COPD

[Davy9]

Hello Jinny,

I think you understand that your sister and Jenny's father are in similar situations. I think that your sister is not quite as compromised.

The values you mention of CO2 at "30" is more likely what is referred as combined CO2 in the form of HCO3. It reflects the status of the blood acid buffering capacity in managing retained CO2 gas from under-ventilating. Simply it is one of the bodies compensating tools to deal with inefficient breathing. If it is this value it is moderately elevated.

It could be that the CO2 of "30" is actually her arterial partial pressure of CO2 gas. If so that would reflect hyperventilation but that is not usually the case for the latter stages of COPD (but is does happen).

The ventilator displays can show all sorts of information in both numerical and waveform formats. There are many different ventilator designs that are used in medical care. Most are built to meet a broad range of applications most in intensive care scenarios. A lot of the information you're seeing may not apply to her use of the machine while others will. We can tell a lot from ventilator data and how the machine is interacting with the patient. It is too complex to try and explain here.

Basically it is in with the good air and out with the bad air, every day breathing. All of the muscles responsible for breathing are of the same type as are regular arm and leg muscles. Like those muscles they do work, they can be conditioned and they can be overtaxed. They can tire to the point of having to rest. The changes that happen to the lungs in end stage COPD make the work of breathing very hard. If you ran as fast as you could until you become so short of breath you had to stop you would have a taste of how their breathing is while doing a very simple chore.

When someone with severe COPD goes on a ventilator the machine does the work of breathing for them. This does 2 things. In a short time the muscles that are responsible for their breathing decondition, especially if they have been sick. Secondly they feel life without having to meet the high cost of breathing. For once they are not short of breath or fear getting short of breath. When weaning the idea is to get those muscles back into the best condition possible in and to get the person to re-accept that work. Both tasks can be very hard.

Ideally they can keep her heart and its related functions in good order, her fluid balance can be kept under control, they can get her proper nutrition and can keep her from getting secondary infections. In others words they want to keep her stable and work her off of the ventilator. If all goes well she may be able to rehab back to being independent and as functional as she was before (or better).

[Jinny]

I'm tired, but still seeking answers. Today I was with my sister from 11am to 7pm. When I arrived, the nurses and resp therapist were speaking with my brother in law and told him that three times during the night she pulled the vent off. They said that the doctor would like a signed DNR or not with her signature. I also heard them say that they are looking into another facility for her. Presently she is in a Rehab facility. So.......since my brother in law does not tell me anything. I have to conclude that perhaps the Rehab facility feels that she should be in a hospice facility, perhaps they feel if she is pulling out the vent she should have a DNR order. With all that said, today she slept most of the day, when she was awake, she was confused, was seeing things that weren't there, and seemed to be off in the distance. The blood pressure is now lower. She still has fluid retention in the legs and face. Her feet and hands didn't feel cool. She seemed to have more suctioning needed.

Would it be possible that the rehab facility would actually determine that is was time for hospice and want her moved to there?? Why would they even talk about looking for another facility for her? Yesterday she was not able to be off the vent at all. Today, she made it 20 minutes.

Are we moving closer?

[Jinny]

Also forgot, when the nurses were listening to her lungs, she said, she heard wheezing and crackling.
What would that signify?

[Davy9]

The facility does not determine the timing to enter into hospice care. It is the patient and their family along with their physician. But it is primarily the patient who accepts the notion that the care goals should be supportive as opposed to curative. That is what hospice is about, making the end of ones life pass as pain free and comfortable as possible. They do not accelerate the process but work to make its natural course tolerable and understood. Yet, in that regard, if your sister decides that she wants that ventilator removed and understands the consequences then they may allow that to happen. In that instance she would certainly not last very long.

Is this approaching the end? It is hard to say. You have followed the other thread here and you have read where that patient rallies, then fails and rallies again. Your sister could succumb in a short time or not. She could even surprise herself. They might pull that ventilator and she could possibly survive without it. I suspect not, but it is a possibility. The eminence of her demise certainly is not simple to determine in person and even more difficult from the few writings shared here.

The breath sounds you mention describe tightness in the airways and moisture either in the airways or the air sacs. Breath sounds and describing them are practically a science unto their own.

[jennyj1979]

Jinny,

My heart goes out to you and your family. I am currently at a hospice facility in Southern Maine. My father was trasported here yesterday because medically they have done all the can for him. We opted for comfort care and honestly this hospice facility has been a blessing. He is much more comfortable, the place is much more peaceful then a hospital. My fathers time is now down to days. he sleeps 24-7 and the doctor told us today that within the next 24 hours she expects that he will be unresponsive. And within 72 hours after that he will pass. This is extremly difficult news to hear I do know that he is going to be at peace and will not be in pain anymore. Jinny I would love tp talk to you if there was a way outside of here for us to communicate. I do understand what you are going through. My thoughts and prayers are with you.

[Jinny]

Where is the facility in southern maine? I am a minister, my website it lovingunity.com

[jennyj1979]

Jinny its called the Gosnell House.. its done by Southern, Maine hospice (They are out of Scarborough.) If your sister is going to go some place I highly recomend it. They are extremly patient and caring and they made my fathers passing very peaceful. (he passed at 7:30 this evening.) Not to mention the place is absolutly gorgeous.

Please do hesitate to contact me Jinny, I would chat with you about what you are going through.. I know so much about it.

God Bless

[Jinny]

Jenny,
May the happy memories of the past bring you some comfort at this time.........thank you for your kindness...thank the Lord for this posting board, it has truly been like having a friend right there with you holding you hand all the time....

[Davy9]

A true and interesting story for you both. My wife is a hospice RN. Last Friday she had one of her patients pass. Her name was Ruth. For decades Ruth had told her family that when she died and got to heaven that she'd make a thunderstorm and show them what a real thunderstorm was like. Needless to say that night we had a thunderstorm. I am from the midwest and now live in Idaho. From Missouri standards this wasn't much of a storm. But for North Idaho it was a dandy storm. 4 hours of constant thunderous registering. Neighbors who have been residents here all their lives had never experienced anything like it. So Ruth got to say goodbye her way.

Jenny your father is now at peace and you have his loving memories and inherited his wonderful ways. Finalize the formalities. Carve out how you can keep him in your life joyfully and carry on your life joyfully. It was a rough row to hoe. They usually are. You done good.

[Jinny]

Today my sister was even more removed. She was sitting up, but staring off. At times, she was sad and crying and at other times she was angry. They have started a morphine patch. She has a feeding tube and her stomach is extremely bloated. Not sure how to make her more comfortable. When I arrived, she looked at me and told me it will be tonight, then she never said it again for the rest of the time I was there. It seemed like even tho he was on the vent, she required more combivent medicine. She said she was not getting enough oxygen. She is getting colace but is still constipated. I know this is disjointed, I wish I knew what else to do.