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Providing non-judgmental and non-criticizing support for family and friends of end-stage alcoholics through one-on-one coaching, support groups, blog posts, workshops and public speaking.

Friday, February 17, 2012

No detox zone...

When I took Riley to the doc for his arm they did blood work. I got the results on Wednesday morning when I was called and told that I MUST get him to the hospital immediately. His ammonia level was over 700 when it should be in the 100s. Also his LFT (liver function) was extremely bad as well as his potassium level. Erica is our PA and I told her that it was not my decision to make. I let her talk to Riley and he refused to go. She told him that I had agreed to take him, if he consented to go but that if he didn’t go, she would have to call the rescue squad and get him to the hospital. He agreed to go, but made it clear he did not want to detox.

But, while I was getting dressed he called her back and told her he did not want to go. Since she didn't pick up, he got in the van and went with me to the hospital.
At the hospital, as Riley went longer and longer without a drink, he became more and more agitated. I refused to intervene. I gave information when I was asked and corrected him on details that he didn't remember clearly. But, when it came to whether or not he would stay -- I shut up. Eventually, he agreed to being admitted and was placed in ICU.

He was now into more than 6 hours of withdrawal. I started my mental countdown - only about 30 more hours and he would be in full blown DTs. He was told they would only keep him overnight, but that they were prepared for the possibility of seizures since he had all the appropriate padding around his bed.  Their goal for him was to elevate his potassium and get him more stabilized.
The ICU doc came in and told us that the lab results she had used were based on a different and using her method, Riley’s ammonia levels were really not that bad. So she wasn’t that concerned. When she started asking Riley questions, the same inaccurate garbage was spewed as it had been in the ER. I started to give her the facts, but was abruptly stopped and told she wanted to hear it from Riley. Well… OK… I let it go and sat quietly marveling at how much misinformation was being bantered about.

While this whole process was going on, I was continually thinking – So now what??? Will this trip to the ER mean another year of hell with Riley? I have vowed not to pull him back from the brink of death, but when  a medical professional gets involved and makes the decision for me or for Riley – I see no way of being able to stop what could easily turn into a snowball rolling down a mountain in the Alps. I can see in my mind and follow the progression. They just want to give him some potassium; then he has a seizure and they have to keep him because he is too weak to be discharged; next thing ya know he’s in full blown detox and that silly little snowball is now an avalanche. And I feel helpless to stop it.
I was invited to spend the night in Riley’s room. They would bring in a cot and make accommodations for me. Sure, like that was going to happen. I had a Riley-free night and intended to make the most of it. I went home and cooked some of my favorite foods, curled up on the sofa with a soft blanky and watched Survivor. Then I took a long hot bubble bath followed by climbing into bed with fresh sheets. Jax joined me on one side and I allowed Jade to sleep in my room next to my bed.
That’s where we all snored the night away until almost 6 a.m.

The doctor made her rounds between 8 and 9 a.m. I had called Gill and he was going to try to meet me at the hospital to talk to the doctor. I really didn’t know what I would be walking into this morning, but I didn’t really expect to see that much of a change from the night before.

Riley was sitting up eating his breakfast complaining that what he needed and wanted was a drink. His night had been OK because they had given him Librium. He was shaky and weak. When the nurse came in and told him to push himself up high in the bed, he could not do it. His general appearance was one of a weak old man, even more so than when I brought him in.
The ER doc said Riley’s lab work looked much better and he would be released that day. I was impressed that they had actually been able to accomplish their goal without him going into DTs. In my mind, I’m still questioning the point in all of it. Why did we really go through this?

I went to get a cup of coffee and when I returned to the room, Riley was sitting up in the recliner. The nurse told me to get him dressed. Oh. Really. Was it really my job? I pulled out the sweat suit I brought with me and started the task of getting him into it. First there was the issue of the Depends – which he did not want to wear. I informed him it was not his choice to make – Depends or stay in the hospital. Once he conceded, trying to get the Depends actually on his body was still another issue. I told Riley to lift his butt so I could slip them on. He couldn’t lift himself high enough for me to slip them on. When they were half-way on, I moved on to the sweat pants and it was the same thing. I thought if I got them partially on, I’d have him stand up and pull them up the rest of the way. The sweat shirt was no problem as were the socks and slippers. I told him to stand up and I’d finish his pants – but he couldn’t stand up at all. He couldn’t walk. He couldn’t do anything but sit. At least when we came into the hospital, he was able to move under his own steam. He was worse now that he was before!
The problem-solving part of my personality kicked in. I could drive up the ER entrance and the nurses could get Riley into the van. But what was I supposed to do after that?? I couldn’t carry him into the house. He couldn’t walk. I expressed my concerns to the nurse. She told me to call a neighbor for help or a family member. WHAT?? The only neighbor I have is at work. My kids are about two hours away and at work. To me the suggestion was ludicrous. I asked if they thought I should call the rescue squad to help me get him inside. After a lot of mucking about, it was decided he would be transported home via the rescue squad. That sounded like a good plan to me.

While waiting for the rescue squad, the hospital case manager came in and told me she would be having a home health agency contact me so that I would have some assistance in caring for him. They knew Riley’s aversion to bathing and knew I needed help at that area – at least. I was extremely happy to hear it. I was also told that I might be able to get assistance from the Veterans Administration since Riley was considered a Viet Nam vet, there may be programs open to him that we didn’t know about until now. Wow! More useful information – this hospital overnight was turning out to be a pretty good deal.

I got home, fixed Riley a drink and within a few hours he was trying to make his way around the house. The more drinks he had, the more mobile he became. So, the drunker he was, the more stable he was. The irony in that amazes me.
Tomorrow I am to take Riley back to the docs office so they can repeat the blood work and see how much he has improved. OK. I can do that. I will comply.

I checked back in my records and when Riley was admitted to detox in SoCal, his ammonia level was almost 900. So while a level of 700 is alarming, Riley has survived much more startling lab results. I suppose to someone who is new to the Immortal Alcoholic, he seems in dire need of help. I know that’s their only goal – to help. I respect that and understand it. It makes my job more difficult and the medical pros don’t seem to understand my point of view.
I’m not upset over the hospital stay because Riley did NOT go into DT’s. They released them exactly as they said they would. I’m thankful for my 24 hours free of Riley insanity. Gill informs me that I have some other decisions to make and wants to meet with me as soon as things settle down. At this point, I feel I’ve made all the decisions I need to make. But, we’ll see what he has to say.


Alice said...

Linda, I am STUNNED that they did not give him valium to stop him seizing as soon as they realised he was a detoxing alcoholic. WHY NOT?

I suppose things must be different here in Australia, but as soon as one's BAC has dropped to 0.15 they will administer valium. This is in a rehab ward of a psychiatric hospital, but I think the same would go for Emergency.

It seems so dangerous to me, and so likely to make the alcoholic either leave AMA or cause a huge fuss in the hospital. Why not sedate them ASAP, to ease physical AND mental issues?

Linda (The Immortal Alcoholic's Wife) said...

Alice -- His BAC never dropped that low. He wasn't in for detox, but to get some potassium in his system. They gave him librium to help stop the shakes. But he never reached a full detox when the DTs usually start.

ADDY said...

Oh those oases of drunk-free nights snuggling down in clean sheets. I can well understand how you felt. And also what you must have been feeling when they said he could go home again.... unable to walk! It all sounds so familiar. But believe me, one day he will not come home again!

jo said...

i am a bit shocked at the pas comment. ems here will never transport anyone who refuses. they will wait till they are unconcious..but if the patient says no, they wont do it. its against the law. i think she was bsing ya with that threat.

you highlight something we all will face. when do we stop this insanity? is it insanity? when do we wait till they are unconcious to call 911? can we morally and legally? when do we learn we simply cant lift them anymore?

where are the lines? are there any lines?

how do they live thru this? im not surprised alcohol made him appear better. it does that.

are we "saving" them for this to keep happening over and over?

unless riley is disabled and rated thru the VA, they have no help for us. not in texas, i already went thru that crap. the VA hates active alcoholics here and wont do a thing. and with a income level , watch it or you will get billed a endless amount of money for the millions of tests they want to run.

only rated and disabled from service connection qualify for much help long term.

good luck. i have had the morning from hell from mine. quiet sounds wonderful right now. this is no way to live. i hear how old riley is and think...oh my God. surely not.

that is all they are legally required to do. stabilize and discharge. that is what they did. and we get em back. wonderful.

Kibble said...

Glad it worked out OK for you, that he didn't go into full blown withdrawls and you got a blessed break.
I'm guessing you'll be thinking about what happens next time, so please know that Jo is right, the PA can order rescue to your home, but she can't compel them to take him. In every state, the patient or someone legally responsible for him/her must consent to any treatment given, including transport.
The medical community can do some crappy things, but it can't force treatment on someone without a huge legal effort. I know you like your PA, but either you misunderstood her, she is misinformed, or you were bamboozled. I felt compelled to say something because it sounded like you were feeling powerless in the face of the medical professionals, but he can at least say no to them until he's judged incompetent, then it's your call.
And. . . not sure if you know what critically low potassium could have done to him - heart arrhythmias, sometimes fatal, are common when it goes very low. Causes of hypokalemia include vomiting and diarrhea, so with Riley it's likely to happen again unless he's supplemented.

Syd said...

The buildup of ammonia is what sends my FIL into confusion and a coma. It is not good. He usually is in for 4 days minimum. The home health is a good thing. Medicare will pay for a certain number of days. Sounds like a good respite for all.

jo said...

thanks kibble. i learned a lot when i worked home health. one thing is they wont take them unless you have poa and even then im not sure.

one thing i worry on is the line..and will i know it? when to call 911. should i? moral? legal? human? or let them go as they want..drunk..in their own homes.

the prob here is the agencies will not tend to anyone verbally abusive. they will let them drink..but honestly how much can they do with a drunk? cant have much pain meds..which killed my friends husband in 2 days with their morphine but he wouldnt be still or shut up and kept heading outside to fall in the yard.

where are the lines? are there any? is it up to each of us what we choose and to fend off the many who tell us how wrong we are?

i dont know the answers. i would think its up to each of us. not the pa, not the dr. not a nurse. only those of us who do the work every day.

and this is facing us all soon. i pray a lot for God to show me what He wants. i think He will.

what did this accomplish to stablize riley? honestly? it saved him again,no doubt. should it? should it not? who knows? i dont.

linda, this will prob happen again. and again. be as ready as you can. cause the hosp isnt gonna do a thing but send back home, prob a bit weaker each time.

sigh. the beat goes on.

Unknown said...

Linda, after having my mom in the hospital countless times (nausea, dizziness, "flu", back pain, dehydration, weakness, broken arm, split chin, broken hip, etc.), you can expect to receive a different facet of treatment each time. Roll with the punches, girl, and someday you will be free; you know that. If mom keeps drinking at the level she has been, she won't make rehab #5, and I'm ok with that. I love her and look forward to telling all the funny stories at her service. Best of luck and good wishes to you.

Gabriele Goldstone said...

Putting diapers on your drunk - save me!

Karen E. said...

Sounds like we are in similar situations. Mom is still in the hospital drinking her little bit of vodka. Doc told me on Thurdsay that he could not in good conscious send her home if she couldnt walk to bathroom.. I asked can you keep her to Monday? because we havent been away together in over a year..he said..go go go.. we went to Lenior NC didnt call hospital..didnt hear from hospital... Recharged and ready to face the day tomorrow..I think.. How are things with you guys now?

Anonymous said...

I just found your blog, Linda, and am impressed and humbled by your efforts. Everything I have read so far is precisely accurate according to the current "model" of addiction and treatment. So much money, so much mis-information, so much control from "big-pharma," such narrow-mindedness from the "recovery" community . . .

I know. I've been there, done that.

I don't make this suggestion in order to change a single thing that you, or Riley, are doing. It would be apples and oranges . . . but you might be interested in reading a book written by a French cardiologist who was a "dead-drunk." The latest edition is called "Heal Thyself," by Dr. Olivier Ameisen. I, and many people I know on a world-wide forum, have followed his protocol with a generic pharmaceutical to end my craving for alcohol. I am no longer an alcoholic. In the current "accepted" models of addiction, there's not even a category for THAT!

Big-pharma and the entire "treatment" and "recovery" industries have had a hand in suppressing information about this treatment. Of course, the drunk has to want to not be a drunk for Dr. Ameisen's protocol to work, which clearly is not the case for Riley. But your questions about "treatment," insurance, etc., point to a place where there are probably grounds for criminal charges regarding keeping the information in this book out of the hands of those who seriously want to be free from alcohol.

I'm posting this only with deep respect for where you are and what you are doing. But it might be helpful for you to glean an even deeper understanding of the powerful consortium of influences working to KEEP people addicted.

In a decade, or two, we will understand that the current medical model for the treatment of addiction is akin to something from the Dark Ages.

Thank you for your forth-rightness and clarity. I can't imagine that it is an easy feat when faced with the dual insanity of the disease AND the insanity of the medical system which, in fact, has a huge financial investment in keeping people addicted.

Anonymous said...

I too, have run across an article about Dr. Ameisen, and am encouraging my husband to ask his new doctor for a prescription.

He says he wants to quit drinking, but it's hard to know for sure.

Anonymous said...

trying t fnd help for my hubby of 43 yrs,, hes going downhill so fast ,,doesn't eat hardly at al,,, don't know what to do,,i sit and watch him kill him self,,, staring with achol deminta now,, drinks 30 pack a day and now turning to whiskey... why can't the veterns help these vets,,,