tag:blogger.com,1999:blog-2760353953251845523.post6049863151388109548..comments2024-02-10T02:14:39.898-05:00Comments on Buckeye Surgeon: The DwindlesJeffrey Parks MD FACShttp://www.blogger.com/profile/15650563299849196122noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-2760353953251845523.post-19865181894337896042008-11-07T22:45:00.000-05:002008-11-07T22:45:00.000-05:00I couldn't help but wonder if she might have had a...I couldn't help but wonder if she might have had a swallowing problem... as many as 50% do after extubation. This can lead to an aspiration event, perhaps complicated by nausea from meds... then pneumonia. The elderly are very fragile and should avoid the hospital whenever possible. :)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-5794676337872240102008-10-27T16:00:00.000-04:002008-10-27T16:00:00.000-04:00My father-in-law had surgery last February, and it...My father-in-law had surgery last February, and it took a long time for him to recover from the anesthesia and a subsequent move to assisted living. He had been a very intelligent man but moves and anesthesia seem to really set him back. He went from being oriented 99% of the time to being oriented about 50% of the time.<BR/><BR/>I wonder how much these factors could be contributing to dwindling...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-90088369798324758922008-10-25T08:33:00.000-04:002008-10-25T08:33:00.000-04:00annie-I have involved psychiatrists in these scena...annie-<BR/>I have involved psychiatrists in these scenarios. Usually nothing much comes of it. An order is placed for Zoloft and you never see Dr Shrink again. Plus, it's an unfair situation for the psychiatrist. The patient is recovering from an illness, maybe hooked up to a billion lines and tubes in the ICU and it's difficult to do the kind of intense cognitive based therapy that some of these patients need....Jeffrey Parks MD FACShttps://www.blogger.com/profile/15650563299849196122noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-45469114992441091462008-10-25T06:30:00.000-04:002008-10-25T06:30:00.000-04:00reminds me of a patient in my training. not only d...reminds me of a patient in my training. not only didn't she want to get better, but she wanted to die. and she did everything the opposite of what we told her to do. maybe i should blog about it some time. even lipstick wouldn't have helped.Bongihttps://www.blogger.com/profile/12918640034313468627noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-13636580934222033722008-10-23T16:41:00.000-04:002008-10-23T16:41:00.000-04:00Difficult, but all of the cases mentioned in the p...Difficult, but all of the cases mentioned in the post and comments would appear to have sx. of acute depression. <BR/><BR/>Has anyone considered getting a psych consult or at least a soc. work. consult for therapy assessment? If so, did the outcome improve?<BR/><BR/>Family dynamics, perceived degree of loss of independence, anticipatory grieving, fear of dying, etc - all and much more may be in play.<BR/><BR/>Do any of your facilities have a gerontology dept? That would be an ideal consult source, if available.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-1828719501463536642008-10-23T14:58:00.000-04:002008-10-23T14:58:00.000-04:00My internist gave me this advice prior to a surger...My internist gave me this advice prior to a surgery: "Only do it if you can go into it absolutely convinced that everything will go well. If you have any doubt at all, postpone." Of course, the patients you seem to be discussing are not in an "elective" category, and are older. Paralyzing fear -- somatic and psychic -- seems to be at the heart of it, somehow. Not fear of dying, but fear of living, and of the "complications" that life might bring? The lipstick idea makes me smile -- I always pack several -- and whether I wear them or not, I am reminded of hope at the sight. Especially Sassy Cinnamon. But is there an equivalent for dwindling man?Bianca Castafiore?https://www.blogger.com/profile/07088130255223709497noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-34532536014019659212008-10-23T09:43:00.000-04:002008-10-23T09:43:00.000-04:00Ramona- I like that idea! Tomorrow im going to st...Ramona- I like that idea! Tomorrow im going to start sharing my lipstick with my little old lady patients.Jeffrey Parks MD FACShttps://www.blogger.com/profile/15650563299849196122noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-56966327837906532022008-10-22T23:51:00.000-04:002008-10-22T23:51:00.000-04:00Buckeye--You're speaking my language!!! Right now...Buckeye--<BR/>You're speaking my language!!! Right now I have a previously healthy/vibrant 79 yo woman with pancr CA, went thru a 6 hour challenging and technically beautiful resection for cure, now just 'dwindling' away...decided she wants to be DNR/CMO because she 'has nothing to live for.' Can't help but be frustrated that my co-surgeon and I poured our hearts into the surgery and early postop care, and now ...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-19178217109972076432008-10-22T17:20:00.000-04:002008-10-22T17:20:00.000-04:00Buckeye....buckup you did your best, and it is ha...Buckeye....buckup you did your best, and it is hard to accept not getting a 'A' for your hard work and results. Elderly people are not only physically elderly, but some times mentally depleted by life's events....<BR/>Acting early by engaging family, grandchildren friends sometimes can make a difference, not always, but sometimes SSRIs can alter this mental depletion.<BR/>Don't give up on the next one...<BR/>gmlGary M. Levinhttps://www.blogger.com/profile/16205704913440150198noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-18590210161654264722008-10-22T11:27:00.000-04:002008-10-22T11:27:00.000-04:00My grandfather was a dwindler. His esophageal can...My grandfather was a dwindler. His esophageal cancer was completely resected by an esophagectomy but after his wife passed away he just lost the will to rehabilitate. It's a sad reality in our elderly population.MedZaghttps://www.blogger.com/profile/12369686516173224979noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-31095110677881080442008-10-22T08:47:00.000-04:002008-10-22T08:47:00.000-04:00Very frustrating -- the dwindles. I never found a...Very frustrating -- the dwindles. I never found a good way to deal with them. I've taken knitting & crocheting & sewing supplies to some little old ladies. Sometimes it helped, not always. <BR/><BR/>I don't wear much lipstick, but may have to start as I get older. One of the best signs is coming in to round and finding that Mrs Dwindles has put on some lipstick. I love that "sign"!rlbateshttps://www.blogger.com/profile/15236331355857884458noreply@blogger.com