My 90-something mother who lives in an assisted living facility developed a cough last week. It became increasing rough, but not productive so I took her to the ER which ran tests and admitted her to the hospital. After a couple days of antibiotics, the doctors said she was not responding to them so they recommended hospice.
Following their advice, I arranged for my mother to receive hospice care at her assisted living facility. What I later found out was that once in hospice, there are no more curative measures/treatments for the condition identified as justification for hospice care. There are also no more opportunities for therapy.
The discharge diagnosis included acute hypoxic and hypercarbic respiratory failure, pneumonia,aspiration, lethargy, and HTN. It was recommended she be put on 5L of oxygen.
After 2 days of receiving oxygen, the machine was mistakenly turned off. After 1 day with no oxygen administered, my mother's oxygen level was 97%. She is also able to eat/drink with minimal coughing if she tilts her head down towards her chest when swallowing food or liquids.
According to "the web", aspiration pneumonia does not respond to antibiotics. I also learned there is therapy for aspiration to help strengthen/retrain the muscles associated with swallowing and potentially decrease future episodes of aspiration. Unfortunately, entering hospice means no more curative measures or therapy... just comfort meds.
To set my mind at ease, I arranged for a second opinion from a doctor at a different practice. While there are SOME similarities in the two readings, the second opinion doesn't seem to indicate the level of severity documented at the hospital.
1 – Chest PA and Lateral
The right hilar and infrahilar region demonstrate asymmetric focal opacity which appears increased compared to recent prior studies. The previous studies demonstrated asymmetric dense pleural plaque calcifications in the right side which may in part account for this markedly asymmetric focal opacities. Even allowing for the presence of calcified pleural plaques, the extent of right perihilar and infrahilar opacities appears distinctly increased.t PA
Subtle retrocardiac opacity may be present in the left lung base lateral aspect with partial obscuration of the left hemidiaphragmatic outline. Increased streaky densities are suggested in the upper to mid lung zones as well. The cardiac silhouette is mildly prominent.
1) Increased focal mass in right perihilar-infrahilar region. Developing focal consolidation or infiltrate cannot be
2) Asbestos related pleural disese with extensive pleural plaque calcifications particularly on the right side.
3) Subtle streaky densities in the left upper to mid lung zones. Possible related to atelectatic changes vs. less
likely developing infiltrate.
2- Chest PA and Lateral
The cardiac and mediastinal silhouettes are within normal limits. The pulmonary vasculature is unremarkable. Extensive right sided pleural calcifications noted. Questionable small amount of superimposed opacity. Stable osseous structures including kyphoplasty.
1) Chronic changes with questionable small amount of superimposed patchy opacity atelectasis versus infiltrate.
Second Opinion from a physician in a different hospital group ------------------------------------------
Patient is rotated to the left. The cardiomediastinal silhouette appears similar to prior.
Accentuation of the right hilum likely due to differences in positioning. There is evidence of calcified pleural plaques on the right, seen on prior exams as well. There are increased interstitial opacities, especially in the right mid/lower long, not convincingly changed from most recent prior, but definitely increased since 01/21/16 Scattered linear opacities on the left likely due to subsegmental atelectasis. No acute osseous findings.
1) Right mid/lower lung opacities similar to the most recent prior, likely pneumonia. Asymmetric edema is a
less likely possibility.
2) Calcified pleural plaques on the right, a chronic abnormality. This could be related to prior asbestos
exposure;though given that it is unilateral, a prior hemothorax or empyema may be more likely.
The first reading mentions the left lung, the second reading does not. My mother had TB in the late 40's, but neither reading cites TB as a contributing factor.
What I'd like to know is:
A) Are the readings indicating the same problem, just with different words?
Which reading should I believe?
In plain English, what are these guys saying?
B) My mother is still an active woman who would rather be socializing with her friends at the ALF than be in a
haze induced by "comfort meds". She is not in any pain, but does get agitated from time to time.
She doesn't want to be kept alive by machines, but by the same token, she said she's
not ready to cash in her chips.
Based on the info I've provided, is she better off in hospice care, or would she be better off getting professional
therapy for the aspiration issues, and exploring options for non-invasive medical therapies and treatments?
Any advice/opinions would be much appreciated!