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Grandma has a massive brain bleed about 36 hours ago. She is…

Grandma has a massive brain...
Grandma has a massive brain bleed about 36 hours ago. She is in the ICU, and really with supportive therapy. Keep BP under control, gave K to counteract the high INR. The prognosis is very grim. She had some fever -38C and is managed. She is not in brain death. She still has EEG activity and EKG activity.
My mom said something about her face swelling up and chin. What causes that?
Can this bleed ever resorb on its own or a procedure is needed for that? We opted for no surgical procedure as it doesn’t have much promise either. The size affected is huge 10 cm by 8 cm
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Answered in 3 minutes by:
6/13/2018
Connie Pennington
Category: Medical
Satisfied Customers: 678
Experience: Colorectal Surgeon at Colon & Rectal Surgery Consutants, PC
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Hello, this is Dr. Pennington.

It sounds like your grandmother has had a massive bleed on anticoagulation.

I am so sorry.

Face swelling is likely from the IV fluids. We call it 3rd spacing. The IV fluids do not stay in the vascular system in the critically ill.

There is also a risk of brain herniation because the clot is so big, and this causes things like that as well.

The body naturally does absorb blood, but when on the brain, it is not fast enough. This is really serious. I am so sorry.

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Customer reply replied 2 months ago
when you say clot you mean pulled blood?
Customer reply replied 2 months ago
Can you explain to me the brain herniation as well

yes, and if she was on blood thinners, it may not clot.

The skull is a closed space. The blood mass or clot is so big it can push the brain down, through the brainstem. We call that herniation.

Since you elected to not do surgery, have you decided to do comfort measures?

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Customer reply replied 2 months ago
basically that is all that they do.

I am sorry.

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Customer reply replied 2 months ago
basically there is no chance unless the ICP wpuod of been eliminated?
Customer reply replied 2 months ago
They basically said it is on more than half of the brain and that the chance for the recovery is close to none
Customer reply replied 2 months ago
Even with surgery.
Customer reply replied 2 months ago
she is 81 and very sick otherwise. And they said there is the chance that she will have extreme deficiency or disability
Customer reply replied 2 months ago
Even after surgery because the brain is so affected

I agree.

I think it is life-threatening bleed and little can be done.

The neurosurgeon who spoke with you, is right.

At best, ***** ***** pass. And life support can be withdrawn, and sometimes that is the best thing to do.

At worst, she will have brain stem function, and persist in a vegetative state.

These times are very hard on families. I am sorry.

Have they spoken to you about withdrawing support?

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Customer reply replied 2 months ago
this vegetative state may likely last for a long time?
Customer reply replied 2 months ago
do you think we did the right thing? I do not think that surgery would of been a miracle solution when the brain is affected on such a big area sounds like that is a huge area right? 10 by 8

Well...if you feed her, then she can persist. I personally would not advise a feeding tube be placed, but it is not my decision.

Yes, you did the right thing, absolutely. The problem is the clot can be "drained" but when on blood thinners, the bleeding is very difficult to control, and the damage from the bleed is so extensive.

I do think you did the right thing. It is so hard to make end of life calls, and we guide families the best we can, but I do think you have done the right thing.

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Customer reply replied 2 months ago
her heart is so weak, I do not think she would be here after the surgery. I am in the Us my whole family is in Romania. I am attached to her and my mom put the phone to her ear so I can speak with her. I do not know if she hears ot not and they say doctors can’t tell that for sure either. Do you think she might hear anything?
My thing is right now is this life anymore? And what is really the difference between this and actual death.
Customer reply replied 2 months ago
Her heart is very sick. She had rheumatic fever as a kid and got stenosis and was in a fib as a result of it.
I do not think that she would even resist the surgery. She could die on the table. At least now she will die in dignity.
I do not know if this makes any sense .
But overall, if this would be your grandma, and considering the situation we are in, would you have considered surgery? Do you have any faith that the surgery can offer any help?

We never know what they hear, it is true.

You are right when there is no quality of life, there is no life.

So your grandmother is in Romania. I am sorry you cannot be with her.

It is a very spiritual time, nearing death. You can connect on a heart level, even without the phone.

Again, I believe you are doing the right thing. She will die in peace, and no longer struggle with health issues.

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Customer reply replied 2 months ago
Today I went out and I got a bird feeder. I have faith that after she passes, birds will come to the feeder. I have faith in that.
My husband also thinks we should plant a palm tree in our backyard in her memory.
But going back to this step, will this struggle continue for much longer? Do you think she is in pain right now? Is she even capable to feel pain?
Is she technically in a vegetative stage even if she still has EEG traces? How will this progress towards death from here on out?

She most probably does not feel anything.

Is she on a ventilator?

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Customer reply replied 2 months ago
Breathing tube
Customer reply replied 2 months ago
They did not say anything about taking her off of it. I believe is not legal there to be honest. It is not like here.
Customer reply replied 2 months ago
I mean it is not legal to technically “kill” a patient. He has to be brain dead first I want to say

Wow. Well, if she remains on life support, it will prolong her life until an EEG can support brain death.

We would remove the breathing tube, and they usually pass, but not always. If the brain stem is intact, then they will breath. Then we decide on feeding tube or not.All while providing comfort measures.

I do not know how it plays out in Romania.

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Customer reply replied 2 months ago
Well I believe she can’t breath on her own because yesterday before they intubated her her pulse ox kept dropping and therefore she was intubated. Doesn’t that mean she can’t breathe on her own?
Customer reply replied 2 months ago
with a breathing tube on she might be on life support for a very long time will she? Will she eventually flat out on EEG?
Customer reply replied 2 months ago
But what if they would of removed the ICP pressure? What would of been the worst and best scenario?

IF they removed the clot, she may not be a whole lot different. She likely would have passed without the breathing tube.

Its hard to say how long it will take if they have her on life support.

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Customer reply replied 2 months ago
When you say clot you mean pulled blood and pressure?

I mean the blood on the brain, which increases the intracranial pressure (ICP)

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Customer reply replied 2 months ago
how do you think this will evolve from now to brain death? What will continue to happen to cause the eventual death on EEg?

I do not know.

If the bleeding has stopped, she may be trapped in this state.

I would extubate her, but if that is not possible, then she will be kept artificially alive.

Then if she is not fed, she will slowly starve.

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Customer reply replied 2 months ago
I actually believe that the bleeding stopped. At least yesterday when they did thag CT with contrast.
Do you think that she feels hunger if starved? I believe that somehow is inhumane that they do not extubate there.

No, she will not feel hunger.

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Customer reply replied 2 months ago
This is what I found out. That as long as the heart has an isoelectric wave the doctors are not allowed to remove the breathing tube.
Also they are not doing feeding. All they do is NS, and B1 and B6 in the IV and some drug called cerebrolysin, and some coagulation drugs( since the Inr was that high 8)
So I think like you said having no feedings will eventually starve her because B1 B6 is most likely not enough. Right?
Customer reply replied 2 months ago
What do you think?

Yes, but it will be a rather long process.

It could take weeks, if they are giving her fluids.

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Customer reply replied 2 months ago
the system is in such a way that you are not allowed to not do these things my mom says.
How about the ventilator? Is she likely in any sort of discomfort from it or again the fact that she is in this deep coma most likely she does not feel anything?
Customer reply replied 2 months ago
I know that these things will not make her better and eventually will pass , but is she at least “comfortable” now?

Yes, the deep coma is protecting her.

Connie Pennington
Category: Medical
Satisfied Customers: 678
Experience: Colorectal Surgeon at Colon & Rectal Surgery Consutants, PC
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Customer reply replied 2 months ago
Hi, I wanted to help you for your help in the last few days. She passed this morning. Now she is with God free from all the bodily diseases and pain.

Thank you for letting me know.

Grandma's are such gifts to us. We will see them again one day!

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