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Old 03-08-2012, 04:05 AM   #1
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Unhappy cheyne-stokes breathing

Hello all
Last week my mother got a cold and sore throat. The N/H noticed a change in her breathing and called Hospice. She has been under the care of Hospice for about 6 months. They ordered oxygen for her and her breathing has improved somewhat. She is sleeping more and more lately but still I can get her to respond to me. She does not have a fever and her lungs are clear so far but she has a terrible cough. She is 91 years old. I welcome any input if anyone has had a similar experience.
Aras

 
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Old 03-08-2012, 06:32 AM   #2
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Re: cheyne-stokes breathing

Cheyne-stokes breathing is unusually deep and rapid breaths that decrease in intensity until there is no breaths and then the cycle is repeated. It is due to the respiratory control system being out of whack. This system depends on the balance of carbon dioxide and oxygen in the lungs. The oxygen is probably being used to balance the CO2 and why you see the breathing getting some better.

Dad showed cheyne-stokes breathing his last week and I have seen it many times. Dad did sleep more and more. Alertness needs the proper oxygenation of the brain so when there is a breathing imbalance there will be less awareness. With Dad it corresponded with the shut down of his various system including his breathing. Sometimes it can be because of a respiratory infection, caused by medication, or other reasons but it is frequently observed near the end of life.

Know I will keep you and your Mom in my thoughts and prayers...

Love, deb

 
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Old 03-08-2012, 10:21 AM   #3
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Re: cheyne-stokes breathing

My FIL just had upper respiratory infection around 2/24 and they gave him 2 days of oxygen. He got congestive heart failure but the nurse said he still got 90% oxygen capacity on his own. He was also given antibiotics so he is OK now. He is 91 too.

However he does sleep more and he is only alert in the early morning or before lunch. For the rest of the day, he sleeps off and refuses to get into the activities. He closes his eyes in the group automatically. He no longer engages with people around him. My FIL likes to have meals at meal time but that is about it. He still says hi to my husband if my husband tries hard to call for his attention. He does not really say hi or bye to us anymore. He seems to know his son but he is more and more tuned out.
He is in severe stage of Alzheimer's. Maybe it is becoming the end of life? But he is not dying. He is not under hospice as the home has not recommended that yet. My FIL does have shallow breathing as we can see that his chest moves like that

I sure hope your Mom will get off the oxygen soon and breathe on her own.

Hugs,
Nina

Last edited by ninamarc; 03-08-2012 at 11:27 AM.

 
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aras (03-09-2012)
Old 03-08-2012, 11:28 AM   #4
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Re: cheyne-stokes breathing

Mother is feeling well enough this morning that she keeps removing her oxygen. I don't know how we will keep in it place. Deb, how long did your dad have this syndrome before he died? Mom said daybefore yesterday"I don't think I will ever get home." Then she said "Slim, get me out of here." (my dads nickname was Slim, he died in 1974.) Bless her heart, maybe she is trying to tell us she is ready to go. I don't want her to suffer needlessly, but I will miss her so.
Aras

 
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Old 03-08-2012, 07:33 PM   #5
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Re: cheyne-stokes breathing

I felt much like you do the week before Dad passed. It was difficult to see him suffer and he was ready to go yet I knew I would miss him. It's a catch 22 if there ever was one. They are ready and you are ready but yet you are not ready.

Dad started having problems breathing starting on Sunday. Monday was not good either. But Tuesday he actually got up and ate some eggs. Wednesday and Thursday he was in bed with little awareness except for a few statements. He woke up and ask to see his wife. She was sitting right beside the bed but we moved her closer. He told her it was "time to go home". Later he looked beyond the ceiling and declared "Absolutely beautiful".

I sat with him Thursday night for a while. I told him that it was ok for him to go home. I would be ok and I would be sure Mom was ok. I would take good care of her. I ask if he trusted me and he squeezed my hand. He died at sunrise the next morning. So his journey was 5 days.

Recently we had a resident that had breathing difficulties for several weeks and another one for just a few days. So there is no way to tell how long. They will go in their own time. Talk to your Mom. Tell her anything that is in your heart. Let her know you will be ok. Give her permission. As odd as it sounds... it sometimes seems to make a difference. I do hope for your Mom an easy transition and for you the strength and courage you will need.

Love, deb

 
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Old 03-09-2012, 03:43 AM   #6
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Smile Re: cheyne-stokes breathing

Deb, Thank you for sharing. That was beautiful and I know it must still be sad for you to recall. You don't know how much I appreciate everyone on this board and especially you. You have a way of communicating that is easy to understand and a great comfort to me. The aides got mother to sit up in a chair yesterday and that helped some with the congestion. She seems to be doing much better right now. She is still eating some. Hospice is wonderful to have on board.
Aras

 
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Old 03-09-2012, 07:21 AM   #7
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Re: cheyne-stokes breathing

Aras, did they give her antibiotics? For virus, it may not work, but my FIL got antibiotics anyway. Some people don't want antibiotics when they are dying. My FIL wants to take med. (he just doesn't want aritificial means.)
Is Mom still on oxygen? I hope she will get out of this cold.

Hugs,
Nina

Last edited by ninamarc; 03-09-2012 at 07:22 AM.

 
Old 03-09-2012, 08:30 AM   #8
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Re: cheyne-stokes breathing

Aras... I agree about Hospice. They are amazing and such a comfort. It is good that your Mom was able to sit up for a bit. It is easier to breath when there is fluid on the lungs if they are in a sitting position. Be sure that Hospice knows about the lung congestion. If it continues or become a problem with breathing they can give scopalomine, atropine or hyocyamine to dry up the secretions and give your Mom some relief.

Just know that dying is not a constant steady process. There will be ups and downs. We can never be sure it is the end until the end comes. There is one little lady I have know for 3 years that I am sure has the soul of a cat and the nine lives to prove it. I have learned to never count the days until you reach the end for her. This is the fourth time in the last 6 months that the professional have determined she was near the end. Tuesday I would have agreed. But she sat up in her bed eating puree food and talking to me Thursday! She wants to be in Poetry Club next week. The human body is amazing in it's abilities

That is why you have to take each moment as it comes your way and treasure the moments you have. Try not to look forward too much. Prepare what needs to be prepared and then stay in the moment with your Mom.

For me, there is something therapeutic in sharing my stories. If it will benefit one other person then it validates what I have been through as something good and beneficial. I just hope something you have read has been healing and helpful.

Love, deb

 
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Old 03-09-2012, 09:53 AM   #9
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Re: cheyne-stokes breathing

my mom starting with breathing like that approx 4 days before she left us...It is a sign that the end is near as the brain is shutting down more and more and the signals are just not there. this can be a very trying time for all but spend the time you need with mom and bring back thoses memories that you have stored up in your mind.. I hope your mom gets over this and you have many memories to make .. my mom quit eating and refused anything to drink, when she made up her mind to leave us she was very determined... 8 days later she left us..

hugs judy.

 
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Old 03-09-2012, 05:37 PM   #10
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Re: cheyne-stokes breathing

Nina
No antibiotics, just cough syrup when needed. She was not running a fever and her vital signs are good again. She has some white lesions in her mouth and acts like it hurts her to swallow. She has improved some and was up in her chair again for a while today. Ate her food pertty well. But when she takes the oxygen off her breathing is depressed.
She is a very tough lady. When I left her tonight she was talking and singing with her eyes closed. Thanks for your concern. Aras

 
Old 03-09-2012, 09:28 PM   #11
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Re: cheyne-stokes breathing

Get a CT scan of the chest and a arterial blood gas to see what's her respiratory status. I know she's on hospice but is she a DNR/DNH (Do not resuscitate/do not hospitalize?) She may have a nosocomial pneumonia which may need some iv antibiotics or may need bipap if her blood gasses are imbalanced. Talk to the physician.

 
Old 03-10-2012, 03:36 AM   #12
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Re: cheyne-stokes breathing

Thank you but we will not be putting her through that. She is 91 and has a lot of other issues. It hurts her to be moved or pulled around. Her lungs have remained clear. I am not familiar with the type of punemonia you mentioned. You write like you are a medical professional, true? I am interested to know more about the type of pneumonia you mentioned in lay-man's terms.
Aras

 
Old 03-10-2012, 06:22 AM   #13
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Re: cheyne-stokes breathing

Aras, Nosocomial Pneumonia is also known as Hospital Acquired Pneumonia. It is the second most common Nosocomial (Hospital Acquired) infection following the ever dreaded Urinary Tract Infection. It usually starts 24 to 48 hours after a hospitalization. Many times it is caused by cross contamination in the hospital. It is frequently caused by a bacteria that can be treated with IV antibiotics.

Hope you and Mom are having a good day?

Love, deb

 
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Old 03-10-2012, 09:07 AM   #14
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Re: cheyne-stokes breathing

Aras,

Deb sounds right. I don't understand why they didn't try antibiotics.
I understand she cannot be moved to the hospital. It is the same with my FIL. However, the doctor in the home can always make educated guess and prescribed something for my FIL and he was right. For example, the doctor figured my FIL may have minor fracture last May so he gave him some special pain med for a month and he was OK. This time when he had the respiratory infection, he didn't go to the hosptial for any x-ray. The doctor made educated guess and gave him antibiotics. So now he is OK.

It does not hurt to just try the antibiotics. Of course, if Mom has this will saying that she wants no more antibiotics (for side effects reason) and other stuff, then you just have to leave her alone like this. It is up to the family. Sometimes antibiotics may reduce the symtoms and so she would be more comfortable.
I don't quite agree that some people think no antibiotics is good for end of life.

I just thought antibiotics might save her life this time.
My family often trusts that antibiotics helps because there can be bacteria that are not detected. Certainly one needs to be careful with having too much antibiotics but for older people, it may be useful.

Hugs,
Nina

Last edited by ninamarc; 03-10-2012 at 09:50 AM.

 
Old 03-10-2012, 05:03 PM   #15
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Re: cheyne-stokes breathing

Nina
We are taking a very conservative approach to her illness. Antibiotics cause her to have thrush. Then she has to have a swish and swallow mouth treatment. As long as she is resting comfortably we will just let the cold run its course. She seems to be feeling better today.

 
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