Bleed following stroke & now blood clots in legs; dehydration in rehab center

[michie118]

My dad had an ischemic stroke (following bypass surgery) 3 weeks ago, and then developed a bleed after being given a blood thinner.  After the bleed was found, the blood thinner was halted 3 days post-stroke.  He has been in acute rehab for about a week, became dehydrated, and now has developed clots in his legs. His legs are very swollen.  The doctors are telling us there is nothing they can do to treat the blood clots, hopefully they will resolve on their own, they cannot give him any type of blood thinner and say he is not a candidate for surgery, and don't even recommend compression stockings -- this from the vascular surgeon, not neurologist or hematologist --- they have not been consulted on this issue that we know of.  This is a hospital that does not have a stroke center and no real specialty stroke treatment/rehab.  Rehab people are now very pessimistic regarding his recovery, but he had been making progress before.  We are concerned that they let him get dehydrated in the Rehab center and  this has also caused some kidney issues as of today.

Has anyone had any experience with this type situation? Did clots resolve on their own?
Should we look at moving my dad to another hospital that deals more with stroke complications?
Should we be upset that he got dehydrated in rehab center?
Any advice is sincerely appreciated.

[michie118]

We do not know if they took a CT scan before ordering blood thinner after the stroke; however, they did not take another CT scan until 3 days post-stroke and that is when the bleed was found and blood thinner was disontinued.

My dad can swallow, and had been eating quiet well, but has not really acted thirsty. However, he has been catherized and they have been monitoring his urine output in rehab.  When it go low and started turning dark, we questioned them, and they said that was pretty much normal for someone like him, then a few days later they started giving him liquids for dehydration.  He is now catherized a couple of times a day b/c he is not urinating on his own, again, they say that's just how it is since he was catherized for the past 3 weeks. They say his kidneys are functioning.

My dad is not walking, but he has stood some in physical therapy.  The dad of his triple by-pass, he actually was operated on twice and then the stroke, then the brain bleed, then some swelling.  He still acts very tired.  We don't know if we should push him in rehab or let him rest and recover and try to work on the medical issues or keep him in the acute rehab.  They tell us if his brain doesn't get the intense rehab now, that will severely impair recovery.  We feel as if we are b/w a rock and a hard place with about all decisions as to my dad's care.  For right now, my mom wants to keep him in rehab b/c she is afraid if he is moved, he will not get any therapy.  We're not sure if a "stroke center" will take him since the stroke was 3 weeks ago, we've called and they will only talk to a doctor.  The doctors who see him in rehab don't really talk to us or recommend anything until problems come up, and then it's just they treat it best they can, but as to the clots, they basically say they can't do anything.  This is very frustrating for us.

Thanks to all who have responded

[caregiver222]

The clots will probably dissolve on their own, and YES, you should be upset about the dehydration  But it is like getting mad at my cat for upsetting the flower vase.  Unfortunately, dehydration is the norm. It is"the nature of the beast".The only answer is a meticulous accounting of ALL fluid intake AND caloric intake. To the ounce. This is best accomplished by having all drinks poured in two or two and a half ounce cups and as the cups are consumed, have them stacked and counted by the aide.

[jaxn]

I would get him to another hospital if you could.  My Dad is going through a similar situation right now, he just had a severe stroke caused by a heart condition.  I would be upset about the dehydration, there is no reason for that to happen, and I'm wondering why they gave him blood thinner if it caused a brain bleed, did they do a CT scan first to make sure it was safe???  Or did they give him TPA (I think thats what its called) in the first few hours of the stroke.  If it was the TPA then it was the only thing they could do, they HAVE to give that to a stroke victim in the first few hours, the negative of giving it is just as bad as not giving it.  But before they put him back on any blood thinner make sure they do a CT scan of the brain before, if it is too damaged the blood thinner can cause more harm than good.

[PamRam228]

Here's hoping for your dad a speedy and successful recovery....

...Yes, blood clots can dissolve on their own.  My husband had a blood clot in his leg when he was in the hospital after his stroke.  He, too, had a bleed.  The clot took weeks, but it did resolve.  He also had a filter put in him to catch clots if they moved.  

How is your dad doing?  Is he walking?  My husband was given compression stockings in the rehab center.  His physical therapist suggested that. He only wore them a few times because he didn't like having to work hard at getting them on.

If I were you I'd hurry up and get dad to a different hospital that deals more with stroke patients.  Although it's a waiting game, seems like the doctors are playing a guessing game with your dad, also.  

As for the dehydration, make sure dad is drinking plenty of liquids.  How is his swallowing?  If he is having swallowing problems, that may be the reason for being dehydrated.

Keep us posted and God bless.