General Medical issues thread

[love_the_life]

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.

But need to get assessment whilst still in hospital for transition care.

 

[Quickstatus]

But need to get assessment whilst still in hospital for transition care.

Transition care is different but also a good idea.

 

[love_the_life]

Transition care is different but also a good idea.

Yes, aware that transition care is a different program and is funded differently (can be either resi or at home or a mix) but Seat08 might want to look at it as an option. Either way, a clinical aged care needs assessment will be needed and will probably need to push for an urgent assessment (in hospital should be quicker hopefully).

 

[drron]

Having just gone down the transition care pathway get the appointment for assessment done quickly I was in a rehabilitation ward which is the fast track to assessment here in QLD. Social worker asked in afternoon, seen the next morning and approved that afternoon for Transition to Home program.
Social worker said that people in the other parts of the program had a. 3-4 day wait for being assessed.

 

[Quickstatus]

was in a rehabilitation ward which is the fast track to assessment here in QLD

Private health funds are increasingly not funding postop rehab and expecting that to be funded from the bundled fixed prices for particular surgeries like elective joint replacement (not saying that applies to your particular situation). Getting people out of rehab and hopsital is a priority.

 

[prozac]

Potentially had my last IVIG last Friday. That said I have been having my last IVIG all of this year. The difference this time is my next specialist appointment will be without the following infusion. If still required the infusion will be for the following Friday and I have already arranged this with the nursing team. It can always be cancelled if not required. There is some discussion whether we are measuring the donor immunity and not my own so time will tell and so it is possible I will miss the next infusion but resume again on the following cycle. I'm not bothered either way and just go with the flow.

 

[Seat0B]

So finally last Friday there was an outbreak of common sense and the social worker and OT refused to sign off on mum going home, even though the neurologist and physio were happy for her to leave the hospital.

After some to and fro, she ended up in a private hospital (thank you Teachers Health) on Sunday for rehab, which is a bit open-ended as no one knows how she will respond.

She's much happier in the nicer surroundings, with better food. She has visibly lost quite a bit of weight since the stroke 10 days ago. An indicative example - she was served a disgusting looking tuna mornay for lunch at 1130 one day while I was there. She says she did not order it, and I believe her because she has hated tuna for as long as I can remember. So I let the staff know that she would not eat it and asked for something else. They said that there was nothing else, they would try to find her a sandwich. I asked once an hour for the 3 hr visit, but no food was produced. My sister arrived, I updated her and left and she was more aggressive, asking every 30 minutes until dinner arrived. Mum had no lunch that day. Her dinner was apparently a very unappealing roast of beef that could have doubled as shoe leather served with cold mashed potato and congealed gravy. She did not eat that either.

She has seen a dietician, physio and OT today. Physio has her rubbing the left hand with a coarse towel and wet baby wipes to "wake it up a bit" and OT set her the task of being able to pick up a pen in her left had as if she were planning to write with it. She is finding the pen task very difficult to impossible and says she can't really feel anything when she does the towel/wet wipe routine. She also had a vague out with slurred speech today - I did not see it, but she said the OT got a nurse, who got a doctor, who said it was normal and not anything to worry about. No scans taken. Should I be worried about this?

I'm tired and the emotional icing on the cake for me is that mum is now in the same ward where I was located for my 6 days of chemo in 2023, and I have to walk past the chemo/infusion ward to get to her. I'm actually quite triggered by this and I really don't want to visit. Must put on my big girl pants and just be glad I'm walking past that door not through it, I guess.

 

[Quickstatus]

She also had a vague out with slurred speech today

Hard to know using an AFF telescope.

There is often an ebb and flow in a stroke recovery and something called "recrudescence" which may mimic a TIA or stroke, but is not, and can be triggered by fatigue, stress, hospital acquired infections.
I also wonder if part of the weight loss is due to dehydration. I am assuming dietary and fluid intake is adequate? Holding eating utensils OK?

So I let the staff know that she would not eat it and asked for something else

So much is spent on the medical side - advanced tech, medicines etc but the basics such as food is overlooked. I just dont get it.

 

[andye]

...She also had a vague out with slurred speech today - I did not see it, but she said the OT got a nurse, who got a doctor, who said it was normal and not anything to worry about. No scans taken. Should I be worried about this?
...

Whilst (as an experienced stroke doctor also a Geriatrician), I wouldn't say it was normal, it's not uncommon and a cause may not be discovered even with extensive (potentially arduous) testing..

Various possibilities including dehydration, BP drop in a mending brain, brewing infection. It doesn't sound particularly like a small seizure but that might be a consideration if recurs.

Another stroke is not highly likely, but with mild transient symptoms and a recent stroke, the big interventions (clot-busting (thrombolysis) and removing clot via the groin) are not in play as risks outweigh benfit. Personally, I'd order a CT to check for bleeding but many of my colleagues would not.
.
Contrary to the initial counselling, once through the first couple of weeks, on good preventative treatment and without an uncommon untreatable cause, the risk of another stroke should be less than 5% a year.

That's not to say that a small to medium-sized stroke in the elderly is trivial. The essence of frailty is the lack of reserve to withstand illnesses and, as you've seen, it has knocked your mother about.

Nevertheless, stroke is a condition with scope for recovery over weeks and months. Things frequently improve more than one might expect.

Best wishes at a difficult time

 

[Seat0B]

I also wonder if part of the weight loss is due to dehydration. I am assuming dietary and fluid intake is adequate? Holding eating utensils OK?

No she isn’t eating and drinking well at all. She is struggling with the utensils and can’t cut her food. She also struggles to scoop eg mashed potato because she forgets to use her left hand to steady the bowl. She is spilling tea on herself at least once every day. So they gave her a thermal cup - but she has to use a straw which she dislikes. The juice, fruit and custard all come in plastic sealed single serve tubs that she cannot open. And no one but no one has time to help her. That’s why my sister and I are trying to get here for at least some meals. The rehab is going to have to really make some improvements before she could look after her meals and hydration at home.

 

[Seat0B]

Thank you both @Quickstatus and @andye

 

[Quickstatus]

And no one but no one has time to help her.

This is a very difficult situation.
Unfortunately nurses don't have the time to be a nurse anymore.
Apart from advocating/pressing for extra attention from the RNs
Supplement food from home?
High calorie nutritional supplement via the dieticians?
Patient advocate in the Hospital?
Maybe a quiet word with the Nurse Manager in their office?

Swallowing is OK?

 

[Seat0B]

This is a very difficult situation.
Unfortunately nurses don't have the time to be a nurse anymore.
Apart from advocating/pressing for extra attention from the RNs
Supplement food from home?
High calorie nutritional supplement via the dieticians?
Patient advocate in the Hospital?
Maybe a quiet word with the Nurse Manager in their office?

Swallowing is OK?

Thank you for these very practical suggestions. We are bringing her fresh fruit that we can peel for her and she can eat when she wants eg a banana that we start off and then she can manage, peeled mandarin segments etc. Also some up and go drinks that she quite likes. The dietician is working with her but so far it is only info to eat the protein part of all meals first and suggestions for fortifying meals and snacks when she comes home. I will follow up with advocate or senior nurse. Last night’s dinner involved soup in a cup - with a firm plastic lid on the cup, which, you’ve guessed it, she could not remove.

Her swallowing is ok, but pre-stroke it still wasn’t great on crunchy/crispy foods.

 

[drron]

A simple remedy might lie with h staff who deliver meals. I found it hard to remove the plastic from those small juice containers. Fortunately the woman that delivered my meals most days remembered me so I asked her to remove it which she gladly did. Fortunately Karma also kicked in as I always treated every staff member in the same way. So addition it was lids off a liquid food such s the soups. She also made sure that other who delivered food to me did the same.
Worth a try.

 

[prozac]

I am spasmodically having difficulty walking. My right ankle will be ok and then suddenly I am hobbling like an old man. Five minutes later I am ok again and then suddenly revert to hobbling. Put the leg up and my ankle is so swollen which explains the piercing soft tissue pain. DrGoogle says swollen ankles can be a side effect of IVIG though I do not recall previous issues, but I do tend to block out coughty experiences.
I am hoping the swelling will subside naturally and not take too long about it. Would walking a bit more help pump the fluid back up the leg? Any medical comments?

 

[Quickstatus]

Would walking a bit more help pump the fluid back

RICE (abbrev)

 

[prozac]

RICE (abbrev)

Of-course, thank you. I've now put it up.

 

[andye]

I am spasmodically having difficulty walking. My right ankle will be ok and then suddenly I am hobbling like an old man. Five minutes later I am ok again and then suddenly revert to hobbling. Put the leg up and my ankle is so swollen which explains the piercing soft tissue pain. DrGoogle says swollen ankles can be a side effect of IVIG though I do not recall previous issues, but I do tend to block out coughty experiences.
I am hoping the swelling will subside naturally and not take too long about it. Would walking a bit more help pump the fluid back up the leg? Any medical comments?

I'm afraid I'm rubbish at feet
At my Med School, the anatomy of the lower leg was taught in the last 2 weeks before final 1st year exams.
It was received wisdom to skip those lectures to make time to revise, knowing there would be an upper leg question as an option

 

[Quickstatus]

Cardiothoracic registrar dies while driving back home after work from Launceston Hospital to Hobart. The crash occurred near Pontville for those familiar with the area which is much closer to Hobart than Launceston. Never made it home.

The CT unit in TAS apparently covers the whole State - Hobart, Launceston, NWRH and private hospital. Apparently a 1:3 registrar roster (on call for 24hrs every 3 days) . When on call, this potentially means working the day , then on call, then working the next day could mean a 36hr. A comment on a Subreddit suggests that the 2 remaining registrars now covering 1:2.

That the crash occurred at 11pm Friday night 12June (suggesting he started driving at 9pm perhaps after a long day at work and possibly recent on call) also suggests there is no effective fatigue management despite what the health dept says.

Of course, the coroner yet to hold an inquest so let's see what they say.
......

I remember in my junior days doing a Friday, Saturday and Sunday 72hr including overnight on call. If lucky you got some sleep.

 

[prozac]

Cardiothoracic registrar dies while driving back home after work from Launceston Hospital to Hobart. The crash occurred near Pontville for those familiar with the area which is much closer to Hobart than Launceston. Never made it home.

The CT unit in TAS apparently covers the whole State - Hobart, Launceston, NWRH and private hospital. Apparently a 1:3 registrar roster (on call for 24hrs) every 3 days. This also means that working the day , then on call, then working the next day could mean a 36hr. Some comment on a Subreddit suggests that the 2 remaining registrars now covering 1:2.

That the crash occurred at 11pm Friday night 12June (suggesting he started driving at 9pm perhaps after a long day at work and possibly recent on call) also suggests there is no effective fatigue management despite what the health dept says.

Of course, the coroner yet to hold an inquest so let's see what they say.
......

I remember in my junior days doing a Friday, Saturday and Sunday 72hr including overnight on call. If lucky you got some sleep.

Quite possibly fatigue. I recall working 18hrs then being told to start a new shift at a different port (this reset the clock) and waking up part way on the wrong side of the road. The studies say work fatigue is the same as being drunk.
Sad.