The Blood Thinner Dilemma
Yesterday was visit the doctor day. When possible, I prefer to leave Hubby at home. He is fragile these days. He does not need unnecessary exposure to the germs of other people. If he should be seriously unwell, I prefer to bring a doctor to our home. However, that is not always an option.
For most people, the number of pills which they take regularly builds up over the years. It is rare to find a doctor who wants to take the responsibility of deleting items from the list. Still, when dealing with an older patient or anyone with Dementia, pill taking is a serious issue. If the patient/spouse begins to refuse to take medications, even grinding them up and hiding them in food may not be a solution. If the patient is taking 20 pills a day, how does one grind them all and get them successfully into another’s body? In some instances, medications originally intended to help, (if conditions change with time), could potentially cause harm. It is important to ask guidance from the family physician to sort-out all of these issues.
An example from our experience illustrates how important it is to have someone clear thinking to care for a patient with medical issues. Hubby has a pacemaker. One day he was having it checked and the technician panicked. Hubby was having Arterial Fibrillation (otherwise known as A-Fib). An emergency appointment with our cardiologist resulted in the proclamation: “He must go on serious blood thinners immediately!” He had already been on either Plavix or Aspirin for over twenty-five years. Suddenly we were told that was not sufficient.
When we brought a private geriatrician to our home for a series of consultations, he had a warning to share. The flip side of the benefits from blood thinners, is that internal bleeding can be severe in the case of an accident. Dementia patients, and the elderly even without the condition have frequent falls. The fall is considered the most threatening risk to both categories. The reasons that they fall are many. Their vision may be poor and their balance undependable. Multiple falls do great damage resulting in fractured or broken bones, and inevitable internal bleeding along with torn skin and cuts. Even one fall onto a hard surface, or one causing head injury, can have severe consequences.
Most hematomas resulting from falls, are absorbed with time, but a bleed in the brain can cause a stroke, paralysis, or even death.
On a personal note, we decided with Dr. S. that Hubby should no longer take his blood thinning medication. If you can imagine the statue of lady justice holding a scale and weighing the evidence, that is what a spouse or family caregiver becomes. If Hubby were to have a bad fall on his head, he could have a life-threatening bleed in the brain if he should remain on the blood thinners. Without them, he would have A-fib, and potential blood clots. One needs the wisdom of Solomon to know what to do in a situation like this. What often happens, is that we “ay-persons are given the options by the medical establishment, but the doctor really does not want to make the decision for us. They do not want to be liable, or to be blamed if the decisions should prove, to be the wrong one.
After consultation with Hubby’s favorite hematologist, it appeared that he was more likely to expire from internal bleeding, than from the other dangers. Hence, it was decided to take him off the blood-thinner. He had not fallen on his head in a long time. Falling on one’s bum does not have the same risks. Our home has wall to wall carpets, which have cushioned his falls frequently. I have recommended this to many people, but few actually listen.
Yesterday’s appointment with our primary care doctor was an opportunity to clarify which pills Hubby no longer ingests, and why the decisions were made. He did not object to the removal, but it becomes complex when multiple doctors get involved and do not keep the others appraised of changes. Generally, the caregiver needs to share information about any changes with multiple doctors.
All of this information heretofore, is to bring us to 5 AM this morning, when I heard massive groans from the living room. I knew it was not a sound to be ignored. I removed myself from my comfy warm pink blanket and rushed toward the sounds. Hubby was sitting on the floor, legs akimbo (good word?), with blood pouring down his forehead. Somehow, he had caught his foot in an electrical lead to a floor heater, went flying head first into the sofa, and ended up sitting bolt upright in shock on the carpet. Only G-d himself has a clue as to why Hubby had gone for a walk-about at 5 AM.
I called for Violet to wake up, to give him first aid, and we lifted him from the floor. All that I could think of was “What if he was still on the blood thinners?” Hubby’s forehead wounds clotted fairly quickly, and he was quite intact if we do not include the whip-lash he gave himself upon the unexpected impact.
You might be scratching your head (do diaries have heads????) and wondering why this irresponsible wife did not call the paramedics and rush hubby to the hospital for CT scans and MRIs. That would have been the proper approach for a younger and healthier person. It is normal to look for a bleed in the head, but the only way to reduce that would be to open up the skull. That is no longer an option. We have been this route many times. All the proper procedures have ended in the same conclusion: For Hubby, there is nothing to be done. The risks of the procedures outweigh the benefits almost every time.
There are times when I must decide to do what is best for my patient. The responsibility is all mine. No medical degree. No PhD No guarantees. No stress at all!
