Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision
making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another question from our readers and the question was
My Dad Got Multiple Infections and Pressure Ulcers in LTAC. Was there medical negligence on the part of the ICU team?
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED“ I want to answer the succeeding questions from one of my clients Peter as part of my 1:1
consulting and advocacy service! wanting his dad in the rehab facility to be discharged home but the doctors are refusing to because of yeast infection.
My Dad in LTAC Won’t be Discharged Home Because of Yeast Infection. What Causes This Infection?
“You can also check out previous 1:1 consulting and advocacy session with me and Peter here.”
PART 1
PART 2
PART 3
PART 4
PART 5
PART 6
PART 7
Patrik: Okay. I can tell you, Peter, I can tell you with what you’re telling me, with the sediment and the yeast in the catheter and potassium and
sodium high, he’s not getting enough water. They’re dehydrating him. I’m just, it’s not what they-
Peter: They have a nutritionist that-
Patrik: If people, I tell you, even if nutritionist or the nursing staff there, if they happened, in intensive care, I know he’s not in intensive care, but from my experience, in intensive you’re keeping a very close eye on people’s fluid balances, right? And I know from experience, if you are not giving patients enough fluids, their catheters block and they get sediment in the urine and potassium and sodium are going up if people are getting dehydrated. They might tell you that, but from my perspective, they don’t know what they’re doing.
Peter: Yeah, but what happens sometimes, if he gets too much water, his kidneys stop working. There’s some kind of a dynamic, they told me, between too much water and not enough, it’s sort of a-
Patrik: Yeah, it’s a fine line.
Peter: They gave him a lot of water once, they had to give him Lasix and Lasix had to get rid of the fluid and then once he’s clean, then they take him off the Lasix and all the rest of the fluid comes out, so, he does have some kidney, so what I’m getting at is that, this place, I just think they wanna keep him and hold him from one infection to the next. And never send him home. They’re always gonna say he’s not ready, he’s not stable, you
know? I’m just to the point where, I don’t know.
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Patrik: Have you looked into, so he’s off the ventilator 24 hours a day?
Peter: Oh yeah, he’s off it. Yeah.
Patrik: Yeah. So, have you looked into home care like, I hear you are prepared to do some of the work, obviously, but have you looked into other nursing care he might need at home? Have you looked into that?
Peter: Absolutely. In fact, I’ve got a nurse practitioner that’s gonna come to the house as needed. She does home care. And she can have, if he needs an X ray, she has a private company that comes to the house and does an X ray. He needs, yeah, it’s a great service. Do you guys have any services like that
down there?
Patrik: Oh yeah, we have a similar service where we can send nurses to the home and manage-
Peter: What about X ray, ultrasound?
Patrik: Yep.
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Peter: Portable ultrasound, portable EKG, portable labs. I’m gonna say it’s a good business for you to start down there.
Patrik: Oh, absolutely. Absolutely. It is what we-
Peter: If you don’t already have something like that.
Patrik: Yeah.
Peter: People have to stay home, you know?
Patrik: Absolutely. So, who’s making that decision from now going to another facility instead of, who are the decision makers? Are they nurses? Are they doctors? Who’s calling the shots?
Peter: The doctors want him to go back to that rehab place.
Patrik: And they wanna do that now?
Peter: Yeah, actually. And I already protested with Medicare and they let me stay here another couple of days, but what I want them to do is to treat that urine and they won’t treat it. They won’t treat, they say oh, that stuff, what is that stuff that begins with an F? Flu something.
Patrik: Flucloxacillin?
Peter: The one for the, that treats, the yeast, yeah.
Patrik: Fluconazole.
Peter: I think that sounds like, yeah. IV, I don’t know why they won’t give it to him. ‘Cause it’s hard on him, it might make him, I don’t know. And then there’s a bladder wash they could do.
Patrik: Absolutely. They can.
Peter: Oh, can’t do that.
Patrik: Sounds to me like he needs to leave there rather sooner than later, going home. Because the home care nurse practitioner, they would probably do all of that like flushing the catheter, you know? They would probably do that.
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Peter: Yeah, I’ve heard that they would.
Patrik: And that’s why, I agree with you that he needs to leave there. They wanna keep him because they’re making money, probably.
Peter: I know. And that’s what I’m thinking about, but even, he has a urologist, even he won’t give him, he goes no we don’t treat the yeast in the urine. Well we’ll flush it out he said. With saline.
Patrik: But they’re not flushing it out, either, are they?
Peter: He said you know how to do it, it’s easy to do, but it’s just the idea that they don’t wanna get rid of this stuff. Maybe it’s possible that they’re making the inside of his bladder and kidneys more irritated and raw and maybe that’s how these bacteria are getting into his blood? I’m
always asking to the doctors that question.
Patrik: I think you should, but if he’s not getting enough fluid and he’s not having enough through put, it’s much more likely for an infection to happen, you know? That’s just the nature of what’s happening there.
Peter: If I decide that I don’t wanna go back there and that I wanna bring him home.
Patrik: Yeah.
Peter: I don’t know if I should just discharge him and then Medicare will give me another day or two and that’ll give me time to get us ready-
Patrik: Well, that’s what I think, when you’re going home, have you got a visiting medical doctor as well? Or is it all-
Peter: Yes.
Patrik: Okay, so you’ve got it all in place, really.
Peter: Yeah, but it’s not easy for him to travel, so, I have a van and all-
Patrik: So, how would he get from where he is now to the other facility? He would travel too, wouldn’t he?
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Peter: He’d go in an ambulance. He goes by ambulance.
Patrik: Yeah, but why can’t he go home by an ambulance? There’s no reason he can’t go home by an ambulance either.
Peter: Exactly my point. That’s exactly my point. They just gotta plunk him in the bed, all they’re gonna do is suction him, give him the food that I give him every night and every morning, the IV, the food that he’s supposed to have and the water and his medicine. And I do all that. The only thing is that he needs the IV antibiotics and that’s gonna be given by a company that comes out to the house.
Patrik: Yeah.
Peter: There’s a company, I hired them, they’ve already said they can do it.
Patrik: Yeah, of course.
Peter: They’re already set up, they can do it, they come to the house and then they do it. Then they teach me how to do it, I’ve done it before. Then we get the IV, the flushers, the saline.
Patrik: I think you really need to, has this nurse, the nurse that’s going to see him at home, has this nurse seen him where he is now?
Peter: No, she hasn’t seen him yet. I had this set up prior to him, so they already agreed to see him.
Patrik: I think that’s another thing that needs to happen. The nurse needs to see him where he is now.
Peter: Well, no, she can’t. They won’t allow that.
Patrik: Really?
Peter: She comes to the house, she won’t come to the hospital.
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Patrik: But she needs to do an assessment. She needs to see your dad before he’s going home. So she knows what she’s dealing with.
Peter: They go by the doctor okays this, then that’s okay with them. My concern is the doctor might decide, I’ll tell you, we’re not gonna give them to you, so if you don’t wanna go back to that rehab, you’re gonna have to go to a nursing home. We’re not gonna let you take-
Patrik: That’s just terrible. This is all about making money. They don’t wanna let your dad home because they’re gonna keep him because for them, it’s making money. That’s what it’s all about.
Peter: I don’t know that for a fact, but it just seems like they’re gonna give me the, read me the riot act here.
Patrik: So, okay, to take practical steps there, Peter, I think you really need the nurse, as a starting point, to make an assessment. The home care nurse I mean.
Peter: Say again, now, I’m sorry.
Patrik: Practical steps to take it back home, the next step is you need to get that home care nurse to make an assessment, but also, who’s going to be the doctor looking after your dad at home? Who’s that?
Peter: I have the name, there is somebody.
Patrik: Okay. Those two people, the doctor and the nurse, who are going to be involved in home care, they need to speak to the facility to get that going. You’re not far away.
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Peter: The only thing is that I have 30 days to go back in, but once you’re discharged from these rehabs, you’ve got 30 days, you can go back. It gives you 30 days to go back, so I don’t know if I should go back there first, though, and then get discharged. I don’t know. Seems like these people, they don’t wanna let him go, they wanna hold him and hold him until he’s sick again. And they’re gonna say see, he can’t go home, he gets sick
every three weeks. But he could’ve been home with me.
Patrik: Absolutely.
Peter: Home with us. And it just, we have to pay a nurses aid all day to stay with my mother so I can go visit my father. Which is killing us in the wallet too. We gotta pay 25 dollars an hour for, that’s 2000 a month.
Patrik: Right.
Peter: I’m just thinking, I know, I’m not trying to get you to make any decisions for me, but I just wanted to ask you about, you guys, routinely, do you treat those yeast type-
Patrik: Yes, absolutely. But before, if I’ve heard from everything you’re describing me, what you’re describing to me, before treating the infection I really believe they need to look at fluid intake, right? And they might have to look at changing the catheter more often and they might
have to look at flushing the catheter too. But I really argue that two litres a day is not enough water intake. It’s not enough.
Peter: Like I said, they tried giving him a lot of water once and he couldn’t keep up with getting rid of it.
Patrik: I understand, is he getting-
Peter: His hands get fat, his feet get swollen, then he starts getting congested, they say it might be backing up into his lungs, and this is the cycle we’ve been in with them. They try to give him, it has a tendency to back up on him, so they’re trying to get a spot, they’ve been trying for a while to get him to a good level. So, anyway, I’d love to go back to this place, but they don’t seem to wanna let him go once they have him.
They’re able to say we don’t want him to go home and maybe they could try to keep him.
Patrik: Well, especially with the E. Coli as well, it sounds to me like they’re just not doing a good job in keeping everything clean.
Peter: Yeah, I don’t think they’re doing a good job over there. That didn’t happen under our watch. That happened under theirs. I’m changing him every minute, making sure, and they were telling me oh that stuff’s, whatever that is for the yeast, that’s toxic to the body. If we give him that we could, you guys have any, a view on that about this question of toxicity of that fluco, whatever it is?
Patrik: It shouldn’t be given-
Peter: oh, this, I’m supposed to only take in sugar, you know?
Patrik: Yeah. With the Fluconazole, it’s not something you do lightly, but if there’s a yeast infection, it’s usually the first point of treatment, if that makes sense.
Peter: What about people with kidney trouble? Have you seen any issue with that?
Patrik: Well, there can be. But you know, Fluconazole can be impacting on kidneys as well, but you got to weigh up what’s more important. Treating an infection or looking after the kidneys. Is your dad on Furosemide at the moment?
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Peter: What is it called now, no he doesn’t have any, the yeast medicine?
Patrik: No, Lasix.
Peter: Oh, no, they withdrew that. Once the urine starts pouring out they stop the Lasix.
Patrik: Right, I see.
Peter: They keep kind of a mechanism between fluid and his blood and the urine output, some kind of interesting way they work with that.
Patrik: Right.
Peter: Anyway. I’m sorry to bother you.
Patrik: No, don’t be sorry. So, I would, you’re on the right track, I believe, he needs to go home. He doesn’t need to stay in one of those facilities. From what you’re telling me. The nurse at home would probably do a better job keeping an eye on his pressures, keeping an eye on urine, keeping an eye on the catheter, because they have a goal to keep your dad at home, rather than making him sick.
Which is what they’re doing in there, by the sounds of things.
Peter: Yeah. It’s true. They don’t listen to you. If you want them to do something, no, we can’t use the, can you imagine saying you don’t wanna use a four inch cushion that’s much softer than the inch. We have our material and then on the air mattress they have this big draw sheet, it’s some kind of a nylon thing, do you guys use those, they’re like floating, they put air in them and they float the patient?
Patrik: Oh, yeah.
Peter: Yeah, some kind of a, well they use that, they leave it under him at the rehab. They leave it under, the air cushion. So he’s gonna lose some of the value of the air cushion with that thing sitting on top. They take all that away, they have just my father and the air cushion, I mean, a sheet, and that’s it. Over there they got four things under him. I think it’s inhibiting the thing from healing. Anyway. I’m gonna go up and see
the doctors now and I’m gonna try to argue for-
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Patrik: I think you should.
Peter: For one thing, I want him to see urology to evaluate this issue with the urine. That’s what I wanna argue for. And then to go home.
Patrik: I think so. I think it’s way overdue that he’s going home.
Peter: Yeah. He’s been there, now, for almost two months. It’s like they don’t wanna let him go. They know that between every three or four weeks he gets an infection, so they’re trying to make like oh, he’s chronic, he’s long term, he’s there. He fits the profile. But we can take care of him at home and every once a month bring him to the hospital.
Patrik: Absolutely.
Peter: He’s out, then that’s the trick, that really makes it easy, because they can put him on the vent, it’s like having a little play and while they suction while he’s getting better with his infection, the vent picks up the CO2 and well actually, brings it down, and then helps
him recover much better.
Patrik: Absolutely.
Peter: In his lungs, you know? Very easy to suction. He picks up this infection, he was feeling good in three days with the being on the ventilator, it was amazing. But anyway, yeah, I need to get supplies. I asked them for supplies, they won’t give me any supplies to go home with. The hospital should give them.
Patrik: You might have, again, with supplies, you probably might have to get back to the nurse as well. To the home care nurse. She might be able to help you with supplies.
Peter: Yeah. All right. Well, thank you.
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Patrik: You’re most welcome. Let me know if you get stuck, if you want me to talk to the doctor, please let me know.
Peter: All right. All right. I have to wait a minute. Looks like the elevator’s here now. I’m heading up to see him and I’m gonna get pounced. Doctor’s gonna pounce right on me, soon as I walk in the door. Anyway, I’m gonna argue for him to, for him to get those treatments at home and for the, they’re gonna be stubborn. All right, I gotta go, I got the doctor here.
Patrik: Okay.
Peter: I’ll see you, thank you.
Patrik: Okay, you’re most welcome.
Peter: All right, thank you.
Patrik: Thank you.
Kind Regards
Patrik
