I’m so new to care giving that I hope this question does not seem too stupid. It seems that it should be obvious when something is an emergency and a visit to the ER is warranted. I have a list of 911 symptoms that home health care gave me and of course they are pretty obvious. For example, my mom had a psychotic episode back in October and she fell while I was out shopping. The minute I came home, I followed the directions by making her comfortable and calling 911. Fortunately, she was OK and was not too confused so we didn’t go to the ER that night but after seeing one of her doctors the next day, we ended up at the hospital anyway because her psychosis was so bad. I guess my concern is two part, missing something that really needs immediate attention at the ER and not going and or having to go the hospital anyway. Right now, my mom is complaining about wheezing and congestion. She doesn’t have a temperature, I am watching her carefully, and it just seems like she has a cold or bronchitis. I called the doctor and we are scheduled to see him tomorrow. However, I keep debating with my self that I should take her to the ER tonight! But then, I go in and check on her and she's OK. She can breathe and talks to me OK. She doesn’t have tightness or pressure on her chest, no temp. or color change. She's just real uncomfortable, like when you get sick. I start to think well, let’s go to the ER now, get it over with and if she stays the night, I’ll at least get some sleep tonight. Instead, I’ll be up all night worrying about her until tomorrow. It’s just not easy making these decisions for someone other than yourself.

Thanks MomsBuddy:

I'm going to start trusting myself a little more.... this is certainly not the time to be a wall flower.

By the way, the diagnosis on Mom's CAT paperwork for Saturday reads: Shortness of Breath (SOB), Rule Out Pulmonary Embolism. According to the Chest X Ray done on Thursday, she has fluid in the lung. She feels a little better after a day of meds. but has the SOB when she walks around. The wheezing she was complaining about so much as subsided.

I wouldn't have minded the ear infection if it had not landed her in the hospital. Whatever happened to "first do no harm". As soon as we get through this, I'll start looking around for a new PCP. Her current PCP has to turn her records over to us if we ask, right?

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The blood test was ordered because she has fluid in the lungs

So does she have fluid in her lungs or blood clots (embolus)? I am a little confused...

Does she have a cardiologist or a history of any vascular or heart-related problems?

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I’m kinda worried because there have been other things this PCP has done, like cleaning her ear out only to give her an infection

This is not unusual. When ear canals are cleaned, the skin has been irritated and is more susceptible to infection. Heck, at least he CLEANED her ears - my mom's doc never even LOOKS into hers unless I insist!

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If a person has a history of Anemia, doesn’t it make sense to test for it as part of their regular care? Should I ask the PCP about this or am I being stupid.

Absolutely! One mo' time - you are NOT stupid! You SHOULD ask about ANYTHING you think is pertinent because doctors are human beings and forget, miss connections, don't know about stuff, etc. In asking questions, we not only get answers (or not) but we gain insight into how the doctor is thinking - the logic (or lack thereof...) of his/her treatment or diagnosis.
Ideally, all our elders should have geratricians because there is a lot of difference between adult medicine and geriatrics, just as there's a lot of difference between pediatrics and adult medicine. Medicine is so specialized nowadays that it is difficult for a general practitioner to know how to coordinate everything because they don't know about all the nitsy details that make all the difference in patient outcome. ANYONE who trusts everything to the docs and nurses is headed for a train wreck, or they are the LUCKIEST people in the world and I wanna take them with me to Las Vegas.

It is the unenviable task of those of us caring for our loved ones to be their advocates in all arenas. Few of us have any formal training or are particularly medically astute, but we have to catch on fast. I HOPE that you will not be afraid to ask about anything and everything... Despite their manner and reluctance to discuss their reasoning, we have the right and responsibility to ASK and keep asking if what we are told doesn't make sense. Some of us wear the title of "The Daughter" proudly even if it is accompanied by rolling eyeballs because that means they know who we are and that we are not going to accept information and treatment simply because someone said so...

The only things I would change about how my mom's health care has been managed were two recommendations by her doctor. Had I not gone along with the program way back then, things might be VERY different for her today. However, I must say that I have also saved her many times over because of my advocacy, so all-in-all, not a bad track record for a loving amateur!

I worry more these days about whether I like and can work with Mom's docs rather than how she feels about them. She has diminished capacity and I am still firing on all cylindars (I think...). If you feel uncomfortable with her docs and realize that Marcus Welby was a fictional character and is dead now anyway, talk to others and looks for recommendations for other physicians for her. Asking around home health workers is a good place for recommendations as is asking around wherever old folks congregate. The more folks you ask, the more chances that a few names will start being mentioned over and over again. Interview the docs without your mom first to save yourself some time and nerve tissue. It's worth the money and time for sure!

I think you are doing a GREAT job and hope that you'll continue to pipe up, ask questions, get on the 'net and research and take NOTHING at face value.

I just got a call from the PCP, looks like my mom is anemic again! The blood test was ordered because she has fluid in the lungs. Now, early last year she was put on Feosol x 2 (Iron Supplement) but the PCP never explained that it would react with her PD med. Instead, her PD got worse and because I take a print out of everything I give to her to the Neurologist, he caught my error and told me about the 2 hour delay. We adjusted the best we could to make her PD better. However, I think with her Dementia, she probably forgot about the 2 hour delay. The bottle seems to have too many pills in it. I feel really bad about this because I think this is my fault.

What I can’t understand is that we just had blood work done on the first of January and the PCP said nothing about anemia. He was more worried about her Kidney Function and took her off of TRIAMT. Why wouldn’t the signs of anemia show up in the standard blood work done the first week of January? If a person has a history of Anemia, doesn’t it make sense to test for it as part of their regular care? Should I ask the PCP about this or am I being stupid. I’m kinda worried because there have been other things this PCP has done, like cleaning her ear out only to give her an infection, not telling me about the Iron / PD med connection, giving me referrals for tests that her Neurologist feels are unnecessary do to her memory and PD. To be fair, he is not a gerontologist, just adult medicine. My mom likes him and trusts him and I would hate to change PCPs but I am worried. There’s nothing I can do now until we clear this thing up with her lungs but after I should probably have her see someone else.

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Originally posted by Bobcat:
The blood thinners are a tad scary, protecting against clots, but they start to bruise so easily. I hope all goes well now. Now, breathe deep and do something nice for you. Cup of tea, bubble bath, (slice of cheese cake.)

See what a novice I am... The DR didn't prescribe blood thinners! I had that in my head because of the pulmonary embolism. The more I read about it the more scared I get. The DR prescribed only a Diuretic (Furosemide) and 20MG Potassium. I couldn't give her the Potassium pill. It was too big and the instructions said to call the pharmacist if unable to swallow it. I will call in the morning.

Good idea Bobcat but not the cheese cake, please I don't need to gain any more weight. Ever since Mom started to have trouble the weight keeps creeping up. Thanks for all your help.

Hi Anna, sorry I am late responding to your post, but Moms_Buddy said it all. You are not stupid. I will say this, If I called 911 as often as I'ld like, my Mom would probably ban me from the house. Mom is very old and fragile, but knows her own mind and hates the hospital with a passion.

If she is conscious, she will probably tell them (EMTS) to leave, unless she is really scared, or thinks I will loose it completely. Death doesn't seem to be very frightening to her anymore, but the thought of me in a tantrum scares her as bad as when I was 5.

You did all the right things, check temperature, check the home health check list, ask her, check her responses. Do it all again. Watch for changes. Check with the doctor. It is a lot like what new parents describe. Totally new territory, the "instruction manuel" just doesn't cover it.

You are so right about the weight of making decisions for another. The ER is situations of sudden concern,,,, a sudden increase in pain, breaks, bleeding, change in consciousness and response, especially in connection with a fall. AND when you are really scared for them.

That sounds like any time, or 5 times a day. You did well. The blood thinners are a tad scary, protecting against clots, but they start to bruise so easily. I hope all goes well now. Now, breathe deep and do something nice for you. Cup of tea, bubble bath, (slice of cheese cake.)

Thanks MB, took my mom to the DR this AM and it turns out that she may have a pulmonary embolism or maybe pneumonia. DR did ECG (Normal) & checked her oxygen levels (a little low) and decided to order a chest x-ray, CT Scan & blood work. It was a lot of running around today, but we got all of the tests done today except the CT scan, which will be done on Saturday. In the meantime, she will take a blood thinner but the DR did mention hospitalization, if we can’t treat this at home with medication.

You're NOT stupid, Anna! It is really hard to know when things are emergencies and when they are not. A fall should always be checked at an ER because of the possibility of cracked or fractured bones that may not hurt. She also should be checked after a fall because the jarring can loosen plaques in the bloodstream and cause trouble. Always best to have her checked.

For colds and upper respiratory viruses, try to get her to the doc's office during the day. The ER is rife with viruses at this time of year and she doesn't need exposure unless she is really having respiratory distress.

Guessing how someone else is feeling is hard. Sometimes, they seem sicker than they really are - maybe because they often have become so frail. It's normal to get scared sometimes. Better to be overly concerned than to wish that you had been.

I can't believe I'm so stupid....

Mom is OK.... she ate some soup tonight and though feeling like crap, she is sleeping well. I think with her Dementia, she gets scared and anxious. Which of course leads me to believe that something serious is wrong and I then get scared. I'm sure she will be OK but we are still going to the DR tomorrow. Didn't want to scare anybody.