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Bed sores after fall
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rise_above posted:
My dad is 80 years old. He has been dealing with Parkinsons for the past 7-8 years. He is in India. His neurologist prescribed him syndopa(cinamet) 4 times a day, and also quetiapine(seroquel) once a day(before going to bed). Until this January, he was able to walk within the house and eat by himself although he was slow. The only help he needed was when taking a bath. He would have hallucination once in a while but it was manageable.

In January of this year he fell down and fractured his hip. This required a partial hip replacement surgery. He was in the hospital for about a month which resulted in bed sores. All of them healed except for one which is about 3-4 inches in diameter with almost .5-1 inch deep. He also has a catheter tube. The bed sore is healing very slowly. Are there any suggestions for a faster healing? He has been taking protein shakes.

Also, we noticed that his parkinsons got worse because he can sit up for maybe an hour or two every day. Also, he can hardly walk. He chokes very often because he can not swallow his saliva. There has been nights where my mom would say he was choking almost the whole night. Any help anyone can offer about the choking will be greatly helpful. I asked him to try a sucker, but he is least interested in it.

Thanks
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atti_editor responded:
Hi rise_above,

Here is an article about pressure sores that contains treatment information you may find helpful. Keeping the sore clean and covered, eating a healthy diet with enough protein, and applying any ointment given to you by the doctor are some of the methods described.

Have you spoken with your dad's doctor about his worsening Parkinson's symptoms? This article discusses swallowing problems, diagnosis of these problems and possible treatments. Please keep us updated on how your dad is doing!

Best wishes,
Atti
 
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rise_above replied to atti_editor's response:
Hi atti_editor,

Thanks for the tips. I am going to pass all these tips to my mom so she can try it on my dad.
 
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lovedogs1955 responded:
Let me see if I can give a helping thought or two. First of all, the fall and hospitalization can definitely make Parkinson's worse---it's called a flare and sometimes a crisis. I know that each time I have even the slightest amount of illness or change, I have a flare and never come back as far as I was prior to the situation.

Do you have any home health services involved with his care? From the description you give of the size/depth of that bed sore, that surely is a trigger for home health to get involved in his wound healing and instruction in care for you. Ask his physician about getting it ordered. I'm surprised that the discharge planner at the hospital didn't get that all taken care of before he came home. Is there an air mattress for his bed? If the bedsore is located at his coccyx, he needs to be kept on his sides, rotating every 2 hours or so. If he keeps lying/sitting on it, it will not get better. It also sounds like some physical therapy would be a huge help.

I am a disabled RN and used to work a lot with homebound elderly. Don't give up----there are services that are most likely available to you.
 
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rise_above replied to lovedogs1955's response:
lovedogs,

Thanks for responding!

There is a nurse dressing the wound twice a day every day. In the past 2 months, the size has gotten smaller, but there is still a hole for about an inch. He sleeps on a water bed. I am sure he feels uncomfortable sleeping on this bed because getting up from the bed is not easy (he needs help anyway).

The traditional mattress was not helping for sure. Couple of weeks ago he was admitted back int he hospital urinary tract infection and from the 4 days of hospital day he got another small bed sore. Thankfully, it has healed in about week or so.

He is being turned almost every 2 hours. I think that is helping too. There is a physical therapist helping too. But he just doesnt have the strength to do any exercise. I almost feel like he is doing it for the sake of doing. He is either week or his parkinsons symptoms have worsened.
 
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lovedogs1955 replied to rise_above's response:
From what you describe, you seem to have hit the nail on the head. He is both weaker and his PD symptoms have changed and might even have a few new ones. The choking and swallowing problems are extremely common with Parkinson's. Has his doctor or nurse suggested adding thickeners to his liquids?

I hope that you and your famiily understand exactly what his end of life wishes are so that you know just how far to push him and these treatments. I hate to sound morbid, but it is something that needs to be discussed before you are not able to anymore.

Keep us posted, okay?
 
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rise_above replied to lovedogs1955's response:
Hi lovedog,

Thanks again for your response. His end of life is certainly something I am working on, although it sounds hard. It's just hard to let him go.

In the past one week, it seems like he is getting strength back. I hear from my mom that he can get up from the chair and stand up for a min or so which he was unable to do since his last hospital visit 3 weeks ago. Also, with help, he is able to walk, maybe 10-15 steps or so. All to say, the whole situation doesn't sound so bad. Just being positive here, if I can address choking and swallowing problem and with proper nutrition, he can survive for some more time.

He goes to see his Dr in a few days to change his catheter tube, so I will definitely ask about the thickeners.

I posted another thread about acupuncture. I read that acupuncture can relieve the stiffness in his body. So I am trying to find a acupuncturist, of course a qualified one and who has experience with Parkinson's patients. I saw a few videos that there is remarkable improvement with this natural treatment. It looks like it has no side effects, so I thought I would give it a try. Can you shed any light on this?

I am glad to find people like you on this forum! Your help is sincerely appreciated.
 
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lovedogs1955 replied to rise_above's response:
Glad to hear that some progress is being made with your Dad's physical condition! It would be nice for him to get even a little bit of quality of life.

I don't know anything about the accupuncture---sorry! For me, pain medications and keeping my body moving is the best help for the stiffness.

A thought just occured to me and I wanted to pass it by you as food for thought. If your Dad is unable to swallow, the physician might as about putting in a feeding tube for liquid nutrition to go directly into his stomach. Personally, I have not ever seen any REAL progression made with using this things ( worked for about 32 years) and I do not ever want one for me. You and your family need to have this discussion. Good luck!
 
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rise_above replied to lovedogs1955's response:
Regarding the swallowing issue, it is not so much about during eating. He can eat fine without much difficulty. The issue is while he is laying down or sleeping in the night. Because he can not swallow his saliva, he tends to cough and sometimes choke if he has too much. Thats the problem I am trying to address.

We would try him to spit the saliva out as much as possible before going to bed. But it keeps accumulating after an hour so,and thats when the problem starts.

Thanks again for all your inputs.
 
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atti_editor replied to rise_above's response:
Hi rise_above,

Here are some tips that I found from the National Parkinson Foundation to help alleviate swallowing problems. Most are related to wallowing when eating, but they may be useful (especially the bit about sleeping with head raised):
  • Drink frequent sips of water or suck on ice chips during the day and before meals to help increase swallowing and thin phlegm;
  • Reduce sugar intake, as sugar increases saliva;
  • Suck on sugarless candy or chew sugarless gum for temporary relief from drooling;
  • Take smaller bites of food, chew food thoroughly and eat slowly;.
  • Sit upright for at least 15 minutes after eating;
  • Take small sips of water or beverage when eating;
  • Sit upright with head slightly forward when eating, drinking and taking pills. Tilting head backwards can increase the risk of food or liquids going into the lungs. If a glass is half empty, refill it;
  • Maintain an upright posture and keep chin up, because a flexed neck or stooped posture exacerbates drooling;
  • Rinse mouth after meals;
  • Eat softer foods, pureed if necessary;
  • Drink tea with lemon or carbonated beverages to help thin phlegm;
  • Avoid dairy products, as they can make phlegm worse;
  • Drink thicker liquids, as they are easier to swallow, because they do not go down as fast;
  • Moisten dry foods to make them easier to swallow; and
  • Sleep with head raised up to prevent choking.


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