What to do when an aging parent becomes ill on a family vacation? With little knowledge about the quality of care in an away-from-home location, even in a place visited for years, double anxiety is the name of the game if a loved-one is taken to the hospital.
We faced this issue last weekend when, just after breakfast as we were leaving for home, my dad had difficulty standing. Although he recovered fairly quickly, a trip to a hospital emergency room was in order. In this case we asked ourselves, how can we judge the knowledge of the caregivers and be certain he receives the best care? That’s a tall order.
After receiving a day of assiduous and personalized attention at the small, local hospital, The River Hospital (click to see the amazing St. Lawrence River view from the emergency waiting room below), an ambulance transported Dad 90 miles south to Upstate Medical University Hospital, a teaching hospital in Syracuse, New York. River Hospital staff made all of the arrangements, ensuring an easy and smooth transfer, so when he reached Syracuse, the ambulance crew carried him right up to an assigned hospital room on the 8th floor — an extraordinary convenience in itself.
The good news, and there is only good news, is that the attending Upstate physician, who specializes in adult chronic disease management, conducted an experiment. He skipped one of the evening medications and sometime later asked the resident and nurse to take my father’s vitals lying down, sitting up, standing, and after taking a few steps. As a result of this mini-investigation the doctor identified what he thought was a medication side effect.
Several years ago, when my dad started taking this medication before stent surgery, it was appropriate, but no one ever re-evaluated whether it was still necessary, despite the fact that Dad has lifelong low blood pressure and this particular medication lowers it farther. The longer Dad took the medication the lower his BP became, resulting in intermittent and significant light-headedness and dizziness over the past year.
At Upstate, when my father skipped the evening dose of the medication, his blood pressure bounced up, and it settled in to the low-normal range after skipping a second dose in the morning. Here’s one of my past blog posts, Too Many Medications, that has more information about seniors and medications.
I am so grateful to the medical staff at River Hospital in Alexandria Bay who knew the type of medical care that my father required and did the work to get dad to the right place.
So this leaves me with questions.
- How does one periodically evaluate medications to ensure this type of this problem occurs as infrequently as possible? Most of us have prescriptions from several physicians, but who examines the whole picture?
- Who should do the evaluation? I am not certain that a person’s primary care physician is always in the best position to check out the whole picture.
- When should a patient gently, or not so gently, nudge a physician to explore whether a medication’s side effects can be prevented rather than accepting such a condition as a necessary evil of treatment?
- With older adults can physicians design and ask more precise questions to solicit more accurate information about how they are really feeling?
By the way, Dad now has more energy than he’s had in ages. Of course, his congestive heart failure is still an issue, so he complies with an appropriate diet, exercise, and medications, but we all feel like we’ve received a gift of sorts — increased quality of life.