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Brain stem meningioma recovery (long and grim)

5 replies

Iamcuriousyellow · 15/09/2014 19:10

Hello lovely mumsnetters

I posted here about a month ago, about my poor sister who had brain surgery late June, which didn't go well, and here I am with another question..

My sister was recently sent to a neurological rehabilitation facility - she was there 24 hours and fell twice, the second time knocking herself unconscious with memory loss. A&E sent her back to the neurosurgical ward she was in before, where she is still and they're talking about sending her back to rehab tomorrow. I think I'm going to have to have a word about leaving her to cope and do things alone - I know this is probably usually their MO but I feel it's not appropriate at the moment. But I might be wrong.

All I know is that because of incontinence issues, she has very little time between realising she needs the toilet and the deed itself, and my feeling is they don't answer the bell very promptly and she tries to do it herself. She can mobilise with another person and a Zimmer frame, but it's precarious.

Also - the SLTs have not been able to come up with much to help her communicate. She's deaf now as well - I take her A4 lined books in which we have written conversations. She's been given a small whiteboard and a magic marker which she uses to communicate with the nurses. She saw an ENT consultant recently who wants (a bit too keen I'm thinking) to carry out a laryngectomy because of the risk of aspiration pneumonia. The trouble with this is that she is clinging to the hope that her throat function might improve over time and allow her to breathe, speak and eat normally again.

And this is the knotty bit.. If she were to have the laryngectomy, could she eat? Or would the benefit to her just be that she wouldn't be at risk of skin breakdown and pneumonia? (The skin behind the trach always looks a bit grotty to me, but maybe this is normal.)

Her hope is that if she could eat again, she could fix the incontinence - and for background, the incontinence arose when she had a long standing colostomy reversed, and before BT diagnosis she was managing with a low residue diet. She has a bagged feed which is meant to be low residue, but she still has very little and sometimes no warning, particularly at night.

If anyone can shine any light on any of this, I'd be so grateful. My sister has no children and no partner to help her, in fact only a year ago she left an abusive relationship she'd been in for 30 years and came to live with us, so I'm her only champion, and I'm way out of my depth.

Thanks for reading all this

OP posts:
Matildathecat · 15/09/2014 19:50

Iam what a grim situation. It must be terrible for your sister and awful for you to witness. I don't have any answers, I'm afraid. It sounds highly specialised and individual.

Can you request a meeting with the doctors concerned? Especially the ENT as this surgery sounds very far reaching. Of you are next of kin I presume you would be involved in the consent process?

I'm sure you have already been in touch but [[https://www.headway.org.uk/rehabilitation-after-brain-injury.aspx this]] may be helpful.

Best wishes.x

Iamcuriousyellow · 16/09/2014 21:10

Thank you Matilda. I'll get a meeting together as you suggest.

OP posts:
shouldnthavesaid · 17/09/2014 08:39

Is she NG or PEG fed (nose or tummy), just out of interest?

I think it's not unusual for the skin around a trachy stoma to get a bit grotty looking - I think there can be a small bit of bleeding occasionally and normal secretions as well that can collect a little bit around the site. So that's not very unusual, but it should be managed on a daily basis as far as I know.

It depends on the individual circumstance with regards to eating after a layrengectomy - it may actually be safer, because there's as far as I know zero risk of choking and therefore no risk of aspiration pneumonia (which I have seen the results of, not good at all). It's a major procedure though and I would urge you and your sister to discuss it fully with all the doctors involved, also SALT.

Incontinence wise.. It's so hard. I work with patients with similar problems every day and every day I wish there was a solution that didn't have to involve soiling or rushing to the loo. We are told to answer the buzzer promptly but it's often time very difficult to do so.

Yes to organising a meeting with all involved, that would be the best way of making sure that this is all discussed fully before consenting to the laryngectomy etc.

Ask if you can see the nurse in charge as well - maybe ask if she can be present at the meeting - and ask if you can see a continence advisor too.

(Disclaimer - all that is 'as far as I know' - I'm not expert by any means, just auxiliary on neurosurgical unit).

Iamcuriousyellow · 17/09/2014 17:29

Thank you, shouldn't.. She has a PEG, following the NG tube. She was four weeks in neuro ICU but when she went to the neurosurgical ward they changed it over. (The skin around that is ulcerated too now)

OP posts:
shouldnthavesaid · 17/09/2014 17:49

That's not right. Is she seeing a tissue viability specialist? The stoma certainly shouldn't be ulcerated - never acceptable but especially important with your sister as she'll be so vulnerable to infection and unable to express pain easily.

That said, I am more than relieved that she doesn't have to cope with an NG, they aren't pleasant at all.

Definitely try to see the charge nurse. Ask to see evidence of skin care, PEG stoma care, oral care, etc - basically, make sure everything that should be done is done.

Remember as well to take care of you too xxx

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