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Lung diseases

Grandmother`s problem

05/05/2011

Question:

on saturday i went to see my Grandma at the nursing home, the nurse said she had been wheezing that morning but was fine when i got there, she seemed to be doing really well, her breathing seemed peaceful. Later that evening after she had been back in bed awhile she started wheezing, but still seemed ok, not out of breath or distressed, just sounded like she needed to cough real good. then the next day the nurse called saying she had wet breathing and they were going to do a chest xray-- it didn`t show any change and she seemed ok except you could here her wheezing. then the next day she was very agitated in bed- the head was up, but very out of breath and loud wheezing when moving , but once up in chair was better, also had a cough, so they started levaquin. the next day it was hard to tell if she was better, she would seem ok but then start being out of breath and wheezing, but then would cough and seem better, but i asked for the doctor to check her and they did add some lasix doses. 

then early the next morning they called to say she was very labored breathing, she went to er, with difficulty breathing, wheeze, and cough. she ended up passing away several days later. the chest xray showed course interstitial markings, small bilateral pleural effusions, prominent pulmonary vasulature. on that saturday when the wheeze started, i `m wondering if she could have aspirated stomach acid when we got her in bed that saturday evening, like silently? she seemed okay after we got her in bed,no cough or any symptoms, but we did put her head of bed down to change her diaper, and roll her back and forth several times and pull her up in bed a couple of times-- jostled her around a bit-but it had been 3 hours since she had her last g tube feeding. then we put her head right back up. But then later she started wheezing again. the way her symptoms developed do you think that could be what happened? like maybe she had gerd or something and we didn`t know it?

Answer:

I am sorry to hear about your loss of your grandmother. It is difficult to fully understand your grandmother's situation leading up to her passing, without the benefit of having had full knowledge of her medical conditions and course. It sounds, though, as if she suffered from multiple health problems and that she was likely very weak as she became even more ill and ultimately passed away. Patients who require complete care and support such as you describe with your grandmother, as you may imagine, are nearly always closer to dying than healthier individuals who can walk around and fend for themselves. They often have many ongoing internal bodily challenges and deteriorations and do not have as much capacity to recover from even minor additional difficulties. It is not unusual, as the body is beginning to fail, for patients to have breathing symptoms and to make noises as they breathe, as you describe. It is unlikely that one specific single factor led to her further deterioration, least of all the kind and loving physical care you helped deliver for her.

Please accept our condolences.

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Response by:

Amy L Pope-Harman, MD Amy L Pope-Harman, MD
Clinical Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University