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Old 08-19-2011, 09:04 AM   #1
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Why is he so weak?

My FIL's elder son is wondering why his Dad is so weak. My FIL can now only walk about a big room's distance on the walker poorly and then gets very tired. He has heart failure. He also has a very very slow time to sit down. At first he wants to find the chair behind him. But I think he also has trouble sitting down.

Deb, you said your Mom cannot sit. I don't understand how she cannot sit? Could you please explain? If she cannot sit, how can she be in a seated position??? Does she need help to sit, is this what you mean?

Is it because of the weak muscle resulting from the decline of AD?

Also the UTI may be from the bladder retention issue. Is it possible also due to the incontinence? He now also pees overnight on the bed with the disposable lining.

Thanks for any advice,
Nina

Last edited by ninamarc; 08-19-2011 at 09:04 AM.

 
Old 08-19-2011, 11:51 PM   #2
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Re: Why is he so weak?

Your FIL has heart failure and advanced Alzheimer's. That explains the weakness. Heart failure itself will cause the weakness. His heart is probably not functioning adequately to supply him with the blood flow that he needs. This saps him of his energy. Dad has heart failure. He slept more and more and became weaker and weaker. A short walk to the bathroom would exhaust him and he would have to rest on the toilet a while before he could walk back to bed. Then you have the Alzheimer's . The brain is not functioning properly. It is not telling the muscles how to function effectively. This could cause him to use a lot more energy for him to walk. It would also make him slow down. All this will effect how well he can stand from a seated position, walk, and then reseat himself. Also, with Alzheimer's they don't know where the chair is and are hesitant to sit because they don't want to fall. This can cause them to be hesitant to sit or resistant to sitting.

My comment that Mom couldn't sit down was not due to anything physical. She is a chronic wanderer. She is always on the go. If she wants to sit she can physically sit down... she just doesn't want to!!! She will resist sitting by stiffening but I think this is just a function of her desire to go go go go go!! So yes she needs encouragement and even physical help to get her to sit down. Not because she physically can't but again because that is not what she wants to do.

The UTI is because a bacteria has invaded the urinary tract. It is hard to say exactly what it is from but it is not unusual for incontinent residents to have UTIs. They are usually due to the e-coli bacteria that is found in feces and from improper hygiene. They do need to be changed and cleaned frequently, and as soon as possible about a bowel movement.

It can also be a function of dehydration. If there is not enough fluid to flush the urinary system then the bacteria have a better opportunity to grow. Bladder retention with proper hygiene and enough fluid should not be a huge problem. You might want the facility to start giving him cranberry juice on a regular basis. It has properties that flush the urinary system of the bacteria better than just water and it is thought that cranberry juice actually has antibacterial properties as well.

Love, deb

 
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Old 08-20-2011, 08:10 AM   #3
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Re: Why is he so weak?

The home always has cranbeery juice in the fridge in the afternoons. The afternoon snack usually has cranberry juice. That one is pretty good and does not get stuck in the throat. Also the pureed food seems to have lots of fluid too so he ends up with more urines.

I kind of think what you said is true. Someone else in the internet also said the elder sometimes has trouble with the depth of perception for the chair behind him and even his feet before him when he gets up. The co-ordination is not working. So it takes forever to get him out of the home - in fact he has not been outside of the home since May 2 (except for the ER trip in May.) He needs the wheelchair to transport him.

Nina

 
Old 08-20-2011, 12:09 PM   #4
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Re: Why is he so weak?

Well, things just changed! My FIL's prostate issue is back!! He had to be catherized to pee last night at 11pm for a short time! He is combative today as he is axious about this thing. He never likes to be catherized to pee and all that.

So it is not his weakness and he actually gets along with the one on one caregiver (she cooked the omelet with him in the activity room - there is an oven and stove.)

Now the story has changed! It is a big change. The nurse said well my FIL needs to have another pill for anxiety. The doctor will see him Thursday. They will check his urine again for UTI.

Well, he won't go through any procedure again! Last May, he went through the local microwave therapy to shrink it. Apparently it is back!

Nina

Last edited by ninamarc; 08-20-2011 at 12:44 PM.

 
Old 08-20-2011, 06:08 PM   #5
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Re: Why is he so weak?

Nina... I am sorry to hear that this is happening with your FIL. Please take this in the way it is meant. They say your FIL's prostate problems are back. The procedure they used to correct it before only worked for a short period of time. Then they catherized him last night and he got upset. So they want to give him more medication for anxiety. The medication is eliminated via the liver and kidneys. That distresses the urinary system. Around and around and around we go and FIL becomes more anxious and more anxious and there is more medication and more medication and more complications. Not to mention the potential for infections caused by the catherizations especially since his body is not effective at fighting off infections.

This weakness problem is not a result of the urinary tract problems that have developed in the last few days. You yourself said it started back in May. So the urinary tract problems are more than likely just a continuation of the the problem and not the cause. At some point you just need to let him be. Manage the pain and let him be. This is why I suggested Hospice. We want our loved ones to live comfortably and with contentment. When that is no longer possible it is time to reconsider the medical interventions that we chose. The guidance I received from Hospice with Dad to make him comfortable and content was wonderful... and the same is now true with Mom. There comes a point when less is better.....

I do hope he will find comfort and contentment again...

Love, deb

 
Old 08-21-2011, 08:08 AM   #6
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Re: Why is he so weak?

You are talking about the worst scenario, Deb. I understand the potential problem and the future...

Fortuantely my FIL started this issue slowly and he is not on catheter now. They take out his urine once in a while. In the ER in May, they did it too.
He can still enjoy activites later on.

Some families don't like hospice thinking it is to kill the patient. It is the old school thought. My FIL does not want to be killed and he wants to be treated. He did this in 2009 thinking we wanted to kill him by sending him to the hospital ward to stay overnight for heart observation for medication! He said he forgave us and etc. He knows the animals can be put down and all that. Later on he said he wanted to die. He was confused with this "information".
I do know that hospice is not to kill but is to give people comfort. At times, people dying don't need food or water.
I still think starvation is horrible, but if they need comfort care, they should have it. My late MIL had hospice because of cancer, she died soon because she came to the hospice after 2 surgeries - kind of too late for that. She was there for a week.

Probably next year or so, he will be worse. He can get used to the catheter after a while also. He does not get UTI very easily. Last year he only got UTI once when he pulled it out by force at night and had to go to the ER to put it back. Not that he won't have UTI or what.

The medications surely will not be good for him and will be toxic. For now, the meds are helping him to have comfort. My FIL does want comfort care in his living will.

We will do it one step at a time but I am realistic. This home does not offer feeding tubes and serious nursing stuff, but it offers catheter and oxygen. They can handle immobile residents.
Sure hope he can stay in this home without being told to leave due to the "violence".

Nina

Last edited by ninamarc; 08-21-2011 at 08:15 AM.

 
Old 08-21-2011, 09:19 AM   #7
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Re: Why is he so weak?

I'm sorry Nina but Hospice is not killing or starving anybody. My mother is on Hospice. My mother is ambulatory and she eats. They are working with her to maintain her weight. They are actually supplying the Ensure dietary supplement for her. We discussed Friday, a Speech Therapist to evaluate her eating to find ways to improve her intake. Not once have they suggested not feeding Mom. They are working with me to find the best possible solutions for Mom's care without invasive treatments. That old school thought that Hospice is for starving and dying just is not true.

Hospice becomes involved when the patient has a terminal disease with little or no hope of recovery. Alzheimer's, from the moment of diagnosis is just such a diagnosis. As I have said before, Hospice does treat the patient. They just use a different basis for treatment. They do not treat for longevity but for the comfort of the patient. Yes, it takes an acceptance that a loved one has a terminal disease that is not going to improve to call Hospice but they can help the loved one live until they dye which is not the same as killing or starving.

As for the starving. At the end of life when a patient is not able to eat or drink, you are not starving them. It is their disease that has taken away the ability for them to take in nourishment. Other changes take place that feeding may not help at all. There are concerns with aspiration. Aspiration pneumonia is painful and difficult to treat. It is all part of the process of dying. You have said the facility would not use feeding tubes. If a patient is incapable of eating then there are no other options but to let their disease take it's natural course or to use feeding tubes. If you do not use the feeding tubes then the disease will take it's natural course.... and that is not starving a person.

IT doesn't matter to me if you use Hospice or not. I just have a problem with words like killing and starving being used when referring to Hospice. This is not what they are about. It is an erroneous idea and harmful to their basic cause. It is why people are scared to accept the wonderful help that they provide. Yep, my Mom is ambulatory, she still expresses herself even though she does have Aphasia, she is eating though she is having increasing difficulties, and she is on Hospice. What I get is a doctor, a case manager, a nurse, a caregiver is needed, volunteers, and a social worker to watch over Mom. I will say that since I called Hospice she has received better medical care than she did before. Their efforts have actually lead to a weight increase for her rather than a weight decrease. This will allow her to live her remaining life with more comfort and quality than she would have otherwise. So I see Hospice not as killing or starvation but as helping my Mom live her best until this horrible disease takes her.

Hospice will also treat behavioral issues. I watched them work diligently with my friend and her Mom to remedy her Mom's behavioral issues while maintaining the cognition that she still had. They have also been very helpful with me and Mom's behavioral issues. They treat the entire persons... physically, emotionally, and spiritually.... to live their best with comfort until they dye of natural causes without excessive medical intervention that extends the inevitable.

Stepping down from her soap box

Love, deb

 
Old 08-21-2011, 09:41 AM   #8
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Re: Why is he so weak?

Deb, I am talking about some old fashioned people who think that.
Even my FIL did. When my late MIL went to the hospice, the nurse took off her food iv. My FIL as a doctor in Europe, was so ****** off thinking it is cruel and he called upon the nurse/doctor to put it back. She did eat once suddenly out of the blue (I think her pain was controlled by strong morphine.)
So this gave my FIL the impression that she would like to "eat" through the iv.

I have a little trouble with that issue but I know sometimes the dying person does not need water. The case with this guy who decided his "wife" does not need to live more and the judge allowed her to starve to death is not something to my favor. Why not just give her a shot and let her go quickly!!

Anyway, I am not against hospice, but my parents don't even want to write a health proxy thinking it is omen. They don't even buy life insurance thinking it is omen. They are in the 80s. My FIL wants to feed the patient as I mentioned...

So it is the old people thinking. Sometimes the society just cannot put on the families thinking this is the only way. It also has to do with religion or culture or philosophy.... The science part of the dying is not the only factor...

Hugs,
Nina

Last edited by ninamarc; 08-21-2011 at 09:45 AM.

 
Old 08-21-2011, 06:39 PM   #9
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Re: Why is he so weak?

It is fear of dying. We, as a society, do not deal with dying very well. Somehow we have this insane idea that we are immortal or can get out of this life alive. If we just feed them a little more or poke them one more time it will all be ok. If we don't buy life insurance or don't prepare for our end then it won't happen. Our medical professions is exception at keeping us alive but pretty sorry at letting us die with dignity. As my daughter put it so well.... by virtue of being human we are each dying! We have no assurance of tomorrow. An aneurism could take me before the sun comes up or I could live to be 90 with Alzheimer's. It is not my call! But it is my responsibility to accept the fact that I have a few trips around the sun and then I will be no more. To that end there are things that I need to do for those that I leave behind.... and for myself. It is not the fear of Hospice.... it is the fear of death that gives us the heebe jeebies.

My Dad was semi conscious for several days, woke up on Tuesday and ask for eggs. He went back to bed after breakfast and died Friday having nothing more to eat or drink because he was not in a physical state to eat. This happens often and it was not him asking to be tube or IV fed. He had advanced vascular dementia. His heart was failing, his liver was failing, and his kidneys were shutting down. We could have hooked up an IV and he could have laid in that bed for a few more days, maybe even weeks or months developing bed sores and lingering in pain. I did not have a problem with letting him die a natural death without intervention. Yes, we can keep them alive but can we give them quality life. Your FIL was a doctor... they prolong life. Allowing for death is not what they are trained for and I think that is a disservice to many. We will all die. That is the only sure thing about life.

I think I know the case you are speaking of. His wife was being kept alive by artificial means even though she was brain dead with no hope of recovery. If it were not for extraordinary medical intervention she would not have been alive to make such a decision. I perhaps take the other side of the argument. Is it our place to artificially keep a person alive in a comatose state? Is that any more moral than letting a patient die a natural death. In the case you referred to it was only because of the intervention of others that her request to not be kept alive artificially was not honored. Her husband was only fighting for what she wanted. In this society that has a death fear, it is more difficult to stop extraordinary measure once than have been started than it is to honor the wishes at the time the initial decision is made.

My FIL had a massive stroke that paralyzed his throat along with most of the rest of his body. He lost his ability to swallow as well as his ability to ambulate, speak, or care for himself. What little consciousness he had was confusion and agitation. He also ask for eggs once. Attempts to feed him lead to aspiration. But he had a living will and we knew he did not want to exist in this manner. He was in Hospice House for 10 days before he died. The idea of us starving him never entered my mind. What I knew was that he had a horrible debilitating illness with no hope of improvement. The rest was a natural death from his stroke.

Only in the last few centuries have we had the medical knowledge to keep people alive beyond their natural life. So why now is it immoral or cruel to let them die without using these extraordinary measures that we only learned recently?

Love, deb

 
Old 08-22-2011, 07:32 AM   #10
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Re: Why is he so weak?

Quote:
Originally Posted by Gabriel View Post

I think I know the case you are speaking of. His wife was being kept alive by artificial means even though she was brain dead with no hope of recovery. If it were not for extraordinary medical intervention she would not have been alive to make such a decision. I perhaps take the other side of the argument. Is it our place to artificially keep a person alive in a comatose state? Is that any more moral than letting a patient die a natural death. In the case you referred to it was only because of the intervention of others that her request to not be kept alive artificially was not honored. Her husband was only fighting for what she wanted. In this society that has a death fear, it is more difficult to stop extraordinary measure once than have been started than it is to honor the wishes at the time the initial decision is made.


Love, deb

I don't want to turn this thread into the debate for hospice but I would like to say that Terri Schiavo never wrote a will that she wanted to leave. She was still conscious although she needed artificial feeding tube and was very disabled. I understand 20 years is a long time but her parents wanted her back. He could have given her back. He had a girlfriend and a kid already ... This is more complicated - it is about disability as well. She was able to be upset that she knew he wanted to let her go. She made horrible sounds to express that she wanted to stay. He was not really a loving husband anymore after a long time.

My point is I would rather get a shot to die quickly. They stopped the feeding tube and she died slowly and her tongue was dry and parch. He applied a little water on her mouth. It seems cruel. She was not in coma whatsoever.

Anyway, otherwise I am OK with hospice. I also know that quality of life means a lot to some people. My parents want to live whatsoever. I think sometimes suicide might be faster than being starved to death (even if the science is OK with it.) My point is really the method itself. Not necessarily about not dying.

My FIL knew that his late wife was dying. He just wanted her to be comfortable.

Hugs,
Nina

Last edited by ninamarc; 08-22-2011 at 05:19 PM.

 
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