A "Hospital Meeting" about my Dad's next discharge...

Hello Everyone- It's 2AM here & I've been tossing & turning since 12- can't sleep. I'll stay up now & get some work done to keep my mind off things.We had a meeting at the hospital today & I've been a wreck ever since. When we got to the hospital, Bob wasn't in his room- he was having another ultraound. When they brought him back he looked awful & was having pain again.They wheeled him into the meeting- present were a social worker, head of Homecare, Andrea, Bob & myself. A Dr. from the floor stopped in very briefly & dropped the news on us that Bob has a lung nodule- this was out of the blue- no warning. My mind of course zeroed in on this news & I didn't retain much else of what was said after that.This is so unfair- Bob has been through so much & now this? We will keep posting as things develop- Lorrie

Andrea,
All good ideas, whats sad is that the health care people should have lined this all up for you first time around. Now its like your starting all over. When the stoma nurse came the first thing they did was take his temperature, then his blood pressure, home visits are necessary, and comforting.. I can vouch for the boost and ensure energy drinks, and chocolate milk shakes do the trick if with the neo it doesn't cause mucous built up. Along with keeping an eye on the diabetes keep him on a daily routine of walking when he can, moving about,don't let the weight loss scare you to much as he will gain believe it or not if everything else falls into place... I know one thing, taking out the catheter will but in a a much better mood......Ginger Beane

Actually Renee a high Protein diet is exactly what is recommended for diabetics. It is the Carbohydrates that turn to sugar in a diabetics system.

Andrea there should be a diabetic nutritionist/ or specialist on staff at the hospital I am sure you could get a consult with them.

Also, in regards to home care. Contact the Social Worker at the hospital. Tell them what you need when you get home ie...home care (whether nurses aides, nurses, physical therapists, nutritionists etc.) wheelchair, portable potty, shower chair, lift chair, they will contact the insurance company, as well as the supplier to set everything up. They get paid for this so don't feel bad asking. I never once got on the phone with the insurance company, or a supplier when caring for my father, or my husbands grandmother. I always had the primary Dr.'s office or the hospital social worker coordinate everything.

There are also Rehab Facilities if he requires more care than your mom can handle, but less than is provided at the hospital. These are great resources. There are nurses, therapists, and nutritionists on staff there and they will also monitor his diabetes, and input/output until he is stronger and he stablizes more than he is at the moment. Sometimes the patient just wants to come home, but in reality the care they really need cannot be met at home. These Temporary facilities can meet those needs until your father is more suited to take care of himself. Every ones situation is different, don't feel guilty about getting the help that your father needs regardless of where or how he gets it.

Hi Andrea,
You didn't mention homecare, but I am sure you will cover that as well. I hope you get some answers!
I assume he still has a foley (catheter) and bag... if so you can actually see the colour of the urine, which is an indication if your dad drinks enough. Not so scientific, but this was the advice that I was given. My experience in general is that men don't drink a lot (I know I generalize), so the more he drinks the better it is.

Be careful with the fiber... it can be hard on the bowels.
Neobladders, sometimes are causing bowel obstructions, which is something you have to watch out for. My husband had 3... in hospital. The doctors were from the opinion that a special diet was not necessary. It took 3 obstructions, before I realized that a special diet was necessary!
Often walking and lots of fluids will help with constipation as well.

As to nutrition, we consulted a dietician, and we tried her balanced diet. However, after 3 weeks my husband was still losing weight, so after some research I decided on a high protein diet supplemented with nutrional drinks, like Ensure etc.I am not sure if a protein diet interferes with his diabetes, but it may be a question you like to ask. We had very good results with a strictly protein diet.

I hope you get some good and helpful answers. My experience with medical advice, wasn't that great. I don't want to sound pessimistic, but the reason why I am writing is to try to prevent somehow what my husband went through.
Best of luck with the discharge,
Renee

Andrea,

I have a few things that my husband uses that you can ask your Dr. about.

1. Constipation.....Glycolax one heaping tablespoonful in eight ounces of water, coffee, juice, soda, or tea. 1x daily. This we were told is very good at avoiding the cramping that can come with some laxatives.

2. Don't know?

3. what medications is he on? and for what?

4. My husband came home with a container to monitor his input/outtake

5.and 7.Insulin-Nutrition

My husband is also Diabetic. He takes Lantus 2 x's a day 10 units each (this will obviously vary on your fathers weight etc. This is an extended release insulin. We also have a sliding scale insulin called Humulin R. This is for the times when the glucose levels spike.

the following is the scale we use:

less than 70----drink 4 oz. of orange juice
70-199

---

no action necessary
200-250

---

2 units
251-300

---

4 units
301-350

---

6 units
351-400

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8 units
greater than 400 inject 10 units

he tests 4x's daily

He also take "Glucerna" it is a supplement shake designed for diabetics.

see this website for meal plans etc...

diabetes.niddk.nih.gov/dm/pubs/eating_ez/

6. Don't know.

Hope this helps a little, and I wish your father a smooth transition from hospital to home.

Well today, my Mom and I are meeting with a bunch of hospital people, including homecare, one of the hospitalists, and a few other people to come up with a "discharge plan". At least that is what we think the meeting is about.

We wanted to be prepared with as many questions as possible. The goal of this is to make my Dad's fourth, and hopefully final discharge from hospital as smooth as possible and be as informed as possible!!

So, I thought I would bring this question to the group. What questions do you think we need to ask? I figure you bright people will come up with some great ones we have forgotten!

So, here is my list so far...

1. Constipation: what laxatives, stool softeners etc, should dad be taking, and what frequency (for example, the lactulose he has says simple "take as needed"), as I am thinking he should just do these daily.

2. How much fibre should he be taking daily...can there be too much?

3. Medications: what should he be taking (he has numerous prescriptions that have been prescribed over the last few weeks, some of which are redundant)...I want a list of everything he needs to be on and stay on.

4. Fluid Intake vs Output: Can they provide a chart for Dad to use to measure fluids in and urine out? Everytime he is readmitted he is quite dehydrated, and I think part of the problem is that even though he thinks he is drinking enough, he is peeing more...I think if he could visualize this daily it will help him to make sure he is getting enough and help Mom in preparing his food/drink.

5. Insulin: I would like to see a chart of what he is to be taking and be involved in his daily glucose measurements (trending them) to help him out.

6. Important dates: Catheter removal? Rechecks? Etc.

7. Nutrition: maximum nutrition without throwing his diabetes out of whack. Supplements etc. Let's get some weight on him!!

That's all I've come up with at the moment, but I will keep thinking. Anything I am missing? If any of you have any other suggestions that are specific to his neobladder care, I'd appreciate it!!

Thanks again, andrea