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What is criteria for palliative care vs. rehab?
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What is criteria for palliative care vs. rehab?

My 87 year old father-in-law suffered from several strokes 10 days ago.  It took the hospital a few days to diagnosis it as a stroke.  At first, they thought it was an infection.  He has slow growing cancer and Parkinsons.   They think the stroke was cause by atrial fibrillation. I am assuming they were ischemic strokes.  He can not swallow and is at risk of aspiration.  He can not talk but but has grunted occasionally, like when I brought art work from my toddler twins.  His eyes are usually closed but occasionally, he can open them.  He seems to understand what we say in simple terms.  He can squeeze hands, wiggle his toes and do thumbs up but his motion is limited.  I've seen his legs move but I don't think he can lift them or really lift his arms high, though he can move them a little.  The stroke affected his Broca's area and mostly the left but also the right hemisphere.  

The doctors have given up on him.  They had done two CAT scans which didn't show the stroke and we had to ask for the MRI which showed the damage (and it was done a few days after so perhaps that is when the damage became visible.)  They suggest we do not insert a PEG feeding tube.   They tried an NJ but he pulled it out (though one doctor said that doesn't mean he didn't want it) but they don't want to put it back since they are worried about aspiration.  Because he isn't clearing fluid from his lungs on his own, they took him off the blood thinners.  They're trying one more antibiotic for the bacteria in the lungs but I think that's it.  They begrudging said they could order P/T and have suggested palliative care.  

While I know he can't recover to what he was, I was wondering if he could do rehab to at least try to recover to the point where he can have his eyes open during the day and enjoy visits from his family/wife and have meaningful thoughts.  I don't understand the criteria for palliative care vs. sending someone into rehab.  Would someone explain it and do you think there is any hope?  And if so, should we put in the feeding tube for a week just to give everything a full effort?   We find it hard to let him go when he seems cognizant of where he is and who he is with and responds to different sniff tests with thumbs up or down.  He had some movement in swallowing but it was involuntary.

Thank you for your advice!
2 Comments Post a Comment
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Avatar_dr_f_tn
Hello and hope you are doing well.

Palliative care is specialized care focused on the pain, symptoms and stress of serious illness. It helps in improving life and providing comfort to people of all ages with serious, chronic, and life-threatening illnesses. Rehabilitation on the other hand is reviving, helping patients to get back, like from a stroke or drug rehabilitation. Your father in law may need Palliative care.

Hope this helped and do keep us posted.
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Avatar_f_tn
I hope that your father-in-law is still with us.  Sorry I only saw your posting just now.  If the doctors are willing to order PT, have them order it.  My 86 year old mother had a major stroke, also had atrial fibrillation.  She was given 4 days to live and was barely there.  But she kept getting better with PT and lived another 2 years fully cognizant.  So for anyone else, get whatever you can for your loved one.
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