Loved one in hospital critically ill

[scorpiogirly]

I'm posting her in the hopes to get some quick advice.

Female family member is in hospital. 73 yrs of age.

Had a hip replacement in July and had gone downhill since then. She started having pain when eating to the point it became excruciating.

Stomach ulcers present and given meds for that.

This went on for months and she lost 4 stone, unable to eat with the pain.

She was taken into hospital 2 weeks ago

Numerous ct scans, mri.

Diagnosed with c diff which she us receiving antibiotics for.

She's on the maximum pain relief which is now knocking her out. Confused and sleeping a lot.

She has now also been diagnosed with narrowing of the arteries to the stomach, which doctors have said is the cause of the pain.

She is severely malnourished. She had a feeding tube put down her nose but after half an hour of the feed going through, they had to stop this because of the pain.

My cousin has been advocating strongly for her. She was told yesterday that her ischaemia (the narrowing) is too far gone for surgery.

They were going to try another feeding tube but my cousin has pleaded worh them to use IV feeding which they are going to do today, but they have now questioned my cousin as to whether that is best for her or whether it is best to leave things aa they are and let nature take its course I presume.

Cousin wants the iv to at least try.

Has anyone got any advice? Anyone been through similar?

I am annoyed that they did not try feeding as soon as she was admitted, but at that time we were all caught up in tests expecting a fast diagnosis and treatment which has unfortunately taken over 2 weeks.

I'm so sorry OP. I have little experience of this, but DS was very ill and was given IV nutrition which was horrible. It hurt going through and the wave of crying round the ward when it was TPN time was really upsetting.
It's not an easy option.

I'm so sorry to hear about your loved one

Have they not discussed putting her on TPN? I’ve had this, the line is placed either in the neck or chest and goes directly into the bloodstream, bypassing the digestive system.
I was on it for 5 weeks and had no issues (my line was into the neck). Insertion was a ten minute painless procedure and ‘feeding’ took place twice a day, also painless (it’s just liquid going into a large vein).

It’s sounds sadly like your family member has a lot of complex needs. Did she have any care prior to having the hip replacement, as there can be complications for some, from the pain meds which can cause other issues? You will have to think carefully around what sort of quality of life she will have if she does make it out of hospital. Was she walking normally again, able to care for herself in the main after the hip replacement? Simply feeding her isn’t enough to be honest, it may take months of dedicated care to get any kind of life quality back for her.

A lot of people are still relatively young at 73. My mum is still hiking and going on month long treks lol.

But some people don't have much quality of life at 73.

I do think that sometimes we extend life when it only prolongs suffering. It sounds like she will never be able to eat without pain... Would she be on IV nutrition permanently?

It is hard to let people go, but sometimes it is the kindest thing.

TPN shouldn't have been painful - I've had it, I've cared for people on it, and you can read up and see it isn't normal to have pain.

Posting to reassure the OP on this point but I am sorry about what happened to your son but it might be worth asking questions about his hospital experience. TPN is usually flowing constantly so there isn't really a TPN time on the ward except changing bags. That shouldn't affect people. Staff could have been very very bad with managing port? Or were they doing other meds and injections etc at the same time?

Thank you all.

Before the hip op she was fine. She wasn't great with her mobility but she was fine in every other way.

I'm really annoyed and wonder if they had done this IV tube when she first got to the hospital that she would have been okay. Maybe not though. It's been going on for months as I have said but the decline in the last 2 weeks has seemed rapid.

I can't see any reason not to try TPN, OP. Unfortunately hospitals do sometimes neglect nourishment. This is a very severe condition but if they were willing to try tube feeding yesterday why not TPN today? I would let your cousin lead on this if your hospitalised relative can't. There will always be pros and cons.

TPN isn't without its risks. There are all sorts of complications from infection, blood clots, fluid overload, electrolyte imbalances, etc. If the condition that you're giving the TPN for isn't reversible, you're saying that you'll give TPN for the rest of her life. Veins do get shut down and inaccessible, ports do get infected, people do run out of 'good' veins for treatment.

That's before you get to the recovery from the broken hip - which is a major injury at this age. Delirium is a really common condition in the older population. She has several risk factors (age 65+, hip surgery, multiple medications, malnourishment).

I'm just saying that I don't think the medical team are being unrealistic to suggest that a very invasive treatment may not be in your relative's best interests.

I'm so sorry that you're in this situation.

Something to consider is that even if they do the IV feeding, how much is that going to help in the long term?

If your relative's diagnosis of gastric ischaemia is correct, then that is obviously very serious and very painful.

If it is not possible to operate, what is the plan for ongoing pain relief? If the required level of pain relief is knocking her out then her quality of life should be considered.

It's a terrible situation for you all, My heart goes out to you.

Thank you all for your kind words and advice. My cousin is at the hospital now and they are now withdrawing treatment and sending the palliative care team.