Mom is in a private home (6 patient capacity) and they called and told me she had two instances of bloody stool. The second one was significant. She ended up in the ER and was discharged with a Protonix prescription. She took for 2 weeks and another stool sample was collected. No blood visually seen in stool.
Physician office called me this evening and told me it was positive for blood. They asked if I wanted to be referred to a GI specialist for a colonoscopy.
Mom has a benign brain tumor, moderate dementia, incontinent of urine only (she knows it and will ask for assistance to get to the bathroom), pacemaker, on several heart medications, blood thinner, a diuretic, and a few things for depression. She had mild dementia before catching Covid in January, suffered delirium in the hospital, and came out with significant short term memory loss and confusion.
Advanced directive indicates "no treatment for incurable or irreversible condition that would bring death within a relatively short period of time." She's a DNR but not on hospice.
Also she communicates quite well most of the time, but often drops out of the sentence because she can’t remember what she was saying. She’s ambulatory with a rollater, eats and drinks well. She also will become upset quite easily, cries a lot, and on several occasions she’s told me she wants to die. She never says this unless she’s really upset and is crying about something.
I will be asking her if she wants the procedure though I am very scared if she says yes. I have spent hours tonight pouring over some horror stories of going through delirium again, the prep beforehand not being successful and inconclusive test results because of it (resulting in emotional trauma).
If anyone has been through something like this, how did you handle it? Do you know of anyone who went through this at this age with dementia and it was worth it for them?
What would be the most likely causes? Bowel polyps, GI bleed, anal fissure or stomach ulcer?
Are there alternative ways to diagnosis/rule things out? Blood tests, xray, CT, MRI? Things to try before a colonoscopy?
Despite being a very short procedure, it is invasive, the prep is awful & anesthetic is needed (although minimial).
My last experience with a LO inc;
+ the preparation caused urgency = rushing to the bathroom = increased falls risk
+ added to fatigue
+ delerium afterwards (luckily very mild) = increased falls risk
It's a very good question to ask.
Weigh it all up.
Benefits vs Burden
My Mom had very bad delirium in the hospital. The chance of watching her suffer through that again is too much to think about.
I would much rather make the trip for a blood draw every three months than put her through a colonoscopy. She will not be getting one we decided today.
As said, colonoscopies should not be done after 75. The lining could be perforated and cause paretinitus. With Moms directive and all her health problems, I would not put her thru this. The prep is the worst part of it. I had to swallow 12 horse pills 2 separate times. No solid food for a day. At 91, I would not put her thru this. If there was cancer, would u put her thru chemo?
She's on Xarelto. Has been for many years. Her bruising seemed to be getting worse and I talked to her cardiologist about it and he dropped her down from 20mg to 15. She was off it for 2 weeks during the Protonix treatment and now he has her at 10 but he doesn't know about the positive stool sample yet. He's my first phone call tomorrow morning.
Did your Dad do okay off the blood thinner? Has he been able to go the distance without them without too many issues? My Mom has A-fib and a pacemaker and gets edema in her lower legs so this is causing me some significant worry.
I would not do anything. If I did it would be at most a scan or MRI. I would not do colonoscopy and cannot imagine it recommended. A perforared bowel is a very unpleasant way to go. FRANK blood, that is to say RED blood in stool is usually ALREADY a sign there is fragility in colon and a broken small vessel or hemorrhoid. She didn't need blood transfushion so this wasn't appreciable in amount. I would do nothing. Any OCCULT (hidden) blood would be dark, coffeeground in look, and indicate higher bleeding such as ulcer.
Leave well enough alone.
As a retired RN at 81 I am facing now my second cancer. I have had lumpectomy and refused radiation, refused chemo, refused immunotherapy (all of which would at this point be more devastating to my body and cardiovscular system than the cancer itself, which if it spreads will still allow me some time, some good drugs and a delivery via our California MAiD laws. My family and MD and medical team agree with my choices in this.
I would not do this. My advice would be not to do this.
By the way, delirium IS a threat with any cancer and surgery. But almost never with the mild drugs they use for a twilight sleep for colonoscopy. The real threat here is PERFORATION of the bowel.
I was pleased to find her in a great mood today, talkative, and lucid (though typical looping). She remembered her stool was being tested and asked if everything was okay. We had a good discussion about colonoscopy. She said absolutely not, if God wants me home, I'll go home.
Will she remember our discussion tomorrow? I don't know. But while we talked she was very present and in the moment and I got the answer I wanted.
Doctors don't care about quality of life only extending life.
If your mother is not competent to make a decision then the family has to decide what is right or wrong for their parent based on their current health issues and life expectancy and yes quality of life.
And yes your mother may very well say she wants to do the colonoscopy unfortunately if she is able to decide then it is what it is.
I know it feels like you are killing your mother if you don't do all the recommended tests and treatments, but you aren't.
Maybe it is the blood thinner as others have said below.
I'll be consulting with her cardiologist about the blood thinner. He has halved her dosage of Xarelto already and her blood work is excellent. She says she feels good and today she was in excellent spirits and quite lucid and talkative. She said absolutely not to the procedure.
So I'm not sure what I would do in your case. Maybe not tell her, you need to do what you feel is best
But I don't see any evasive test like that being a good thing to do.
We had a good talk today and she said she did not want the test. I am relieved.
I'd get your mother OFF Xarelto completely because it could be what's giving her bloody stools. Let her be, as is, until God calls HER home. Taking all these "cures" winds up causing more trouble than than anything, imo. I'm glad she decided against the colonoscopy. In case mom changes her mind back to wanting one, just tell her all the tests are within normal range and she's doing fine. As POA, it's our job to make decisions FOR THEM they're no longer capable of making.
If it's her time to pass soon, it's not your "fault"....she's lived a very long life already. Wishing you the best of luck with all of this.