General Medical issues thread

[drron]

Though @Ewing and I had weight loss before our accident so not as much padding as most typical people. We both thought we were doing the right thing.
My orthopod was in no doubt that movement was causing my pain.

 

[Quickstatus]

We both thought we were doing the right thing.

Another ortho friend says (obviously T-I-C) that exercise and sport is bad because he ends up fixing all the problems - and generally on weekends and out of hours.

Lack of padding can definitely cause issues
Mrs QS has an intredullary nail in her tibia. The locking screws at the lower part of the shin is causing pain due to lack of padding there. . So can't wear boots or ladies shoes with straps for instance.

 

[Seat0B]

Spoiler alert: this tale ends reasonably well

We’ve had a big couple of days in the Seat household. It was Mr Seat 0A’s birthday this week and so I organised a family morning tea on Saturday morning to celebrate. I picked up my granddaughter (5) and my mum (91) and brought them to our house to prepare the party while Mr Seat0A went to the gym and came home with our daughter and her wife. We were to be joined by our niece and her partner as well.

We three girls were just nattering as little one played, mum sat at the table and I rubbed the butter into a big batch of scones. After a couple of minutes, little one said oh look Gigi has fallen asleep at the table. Now this is not uncommon as she’s on a lot of drowsy medications. But something didn’t look right to me - she was listing awkwardly to the left and looked like she might slide off the chair. So I went to see if I could help her sit up a bit and realised she was having a stroke. Pronounced facial droop on left, unintelligible gibberish speech, drooling, left arm dangling uselessly and left leg non responsive. I knew it was immediate 000 call but realised my phone was about 10m away inside my gym bag in a cupboard. Too hard to send Seat Granddaughter as it would take her a while. So I got her to come over and give Gigi a big lean in hug to hold her up while I ran for the phone and called 000. Luckily she is tall, strong and fit and was a really big help. I tagged with her and addressed all the questions from the 000 dispatcher. We just held mum’s hand and hugged her and told her help was on the way. She was compliant but confused.

While I was still on phone to 000, the doorbell rang and it was niece, quickly followed by rest of family. They removed all cars from driveway for ambo access and Mr Seat 0A took Granddaughter up to the top of our driveway to wait for ambulance and go a child friendly explanation of stroke.

Ambos arrived and were absolutely wonderful - calm, thorough, reassuring and professional. In turn they called for fire and rescue attendance as they couldn’t easily get mum out of the house so she got carried out by 4 lovely strong young men. Then off to hospital - not super fast driving but used sirens at every intersection and traffic light do we did not have to stop. They called the hospital en route and we were met by the stroke specialist nurse and a team of other medical staff. Mum was whisked straight to CT scan while I did admission paperwork. After about 20 mins, a junior doctor told us (my sister had now arrived at the hospital) she was back and being stabilised and we could see her soon. The neurologist saw us then and was very plain speaking “we would like to try the thrombolysis (clot buster) treatment on her as it is her only chance to maintain her independence - but at her age there are risks. 30-40% chance it will help her, 5% chance it will severely worsen her condition and kill her, the rest of patients have no harm but also no benefit. your call.” Sister and I agreed mum would want to try it and that she has repeatedly said she is ready to go anytime now. Luckily mum was in a bit of a lucid period so we were able to confirm with her to proceed.

The stroke occurred around 11am and they started the infusion at 12.44. Well within the strict 3 hr time frame for this. That took an hour with obs every 15 mins and a nurse at her side most of the time. So far so good. By the end of the hour, she was able to move her leg a bit. And the facial droop was gone. Took her to the acute stroke observation ward where intense bobs continued - as did her improvement. By the time we left her (in very good hands) at 1700, she had good movement in her leg and arm although unable to control her arm well and unable to touch her nose. Loss of sensation still in left hand/arm and fingers not working well. Her speech was totally normal. What a miracle.

Her improvement had continued today as she was able to sit in a chair with a cuppa. She can now touch her nose. Still no sensation in left arm and movements still jerky and a bit unco. But amazing improvement from where she was.

They will keep her for a few days for progress CT scan(s), neuro consult, physio, OT and speech pathology and then decide what’s next. She of course wants to go home (alone). We are all quite anxious about that as neuro mentioned in passing yesterday that she was “quite likely” to have another stroke in the future. Her plan for that was to use her emergency call necklace. But seeing how she was in the throes of it yesterday, I don’t think she could have managed. Not only the physical paralysis, but she was not cognitively alert enough. Hard conversations ahead I fear. Plus I’m knackered after all this!

But what a good result. Amazing.

 

[ellen10]

Wow @Seat0B what a frightening ordeal for yourself and the family.
So glad that your mum received excellent care from all the medical teams that have assisted you along this journey so far.

Hoping your mum continues to make good recovery progress, and yes some very hard family conversations and decisions to come. Sending you virtual hugs to your exhausted self. And maybe some belated delicious scones down the track!

 

[Seat0B]

Thanks @ellen10. It’s hard to watch the long decline towards the inevitable outcome. There really are worse things at almost 92 than a quick end. She has been adamant for some time that there are to be no heroics and that she does not want to live with a high level of impairment.

Hoping things are going better for you and Mr ellen10 at this point too. It’s been a very long haul for you both.

 

[Quickstatus]

Stroke Thrombolysissomething didn’t look right to me

Just as well you were there at the right time and luckily the hospital had an 24/7 Acute Stoke Centre
Generally these are the big hospitals
However regional hospitals can do a NSW Telestroke Service and they can do thrombolysis

There is also Endovascular clot retrieval but only in some hospitals

 

[Seat0B]

Just as well you were there at the right time and luckily the hospital had an 24/7 Acute Stoke Centre
Generally these are the big hospitals
However regional hospitals can do a NSW Telestroke Service and they can do thrombolysis

There is also Endovascular clot retrieval but only in some hospitals

Yes, it was the Canberra Hospital, so a big regional centre for care.

And yes, being there at the right time, and recognising the symptoms quickly was crucial to her improved outcome - I had the FAST poster in my mind's eye and knew immediately from her symptoms that it was a stroke, and that time was of the essence. So I ignored her trying to tell me not to call the ambos.

But now not being there is what concerns me about her coming home, which is what she wants to do. She has lived alone since my dad died in 2018. We are NOT able to be with her 24/7 although a family member or carer sees her 7 days a week. But in reality she is alone most days from about 5pm until 9am the next day. That's a lot of time for her to have a repeat stroke that is not picked up. And having seen how incapacitated she was, both physically and cognitively, I am no longer at all confident that our previous confidence in the emergency call button necklace is well founded. Frankly, I don't think she would be able to call for help if she needed it. So the best outcome for her would be a catastrophic stroke that killed her rather than one that left her untreated for hours and then with long term significant impairments. But this is a very hard sell to someone so independently minded as my dear mother . It is very clear to us all that she is well into age related decline, and the end is definitely coming. It's just a question of how much stress and suffering there is before that happens.

 

[Quickstatus]

It's just a question of how much stress and suffering there is before that happens.

Might need residential aged care?

 

[Seat0B]

Might need residential aged care?

Yes I agree - but at the moment mum’s view is “over my dead body” - which I am afraid may be the actual case.

She ready has myAgedCare approval for residential and is a pensioner, so it would “just” be a case of finding a suitable place. Which I know is not an easy task. The issue is her refusal and my sister supports her in that “it’s her call what she wants to do.” Well yes, except that at the moment pre-stroke it was taking about 60 family person hours per week plus the carers to keep up the illusion that she is coping at home. That was already stretching us, and I personally cannot do more. I note my sister is NOT offering to move in with mum of course. Despite all this, I feel extreme pressure to continue provide escalating support even though I think we are well past home care now. Because it seems the alternative will benign or not so benign neglect, which I don’t think I can live with

 

[tgh]

There is a yawning gulf between hospital care and home care and I opine that many fail to survive this abyss.
A close friend of swmbo is near the end; she has had enormous support from a network of long time buddies but the load on these folks has been significant.

 

[Seat0B]

There is a yawning gulf between hospital care and home care and I opine that many fail to survive this abyss.
A close friend of swmbo is near the end; she has had enormous support from a network of long time buddies but the load on these folks has been significant.

Yes all round.

 

[Quickstatus]

at the moment pre-stroke it was taking about 60 family person hours per week plus the carers to keep up the illusion that she is coping at home.

The hospital social workers might be able to help with aged care decision

 

[Seat0B]

The hospital social workers might be able to help with aged care decision

Yes - as always you are on the money. I am leaving in a few minutes for my appointment with …. The hospital social worker

 

[tgh]

mum’s view is “over my dead body”

As someone approaching this time of my life, I have some sympathy for this vision.
It is after all , a persnal choice to be coddled slowly into the box, or just drop in quietly and quickly
The other side of the coin of course, is per my earlier post is that unwell associates siphon up a lot of sympathy and care
from close associates who pay a signifant cost in the process.

 

[Seat0B]

mum’s view is “over my dead body”

As someone approaching this time of my life, I have some sympathy for this vision.
It is after all , a persnal choice to be coddled slowly into the box, or just drop in quietly and quickly
The other side of the coin of course, is per my earlier post is that unwell associates siphon up a lot of sympathy and care
from close associates who pay a signifant cost in the process.

I think everyone would understand if she were to just slip off. However there’s a real risk of NOT dying and ending up a fuddled drooling incontinent paralysed mess.

 

[Quickstatus]

I did not know these existed
Plutonium powered pacemakers

 

[drron]

All the major hospitals in Tasmania are hooked up to Royal Melbourne acute stroke team. Only need someone to come in and do a CT within the time limit. The CT is immediately read in Melbourne and the Neurologist rings the physician on call and calls the shots re thrombolysis.

 

[Seat0B]

The throbolysis has been absolutely life changing for mum - in a good way.

She’s making slow progress each day now with many of her symptoms totally resolved. However at the moment she clearly has some minor cognitive impairments - telling the same story repeatedly in a very short space of time, searching for words, and mis-naming people yet still giving a fairly accurate account of various interactions with physio and OT. She seems a bit short tempered and quick to anger which is unusual for her but maybe she’s just frustrated. Her left hand is a bit problematic. She has no strength - complained her phone was too heavy to hold and can’t apply the brakes on her walker, no dexterity- can’t insert hearing aids, put on her glasses, pull up her pants, hold a drink, type on her iPad etc but can now touch her nose . Her hand is starting to claw and she can't really grip things and if she manages to, she can’t release her grip.
Last night at 11.45 she was moved from her bed in the stroke ward because someone else needed it more. They took her to cardiac ward which had a spare bed. But while I was there this afternoon they told her she would be moving again because someone needed that bed. There is no doubt in my mind they will try to discharge her at the earliest possible opportunity.
Social worker was a bust. Called away at the very start of our meeting and promised to call me today but did not.

 

[Quickstatus]

There is no doubt in my mind they will try to discharge her at the earliest possible opportunity.

Perhaps the social worker can help organise respite after discharge.
Entitlement is 63 days free respite a year which can be extended to 84 days if approved by aged care assessor.