BNP values

[hersonswife]

My mother-in-law has CHF as well as bronchiectasis.  Up until August, she had been on oxygen only as needed.  Her BNP was 900 in June, >5000 last week, and 6250 this week. Prior to the BNP of >5000, she was taking 80mg of lasix/day.  There was no swelling of the extremities with the 5000 value, but her cardiologist upped the lasix to 80mg twice/day.  She then went to her pulmonologist who told my husband that she was having a flare of her bronchiectasis and that the pulmonary HTN would cause the BNP to go up.  He put her on nebulizer treatments and an antibiotic.  4 days into that, her BNP rose to 6250 and she is now having 4+ pitting edema in her feet and ankles and must use oxygen at all times.  She is usually a human dynamo and she has stopped all activities and rarely goes down to meals at her retirement community.  She's making phone calls to her daughters to say goodby and while she is normally very melodramatic, given the lab values, we are wondering if this is truly the end.  She is 90 years old.  I think in our minds, we know she doesn't have much time, but she has cried wolf so many times that we don't know how to respond.  Any advise?  Her daughters all live far away and are counting on us for accurate info, but her docs here seem unconcerned or know the prognosis and don't think they need to voice it out loud.  Thanks for any response.

[hersonswife]

Thanks so much for commenting.  Surely all anyone can expect is for nature to take it's course:-(  Our kids have read this email and are being more proactive with their Grandmother which is a big help.  Hope you stay well!

[gmachris518]

Don't let the doctors lack of concern control whether  you believe she is bad off, or not.

Last week I went to see a cardiologist who told me I was in danger of sudden death and needed an ICD.  Then, the same doctor, in the next breath told me, she could do the operation next week, or I could put it off for now, if I wanted to, that it was up to me.  She didn't seemed concerned about my plight.  She simply offered her services and then left it up to me to decide.  So, I'm sitting there in her office thinking that if I don't have it done, I may be dead by next week, and she doesn't really care.  My point is, doctors do what they think they should, and then let nature take it's course.  If  what they do works, fine, and if it doesn't, oh well.

And.......at 90 years old, they are even less likely to worry about whether a patient lives or dies.  I know that's a harsh thing to say, but it's true.  

My advice is to treat your mother in law as though everyday is her last.  Tell her daughters what you have written here, and then it's on their shoulders to do what they feel them must.  Keep in mind that she has already outlived the majority of people in their senior years, and be thankful for it.

I hope the best for her and all of her family.