CHF - Need a professional take on this

[SerenaWelsh]

Is there ever a time that CHF would not be treated with meds?

My father is 69. He was just hospitalized for 2 weeks for what turned out to be a blocked small intestine. Surgery was postponed initially because he was found to be in CHF. They stabalized his fluids and mag, then proceeded with the surgery a couple of days later. He did fine, and is now home recovering.

I learned, however, that he has been in CHF for several months at least. If anybody remembers I posted that his EF was 70% when he finally went and got himself checked out a couple of months back. Turns out that was incorrect. His pulse was 70. His EF was 39%. He told me then he had an enlarged heart, also. I found out all the rest from his surgeion when I went to visit him last week.

Anyway, he's home without any heart meds. His cardiologist (the only one in this small town, and the same one who was perfectly willing to let my mother die when she had prolapsed mitral valve [didn't even mention those can be repaired or replaced] 5 years ago) reportedly told my mother that, "Congestive heart failure is just when fluid builds up because the heart is weakened and can no longer pump effeciently. We don't medicate that."
Now, it seems to me he has a pretty clear understanding of WHAT CHF is, but I thought the standard treatment was BB, ace-I, and diuretic. Sometimes digoxin. But as it stands, the doctor in this one horse town has no plan to do anything at all about my father's congestive heart failure.

Is this normal?? Is this doctor 15 years behind in what can be done for CHF? Or am I playing armchair cardiologist and need to get over myself????

[christyh]

Serena,
I am no professional by far, but it seems to me that you need to get your father to another doctor right away. I see "senior" patients prescribed meds for heart failure every week. It does indeed sound like he is 15+ years behind!

Christy H

[JAMESFETT]

Confirmed heart failure merits treatment, for which there is a wide range, not difficult to take, improves function. Your father doesn't have any other medical conditions, does he, so that he and his doctor together would decide best course just observation?

James

[SerenaWelsh]

Dr. Fett,

My father has numerous health concerns.

He has been diagnosed with emphysema. No tests were ever actually done. He can't breathe; his doctor concluded that since he smoked 3 packs a day for 40+ years, it must me emphysema. He is on oxygen 24/7 and uses a nebulizer roughly every 90 minutes while awake.

He has Burger's disease and has lost nearly all of his fingers accordingly.

He was thought to have Chron's disease, but with this recent surgery, he was told that he absolutely did not have any sign of it. All of those problems were caused by the blockage in the small intestine.

He was found to have a blockage in an artery a little over 6 months ago and had a stent put in (This was done in another town, after his own cardiologist gave him a clean bill of health).

He takes several different drugs for arthritis. Like alot of older patients, he doesn't know the name of them. Because of the recent warnings about some arthritis drugs and heart failure, this concerns me, too. He also takes perscription medication for GERD.

I know these are things that have to be discussed between a patient and his doctor, but I worry so much about my parents. They are in a VERY rural area of appalachia. I believe their medical care is little better than that of your patients at HAS before they find your facility. When coupled with how little they understand of what information they are given, I feel their circumstances could be dire. I've begged them to please crawl down off their mountain and let me make an appointment at any number of facilities here, but they don't fully understand that every MD isn't equal to the next.

During my last visit, I tried going through all of his perscription medications and setting them up in little pill organizers that I bought for him for a month's supply at a time. Unfortunately, he has been mixing pills and putting them in the wrong bottles and most of the time doesn't know at all what he's taking and what he's missed.

And after proof reading this, I suppose that's the bigger problem here after all. Even given what I might think is the "proper treatment" there's little likelihood he'd follow the regimen put in place.

So, I guess my real question - Is there anything to reverse the aging process of our parents? Or at least a pill to keep their children from borrowing their worries?

[JAMESFETT]

Serena, that's nice, you're doing the best you can to help a difficult situation. At some point in time children often become responsible for medical decisions for their parent(s), but sounds like your father is in control, and will do pretty much as he pleases. Still, I admire you for your concern and efforts to help.

James

[tinabowen]

Serena where is your dad at?
I know the small NC towns(was born and raised in one) have horribel Dr's most of the time that are so far behind the times it isn't funny..

I hope you Dad gets proper treatment..


Tina

[Karen T]

Hi Serena,
Is there a local visiting nurse association? I'm assuming your father has medicare or possibly other insurance? If this is so, you may want to request a referral from his primary care doctor, to the visiting nurses. Based on my experience in home care, it seems as if your father would qualify for at least a couple of nursing visits for med teaching and medical management of his diseases. Some times patients are more willing to listen to a total stranger and possibly he would let the nurses set up a pill planner for him. Unfortunately, this will not solve all your problems. As soon as a patient becomes "stable" medicare will no longer continue to pay for home care nursing visits, therefore its important that the family not depend on the visiting nurse to always be there (for example, to fill the pill box). It is possible for the visiting nurse to teach someone to do what she has been doing. The diseases your dad has (emphysema, CHF) are chronic diseases and there are periods of exacerbation and remission and many times there is a fine line that one has to walk to prevent an exacerbation.
On the other hand, there are times when no matter how hard you try, there is nothing you can do to "fix" the situation. It seems as if your dad is able to make the decisions regarding his health care, even if they are not the decisions that you would want him to make.
Does he have a good relationship with his PCP? Is it possible that they have discussed not treating his disease, but rather treat the symptoms and keep him comfortable?
Where you are is a really lousy position to be in. You know things could be better for him, but he has to agree and accept the help. There are still may people out there (mostly older generations) who feel that their doctors are "GOD" and whatever they say goes. Because we all became ill at such a young age, we have learned that we do have quite a say in our healthcare decisions and learned to advocate for ourselves.
Continue to be the compassionate loving daughter that you are. That is what he needs most!

[SusanD]

Serena....you echo the concerns of hundreds of thousands of adult children who are watching their parents slip slowly into dementia and ill health. Your father's inability and non-motivation to keep track of his meds sounds like early signs of dementia...sounds like you have already noticed this. There *are* some resources to help him in his community I'm sure, but the trouble is getting him to agree to use them.

Hang in there...we can only do so much. You sound rightly concerned.

[SerenaWelsh]

Thanks to all of you.

Yes, he is able to have a home nurse visit him - and one is doing so currently to check in on him every day since his operation. Today should be her first visit...(here I'm assuming it will be a "her").
Having my father understand the roll of a PCP is one problem. He tends to see different doctors for different things, even if they aren't specialists. He would see one family doctor for foot problems, one for his breathing treatments, one for his intestinal problems. The only specialist he has seen is a cardiologist. See above note on that. He has fought having all of his care managed under one roof, and he has no good reason that he can communicate.
While it is possible he's discussed not being treated for his ailments, I don't think that's the case. Looking back at his bills over the last 18 months, he's averaged 1.5 visits to a doctor per week. He's clearly seeking some sort of assistance from the medical community.
He is still able, I think, to being able to make his own decisions. My concern is that he isn't being given the opportunity to make informed decisions. I could tell you stories about the health care situation up there, but it would take forever, and you'd probably not believe there are people like that practicing anyway.
My mother, for whatever her own reasons are, is not able to be an advocate for him. I don't know if it's lack of interest, intimidation, or what. It's been clear for a very long time that she does not consider that her job.

<sigh> Thanks again to everyone for letting me vent - or whatever it is I'm doing.