Feeling Very Sad Everyday About What Happen to Dad So Quickly!

I have reviewed (over and over again) all the medical reports from the Doctor's and Staff in Joplin that led up to Dad's death. I just could not understand how he got so many life threating issues from Dec. 7th-April 8th? I must justify his death and move on, it's just he was so sick when he was sent to Joplin by himself. I feel I failed him, he would have never not been there for me.

Dad was transferred to Joplin, Freeman Health Care Systems on Jan. 29, 2008. (see reports below)

He arrived at Freeman Serenity Center Feb. 2, 2008

After all the medical tests and physical issues he had been through his attending Physician, Dr. Michael Collins, wrote the following:

"Patient is suffering severe dementia & accute renal failure, this explains his mental status changes over the preceding recent weeks that would involve increased aggression"

(meaning Dad was suffering severe medical issues, including acute renal failure, chronic anemia, hyperkalemia (Hyperkalemia can occur from a variety of causes, including the consumption of too much of a potassium salt; the failure of the kidneys to normally excrete potassium ions into the urine; the leakage of potassium from cells and tissues into the bloodstream; and from acidosis. The most common cause of hyperkalemia is kidney (or renal) disease, which accounts for about three quarters of all cases) & dehydration, that were not treated at Moore Few.

Dad was admitted to Freeman Hospital, 1/29/08 attending Physician, Dr. Habib's report:

Patient is suffering chronic dementia, aggressive behavior noted by Moore Few Care Center over last 1-2 weeks.

Patient is demented and disorientated

Patient is suffering from the following know medical ailments:

Diabetes type 1

Hypertension

Gout

Chronic Dementia

Kidney Disorder and Infection (this was the first I heard of this??)

DRUGS:

Risperdal .25 mg b.i.d twice a day Generic Name: risperidone (oral) (ris PER i done)Brand Names: Risperdal, Risperdal M-Tab (Dr. Barnes started Dad out on a full strength 1 mg?? the last of Dec. 2008, I had asked Dr. Barnes to give Dad something to help him cope/relax with living in the care center 24/7, Dad was becoming restless and wanted to go home with Mom, Mom could not go home, she was to ill) Why didn't he start him out with a lower strength? Dad immediately started slurring his speach and falling)

Warning on Drugs for Elderly Behavioral Issues
FDA Orders Warning Labels After More Deaths Seen in Elderly Patients With Dementia
WebMD Health News
April 11, 2005 -- The FDA has issued a public health advisory about certain drugs used to treat behavioral problems in elderly patients with dementia.
That's an unapproved use of the drugs, called antipsychotic drugs, which include:

Risperdal **sometimes used to treat agitation and other behavior disturbances in elderly patients with dementia, such as Alzheimer's disease. Doctors should review treatment for elderly patients with dementia who are taking the drugs for behavioral problems, says the FDA's advisory.
More Deaths
The FDA's decision was based on 17 studies of four of (Risperdal, and Seroquel) in elderly patients with dementia and behavioral disorders.
In those studies, the death rate was about 1.6 to 1.7 times higher for elderly patients with dementia than for those taking a placebo.
The causes of death varied. Most seemed to be either heart-related (such as heart failure or sudden death) or from infections (mostly pneumonia), says the FDA.
Atypical antipsychotic drugs fall into three categories based on their chemical structure. Because the increased death rate was seen with drugs from all three classes, the FDA concluded that the effect is probably related to common effects of all such drugs, including those drugs that haven't been studied in people with dementia.
New Warning Labels
The FDA has asked the drugs' makers to add a boxed warning to the drugs' labels describing the risk. The label will also note that the drugs are not approved for the treatment of behavioral symptoms in elderly patients with dementia.

Prozac 20 mg p.o.q. day- is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs).

Prozac affects chemicals in the brain that may become unbalanced and cause depression, panic, anxiety, or obsessive-compulsive symptoms.
Prozac is used to treat major depressive disorder, bulimia nervosa (an eating disorder) obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD).

Diltiazem VR 180 mg p.o.q. day Diltiazem is used to prevent chest pain (angina). It may help to increase your ability to exercise and decrease how often you may get angina attacks. Diltiazem is called a calcium channel blocker. It works by relaxing blood vessels in the body and heart and lowers the heart rate. Blood can flow more easily and your heart works less hard to pump blood.

Ativan .5mg q 4hours, prn LORAZEPAM - ORAL
Pronunciation: (lor-AYE-zeh-pam)
Brand Name(s): Ativan This medication is used to treat anxiety. Lorazepam belongs to a class of drugs known as benzodiazepines which act on the brain and nerves (central nervous system) to produce a calming effect. This drug works by enhancing the effects of a certain natural chemical in the body (GABA).


Lisinopril/Hydrochlorothizaide 12/12/.5mg p.o. q.day LISINOPRIL / HYDROCHLOROTHIAZIDE - ORAL
Pronunciation: (lyse-IN-oh-pril/HYE-droe-KLOR-oh-THYE-a-zide)
Brand Name(s): Prinzide, Zestoretic




This medication is used to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. This product contains 2 medications, lisinopril and hydrochlorothiazide. Lisinopril is called an ACE inhibitor and works by relaxing blood vessels so that blood can flow through the body more easily.



Hydrochlorothiazide is called a "water pill" (diuretic) and causes your body to get rid of extra salt and water. This effect may increase the amount of urine you make when you first start the medication. It also helps to relax the blood vessels so that blood can flow through the body more easily.


Sliding Scale Insulin of Humalog



Allopurinal 300 mg p.o.q day ALLOPURINOL - ORAL
Pronunciation: (AL-oh-PURE-i-nol)
Brand Name(s): Zyloprim Allopurinol is used to treat gout and certain types of kidney stones. It is also used to prevent increased uric acid levels in patients receiving cancer chemotherapy. These patients can have increased uric acid levels due to release of uric acid from the dying cancer cells. Allopurinol works by reducing the amount of uric acid made by the body. Increased uric acid levels can cause gout and kidney problems.



Naproxen 500 mg p.o. b.i.d. Naproxen is used to relieve pain and swelling (inflammation) from various conditions. It is used to treat headaches, muscle aches, backaches, tendonitis, dental pain, and menstrual cramps. It also reduces pain, swelling, and joint stiffness caused by arthritis, bursitis, and gout attacks. Reducing these symptoms helps you do more of your normal daily activities. This medication is known as a nonsteroidal anti-inflammatory drug (NSAID).



Alprazolam .5 mg t.d. ALPRAZOLAM - ORAL
Pronunciation: (al-PRA-zoe-lam)Alprazolam is used to treat anxiety and panic disorders. It belongs to a class of medications called benzodiazepines which act on the brain and nerves (central nervous system) to produce a calming effect. It works by enhancing the effects of a certain natural chemical in the body (GABA).
Brand Name(s): Xanax


Tylenol 650mg 4 hours prn



Ibuprofen 600 mg q. 4 hours prn



2/02/08



Dad arrived at Freeman Serinity Center, Dr. Goad attending Physician-Noted: Diabetes Type 1, hypertension, gout, chronic dementia, unspecified kidney disorder, arterial renal failure/anemic & dehydration. Reduce medications to-

Insulin



Nameda 5 mg MEMANTINE - ORAL
Pronunciation: (meh-MAN-teen)
Brand Name(s): Namenda Memantine is used to treat moderate to severe confusion (dementia) related to Alzheimer's disease. It does not cure Alzheimer's disease, but it may improve memory, awareness, and the ability to perform daily functions. This medication works by blocking the action of a certain natural substance in the brain (glutamate) that is believed to be linked to symptoms of Alzheimer's disease.



Diltiazem XR 5 mg h.s.



Weight 159



Blood pressure 108/31

Hypotension (HI-po-TEN-shun) is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood.
Blood pressure is measured as systolic (sis-TOL-ik) and diastolic (di-a-STOL-ik) pressures. Systolic blood pressure is the pressure when the heart beats while pumping blood. Diastolic blood pressure is the pressure when the heart is at rest between beats.
You will most often see blood pressure numbers written with the systolic number above or before the diastolic, such as 120/80 mmHg. (The mmHg is millimeters of mercury-the units used to measure blood pressure.)
Normal blood pressure in adults is lower than 120/80 mmHg. Hypotension is blood pressure that's lower than 90/60 mmHg.



Heart 57

What is a normal pulse?

Adults (age 18 and over)
60 - 100 beats per minute


Respirations 17

Normal respiration rates for an adult person at rest range from 15 to 20 breaths per minute. Respiration rates over 25 breaths per minute or under 12 breaths per minute (when at rest) may be considered abnormal.


Chest & Brain xray did reveal cerebral atrophy-


Cerebral atrophy is a common feature of many of the diseases that affect the brain. Atrophy of any tissue means loss of cells. In brain tissue, atrophy describes a loss of neurons and the connections between them. Atrophy can be generalized, which means that all of the brain has shrunk; or it can be focal, affecting only a limited area of the brain and resulting in a decrease of the functions that area of the brain controls. If the cerebral hemispheres (the two lobes of the brain that form the cerebrum) are affected, conscious thought and voluntary processes may be impaired. What is Cerebral Atrophy?Cerebral atrophy is a condition characterized by a decrease in the size or a wasting away of brain cells and tissues. It may result from malnutrition, abnormal cell or hormonal changes, or stroke. Symptoms include muscle weakness, vision or speech impairments, and dementia. Neuroimaging techniques such as magnetic resonance imaging (MRI), computer tomography (CT), positron emission tomography (PET), and single-photon emission computed tomography (SPECT), are used to diagnose the disorder. Cerebral atrophy may be a feature of numerous disorders, and may affect only part of the brain.
Is there any treatment?Generally, treatment-which is symptomatic and supportive-depends upon the specific disorder of which cerebral atrophy is a component. In some cases, drug therapy may relieve some symptoms. Care that maintains and stimulates individuals with the disorder improves their quality of life.
What is the prognosis?The prognosis for individuals with the disorder varies. Progressive cerebral atrophy is fatal because the atrophy spreads to all parts of the brain. Cerebral atrophy that is limited to a specific area of the brain affects normal functioning, however, it is not necessarily fatal.


Renal Failure-Chronic kidney failure occurs when disease or disorder damages the kidneys so that they are no longer capable of adequately removing fluids and wastes from the body or of maintaining the proper level of certain kidney-regulated chemicals in the bloodstream.
Description
Chronic kidney failure, also known as chronic renal failure, affects over 250,000 Americans annually. It is caused by a number of diseases and inherited disorders, but the progression of chronic kidney failure is always the same. The kidneys, which serve as the body's natural filtration system, gradually lose their ability to remove fluids and waste products (urea) from the bloodstream. They also fail to regulate certain chemicals in the bloodstream, and deposit protein into the urine. Chronic kidney failure is irreversible, and will eventually lead to total kidney failure, also known as end-stage renal disease (ESRD). Without proper treatment intervention to remove wastes and fluids from the bloodstream, ESRD is fatal.

Hypovolemic Shock

Hypovolemic shock is an emergency condition in which severe blood and fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.

Causes
Losing about 1/5 or more of the normal amount of blood in your body causes hypovolemic shock.
Blood loss can be due to bleeding from cuts or other injury or internal bleeding such as gastrointestinal tract bleeding. The amount of blood in your body may drop when you lose too many other body fluids, which can happen with diarrhea, vomiting, burns, and other conditions.
The greater and more rapid the blood loss, the more severe the shock symptoms.



Dehydrated Hyponatremia-The normal concentration of sodium in the blood plasma is 136–145 mM. Hyponatremia occurs when sodium falls below 130 mM. Plasma sodium levels of 125 mM or less are dangerous and can result in seizures and coma.



Dehydrated-By the time a person becomes severely dehydrated, there is no longer enough fluid in the body to carry enough blood to vital organs. Shock, which is a life-threatening condition, can develop quickly.
A severely dehydrated person may not be able to cooperate or communicate.


Medications changed to:

Discontinue, Risperdal, Prozac, Xanax and Ativan-

New drug-Nameda 5 mg Generic Name: memantine Brand Name: Namenda

Memantine reduces the actions of chemicals in the brain that may contribute to the symptoms of Alzheimer's disease.
Memantine is used to treat moderate to severe dementia of the Alzheimer's type.



Aricept 5 mg at nite-Generic Name: donepezil Brand Name: Aricept

Donepezil improves the function of nerve cells in the brain. It works by preventing the breakdown of a chemical called acetylcholine (ah see til KO leen). People with dementia usually have lower levels of this chemical, which is important for the processes of memory, thinking, and reasoning.
Donepezil is used to treat mild to moderate dementia caused by Alzheimer's disease.



Hydrochlorothiazide 12.5 mg per day

Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.
Hydrochlorothiazide treats fluid retention (edema) in people with congestive heart failure, cirrhosis of the liver, or kidney disorders, or edema caused by taking steroids or estrogen. This medication is also used to treat high blood pressure (hypertension).



Tiazac 120 mg per day-Generic Name: diltiazem Brand Name: Tiazac

Diltiazem is in a group of drugs called calcium channel blockers. It works by relaxing the muscles of your heart and blood vessels.
Diltiazem is used to treat hypertension (high blood pressure), angina (chest pain), and certain heart rhythm disorders.



NOTE: NO ACCUTE PHSYCHIATRIC NEEDS.



2/4/08

Barbara and I visited Dad the first time since Moore Few shipped him to Joplin so ABRUPTLY!
Dad was very hot, he had no shirt on and had his jogging pants rolled up like shorts? He knew us immediately, he said, "There's my daughter's" but still I knew something serious was wrong with him?? Dad wanted Ice Cream and I went and got it for him. He asked Barbara and I to get boxes for Marty's things? He asked "how much do you think they will cost?" He said to buy about a $100.00 worth. We sat with Dad a while, he fall asleep and we left. The next morning his vital signs were so low he was transferred back to Freeman hospital to the emergency room, Valerie his nurse thought he would not make it.

2/5/08
Dr. Habis evaluation, low vital signs was the cause of concern-

Hypotension
Acute Renal insufficiency/failure
Dehydration
Leukocytosis with concern of Sepsis
Minimal elevation of total Bilirubin
Advance Dementia
Altered Mental Status
anemia-Normocytic
Very weak, altered mental stage
Hypotensive and labs, creatinine 2.5, appeared icteric (Jaundice is not an illness, but a medical condition in which too much bilirubin – a compound produced by the breakdown of hemoglobin from red blood cells – is circulating in the blood. This excess of bilirubin causes the skin, eyes, and the mucus membranes (inside of the mouth) to turn a yellowish color. This yellowish color is due to the bilirubin dissolving in the fat layer just below the skin)

Tranfer patient to ICU for possible Sepsis (Sepsis is a severe illness caused by overwhelming infection of the bloodstream by toxin-producing bacteria) Sepsis occurs when bacteria infect your bloodstream. Sepsis can be deadly. Blood pressure may drop and the lungs and kidneys may start to fail. Emergency care for sepsis is crucial.

White Blood Count 20,000 (The normal range for WBC count is 4,300 to 10,800 cells per cubic millimeter (cmm) or 4.3 to 10.8 x 109 cells per liter. A range of 11 to 17 x 109/L may be considered mild to moderate leukocytosis, and a range of 3.0 to 5.0x109/L may be considered mild leukopenia) A high WBC count can be an indicator of an infection, inflammation, or allergy. Some conditions may cause a decrease in the WBC count.
Leukocytosis is the presence of an elevated WBC count; leukopenia is a decreased WBC count. Leukocytosis may be caused by several conditions including bacterial infection, inflammation, leukemia, trauma, or stress. Leukopenia may occur as a result of chemotherapy, radiation therapy, or immune system disorders.

Upon arrival patient was normotensive (Normotensive: Refers to blood pressure within the normal range) weak, Leukocytosis with Sepsis, Acute renal failure and hyponatremia. Blood pressure 104/109/40's-50's, Respiratiory 23, Pulse 80's/low 90's, Temperature 97.7.
Awake, confused withdrawn and will not answer quesitons, would not follow commands, Very Dehydrated, Very Weak.
Start Zosyn, antibotic for kidney infection-Generic Name: piperacillin-tazobactam Brand Name: Zosyn, Piperacillin is an antibiotic in a group of drugs called penicillins. Piperacillin fights bacteria in the body.
Tazobactam is in a similar group of antibiotic drugs and also fights bacteria in the body.
The combination of piperacillin and tazobactam is used to treat many different infections caused by bacteria, such as urinary tract infections, bone and joint infections, severe vaginal infections, stomach infections, skin infections, and pneumonia.

Dad was in Freeman Hospital on Friday Feb. 8th when he had a serious episode of Delirum-

Delirium is a medical condition characterized by a vascillating general disorientation, which is accompanied by cognitive impairment, mood shift, self-awareness, and inability to attend (the inability to focus and maintain attention). The change occurs over a short period of time— hours to days— and the disturbance in consciousness fluctuates throughout the day. It was AWFUL!

His nurse called me and Dad was saying things that were completely not like him. He had his clothes and wanted to leave, the staff had to subdue him. He was then transferred back to the Serenity Center for mental evaluation???

02/13/08 After all this was said and done, Dad was treated by Dr. Collins, his evaluation-
"Patient is suffering severe dementia & accute renal failure, this explains his mental status changes over the preceding recent weeks that would involve increased aggression"

Dad was released and transferred to Moore Few where in the next few weeks Diabetes black ulcers took over his feet (Diabetic ulcers are the most common foot injuries leading to lower extremity amputation. Family physicians have a pivotal role in the prevention or early diagnosis of diabetic foot complications. Management of the diabetic foot requires a thorough knowledge of the major risk factors for amputation, frequent routine evaluation and meticulous preventive maintenance. The most common risk factors for ulcer formation include diabetic neuropathy, structural foot deformity and peripheral arterial occlusive disease. A careful physical examination, buttressed by monofilament testing for neuropathy and noninvasive testing for arterial insufficiency, can identify patients at risk for foot ulcers and appropriately classify patients who already have ulcers or other diabetic foot complications. Patient education regarding foot hygiene, nail care and proper footwear is crucial to reducing the risk of an injury that can lead to ulcer formation. Adherence to a systematic regimen of diagnosis and classification can improve communication between family physicians and diabetes subspecialists and facilitate appropriate treatment of complications. This team approach may ultimately lead to a reduction in lower extremity amputations related to diabetes) his heart and kidneys were failing, he battled dehydration and severe weight loss, he passed away at 7:30 a.m. Tuesday April 8th, 2008. I miss him everyday, he is my first thought in the morning and at night. I miss both Mom and Dad, the doctor's had Mom very comfortable and she was as happy as possible. Dad suffered so. I will NEVER FORGIVE myself for not being in Joplin to help him.