Is waiting 3 weeks to see a doctor dangerous?

In My Humble Opinion
1

Here’s the situation: my mother-in-law is 85 years old. She has heart problems (quad. bypass four years ago), high blood pressure, arthritis, Alzheimer’s. 18 months ago she had a small heart attack (diagnosed as atrial fibrulation) but since then has seemed steady on medications.

Friday at 2 a.m. she got up to go to the bathroom and fell, hitting her head. She wasn’t knocked out, and there was no bleeding, but it resulted in a sizable lump. Fortunately she is staying with us and we heard her fall. We called an ambulance to take her to the emergency room straight off. (Necessary because she’s on warfarin, and thus at risk for internal bleeding.)

At the ER she got a cat scan, plus xrays of her hip and knees, since she complained they were hurting. Also various blood tests. At eight a.m. they sent her home, saying there was nothing (new) wrong. The doc gave her a vicodan, which left her loopy, and a script for more if necessary but suggested if she could get by on Tylenol that would be better. Actually, she hasn’t complained of any pain at all, so no pain pills since the first.

But it’s been a couple of days now, and she’s still so dizzy we dare not let her get up without one of us helping her, and she only walks with one of us standing right behind her and holding onto her walker so she is ‘surrounded’ by the walker, our arms, and our body. If she turns her head too fast, if she tries to turn a corner, if she even looks at the ground too long she starts to fall in that direction and we have to hold her up until she gets her balance back.

Also, I’m pretty sure she is complaining of double vision, though it’s hard to be sure, given her AD fogginess.

Further complication: the medical association her internist is in ended their association with her Medicare HMO as of December. We found a new internest for her in December, but the earliest we were able to schecule her for a checkup was Feb 7.

IOW, she is scheduled to meet ‘her’ doctor for the first time in three weeks.

It seems to me that that is too long to just wait, if something that can be getting worse is going on.

OTOH, her daughter thinks we might as well wait. She says the problem is no doubt a concussion, and since she’s already had the cat scan, there’s really nothing else to do but wait for her body to heal from it. She says the doctor will just tell us to keep a close eye on her and wait – and what’s the point of putting her through the stress of getting to the doctor’s office just to be told to do what we are already doing?

Which sort of makes sense. And, in truth, I have no idea how we’d get her to her doctor’s office other than calling an ambulance again. There are 8 steps from the ground to our front door, and zero chance she could make it down them. It took my husband and me and the help of a neighbor to get her UP those stairs Friday morning after the ER visit. (She’s always been better at going up than down for some reason.)

The other problem is what to do about her if we don’t go to the doctor, or even if we do, and he just says ‘wait.’ She cannot possibly go back to stay alone in her apartment. Her daughter says there’s no way she can take her at her house. (Reasonable: she already got her own three children and a toddler grandchild living with her.) We have the room – no children – but besides the stairs to the front door, all the bedrooms are on the second floor, so she’s sleeping on a rollaway bed in the living/dining room, obviously not ideal.

A bigger problem is that she needs constant supervision, at least right now. Tomorrow my husband is off for the holiday and can watch her, but what about the day after that?

I’m thinking a nursing home is most likely the proper solution – but both hubby and his sister are appalled at the idea. She’d made them promise to never ‘put her in a home’ years ago, when her medical problems started mounting.

Sorry, I’m rambling. I only meant to ask about the short term. Do you think the dizziness & double vision mean we should get her back to a doctor ASAP? Could we safely wait until her Feb 7 appointment? Or…do we take a middle road and see what another day or two brings?

Thanks for any advice.

2

My sympathies with your difficulties, and kudos for doing your best to care for her. Also the obligatory IANAD.

If she is definitely diagnosed with Alzheimer’s, then sooner or later she is probably going to need full-time care, most likely in a special Alzheimer’s unit, unless your family has the resources to hire someone to be with her 24/7. If you haven’t started planning for this already, best start immediately.

As to the dizziness, etc., this could be from so many things I dare not even guess. My 91-year-old MIL had similar symptoms that turned out to be nothing more than needing a decrease in one of her blood pressure meds.

If it were my family, I’d wait until the weekend’s over and see if her former doctor will see her one more time on a self-pay basis.

Many HMOs have call-in “help” numbers and may be able to advise you. Also they may have a lead on transportation services.

Isn’t she on Medicaid? She certainly qualifies by age.

3

If it were me, I would absolutely bring her to the doctor as soon as possible. I would not mess around with that level of dizziness.

You can get into her doctor by calling and saying you have an emergency- that she was seen in the ER and has some worrying symptoms. The doctor probably has time where he/she fits in urgent cases. Either that or head back to the ER if you have to.

4

For the immediate problem, I’d take her back to the doctor as soon as you can or take her back to emergency if you can’t get a quicker appointment. What caused her to fall in the first place?

As far as long term if you don’t want to put her in a nursing home, she may be eligible for an aid to come to your house. Our community has a day care for Alzheimer’s patients. A bus picks them up every day or a couple days a week for a few hours. Something like that is great because it gives you some time to yourself and they’re monitored by doctors and therapists. I don’t know where you live but something like this might be available in your area.

5

I’d take her to her old doctor on a self-pay basis for a visit this week. You can rent ramps and wheelchairs if she can continue to stay with you for the short term. Surely a rollaway bed in the diningroom is preferable to staying by herself right now.

For the long-term, I’d suggest some sort of companion/roomate. Someone who, in return for a room, can be there to help. As long as she isn’t requiring lots of special care, like help bathing and dressing, you might be able to find someone just to be there to make sure she’s eating and taking her meds. If she needs constant supervision, I’d guess your most logical step would be a nursing facility or a senior living facility that allows older folks to keep their own apartments but helps with dining and outings. Unless an adult grandchild moves in with her and takes care of her while the family pays them a stipend. At some point someone has to realize that what she wants isn’t necesarily what is going to work out.

Good luck. The aging parent issue is heart-breaking. We can keep people alive longer, but they aren’t always able to look after themselves, and sometimes haven’t planned financially to live that long, creating a hardship on their children and grandchildren, who love them and want the best for them.

StG

6

Thank you guys! Some really great suggestions.

Somehow it never occured to me that we could take her to her old doctor! Okay, if she’s not a whole lot better tomorrow morning, I’ll start working the phone and get her in to see either the new doctor or the old one ASAP. (The ER doesn’t seem hopeful, given the way they shoved her back out the door.)

The idea of having a responsible grand child move in is splendid. It might be just perfect for one of our nieces – she’s chafing at still being at home, crowded in with siblings and mother and toddler.

As for the other arrangements, we already were paying for an aide to come to MIL’s apartment every morning for a couple of hours. She helps her get up, groomed, dressed, makes her bed, feeds her breakfast. Her daughter and I take care of shopping and housekeeping. That used to be enough to allow MIL to live ‘independently’ - but if she doesn’t get back close to what she was… Well. Time to cross that bridge later.

Again, thanks for the feedback, especially backing me on it being not good to just wait around for three weeks.

7

I would take her to the doctor ASAP. My grandfather did something similar some years ago (whacked his head in the middle of the night) and didn’t treat it for weeks, until he literally could no longer stand on his feet. It ended up being a slow bleed putting pressure on his brain, and he had to have emergency brain surgery. He ended up being OK (that man had more lives than a cat!) but I think a head injury, especially in someone with so many other issues, is not something to mess around with.

8

There’s a Stroke Screening for Dummies that goes something like this. Ask her to smile. Do the sides of the face match, more or less? Can she wave at you with one hand, then the other? Can she walk, without falling down? Can she read a nursery rhyme without messing up? If not, take her to a doctor. Immediately. The quickness is vitally important.

9

The dizziness and double vision are both concerning symptoms after a head injury, and she needs to be rechecked. Initial head CT scans show perhaps 85% of intracranial bleeds but miss a significant number. Many other things could also be causing her symptoms, but some of them are serious. In short, I agree three weeks is too long to wait.

10

IANA-DR, I can’t give you medical advice

What would you have had them do, if her CAT scan, xrays and blood tests were normal and her pain was controlled?

Having said that as Dr Paprika noted intracranial bleeds come in a couple of varieties; if you have an arterial bleed, there’s high pressure and rapid accumulation of blood inside the skull, this usually shows up on he CAT scan right away. Alternatively, if you have a venous bleed, it’s low pressure, with slow accumulation, this can take days, even weeks to build up enough to show on a CAT scan or for symptoms to become apparent, but once they start, they should progresively worsen.

Something to consider is where she needs to be for treatment, If she has bleed, she’ll need to be admitted, maybe have surgery, so if her internist thinks she does, the first thing they’ll do is send you to the ER.

11

I’ll comment on another part of your OP, hopefully that’s ok.

It sounds like you may have a neice or family member who can look after her for a while, but if she really has as many issues as you say, that is only going to be a temporary fix. My grandfather had Alzheimer’s and there is no way that anything short of professional round the clock care and supervision would work when it got bad. If your neice has anything like a life at all she is not going to be enough. It is very hard work, mentally, spiritually, physically, and emotionally to take care of a family member and one person cannot do it alone.

I understand your husband made a promise to your mother, but hopefully she will realize that she needs more care than what you can give her forever. I would have a hard time putting my parents in a home, but I know what can happen as people age and I would not be able to make a promise to them that I would never do it. People can live for years with Alzheimer’s but they can never be left alone. Even when you are asleep, they can wander off, hurt themselves, start fires, etc. Your husband has to think of her safety too - I am sure he would feel even more guilty if something happened to her because she was not in a home. I hate to bring more worry into this for you, but hopefully you can start to make long term plans and have discussions with your mom and your whole family while she is still able to have some input.

Good luck with everything, and remember you need to do what is best for you and your own family too. I really don’t think it is fair for your MIL to hold her kids to that promise, but I understand that she is probably afraid and it is a tough situation for everyone. Hopefully you can find a solution.

12

I’d like to address the same point as Velma - your husband and his sister need to face the reality of their mother’s physical condition. From what I’ve seen from both of Jim’s grandmas, she will probably never completely recover from a serious injury like this one, at 85, with all her pre-existing conditions; she will likely decline from here. Her body is just worn-out. She needs looking after. They need to get it right in their heads that putting her in a good nursing facility where she can get the care she needs is what loving adult children have to do.