Dr Hive... Any help? update post #15

[anneinco]

My sister and I are reaching out for ideas... I am heading down Friday.

 

My dad is currently on day 4 in the hospital. Entered Sunday evening. She talked to him Friday and he said he had the flu since Tues or Wed. She went to check on him. Fever was 101.9, not able to walk, excruciating pain in bad knee. Saturday he seemed better but still not willing to walk. At some point he tried to use a walker (not a normal tool for him) and fell twice, according to my dad.

 

Sunday she got a call from him and something was off. (This is the first I heard something was wrong) She went over, he was acting delirious and seeing things. At this point it was decided to take him to the ER. He was sweating/short of breath. temp was 102.8 At hospital HR was 108.

 

Seen and admitted to Cardiac Care Unit where he stayed until Tuesday night when he was transferred to general. HR under control now by meds.

 

Speech has been like he has a swollen tongue (normal for about 15 mins Monday)

 

Tuesday seemed better with the delirium, but worse today (however he is on morphine due to lots of pain in knees) unbearable pain Wednesday when PT tried to sit him up.

 

Pain in both arms, using left hand to eat/write and he is right hand dominate

 

asking for a neuroconsult

 

What we are being told:

 

He was septic upon arrival and very dehydrated.

do not believe a stroke

Bacteria in blood

test for UTI negative

Catscan of abdomen clear

X-ray of chest clear

ultrasound through esophagus looking at heart valve showed no infection

Catscan of head clear (mixed messages on this. trying to get another opinion)

X-rays of legs/arms taken, and they are clear.

 

Any idea where to go from here? What questions to ask and tests to ask for? Sister is being told that they are proceeding day to day. He has been off his feet for about a week now, and was weak to begin. Most likely will be in rehab center once he is cleared from hospital.

 

She is finding they are seeing him as a 'frail elderly man' and are absolutely shocked he lived by himself up until this and had driven cross county 3x in the past 6 months.

 

*****************

POA question...

 

Adding this on here because I think the above is possibly helpful. We have no clue if he has power of attorney financially or medically. He has said in the past he does not trust either of us due to the fact he does not like how we 'handled' treatment at the end of my mom's life 4 years ago. We sided with him on treatment however voiced concerns (she was terminal and we questioned prolonging).

 

My sister is dead set against even discussing this right now, and I think it is necessary, especially financial POA just in case. My aunt (his sister) is out of the country for a few more days and I am hoping she knows whether he has a POA written up. She knows nothing yet.

 

I don't know if I can call his lawyer (assuming i can find out who he is) and ask if there is even one filed? I think my dad will take it the wrong way but I am not sure he is in condition to even question... My biggest fear is if there is not one and something goes wrong, is the time and money to fight it in court to get access to his money to pay bills/help him.

 

What else do I need to worry about when I am down there?

Edited September 19, 2016 by anneinco

[trulycrabby]

I am sorry your dad is so sick, but is sounds like he is getting good care in the hospital.

 

Sepsis can turn a vigorous senior into frail elderly overnight, and can temporarily change their cognitive ability too.

 

The good news is that treatment and physical therapy can help him return to health and activity within a reasonable amount of time.

 

I am not sure that now is the time to ask about power of attorney as he is likely in no shape to make a rational decision; I am sure someone with more experience in this matter can lend some advice.

 

I hope he gets better very soon! :grouphug:

[Melissa in Australia]

Hugs

[magnificent_baby]

Some random medical thoughts:

 

My first thought is a septic joint with the painful knees. Have they checked for that? It would require a joint aspiration. 

 

Does he have gout? Could be having an attack due to the dehydration and causing the knee pain. (Needs uric acid level checked).

 

Has he had a spinal tap to check for bacteria causing meningitis? 

 

Tested for west nile virus? (flu like and neuro symptoms/encephalitis)

 

Have they actually tested for the flu?

 

If he's stable, an MRI of the brain may be a reasonable next step if the CT wasn't clearly evident. 

 

I hope they will repeat the chest xray in case the pneumonia wasn't showing up on the first one yet. Sometimes it can take a bit to be evident. 

 

On the POA issue, since you are right there you will be able to make medical decisions since you are next of kin, should be become unable to answer for himself during this hospitalization. You should talk with the social worker there, they can guide you through the steps to get the ball rolling on the rest, or be able to help you find out if this has already been done. Perhaps he will open up to her about this issue, if he doesn't want to discuss it with his daughters. 

[anneinco]

I am sorry your dad is so sick, but is sounds like he is getting good care in the hospital.

 

Sepsis can turn a vigorous senior into frail elderly overnight, and can temporarily change their cognitive ability too.

 

The good news is that treatment and physical therapy can help him return to health and activity within a reasonable amount of time.

 

I am not sure that now is the time to ask about power of attorney as he is likely in no shape to make a rational decision; I am sure someone with more experience in this matter can lend some advice.

 

I hope he gets better very soon! :grouphug:

 

 Thank you for your reply... 

 

Can sepsis cause the extreme pain he seems to be having (legs) and the pain in his arms?  

 

Not planning on asking him about POA at this time, but if I can track something down I can at least put my mind at ease.  I honestly don't care whose name is on it (unless its only my moms because she passed away 4 years ago)  I just want to make sure someone has permission to handle finances if needed.  I don't even care about health care proxy because I know we can speak for him now if he is unable.  

[J-rap]

I'm sorry, I don't really have answers but my father went through something similar last winter.  He went from feeling mildly sick/flu-like to being completely incoherent and unable to stand up the next day, taken by ambulance to the ER where we weren't sure if he'd survive.  In his case, they discovered pneumonia and dehydration and a partially collapsed lung, which then turned into heart failure.  We couldn't believe how quickly it happened.

 

Once they got things under control, and because he had been in very good health for an 88-year-old, things slowly turned around.  However, my brother -- who is a doctor, flew in from another part of the state to offer insight;  he caught things that the staff there were not catching.  It was very scary.  So don't be afraid to step in and assert yourself if necessary.  If the brain CT scan wasn't clear, hopefully they'll do an MRI.

 

My father is healthy again and back in his home, thankfully.  The toughest part has been regaining his balance and muscle tone after that.  It really knocked him down for awhile.  He continues to see a physical therapist and goes to LA Fitness almost every day.  He is slowly getting better!  It's been about half a year now.

 

One thought about the POA is that sometimes hospitals have POA forms right there that you could look over with your father, if he is cognitively aware.  You could always ask a social worker to be the one to bring it up.  On some POA forms, I believe you (meaning your father) have the right to check what you're comfortable with signing over to someone.  So, that might help him feel better about it as well.

 

I hope everything goes well for him!  

 

 

[anneinco]

Some random medical thoughts:

 

My first thought is a septic joint with the painful knees. Have they checked for that? It would require a joint aspiration. 

 

Does he have gout? Could be having an attack due to the dehydration and causing the knee pain. (Needs uric acid level checked).

 

Has he had a spinal tap to check for bacteria causing meningitis? 

 

Tested for west nile virus? (flu like and neuro symptoms/encephalitis)

 

Have they actually tested for the flu?

 

If he's stable, an MRI of the brain may be a reasonable next step if the CT wasn't clearly evident. 

 

I hope they will repeat the chest xray in case the pneumonia wasn't showing up on the first one yet. Sometimes it can take a bit to be evident. 

 

On the POA issue, since you are right there you will be able to make medical decisions since you are next of kin, should be become unable to answer for himself during this hospitalization. You should talk with the social worker there, they can guide you through the steps to get the ball rolling on the rest, or be able to help you find out if this has already been done. Perhaps he will open up to her about this issue, if he doesn't want to discuss it with his daughters. 

 

I will keep these with me and discuss with my sister.  I want to say they ruled out septic joint, however, the procedure you mentioned does not ring a bell.   Not sure about gout but he was never forthcoming about his medical history.  

 

Not worried about medical POA just financial.  Just in case something goes wrong.  I don't want to fight with the courts and go through that battle.  There is a very decent change there is already a POA if he has a decent lawyer, just need to make sure its current (mom died 4 years ago).  Good point about social worker.  He is the last person I want to burden its questions right now... stress-wise and not sure he could handle it mentally right now anyways.  

 

If nothing else, this is giving me a good life lesson reminder to get affairs in order no matter what age.

[TechWife]

 

On the POA issue, since you are right there you will be able to make medical decisions since you are next of kin, should be become unable to answer for himself during this hospitalization. You should talk with the social worker there, they can guide you through the steps to get the ball rolling on the rest, or be able to help you find out if this has already been done. Perhaps he will open up to her about this issue, if he doesn't want to discuss it with his daughters. 

 

This is exactly what I was going to say! 

 

I am a fairly new Financial POA for both of my parents. These are the things I could not do without it: 

sign checks

talk to the cable company (seriously!)

put his pension check on auto deposit

talk to AT&T (another really weird one - I actually have to present the POA papers in person)

hire anyone to perform routine maintenance on their house (it needs a new roof, owners have to sign papers)

talk to Medicare or the VA

 

If it hadn't been for being able to set up auto-draft online for their utilities, their bills would have gone unpaid for several months while we got things lined up with the lawyer. 

 

In addition, without POA, you will not be able to buy or sell any property, including real estate, automobiles, boats, etc. - this could become an issue if he goes to a nursing home. 

 

Also have the social worker talk to him about an Advance Directive for Healthcare. It is an opportunity for him to state what types of interventions he wants through answering a series of questions. It then has a space to say that if he is incapacitated, who he wants to make decisions about his care on his behalf. 

 

When he recovers, connect him with an attorney that specializes in elder issues. We did this for my parents and the attorney has been worth his weight in gold! It's been a really good experience and his office is doing quite a lot to help us make sure that their affairs are in order and to help us change their living situation a bit. The attorney's fee isn't cheap, but he has saved a lot of money and anguish. 

 

Feel free to PM me if you want to ask any specific questions about how it's working out. 

 

ETA: I listed all of those things I couldn't do to make a point, then I forgot to make it! When my parents realized the sum of all of the things that were going on that they could no longer take care of, they were more than willing to sign the POA's. Sometimes the practicalities just have to hit home and having the social worker talk to him about what could happen might be helpful. 

Edited September 15, 2016 by TechWife

[anneinco]

I'm sorry, I don't really have answers but my father went through something similar last winter.  He went from feeling mildly sick/flu-like to being completely incoherent and unable to stand up the next day, taken by ambulance to the ER where we weren't sure if he'd survive.  In his case, they discovered pneumonia and dehydration and a partially collapsed lung, which then turned into heart failure.  We couldn't believe how quickly it happened.

 

Once they got things under control, and because he had been in very good health for an 88-year-old, things slowly turned around.  However, my brother -- who is a doctor, flew in from another part of the state to offer insight;  he caught things that the staff there were not catching.  It was very scary.  So don't be afraid to step in and assert yourself if necessary.  If the brain CT scan wasn't clear, hopefully they'll do an MRI.

 

My father is healthy again and back in his home, thankfully.  The toughest part has been regaining his balance and muscle tone after that.  It really knocked him down for awhile.  He continues to see a physical therapist and goes to LA Fitness almost every day.  He is slowly getting better!  It's been about half a year now.

 

One thought about the POA is that sometimes hospitals have POA forms right there that you could look over with your father, if he is cognitively aware.  You could always ask a social worker to be the one to bring it up.  On some POA forms, I believe you (meaning your father) have the right to check what you're comfortable with signing over to someone.  So, that might help him feel better about it as well.

 

I hope everything goes well for him!  

 

Can I ask how long he was down for?  Til he was healthy, and then balance/muscle tone?

 

I know everyone will be different but I am expecting a long recovery especially due to issues with knee and muscle tone in one leg to start with.  He is already well aware of this, which I think is the first step.  He told my sister that he was told it would only take a week off his feet to knock him out and we are starting on week two and he can't even sit up due to pain.

 

I have a double whammy in that I also care for my MIL full time.  She will be in respite while I am down there for a few days so now I am trying to figure out financially how I am going to balance this if I need to be going back and forth.  We are self employed with an employee and trying to at least not have to put that on hold if at all possible. 

[trulycrabby]

Thank you for your reply...

 

Can sepsis cause the extreme pain he seems to be having (legs) and the pain in his arms?

 

Not planning on asking him about POA at this time, but if I can track something down I can at least put my mind at ease. I honestly don't care whose name is on it (unless its only my moms because she passed away 4 years ago) I just want to make sure someone has permission to handle finances if needed. I don't even care about health care proxy because I know we can speak for him now if he is unable.

Yes! Absolutely! Sepsis, by definition, is infection spreading in the bloodstream, and it can go anywhere in the body and cause pain. Fever also causes body aches, and if he has any arthritis, the aches are magnified. My knees always hurt when I have a fever. If they can get the fever down, then his pain might also go down. Edited September 15, 2016 by trulycrabby

[anneinco]

This is exactly what I was going to say! 

 

I am a fairly new Financial POA for both of my parents. These are the things I could not do without it: 

sign checks

talk to the cable company (seriously!)

put his pension check on auto deposit

talk to AT&T (another really weird one - I actually have to present the POA papers in person)

hire anyone to perform routine maintenance on their house (it needs a new roof, owners have to sign papers)

talk to Medicare or the VA

 

If it hadn't been for being able to set up auto-draft online for their utilities, their bills would have gone unpaid for several months while we got things lined up with the lawyer. 

 

In addition, without POA, you will not be able to buy or sell any property, including real estate, automobiles, boats, etc. - this could become an issue if he goes to a nursing home. 

 

Also have the social worker talk to him about an Advance Directive for Healthcare. It is an opportunity for him to state what types of interventions he wants through answering a series of questions. It then has a space to say that if he is incapacitated, who he wants to make decisions about his care on his behalf. 

 

When he recovers, connect him with an attorney that specializes in elder issues. We did this for my parents and the attorney has been worth his weight in gold! It's been a really good experience and his office is doing quite a lot to help us make sure that their affairs are in order and to help us change their living situation a bit. The attorney's fee isn't cheap, but he has saved a lot of money and anguish. 

 

Feel free to PM me if you want to ask any specific questions about how it's working out. 

 

ETA: I listed all of those things I couldn't do to make a point, then I forgot to make it! When my parents realized the sum of all of the things that were going on that they could no longer take care of, they were more than willing to sign the POA's. Sometimes the practicalities just have to hit home and having the social worker talk to him about what could happen might be helpful. 

 

This is why I am slightly panicked if he doesn't have one....  I have one for my MIL so I know how valuable it is.  I also know that currently we are in no position to get on drawn up.  

 

However, he is a smart guy, has a trust set up, so my fingers are crossed that between him and the attorney, there is one... My sister does not understand the importance, and is too stressed from trying to make sure he is taken care of in the hospital to take time to understand it.   From what I hear, if needed and he was incapable of making the decision (health wise not because he didn't want it done), we would have to go to court and who knows how long or how much $$ that would take.

[anneinco]

Yes! Absolutely! Sepsis, by definition, is infection spreading in the bloodstream, and it can go anywhere in the body and cause pain. Fever also causes body aches, and if he has any arthritis, the aches are magnified. My knees always hurt when I have a fever. If they can get the fever down, then his pain might also go down.

 

This is actually encouraging...  Not that I want him in pain but hopeful that it is due to the sepsis, not an injury to one of the falls (mainly concerned here with right arm).  

[J-rap]

Can I ask how long he was down for?  Til he was healthy, and then balance/muscle tone?

 

I know everyone will be different but I am expecting a long recovery especially due to issues with knee and muscle tone in one leg to start with.  He is already well aware of this, which I think is the first step.  He told my sister that he was told it would only take a week off his feet to knock him out and we are starting on week two and he can't even sit up due to pain.

 

I have a double whammy in that I also care for my MIL full time.  She will be in respite while I am down there for a few days so now I am trying to figure out financially how I am going to balance this if I need to be going back and forth.  We are self employed with an employee and trying to at least not have to put that on hold if at all possible. 

 

I can't remember the time frame exactly.  But, he was able to go home in about a week, and my mother is doing well enough that she could assist him so the two of them could be on their own at home.  He used a walker for maybe a month, and then a cane, and then just a cane at night.  I think he still uses a cane at night.  I think he was driving again in about a month, and probably back to doing most things he was doing in about three months.  He worked hard at walking.  He started by just walking up and down the hall every day, and then 25 yards at a stretch, then 50, then 100.  Now he and my mother try and walk about a mile daily.  His balance still is not perfect, but he does okay.  He is definitely building up his muscle tone again.  He is determined.  I especially have seen improvement after he began both meeting with a physical therapist regularly and doing some exercises at LA Fitness regularly.  (We got him the gym membership for a Father's Day present.)  A couple months ago, he couldn't walk 1/4 mile without hurting all over.  Now he can walk almost a mile, slowly of course. I can see that near the end of his walk, it's not easy, and he is limping.  But he continues to feel stronger.  He is back to leading tours at a metropolitan museum and delivering meals on wheels to the elderly!  :)

[anneinco]

I can't remember the time frame exactly. But, he was able to go home in about a week, and my mother is doing well enough that she could assist him so the two of them could be on their own at home. He used a walker for maybe a month, and then a cane, and then just a cane at night. I think he still uses a cane at night. I think he was driving again in about a month, and probably back to doing most things he was doing in about three months. He worked hard at walking. He started by just walking up and down the hall every day, and then 25 yards at a stretch, then 50, then 100. Now he and my mother try and walk about a mile daily. His balance still is not perfect, but he does okay. He is definitely building up his muscle tone again. He is determined. I especially have seen improvement after he began both meeting with a physical therapist regularly and doing some exercises at LA Fitness regularly. (We got him the gym membership for a Father's Day present.) A couple months ago, he couldn't walk 1/4 mile without hurting all over. Now he can walk almost a mile, slowly of course. I can see that near the end of his walk, it's not easy, and he is limping. But he continues to feel stronger. He is back to leading tours at a metropolitan museum and delivering meals on wheels to the elderly! :)

Thank you.

 

My sister got the discharge call today. She told me early that based on blood draw on 9/12 the infection is clear, but IV antibiotics will continue for two weeks. My sister was the joints addressed and the slurring before we leave so hoping to get a neuro consult for a MRI of head, and a test done on knee to see if there is liquid...

 

Discharge will not be to home. Can't remember what she said but high level rehab center.

[anneinco]

Okay... Any more ideas?

 

Waiting on spinal tap cultures, we are almost 48 hrs into that and I was told it could take up to 72 hrs. Testing for a crap load of things. Preliminary showed elevated white blood cells. MRI showed inflammation around ventricles. They are already treating with 4 major antibiotics for almost 36 hrs and not seeing much improvement. Hoping cultures show something that we can pinpoint and treat.

 

Fluid pulled from knee last night. Infection was present, but not at level they would expect. We are waiting to find out whether it's gout or something that can be drained. Looking at my sister's notes she has 50-100K = infection or gout, he is at 40K

 

MRI with contrast was not possible, double dose of Ativan and he was messed up and unable to lie still. Going to see what the next move is.

 

Still some hallucinations, speech still slurred, but when not foggy appears to be cognitive and aware, but still not right. Pain is a lot better. Still has not gotten out of bed.

 

Doctors starting to say this might not be reversible but it's good that we are seeing it wax and wane, and I am assuming the fact we see inflammation on MRI is a sign something is still wrong and causing the issues we are seeing.

 

Edit to add now that I have talked to nurse. White blood count increased from 11 to 15 over two days. Depending on what we find with the knee and spinal tap, wondering if next screening should be cancer?

Edited September 19, 2016 by anneinco

[J-rap]

Okay... Any more ideas?

 

Waiting on spinal tap cultures, we are almost 48 hrs into that and I was told it could take up to 72 hrs. Testing for a crap load of things. Preliminary showed elevated white blood cells. MRI showed inflammation around ventricles. They are already treating with 4 major antibiotics for almost 36 hrs and not seeing much improvement. Hoping cultures show something that we can pinpoint and treat.

 

Fluid pulled from knee last night. Infection was present, but not at level they would expect. We are waiting to find out whether it's gout or something that can be drained. Looking at my sister's notes she has 50-100K = infection or gout, he is at 40K

 

MRI with contrast was not possible, double dose of Ativan and he was messed up and unable to lie still. Going to see what the next move is.

 

Still some hallucinations, speech still slurred, but when not foggy appears to be cognitive and aware, but still not right. Pain is a lot better. Still has not gotten out of bed.

 

Doctors starting to say this might not be reversible but it's good that we are seeing it wax and wane, and I am assuming the fact we see inflammation on MRI is a sign something is still wrong and causing the issues we are seeing.

 

I have no ideas for you, but I'm very sorry this is ongoing.  Still, he is hanging in there and that's a good sign!  I'm glad his pain is better.  Please keep us posted.  Hoping for the best!

[anneinco]

I have no ideas for you, but I'm very sorry this is ongoing. Still, he is hanging in there and that's a good sign! I'm glad his pain is better. Please keep us posted. Hoping for the best!

Thank you! Just hoping that maybe someone suggests something that hasn't been tried yet. Really worried about permanent damage.

[StephanieZ]

I'm so sorry you are going through this!
 

So far as POAs, I think you are out of luck there until/unless your dad has a change of heart and his health stabilizes.

 

You can call his lawyer, but I doubt he'll be very helpful. 

 

Since you know your dad didn't trust you our your sister with a health care POA, then I doubt one exists. If it does exist, and he chose to withhold it from you, then that's his right, too. I know my mom executed durable financial POAs many years before handing them over to my brother and I. If you can help keep his bills paid while he's in the hospital, that'd be nice, but it's not the end of the world to leave it alone for a few weeks.

 

FWIW, as morbid as this is, I realized long after Mom passed away that the various credit cards, etc, actually stop charging interest as of the date of death, and are totally fine with waiting months for payment. Even as the bills come in, showing interest charges, etc, once you contact them, in the end, they'll reverse all those charges/interest/etc as of the date of death. I had no idea about all that, and I tried to pay all of Mom's bills in full within a few weeks of her death as we had set cash aside for that, but there was one bill that got screwed up (e-bill/auto-pay from an account of Mom's/no paper statements/crazy) and anyway it was maybe 4-5 months after she died that I got it straight, and by the time they straightened it out, I owed way less, because they took off all those months of interest/fees/etc. So, anyway, I realized then that there was really no urgency to having (her) cash for me to access immediately after her death, because those bills could have waited just fine. Anyway, as soon as someone dies, their financial POA dies with them, and you lose access to funds/accounts/etc immediately after death, so if death is imminent, the POA is not very useful.

 

 

When your dad is not able to make decisions for himself, the doctors will allow you and your sister to make reasonable decisions -- as his next of kin. This only gets tricky if you are in disagreement with each other (or there are other immediate family who are in disagreement). You don't need a healthcare POA to help decision making/etc in the hospital. 

 

When your dad recovers, it might be a good time to discuss his estate documents with him. At this point, it is highly unlikely that you can get documents legally executed until/unless he recovers. 

 

(((Hugs)))