low oxygen levels

[Dale_54]

My mother-in-law is 94 years old.  She has had two open heart bypass surgeries and a valve replaced with a St. Judes valve.  She has been on blood thinner, since her first open heart bypass surgery 1974.  Within the last 6 weeks we have had her in the hospital 3 times.  The first time, the doctor said she was in kidney failure.  They took her off all of her blood thinner, Warfarin,  and stated he would not give it to her for fear of her falling and causing internal bleeding.  He also took her off of her lasix, because this contributed to kidney failure.  He would only release her to a nursing home and would not write an order to resume the blood thinner or the lasix.  We were told that without the blood thinner she would develop blood clots around the valve and it would either stop working all together causing a heart attack or it would throw clots causing strokes and this could cause death, paralysis or a coma like state for years. They also told us this would be a very painful way for her to die. We were told with the lasix she would go back into kidney failure.  They told us with kidney failure, as her kidneys shut down, she would go to sleep and die peacefully in her sleep.  We chose to have her resume the blood thinner and the lasix.  At the nursing home she fell, broke a hip and was sent back to the same hospital, again taken off the blood thinner and lasix.  She had pins put in her right hip.  She was sent back to the nursing home. She is now on oxygen all of the time.  This is something she never used before her first trip to the hospital with kidney failure.  She was still living at home and was not having any trouble breathing that the doctors felt she needed oxygen at home.  They now can't get her blood thinner regulated and she has a level of 0.7.  We are told the norms are 1.2-2.0.  She has since had a stroke, but as recovered use of her left arm and leg and her speech is coming back.  In the last week since she had the stroke she has had sudden drops in her oxygen level.  They have dropped all the way down to 78.  If we go in and straighten her up, and work with her to breath in through her nose and out through her mouth it comes back up.  I need to know why she is doing this.  Is it because she is still having Pulmonary Embolisms due to the fact that they still don't have her blood thinned enough?  Or is it something else?  What can we do as far as family?  We have no medical background and really don't know the right questions to ask.  

[Dale_54]

Thank you very much for your suggestions.  When you asked if the doctors had checked for pneumonia or other lung infections, caused by aspiration, would that cause her oxygen levels to rise and fall so quickly?

[Sunny602]

I am amazed by your mother's strength..she has certainly been through many trials in such a short period of time. What have the doctor's been telling you regarding your mother's low oxygen levels? I would start there...ask the doctor for a family conference so that he or she can address all of your concerns. She is a complex case, having endured many problems...stroke, pulmonary embolisms, broken hip etc....
Have the doctors checked for pneumonia or other lung infections? I am just wondering....Because your mother has had a stroke, perhaps it has affected how she swallows. If she has a weak swallow or cough, she is at a higher risk to aspirate food or fluids into her lungs. This would cause an infection ultimately.
I know how hard it is to regulate those warfarin levels. I am on the drug myself for pulmonary embolisms and it swings from very low to high quickly. I am monitored frequently because of this. She is definitely too low...My doc sets my levels at between 2 and 3. I hope that her levels get to theraputic values soon considering she has had so many problems due to not be anticoagulated enough.
I wish I could help more, Sunny