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Brain Injury in elderly patient

Hello,
My father was placed on vent support 1mnth ago for mrsa pneamonia & sepsis which caused swelling around the brain.  Follow-up head ct/eeg came back normal however, his responses and actions remind most of the Shivo case from Florida.  His living will states he does not want to be on life support and we are left to figure out what quesiton to ask in order to abide by his wishes.  One doc has already told us that if his brain does not "turn on" within the next month it is much less likely it will.  He has been transfered to a long term care facility.  What questions should we be asking?  Mom has Alzheimer's which is rapidly progressing through this stress and we dont feel she will be able to make these descisions.  His condition is unchanged. They put a traech in, but we are not sure this was a good idea.  The sepsis is cleared however, he is pos. for MRSA pnemonia, congestive heart failure, edema and was undergoing treatment for lymphoma when he contracted the original MRSA.  Husband & I are pretty straight forward people and deal with facts.  So we want to make sure we are asking the right questions.
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Avatar universal
MEDICAL PROFESSIONAL
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

You are certainly in a very difficult situation. I can not make specific comments about your father's case without being able to see him and review the history, nor can i make specific recommendations, however I will try to provide you with some useful information.

In older adults with already existing medical problems, a severe illness such as MRSA pneumonia can leave permanent damage. If swelling of the brain occurred, I am not entirely clear what the exact meaning of that was, but one question to try and clarify is: was there suspected anoxic injury to the brain, meaning that there is evidence, either historically or by imaging (such as CT scan or MRI of the brain) that there was a time period when the brain did not receive enough blood. In sepsis, when the blood pressure drops, this can commonly happen. If there was anoxic injury, this can be permanent, and can lead to a coma-like or comatose state.

Another question to ask is whether or not your father is breathing on his own, or is the trach connected to a ventilator, so that the machine is breathing for him. If the machine is breathing for him, an important question to ask is do the physicians feel he has chances to ever come off the machine? That is a difficult question to ask, and sometimes the answer is time will tell. However, trachs do not mean permanent life support: if after a few weeks it is confirmed that he is unlikely to breath on his own, the ventilator could be discontinued.

The questions that sound so simple but of course are very difficult to answer are: does he have chances for functional recovery? Everyone has their different goals and criteria for what constitutes a good quality of life. Some want to be able to walk, talk, read, write, be completely independent etc in order to say they have a good quality of life. Others are content if they can sit in bed, though they are dependent fully for care, as long as they can see their loved ones and interact with them. So after thinking about what you think your dad would want, the question for his physicians would be whether or not those goals could be reached.

In difficult situations such as yours, asking to talk to a palliative medicine specialist is a good idea. This does not necessarily commit your father to a particular management plan, to hospice etc., but talking to the palliative medicine specialists can help you understand all the options, and what it would mean to make one decision over another, and what the options would be long-term.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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Avatar universal
Thank you.  I notice you are in Cleveland and have a question regarding Mom.   She has been treated for the last few years for Alzheimer's with an Exelon patch.  I am not sure why she isn't on any other therapy but this is what her family doc has her on.  She has not been "formaly" diagnosed however, the stress of the situation with dad has sent her downward very quickly.  Unfortunetly without him, her anchor, her condition has become severe.  She doesn't want to drive, keeps dressing in the same clothes, calls the same people every 15min to tell the same story, is unsure of time & day, becomes fixated on a single topic of a sentence and has doubled up on medication.  She has stayed with us for the passed month I have even spoken with her family doc who states she now has a 24hr window were she is ok alone.  We are in Toledo area, I know there is no cure however, is there a specific doc we should take her to see to possibly change her meds to slow down the progression of the disease.  Her family doc has told her there really isn't too much more he can do for her.  Thank you again your reply was very helpful in what questions to ask about Dads condition.
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