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 Mom in hospital with the start of pneumonia 
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Joined: Fri Oct 28, 2011 1:31 pm
Posts: 29
Post Mom in hospital with the start of pneumonia
My mother had a fall and said that she couldn't get up. She was taken by ambulance to the hospital. She did not break any bones, but she had a low grade fever. They took an x-ray of her chest and she had what they thought could be the start of pneumonia. She had an allergic reaction (swollen tongue, lethargic) to Avelox and they are changed that to Levaquin. She checked in on Friday. It is now Sunday, and she sounds terrible and is really confused. I thought that she would get immediately better because they caught it so early. Am I wrong? I don't know what to expect. On Friday, they said that she would be out on Monday. On Saturday, they said that she would probably be out on Monday or Tuesday. Today, they said that she would probably be there until Wednesday. I was so grateful that they found it early, but now I am really worried. Anyone with a loved one that has recovered from pneumonia? She is only 74.

Thanks.


Sun Mar 04, 2012 8:10 pm
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Joined: Thu Apr 21, 2011 9:07 pm
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Post Re: Mom in hospital with the start of pneumonia
Hi Marie,
My mother (age 95, LBD diagnosed a year ago) is just recovering from pneumonia. I took her to the doctor Wed afternoon and he sent her straight to ER, where they put her on nebulizer and then oxygen as well as antibiotics (levaquin), and admitted her that night. She improved fairly rapidly and was discharged to the SNF in their retirement community Friday evening. She is still getting the inhaler treatment, maybe 2x/day, not sure, and still on antibiotics, but seems much better, though somewhat the worse for wear from all the commotion. She is quite tired, sleeping a lot, but clearly will recover ok from the pneumonia.

I think it depends a fair amount on what the specific organism is. Levaquin is pretty broad-spectrum. Definitely the right thing for my mom, as she was showing signs of improvement within 12 hours. The symptomatic support also helped as her pulse-ox would fall when she was not on the inhaled med or the oxygen, at least the first 12 hours or so, then she was stable and getting enough oxygen.

Good luck - I hope she manages to recover smoothly -
Laurel

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Laurel - mother (97) diagnosed April, 2011, with LBD; died May, 2014.


Sun Mar 04, 2012 8:39 pm
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Joined: Fri Oct 28, 2011 1:31 pm
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Post Re: Mom in hospital with the start of pneumonia
Laurel,

I am so glad that your mom is doing better.

They do have my mom on oxygen and on a nebulizer treatment every 6 hours. When we checked into the hospital, she wasn't even showing symptoms, we were there for a fall. Maybe the virus or bacteria has to peak before it gets better. She barely had a cough when we checked in and now she is really congested and can't seem to get the congestion out of her chest. It is good to know that levaquin worked for your mother. Hopefully it will work for mine as well.

Thanks.


Sun Mar 04, 2012 8:50 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Mom in hospital with the start of pneumonia
Levaquin and Avelox are both fluoroquinolones. If she had an anaphylactic reaction to one I'm somewhat surprised they put her on another but presumably she is tolerating it. Without being able to do a culture and sensitivity test on her sputum, it is difficult to know just what the organism will respond to. While Levaquin is a broad-spectrum antibiotic there are some strains that do not respond to it. Even so, two to three days is probably not long enough to gauge the efficacy of the treatment.

I'm sorry this has happened--you must be worried sick! My husband has been through several bad infections, some resistant to just about everything. It's scary and frustrating waiting for something to work. God bless!

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Sun Mar 04, 2012 9:13 pm
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Re: Mom in hospital with the start of pneumonia
Marie,

Sorry to hear your mom is in the hospital. Anytime someone with a neurodegenerative disorder -- and on top of that a dementing disorder plus possible pneumonia -- is in the hospital, the situation can lead to their developing delirium (confusion). I would not expect that the confusion would end until she's been out of the hospital for some time.

Is a family member or friend able to stay in the hospital room with her most of the time? This would be especially important if she's awake and confused.

It's a waiting game. Do you know your mother's wishes with regard to intubation and being placed on a ventilator? Hopefully your mother will pull through, with the right medication and some luck. You might say whatever you need to say to her just in case she doesn't make it. And I always advise local support group members at the first hospitalization of their loved ones to use this as a wake-up call to get funeral arrangements (and brain donation arrangements, if you are going to do that) made (or at least looked in to -- comparing prices, etc.).

Many people (not all) in our local support group survive the first bout of pneumonia. Most do not survive the second bout if it comes quickly on the heels of the first. Not everyone treats pneumonia (with antibiotics) the second time. Some don't even treat it the first time.

Robin


Sun Mar 04, 2012 11:50 pm
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Joined: Thu Apr 21, 2011 9:07 pm
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Post Re: Mom in hospital with the start of pneumonia
Wise advice, Robin, on thinking through the treatment options.

My parents have very clear advance directives, and I gave a copy to the hospital for her chart and discussed the options with them. And I live and work less than 10 min from the hospital, so I could be there very quickly if needed. I felt very comfortable choosing to treat this time, given her general good physical health (for age 95 at least) and relatively early stage disease. Also, my dad lost his mother to pneumonia quite abruptly, when she was 93 and apparently in good health, and I knew he was not ready to deal with that decision and outcome yet. In six months, though, the decision might be quite different. He is starting to come to terms with that possibility. We'll see how far she recovers toward baseline.

I hope your mom improves, Marie - it's a tough and frightening time for you and for her. But she is lucky that you can be nearby at least some of the time.
Laurel

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Laurel - mother (97) diagnosed April, 2011, with LBD; died May, 2014.


Mon Mar 05, 2012 12:24 am
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Joined: Fri May 28, 2010 4:46 pm
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Location: Salem, Oregon
Post Re: Mom in hospital with the start of pneumonia
Marie,
I'm the one who started the thread "Mom has a mass in her lungs." The doctor gave her antibiotics and started her on nebulizer treatments, and she is much better. She is at an assisted living facility for memory care, and she did not go to the hospital but is being treated there. She just turned 68. We had another CT scan on Friday, and now they just see a partially collapsed lung and a sinus infection. The doctor expects she'll recover from both; however, she is recommending hospice now. We'll see the doctor again on Friday and ask what she's basing that on. My dad just talked with her nurse over the phone, so we haven't been able to ask questions yet.
Diana


Mon Mar 05, 2012 1:58 pm
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Joined: Tue Dec 29, 2009 2:28 pm
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Location: Minnesota
Post Re: Mom in hospital with the start of pneumonia
Great advice from both Robin and Laurel.

If a family member can be with her throughout her hospital stay, it is a help both for her and for the hospital staff. If the stay goes much longer, and you are getting some pressure to not be there so much, talk with her doctor. In my mom's last hospital stay, largely through the influence of the doctor, not only were we allowed to stay with her, but a mattress was brought into her single room so that we could be there but get adequate sleep, too. When I was with Mom, I was able to work because I could access the Internet via the wireless network at the hospital. The staff expressed often how much this helped, as communicating with an LBD patient is sometimes difficult or impossible and a family caregiver is a lot of help in this area.

And, though I am a big fan of advance directives and adhering to them whenever possible, it is very appropriate to treat pneumonia or any other illness if the family isn't ready to let go yet. The advance directive should be just as much about the family as it is about the patient. If you and/or your dad aren't ready now, there will be other opportunities. The timing needs to be right for you, as well as for your mom.

Kate

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Kate [i](Cared for Mom for years before anyone else noticed the symptoms, but the last year of her life was rough and we needed to place her in an SNF, where she passed in February 2012)[/i]


Mon Mar 05, 2012 2:05 pm
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Location: SF Bay Area (Northern CA)
Post Re: Mom in hospital with the start of pneumonia
It is frightening to me to consider that the advance care directive is about the family's wishes. It's about the wishes of the person who filled them out. Hopefully, the person named the durable power-of-attorney for healthcare can follow exactly what the person's written wishes are.


Mon Mar 05, 2012 3:01 pm
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Joined: Sun Aug 29, 2010 5:46 pm
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Post Re: Mom in hospital with the start of pneumonia
Yes, Robin, that is exactly right. The advanced directive is not about the family at all. It is to express the wishes of the patient, period. I find the suggestion otherwise to be very disturbing, too. .

Julianne


Mon Mar 05, 2012 5:44 pm
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Joined: Fri Oct 28, 2011 1:31 pm
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Post Re: Mom in hospital with the start of pneumonia
Thank you everyone for the support.

My mom seems to be doing somewhat better today on the levaquin. She does seem to have quite a bit of labored breathing and an earache, but she seems to have a little more power when coughing up the phlegm. Her oxygen level remains around 90. Her blood pressure is fairly high in the morning and then drops later in the day to her normal low blood pressure.

My mother just moved to a new (to her) assisted living facility two months ago (memory care). On Sunday, I went to pick up some of her stuff, and pay her rent, and the administration (floor manager and bookkeeper) didn't even ask how she was doing. They didn't even mention her, and they were both sitting right there while I wrote my massive check. I am not sure how to take this. Either there is a huge lack of communication or there is a huge lack of compassion. Either way, I am disappointed. The nurse called today to ask how she is, but the disregard for her interests yesterday still hurts. Am I too sensitive? Do I expect too much?


Mon Mar 05, 2012 9:15 pm
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Joined: Wed Dec 30, 2009 1:46 pm
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Location: WA
Post Re: Mom in hospital with the start of pneumonia
Marie, I'm so glad to hear your mother has improved. And most people's blood pressure is highest in the morning.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Mon Mar 05, 2012 10:19 pm
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Re: Mom in hospital with the start of pneumonia
Marie,
I would mention your disappointment to the care facility so they know what your expectations are.
Robin


Mon Mar 05, 2012 11:20 pm
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Joined: Thu Apr 21, 2011 9:07 pm
Posts: 245
Post Re: Mom in hospital with the start of pneumonia
Hi Marie,
Yes, the staff should know about your expectations - at my parents' place, people asked about them when they were in hospital and tracked how they were doing in the SNF unit. But they've lived there 8 years now and they, and I, know pretty much all the staff (I am there every day and have made a point of getting to know people, especially the ones at front desk, who are the gateway to lots of other resources.) It's hard for them to keep track of everything and everyone, but they do an amazing job, and even the part-time college kids are great. Good luck!

And I'd like to add just a follow-up note to Robin's and Julia's comments on advance directives. My mom's directions are very explicit about some potential situations, and I would absolutely follow them (and explained them to hospital and SNF staff and gave them written copies.) But for other situations, she left decisions in the hands of family. Here we have to rely on a combination of past conversations with her that give insight into her philosophy and opinions on situations she has seen with others, and medical judgment about the likely consequences. Uncomplicated pneumonia, caught early, in someone ambulatory, still able to do most self-care, converse with and enjoy family, and important to her husband? Here I felt quite sure she'd want to be treated, and indeed, she had a reasonable idea what was going on after we talked, and was able to sign the consent forms herself.

She is now home (after 2 days in hospital and 11 days in SNF, 10 of them included in the retirement community's benefits.) She is not quite all the way back to baseline cognitively, pretty close physically, and I think we did the right thing, both from interpretation of her wishes and from clinical judgment. But a year from now, we may well be closer to her description of the setting in which she would rather decline treatment.

Laurel

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Laurel - mother (97) diagnosed April, 2011, with LBD; died May, 2014.


Fri Mar 16, 2012 5:18 pm
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Joined: Sun Aug 29, 2010 5:46 pm
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Post Re: Mom in hospital with the start of pneumonia
Laurel, it seems to me that you did honor your mother's wishes because where her directive was not explicit, you looked to her philosophy, opinions and past comments she had made. I was (and I believe Robin was) addressing the idea of the family's wishes substituting for those of the patient. This does not appear to be at all what you and your family did.

And it is great that your mother is recovering!

Julianne


Fri Mar 16, 2012 5:47 pm
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