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I KNOW THAT YOU HAVE NOT SEEN HER, BUT WE JUST CANNOT GET A ...

Sent to Health Experts June 27 08:35 AM

I KNOW THAT YOU HAVE NOT SEEN HER, BUT WE JUST CANNOT GET A PROGNOSIS REPORT FROM HER DR. THEY HAVE NOT SAID WHAT HER LONG TIME PROGNOSIS WOULD BE, OR HER QUALITY OF LIFE EXPECTENTSY IS. THANK YOU

 

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Female , Age: 79

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HER PORT HAS BEEN CHANGED FROM HER CHEST TO HER ARM, AND THEY ARE JUST DOING ADDED BLOOD WORK, BUT THEY DO NOT SAY MUCH, ONLY THAT SHE IS DOING WELL, BUT I CAN SEE HER FAILING FAST. IS THIS NORMAL WITH DIALYSIS?

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June 27 11:14 AM (2 hours and 39 minutes and 9 seconds later)
         
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What I do not know about her is what was her quality of life and her health status prior to this renal event? That will definitely play into the equation. Young, relatively healthy folks are on dialysis for 20+ years at the hospital in which I work. Those that came in with an unrelated problem and developed kidney failure tend to not do as well, but many do survive to discharge and lead somewhat active lives. Quality of life is dependent on what expectations the patient has-does she like to travel, does she like to do quiet activites, does she live alone, or was she already dependent on someone else for many of her needs? What other health problems will affect her when she is over this acute phase? Did she have a stroke, is she able to communicate? All these unanswered questions make it difficult to judge what her life expectancy and quality of life will be. So the real question is how does her life now differ from how it was prior to the admission during which dialysis was started? If she decides to discontinue dialysis, there may be as long as 3 weeks of time before the toxins build to a point that her life will be threatened. There needs to be a decision first about what other measures she would want-for example, treating electrolytes with medicines will stave off the effect of stopping dialysis, making the life expectancy without dialysis longer than usual. Feel free to continue this communication--I will be on and off the site for most of the day.


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June 27 4:04 PM (4 hours and 50 minutes and 41 seconds later)
         
Reply to Judy's Post: HER QUALITY OF LIFE BEFORE TREATMENT WAS PRETTY MUCH OF WHAT IT IS NOW. THE ONLT DIFFERENCE, IS,
SHE WAS NOT IN TREATMENT BEFORE. SHE IS IN BED MOST OF THE TIME. ONLY GETS UP ONCE IN A WHILE, FOR BATHROOM NEEDS. ALSO THE PORT THAT THEY PUT IN HER AARM LAST WEEK HURTS HER FROM HER SHOULDER TO HER ELBOW. WHAT DO YOU THINK THIS IS FROM? THE PORT IN HER CHEST DOES NOT BOTHER HER. SHE DID NOT HAVE A STROKE BEFORE EITHER. THANK YOU AGAIN.

B.FOOTE
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June 27 4:11 PM (6 minutes and 22 seconds later)
         
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I'm not sure what the pain is from, probably just general post-op pain from manipulation during insertion. Is this a tube you can see from the outside or is it copletely covered by the skin? She should be getting medication as needed for this discomfort.


Edited by judi1 on June 27 2006 at 4:11 PM

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Judy -- Nurse -- 100% Positive Feedback on 871 Health Accepts
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June 27 4:18 PM (6 minutes and 41 seconds later)
         
Reply to Judy's Post: DO YOU THINK HER QUALITY OF LIFE WILL GET BETTER IN THE LONG RUN? OR DO YOU THINK, THIS IS PRETTY MUCH IT?
THANKS
Customer (name blocked for privacy)
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June 27 4:22 PM (4 minutes and 49 seconds later)
         
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If this has been her quality of life before the dialysis, then I don't think you should expect too much more. But of course there is the chance that the renal failure prior to treatment was the cause of the poor quality and that now with treatment she will adjust and start to feel a little better. Has she been able to participate in the decisions to go with dialysis and other things they have done? If not, then maybe someone needs to explain why the decisions were made and that once she is sure she can reverse any she's not happy with. Sometimes families will pressure a patient into a treatment because they don't want to lose the person, but then the patient is left without as much support as they need.


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Judy -- Nurse -- 100% Positive Feedback on 871 Health Accepts
RN in ICU for 35 years
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June 27 4:55 PM (32 minutes and 46 seconds later)
         
Reply to Judy's Post: SHE DID DECIDE ON HER OWN, ABOUT TREATMENT, BUT I THINK THE FAMILY'S EXPECTATIONS, AND HER'S ARE HIGH, WHICH AS A FAMILY MEMBER MYSELF THAT IS WHAT I WOULD EXPECT, WITHOUT A DOUBT. THEY JUST DO NOT KNOW WHAT TO EXPECT. HER DR. HAS NOT RELEASED MANY ANSWERS.
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June 27 5:03 PM (7 minutes and 55 seconds later)
         
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The problem is that all people respond to treatments so differently that sometimes the docs really don't know what to say. When a treatment like dialysis is started, it's basically to fix one thing-in this case it takes over for the failed kidneys. Unfortunately it can't fix the underlying problems that are unrelated to the kidneys and it can't even in most cases fix the kidneys themselves. It simply supports the body in one more way while the rest of it tries to heal itself, or the docs try to fix other areas. I think sometimes we hear what we want to hear and that is that things will be all better once this new wonder treatment or wonder drug is started! Sounds like you are in a holding pattern until something gives one way or another. If she seems especially depressed, I think a psychiatric consult and a trial of one of the antidepressants couldn't hurt. She's not "crazy" she just needs a little help so she can think clearly about the rest of her options. If you can get me some more details about the underlying condition that led up to the kidney failure it's possible that I can be more helpful. Does her family know we are discussing her? Do they have questions that we can help them with as well?


Edited by judi1 on June 27 2006 at 5:07 PM

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