum you need to be up early so you can get a post in on time. Just be up by about 8AM and every ten minutes or so try to post a question. Or you may want to browse the archives on CABG