My father had a stroke and is not getting proper evaluation/ care

[quellie]

My father has had a stroke and the hospital is not doing what should be done. I am distressed and not sure what to do. He is in his late 80’s. He has become an invalid since having covid in January with multiple health issues and several hospital stays since. We took him to er with altered mental status thinking possible uti. He had been screaming terribly and not making sense. I called the on call doc who said go to er. They did not do a cat scan until 15 hours later, at which point he had some facial drooping on one side begin. Yet they did other tests and a toxicology for illegal and class rx drugs. He is an invalid and we are medicating him. Then they were talking about palliative care. 

Then the next day an np, not a doc, said his stroke happened at least 2 days ago because it would not show up for 2 days on the scan which I have now found, and suspected, is not true. They are doing no treatment except to keep his bp high to perfuse the brain and he is on heparin inj. They have not done cat scan perfusion or angiogram to see where the clot is. He has afib and heart failure and had a failed tavr with damage to one femoral artery a month ago. They did and us of the carotid and flow was ok. They are not following their own protocol and I am not sure what to do. No one is telling us much. It is the WE and nothing will be done now for 2 days. We were up late with him last night and did not go in later today I asked to speak to the resident uncle about what was going on and they did not come to speak to us and then I was told I could not stay, only one person, I believe because I was complaining. The night before I stayed two hours longer. 

I wanted to get him transferred elsewhere but I think it is impossible now. 

On the most recent note it states did he have a stroke, tia, etc. vs subarachnoid hemorrhage. This pretty much crazy imo. He was taken off AC warfarin 4 months ago here due to falls and possible gi bleed, there was no bleed. I wanted him put on eliquis instead which is safer and more stable. W was unstable now. It was never done. They said they are goi g to put him on it but have to wait. 

What should/ can be done here, what tests can be done to properly diagnose and treat this? He can’t do a planned special mri due to old leads in his pacemaker. And now they are doing nothing for two days at least and one nurse said he was going to be downgraded from the neuro ici. 

[Erich_Hartmann]

As I stroke victim myself, I sympathize with your situation. The doctor who told you a stroke will not show up a CAT for 2 day is LYING. First, call your primary care doctor or insurance provider and get a referral to another doctor. I hate to tell you this, buy you deserve to know the truth, there is not a damn thing any doctor can do for your father now. The damage to his brain is done (brain cells have died), and dead brain cells, like people, not regenerate. You need to focus on rehabilitative care, and prevention of another stroke. Your father may have trouble speaking, or swallowing. You must give up all hope for a better past, and focus on your father's future needs which means new doctor(s) and rehab care.

[quellie]

Thank you. It was a nurse practitioner or doc assistant at the hospital. He dies not have severe damage he can speak / move etc. but there is damage. I am concerned they have not done any other tests to see if there us a clot and what else can be going on. We are already consulting lawyers over them giving him covid and pressure sores etc. no one has taken the case yet.

[quellie]

Yes I am concerned they are not doing proper treatment to prevent a worse stroke. These tests need to be done to do that. I agree it was a lie, but an easy one to figure out so the question is why. I can see in the records they waited 15 hrs to do the ct scan and his facial droop started after that. So I think the stroke was ongoing not old.

[Erich_Hartmann]

After a CAT scan at a local hospital, I was told by a quack doctor that I had a brain tumor, but there was no neurosurgeon on duty, so I was sent to a real hospital. The neurologist there said, "You don't have a brain tumor, you had a stroke."  Do you know if your father had an ischemic or hemorrhagic stroke? The full extent of the damage done to his brain may not manifest for months. Contrary to popular belief, cognitive function declines with time after a stroke. Watch this  4-min. YouTube video, D. Levine, MD et al., "Trajectory of Cognitive Decline After Incident Stroke," available at https://www.youtube.com/watch?v=tn6Nwpuf2TI

[quellie]

Thanks. They keep saying on the notes it is either tiaa/ ischemic or a sub hemmorage- re I think meaning from another cause. Still no further tests to see what it is if there is a clot etc. his afib and chf would cause ischemic stroke.  I will watch that video and report more as they tell us more. He is in a supposed stroke center hospital but this is the treatment he is getting.  A drug test and no ct scan for 15 hours. He is still taking etc. but having other issues, no food or fluid now due to possible aspiration last night. Some of the brain damage was caused from covid I believe but the stroke has made things worse and his face still has mild droop. So sorry that happened to you. That is terrible. How much damage did you have, was it all after the initial stroke?  and have you recovered?

[quellie]

Here is what the note says: Ischemic stroke/TIA or non traumatic intracerebral
hemorrhage/subarachnoid hemorrhage?: Yes,

[Erich_Hartmann]

   A Transient Ischemic Attack (TIA) is a temporary condition where the brain is deprived of oxygenated blood. TIAs only last a few minutes--not enough to cause permanent damage. You say that your father cannot have an MRI because of old leads in his pacemaker. I'm sorry to hear that, because a CAT scan doesn't provide the detail that an MRI can. I find it hard to believe that, at this point, your father's doctors still don't know whether it was a TIA, or a full-blown stroke--perhaps because they cannot perform an MRI exam.
   There are two different types of strokes: (1) Ischemic, which is caused by blockage--usually a blood clot (thrombotic), and (2) Hemorrhagic, which is caused by bleeding--usually a blood vessel bursting.
   There is a growing and substantial body of evidence that COVID-19 is not a lung disease,  per se, but a CLOTTING disease.
   I had COVID_19 after my stroke--which caused further cognitive decline due to mirco-clots in my brain too small to detect on an MRI, and major blood clots in my left leg requiring two surgeries and a 5-day hospital stay. As for me, physically, I'm doing very well, and fortunate to still be alive, but my IQ has dropped about 50 points!, and I could no longer handle my high level and fast paced job as an engineer. I'm also suffering from extreme irritability and anxiety--which are both very common ailments after a stroke.

[quellie]

I am very sorry that all happened to you, so terrible. That is good you survived covid. Yes i am aware of it being a clotting disease, if my father had not been on warfarin I don’t think he would have survived. I had it too at the beginning with double pneumonia and it attacked my lungs mostly, I still have pain and fatigue, worse asthma and hair loss. I was on eliquis so that helped me I am sure.

That is  terrible you have lost so much iq and can no longer do your job. My father was a scientist and I am worried he will never be the same since covid and now this. So sorry you are having so much anxiety etc. He is having that too. They have just put him on depakote, have they given you any meds for it? I don't know if this will help but it says it can repair stroke damage.

I am aware of the different strokes etc. but I assume he had an ischemic stroke but no one has said. Bleeding should show up on ct scan. But they seemed to be saying bleeding could also be another cause. I think now he was having tia as well due to covid maybe.

[Erich_Hartmann]

IMHO Eliquis the better choice, as Warfarin often causes bleeding that you can actually see on peoples arms, and your father's doctors still don't know if his stroke was ischemic or hemorrhagic. I will look into Depakote. Thanks!

[quellie]

I wish they could do mri but there is no way to do it apparently. It is too dangerous to replace the leads. But I think the other ct scans can show something. How long has it been since your stroke?

[Erich_Hartmann]

I had a right brain stroke in Oct 2018, at the age of 49, due an unknown congenital defect in my heart.

[quellie]

I talked to the neuro in charge yesterday. She was rude to me when I asked questions. Anyway she said it is an embolism from the heart so ischemic. Due to her  attitude I did not even bother to ask what she was basing this on with only one CAT scan that was done 15 hours after he entered the ER. So my brother talked to her later and she said they would repeat ct. ct was done today and showed it is reducing with no midline shift or bleeding which is good. I called PA but have not spoken with them yet because someone told my brother he is getting released today. He continually screams for us to get him out of the hospital every time he is there but she started doing at 7:30 AM. We want him to go to rehab this time I don’t know how we’re going to manage it because they never declare him temp incompetent etc. I think this is his last hope to get some physical therapy and help with everything that he has undergone since Covid and now this so I hope we can convince him. Well it turns out they’re not releasing him tomorrow which I thought would be pure insanity since he’s not even on a normal diet yet. He seemed a lot better after the first day with Depakote but today just seemed worse again in terms of his mood and everything.  I hope that helps you or another med. My father was on carbolevadopa 2 to 3 weeks before this. I read that can also help people who have had a stroke. I stopped it due to possible bladder spasms. That is very young to have a stroke, a friend also had one from a pn undiagnosed irregular heart rhythm. But he is in his 90’s. I hope you will recover more and feel better over time.

[quellie]

Did you have a lot of rehab afterwards and did it help you?

[quellie]

Yes eliquis is better. His hematocrit is dropping so they are testing it more. But he has had some chronic anemia due to crf.

[Erich_Hartmann]

No, I didn't have any rehab at all (so rehab didn't help, but I did have trouble swallowing for about a month). I just soldiered through it. I wasn't given any mental or cognitive testing beyond what a police officer might give for a roadside sobriety test until over two years later. For over two years (with 5 months medical leave) I mentally struggled in my job as an engineer. When I started seeing a neuropsychiatrist due to extreme irritability,  she ordered a "Neuropsychological Evaluation," which is a battery of mental tests--in my case , it was 17 mental tests over the course of two days. They confirmed what was already known, i.e., that I have Mild Neurocognitive Disorder (what used to be called Dementia)  due to Stroke. The dividing line between Mild and Major Neur0cognitive Disorder is the ability to care for oneself. I did lose some hearing, too, but the doctor's only say, "Hmm, that's interesting," when I tell them that music isn't as rich and "colorful" as it used to be. (It's as if I went from an expensive, digital stereo system to an old mono-speaker transistor radio with bad reception.) But hey, it could be worse--I could be dead.

[quellie]

Wow. I am gladyou got some treatment eventually. Things have been crazy so I have not replied. My dad  went crazy at home twice self harming etc. and he is back in hospital. We took him out of rehab after a few hours because he was screaming to get out, they had a covid exposure and they were terrible. He pulled out his catheter and was having delerium so we had to call ambulance  to get him there. He is suicidal.  Now he is going crazy agin in hospital. They took him off all his normal anxiety meds and depakote and he is on resperidal now and halperidol. He was restrained in er for 24 hrs. He also became aggressive throwing things, trying to bite us etc.

[Erich_Hartmann]

Sounds like your father's brain damage is pretty bad. I'm sorry to hear that! I'd tell you to do your own research, but you're already doing that. Doctors , although they may think so, aren't gods. According to a study published in 2016 by John Hopkins School of Medicine, the third leading cause of death (>250,000/year) in America is medical errors: https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us

[quellie]

Thanks. Yes agree, and I know all about medical errors mp etc. we have experienced that in my family. My dad  again was treated with gross negligence left in r d while I screamed for help. Next day he said he felt better and was waking up but his  breathing was still bad, a horrible nurse came and hit his back etc. His heart stopped 5 minutes later. I rescinded dnr and they revived him. But he is on ls now in icu. I was screaming at them the whole time because basicakly they murdered him. Now they are already oressuring to remove from ls. At least one doc was. He had aspirated and food was in the airway at intubation. I don’t know if he will survive this, I am in shock.  He may have had another stroke too. His lung looked better day two on xray. He was able to understand us and shake his head blink the first night to tell me he does not want to be resus if his heart stops again but he wants to live if he can be weaned off ls. He is sedated now with propofol but they said he may still hear us and moves his arms etc. they increased sedation a bit so he does not move his legs and arms too much.