Doctor refusing to approve carotid artery scan

Wilted

Before DBF had his way bypass in 2018, he was showing significant signs of dementia. He'd sleep all day. He was unable to make simple decisions, comprehend contracts, go shopping, use the gas pump, etc...

I was told by the doctor that his carotid artery had been 95% blocked. A couple months after the bypass, his thinking became much clearer. He no longer slept all day - he stopped taking naps altogether. He was able to manage his finances, understand complex contracts, use email, Facebook & messenger again. He was able to m make purchases at the store. He could pump gas with the station's new and more complex credit card system.

A year later, he gradually started going down hill again. I told EVERY medical staff and doctor I met about how he had improved after his bypass. No one had any insight to offer. Eventually, he best option seemed to be to put him in a rest hime where they are providing palliative care.

Last week I learned an ultrasound could show if a carotid artery could be improved with a stent. The work the Mayo Clinic has done seems to show that improved blood flow through the carotid artery can help improve cognitive function in some cases. (Unfortunately, the Mayo Clinic is out of network) It seems, considering his history, his carotid artery should at least be checked out.

His PCP at the rest home is refusing to do an ultrasound to check the condition of his carotid artery. I was told they are providing "comfort care" not treatment.

From what I understand, all that is needed to get the test is a doctor's referral. How can I help him get the test?

I greatly appreciate any insight you are able to offer.

(Arizona)

Joe C.

Wilted, If your are his Medical Power of Attorney you could look into changing his PCP to someone who is more receptive to possible testing & treatment. On a personal note my father-in-law had a 95% blocked carotid artery when he was in the very early state of cognitive decline. Doctors suggested addressing the blockage might improve his cognitive state so he went ahead with the procedure. There was no improvement and he actually had significant decline immediately following the procedure. I have always felt that he would have been better off if he did not go through with the procedure.

Quilting brings calm

I suppose you could take him off palliative care. However that could mean that you would then be required to remove him from the rest home. There’s no guarantee they would find anything fixable, that a procedure would help even if they did. The procedure might even make the dementia decline faster.

You mention that his first episode was quite significant and then that the next was a gradual decline. The two episodes sound different from each other, and suggest that the cause of this second one is not the same as the first.

Wilted

Both episodes escalated gradually.

M1

Wilted, if an artery is chronically blocked and he is not having acute stroke symptoms, opening it up is not likely to help and is in fact pretty risky. There is a lot of what is called "collateral circulation" in the brain, where the blood flow from other arteries compensates for one that is chronically blocked. I know you wish there were something you could to to make him better, but I suspect the docs are giving you the right advice in this case. As Joe C. said, this may well be an "ain't broke don't fix it" situation.

Wilted

I feel they should at least take a look at it.

mrl

Wilted,

This may be way off base, but there is something called "saved by the scan". I would simply state you want this performed. I believe Medicare covers it. Check though- also maybe a Geri PCP would be an option. This should be a no brainer, sorry, but it's making me mad they won't even consider it!!!

Michele

harshedbuzz

https://alzconnected.org/discussion/comment/173118#Comment_173118

@mrl

Saved by the Scan is an initiative to provide a low dose CT scan to detect lung cancer in smokers and former smokers over the age of 50. It has nothing to do with arterial blood flow.

mommyandme (m&m)

Sounds like he’s on hospice instead of palliative care. Hospice being only comfort care without treatment. Palliative being oversight and comfort yet treatment Is still available if desired. The one visit of palliative care my mom received wasn’t covered totally by Medicare like hospice service was. We paid out of pocket for the co-pay. I wonder how they’re billing for his care? Also, when on hospice you can get out of that level of care if treatment is desired, then go back on hospice when not seeking treatments again. For example, when being cared for at home but needing a trip to the ER. If treatment is decided upon then hospice bows out until further notice. I’m just thinking but you should be able to seek tests/treatment if you want to.

With that being said, maybe it’s his time to just be comfortable. The what if’s can really be a struggle later, don’t want that for you either.

Wilted

Now the doctor wants to increase his depikote because they say he's getting combative with some of the staff. (night shift says they don't have a problem with him. I've seen a day shift staff member intentionally agitate him and other residents to the point of striking out at her - other staff commented that she deserved it.)

Last time they increased his depikote, he became a fall risk (I saw him fall multiple times) and he had trouble swallowing his food (pocketing) to the point of being dangerous.

I think they should scan his carotid artery before increasing a medication that puts l him at so much risk.

harshedbuzz

I am sorry @Wilted : this situation seems to pain you a great deal.

Are you the person charged with making his medical decisions or does he have adult children/other family members acting on his behalf?

If you are not, and you witness a staff member intentionally triggering the behavior, I would be inclined to record that discretely and take it to the ombudsman unless it rises to the level of abuse in which case I would contact APS.

HB

Wilted

His children are acting on his behalf.

I'll be sure to keep my phone/camera with me when I visit.