Are your frail elderly facing (hip-replacement, colon cancer) surgery at Credit Valley (or Trillium) Hospital? Some tips.

February 6th, 2011  

It’s been January 22nd, 2011 since my last blog. What can I say? I’ve been busy.

Rather than continue where I last left off detailing the malfeasance and corruption at the City of Mississauga, there’s something much more important —some suggestions on what to do if your elderly loved-one turns so ill he can’t even make it to the doctor’s office.

To be clear this isn’t medical advice, just a heads-up on things we’d have liked to know two weeks ago.

As I write this my 87 year old father is still in Credit Valley Hospital, recovering nicely from successful colon cancer surgery.  Right now it’s my sister’s turn to stay with him and I’m due to ParentWatch and sleep there tonight. He’s supposed to go home tomorrow afternoon. Credit Valley saved his life again.

I could write at least two dozen blogs on our experiences over the last two weeks but instead, I’ll post a Readers Digest version and flesh out details when time permits.

To begin.

Don’t assume that paleness and fatigue are just a natural part of aging –or sleeping the day away is just escape from boredom.

My 87 year old father had been lethargic for several weeks, pale and sleeping far too much. We put it down to just getting older, winter, boredom… Through January he’d complained about dizziness and reported two minor falls but mostly he dozed his days away.

On Tuesday, January 25th my father had fallen once again and took to bed. At first we’d assumed he had picked up some bug. He himself attributed his malaise to something he ate. Problem was, he also blamed his previous crisis on bad food and this time he didn’t bounce back.

We called Teleheath Ontario and described the symptoms. We were told to get our father to a doctor “within four hours”. Not easy when your elder insists he’s too sick to move!

Don’t view an ambulance as just for emergencies.

To get our father to a doctor “within four hours” our only choice was to call 911. We explained it wasn’t an emergency but we needed to get to a hospital. The paramedics were understanding but weren’t entirely sure that an ambulance ride was the way to go. So here’s another piece of advice. You don’t regret an unnecessary ambulance ride! It’s certainly the best 45 bucks we’ve spent believe me, and it might be for you too.

You won’t regret an “unnecessary” ambulance ride! It’s the best 45-bucks you might ever spend.

The ambulance aimed for the closest hospital but en route word came that Trillium already had its share of ambulances. Credit Valley had none in their bay. So Credit Valley it was.

Now you’ll hear stories about ghastly waits in Emergency but we were registered quickly. The paramedics did most of the work and the truth is, they made it easy for us. We were then assigned a gurney inside Emergency and there’s this relief when you hand over your loved one to experts.

My sister and I spent two nights and almost three days in Emergency looking after our father. Only curtains separated patients from each other and there was just room between partitions for medical equipment, one chair (that my sister slept on) and a space on the floor where I spent the nights.

STAY. Stay with your elder the entire time.

So here’s the #2 most important piece of advice I can give anyone whose elder is sick enough to be in the hospital. STAY. Stay with them the entire time.

Imagine how confusing and stressful Emergency is for the elderly. Everyone shows up in Emergency, from the oldest-old to infants. One inconsolable little baby wailed himself to exhaustion. If you spend any time in Emergency you only really get to sleep when you’re too exhausted to stay awake. And that’s what happens to a strong regular person. Now imagine the plight of the elderly (especially non-English speakers or those with mild dementia or worse).

Infants and kids have their parents fretting over them. Too few elderly had family “parenting” them. Those of advanced age can be in just as much need as infants/toddlers –and can even more vulnerable.

If your elder is pale, sleeps a lot, complains of weakness/dizziness, suspect anemia.

By late Tuesday, Credit Valley Hospital had identified the cause of my father’s fatigue and paleness —anemia. Doctors suspected internal bleeding and suggested stomach ulcers or colon cancer. They said he’d need a colonoscopy.

My sister and I freaked. In my father’s 87 years he’d not once had a colonoscopy! How could we, as care-givers, have overlooked this! So, if you’ve read this far, when was the last time your elder had a colonoscopy?

My father was so anemic he needed a blood transfusion –two units!

When was the last time your elder had a colonscopy?

On Wednesday, Credit Valley said that my father would have to prep for the colonoscopy at home because there just wasn’t the sufficient staff to work through the GoLYTELY® bowel cleansing procedure. My sister and I managed to keep our father inside Credit Valley’s expert care by insisting that we could supervise/navigate our father through the GoLYTELY® “experience”.

GoLYTELY® was Thursday and anyone who’s undergone a colonoscopy knows the toughest part is the actual preparation/cleansing and not the peek-and-probe-up-the-butt afterwards.  GoLYTELY-Thursday was by far our toughest day, both for my sister and me –and especially for my father.

Mercifully, by late Thursday, we were transferred out of Emergency and into a semi-private room.

After two nights (and almost three days) in Emergency we're transferred to a semi-private room to await colon cancer surgery on 87 year old patient

Early Friday morning was the colonoscopy and colon cancer confirmed. The good news is the tumour was operable and my father, otherwise healthy, was “low risk” for surgery.

More good news, by late Friday he was wheeled into surgery for his colon operation.

So here’s the #1 most important message, be extremely wary of general anesthesia with the elderly! We requested epidural.

Given our experiences with general anesthetic and hip replacement surgery on a frail elder, we did not want a repeat of what a general anesthetic can do.

Now we’re giving this heads-up. We suggest you Google “effects general anesthesia elderly” and also “epidural anesthesia elderly” so you can ask informed questions about anesthetics. Remember. When your elderly loved one is facing surgery be sure to speak to the anesthesiologist about delivering no more than just enough to get the job done.

We spend an unnecessary extra hour of angst because we waited at the wrong place!

We can’t say this enough. STAY. Stay with your elder the entire time.

When that’s not possible perhaps you’re blessed with a responsible teen who can be pulled from school to be the frail elder’s advocate and companion. In our experience we found that post-surgery delivery of oxygen (first a full mask and later oxygen prongs) is vital to keeping a frail elder’s brains properly oxygenated. Oxygen delivery and also regular cuing your elder to take deep breaths is key in flushing any anesthetic out his system as quickly as possible. The elderly don’t always remember on their own and there were times when our father tried to pull off his oxygen mask!

Also trips to the bathroom are precarious for the elderly at night  -especially after surgery. Even when they’re on a catheter, they’re likely to pull tubes out of arms, and even if frail, they’re still capable of struggling out of bed should they wake to unfamiliar surroundings. (Ask us how we know…)

You might consider requesting a catheter (we now wish we had for a hip replacement procedure two years ago… )

Nightwatch. Post colon cancer surgery. Sister sleeps on floor at Credit Valley ward

There’s a lot of other stuff I can write about regarding our elderly loved ones and surgery (hip, colon cancer) but I’m satisfied that I’ve recorded what we found to be the most important information.

To repeat.

If your elder is pale, sleeps far too much, complains of weakness/dizziness, suspect anemia.

Google “anemia elderly causes” to inform yourself.

When was the last time your elder had a colonoscopy? (There will come a time when you must help them prep/cleanse for this procedure)

Call Teleheath Ontario. It’s a superb resource.

The only ambulance ride you will regret is the one you didn’t request.

Google “effects general anesthesia elderly” and also “epidural anesthesia elderly”. This will help you ask informed questions of surgeons and anesthesiologists.

Prior to surgery on your elder loved one, speak to the anesthesiologist about delivering no more than just enough anesthetic to get the job done. (We went with epidural).

STAY. If you can’t yourself, consider pulling your responsible teen out of school to be your elder’s advocate and hospital companion.

Even if you have to borrow money, book a private room. There is no better hospital investment for frail elders as far as recovery goes.

Private room (Credit Valley Hospital). We sleep on the floor. (light-sleeper sleeps on bathroom-side of 87 year old patient's bed)

Did I mention, STAY?

From the ward we are transferred to a private room (Credit Valley Hospital). Our home until we leave.

First solid food since 87-year old patient entered hospital on January 25, 2011

Signed,

MISSISSAUGAWATCH

CREDIT VALLEY HOSPITAL AMBULANCES "Busy Night" February 6, 2011

2 Responses to “Are your frail elderly facing (hip-replacement, colon cancer) surgery at Credit Valley (or Trillium) Hospital? Some tips.”

  1. The Mississauga Muse Says:

    UPDATE: February 7, 2011

    Just found this recent article while searching “anemia elderly” in Google News.

    Medical Notes

    Anemia in the Elderly

    By EDUARDO GONZALES, MD
    January 17, 2011, 1:42pm

    Q: My father who is 82 years old has slight anemia. His hemoglobin is only 11.5 gm% when we know that the normal for males is 14-18 grams %. We have been giving him iron and folic acid supplements regularly and we make sure he has a balanced diet but his hemoglobin still wouldn’t go up. Is anemia a normal phenomenon among the elderly?
    –Chino C., Makati City

    A: Anemia, which refers to a shortage in the oxygen-carrying capacity of the blood, is caused by a diminished number or volume of red blood cells (i.e., the oxygen-carrying cells in blood), or hemoglobin—the substance in the red blood cells that bind oxygen. The World Health Organization (WHO) criteria for anemia are hemoglobin of less than 12 grams % in females and less than 13 gm% in males. By these standards, your father is indeed anemic.

    Anemia is a very pervasive condition among old people—the prevalence rate in this age group is 8 to 44%. Its occurrence in the elderly increases with age and is highest among men 85 years and older.

    Anemia is so common among old people that some experts think that lower hemoglobin levels may actually be a normal consequence of aging. But, most experts say anemia should not be considered a part of aging because most old people have normal red blood cell count and volume, as well as hemoglobin. Furthermore, in about 80% of anemia in elderly people, a cause for the condition can be identified.

    To read the rest of Anemia in the Elderly click here.

  2. Signs of Cancer Says:

    With cancer being the 2nd leading cause of death, I want to see it destroyed. I don’t know if this is entirely possible, but we do have a starting place. We can learn and educate about the signs and symptoms of cancer in order to achieve earlier diagnoses. Some cancers are curable if found early. This is why I strive to teach the signs of cancer! Thank you for this site and please continue to teach!

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