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Old 05-30-2012, 08:04 PM   #1
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Unhappy Please help me understand

I am hoping I will receive many responses. I will explain my question. My Dad has Alzheimers and has been recently placed in Seniors home.. After 1 month he is doing fine now. He shows more signs of dimention about 30 percent of the time. still knows us. etc.

The specialist came in today and My mom mentioned with all his Anerisms he has 3 stometimes I think it would of been more fair for him to go this way.. but we are fortunate to still have him.> Dr. Replied I understand. I am happy you put him in the home. I was worried about you..

So tonight my mom is in the home and asks to read the doctors report and the nurse/friend of the family gave it to us. We read that the doctor wrote about the converstation and sent a note to his G.P. to take him off his blood pressure medicine as well as his heart medicine, I can't spell it but Metroprolol and Norcasc, If my mom didn't see her friend she likely would fo not known this report. I am certain my Dad would of died of a stroke...

Is this Ethical ? Is it me or isn't this wrong.. Shouldn't we at least be told this is what hsi intentions are... Shouldn't we have a voice... Please respond?
thank yOU Kevin )

 
Old 05-31-2012, 04:09 AM   #2
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Re: Please help me understand

I'm guessing that it was a communications failure, and that your Mom and the doctor weren't talking clearly to each other.

My guess is that the doctor heard your Mom saying something like a death from his other condition would be quicker and less difficult for him and for the family than the long good-bye of dementia. They may have talked about his overall medical condition and prognosis, and whether his condition could result in death at any time. The doctor may have explained that he qualified for end of life decisions, which could replace intervention medications with comfort-care only. Your Mom's responses may have been interpreted as meaning that the family wanted to stop treatments that could extend his life.

It's easy enough for your Mom to call the doctor immediately and clarify that the family does not want treatments stopped yet. You should also determine whether your Dad has a do-not-resuscitate (DNR) order in place, along with other instructions relating to a possible medical emergency if your Dad does have a stroke or heart attack. You will want to confirm that any of those instructions are consistent with any wishes of your Dad and the family.

Last edited by Beginning; 05-31-2012 at 04:16 AM.

 
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Old 05-31-2012, 08:38 AM   #3
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Re: Please help me understand

I don't think this is about hospice or that kind of thing - Dad is far from it.

It may be that the doctor really thinks Dad needs less medications. Once my FIL's former doctor stopped all the medications for 3 months until he got sick again. The doctor reinstated the medications. He stopped all the med. because my FIL had overdose issue once. He has a bad heart. However, no medications at all is not wise since he was 90 already.

Does Mom have POA over Dad? She needs to call the doctor to discuss this - the doctor didn't need her permission if she is not the POA. My FIL's current doctor in the NH asks my husband for permission to change medications since my husband is the POA.

It may be miscommunication and don't suspect too much. It has nothing to do with dying. The doctor may think that too many medications are not good.
But do talk to the specialist or GP about it to understand before you suspect in the wrong way.

If you think the doctor changed it because he thought Mom wants to let him go, it is not right. Dad needs to have advanced directive or living will to tell the family and doctor specificially what to do when he is dying. Dad just had stroke and is not dying now so he should still need the medications. Maybe the doctor was concerned that dad may have stroke again so he was careful with the drugs - drugs have side effects.

Regards,
Nina

Last edited by ninamarc; 05-31-2012 at 09:20 AM.

 
Old 05-31-2012, 09:48 AM   #4
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Re: Please help me understand

Nina: Your answer is a very good one. I leaped to the conclusion that his other medical conditions (heart/stroke) might be terminal since he had been placed in a facility even though his dementia wasn't too bad yet. It could have been something as simple as needing to have his medicines adjusted, as you point out. Good thought.

 
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Old 05-31-2012, 12:41 PM   #5
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Re: Please help me understand

be sure to keep the lines of communication open. dont be afraid to ask questions.

 
Old 05-31-2012, 02:01 PM   #6
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Re: Please help me understand

Usually if the nursing home wants to deal with hospice or have some kind of choice on being treated or not, they need to ask the POA to sign a form to agree to the conditions. Or the family needs to tell the doctor DNR (no CPR) and he will put it down in the paper. Recently my FIL's NH director asked my husband to sign things like this in a piece of paper (POLST) as the state required.

In other words, when it comes to different treatment style (hospice or natural or less aggressive treatment) the doctor or NH has to ask the family or POA for permission. It is Dad's home now.

Rarely a doctor would decide for you to give up and etc. Usually it is to give up antibiotics or food IV, not regular medications.

In this case, it may be adjustment of the med.

However, the way Mom communicates with the doctor is not quite right - the doctor or senior home should have notified your Mom or ask her for permission. At least the family has to know. Did the doctor tell you the next day? Maybe they didn't have time to notify you yet.
It does not make sense that Mom has to look at the record in the back. Ask Mom to call the doctor and talk to him directly.

I don't think the doctor has the guts to do this and he didn't know your Dad for long. The way my FIL's former doctor stopped all medications made me think his former doctor was incompetent, that is all.

Regards,
Nina

Last edited by ninamarc; 06-01-2012 at 09:44 AM.

 
Old 05-31-2012, 09:23 PM   #7
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Re: Please help me understand

I will say that Dad's Heart Doctor took him off of all of his heart medication over 2 years before he died of other complications... not his heart. In the doctor's view it was no longer beneficial. Each case is different. I do believe that your Mom needs to ask the doctor why he requested that the meds to be stopped. It is better to know why than to assume. It could be for any number of reason and she needs to know why

Love, deb

 
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