Sudden rash

[99purdy]

Hi all,
Dad who resides in a challenging behaviour unit, has suddenly come out in a rash. It looks like small bruises under his skin, just on his legs and buttocks. He is currently very well eating, and in a very good mood. His obs are also all fine. If he was unwell I think I would be more concerned. Dad is end stage Lewy bodies and Parkinson’s. Anyway paramedics were called, as advised by 111, they took him to AandE. Of course he was uncooperative and tried to attack the nursing staff. The Junior Doctor offered a referral to a dermatologist. The Head Aand E consultant asked if he could be returned to the nursing home as he was causing chaos in the department. I totally agreed with the consultant. Dad is not happy in hospital at all, he is very aggressive. I have asked if the rash has gone when the appointment letter comes, that we leave him in peace and not take him to the hospital. It will be a total nightmare he will kick up a fuss, will not allow anybody to touch him, and could attack staff and other patients. Do you think I am being unreasonable? my Doctor friends think my approach is very sensible. Even his GP suggested no further treatment.

 

[karaokePete]

I think there is a good argument for minimal or non intervention if someone is at end stage and any intervention is likely to either do more harm than good or hasten the end for a person who is not otherwise in pain, distress or discomfort.

Whether that applies in any given case has, in my opinion, to be up to family and doctors, in consultation, as they know the person and their position best.

I don't think it is unreasonable for you to be considering all options. I myself would be guided by what I have said above; as, indeed, I was when making such a decision when my father was in the terminal stage of cancer some 22 years ago.

It's a tough ethical argument and not everyone will make the same decision

 

[Grannie G]

He is currently very well eating, and in a very good mood. His obs are also all fine. If he was unwell I think I would be more concerned.

I agree, especially if medical examination causes challenging behaviour.

When my husband was at end stage dementia I only agreed to medical intervention if he was in pain. He was hospitalised with a chest infection but it was found at this stage antibiotics were ineffective and so he was sent back to his care home for palliative care.

 

[Linbrusco]

Sorry to hear about your Dad. My Mum has also had challenging behaviour at her care home, and s hospital admission earlier this year was horrendous. I will seriously think twice next time.
Please google Petachiae and Purpura. My Mum has a form of Leukemia which affects her platelets. She gets petachiae on backs of her hands and forearms mostly. They come and go.
If they get big or in a cluster their first concern would be getting a full blood count.
Did they manage this with your Dad.
Has he had any changes in meds?

 

[99purdy]

Hi All, thank you so much for your replies. Whenever Dad has had to go to hospital it has been horrendous, security has been called he has bitten, punched and attacked staff. He hates hospital and has done before he was ill to be honest. He never went to the doctor. I think he has a genuine fear. He has had no change to meds and actually at the moment he is eating well, in a good mood and seems contented. Obviously if he was ill, distressed, in pain then obviously he would have to go. At this stage of his illness, I truly believe that taking him would be detrimental to his wellbeing and would stress him out so much. Thank you Linbrusco, I have googled Purpura and that is exactly like the rash he has. Only problem would be getting a blood test to confirm this, ha ha! Sorry I have to laugh otherwise I would cry. It is like a military operation trying to get blood. I think some nurses have now refused to do any blood tests! I hope I don’t sound heartless, but after 4 years with this nasty illness, everything else seems irrelevant and as long as he is happy, not in pain, eating and seemingly contented then I think he should be left in peace.

 

[canary]

No, you dont sound at all heartless, after all - how would it be treated?
Sometimes it is best to just less nature take its course. I would talk to your dads GP about this and see if you can come to an agreement. You may well find that the GP will support this decision.

 

[Rolypoly]

You could always try taking photos of the rash and send these to dermatology for a possible diagnosis. That’s what the drs initially did with mum.

 

[99purdy]

Thanks Canary, the GP has actually recommended no further treatment! And RolyPoly, great minds think alike! I intend to take some pictures when I visit this afternoon. It is a horrible feeling when you are more or less saying no further treatment please, but I only want what is best for him! He has been to hell and back and whilst he is happy and contented I think everything else is irrelevant. Thanks for your support. Xx

 

[Linbrusco]

99Purdy I get where you are coming from.
We have had two occassions now where Mum was considered end of life. Refusing food, fluids etc.
Both times its been due to urinary infections.
When admitted to hospital back in March, so physically aggressive all 5ft0, security were called and she had to be physically restrained so nursing staff could hive her a sedative.
Mum does however cooperate for blood tests but not to obtain a urine sample. Our only guess with her Leukemia of 7 yrs she is used to them.
When Mum doesnt eat, my sister enevitably starts saying that Mum will need to be put on a drip, and once mentioned tube feeding.
Now that would take some doing!!
I dont agree in any case.
After Leukemia, early stage bowel cancer & surgery and then Alzheimers, how much more does Mum have to endure?

 

[99purdy]

Hi Linbrusco, thank you for your reply. Your poor Mum has also been through the mill. I have had similar with Dad, it is a very emotional roller coaster! Dad has been very very aggressive and has actually hurt people. It has been so upsetting as I know he would be mortified if he saw the way he has behaved. I know it is not him just the horrible illness. Dad has caused mayhem at hospital, he really does not like them. I would just like to keep him safe, happy for however long he has left.

 

[lin1]

Hi All, thank you so much for your replies. Whenever Dad has had to go to hospital it has been horrendous, security has been called he has bitten, punched and attacked staff. He hates hospital and has done before he was ill to be honest. He never went to the doctor. I think he has a genuine fear. He has had no change to meds and actually at the moment he is eating well, in a good mood and seems contented. Obviously if he was ill, distressed, in pain then obviously he would have to go. At this stage of his illness, I truly believe that taking him would be detrimental to his wellbeing and would stress him out so much. Thank you Linbrusco, I have googled Purpura and that is exactly like the rash he has. Only problem would be getting a blood test to confirm this, ha ha! Sorry I have to laugh otherwise I would cry. It is like a military operation trying to get blood. I think some nurses have now refused to do any blood tests! I hope I don’t sound heartless, but after 4 years with this nasty illness, everything else seems irrelevant and as long as he is happy, not in pain, eating and seemingly contented then I think he should be left in peace.

No you don’t sound heartless, quite the opposite in fact.
We decided to do similar for mum, going to hospital would have freaked her out

 

[99purdy]

Thank you lin.xx