u/Icy-Protection867

Does anyone know how robust the intake/screening is for an elderly person being evaluated for a TAVR procedure?

Specifically, are they adept at seeing masking in dementia patients, and requiring enough interactions to accurately identify the level of frailty, as well as cognition?

I have an elderly relative who thinks she’s going in to that 1st appointment and will get a “scan” that fixes her aortic valve, no anesthesia required, and that she’ll be back home that afternoon. In legal parlance, this strongly suggests she is incapable of being able to consent to the procedure, but I’m worried that she’s crafty enough to smile and nod and people please her way through and get a sign off.

When anyone tries to correct her - including the family member that was in the office with her when the referring cardiologist was explaining the next steps - she accuses them of being mentally ill and not knowing anything.

ALSO - I’m concerned about possible delirium post-procedure and a likely presence of alpha synuclein bodies in her brain due to Lewy Body dementia (which remains undiagnosed due to the same insane behaviors) which require a different delirium protocol for safety.

We haven’t had a lot of luck getting UPMC offices to accept information from concerned family due to a) abject misunderstanding of HIPAA, or b) extremely aggressive in-house legal counsel that assumes a total lockdown is safer than actually teaching people what HIPAA allows vs. what it prohibits.

Thanks in advance for any insight or guidance.

My 83 y/o mother is being scheduled for a TAVR due to aortic valve calcification and stenosis. The biggest challenge I see is that she has what we believe to be Lewy Body dementia, but she is paranoid and conspiratorial so has masked the symptoms in front of doctors to the point that they will note “memory issues” but no further exploration.

Her father had Parkinson’s and she exhibits every symptom on the LBD checklist.

In addition, she is wildly out of touch with her ability to do things and lies voraciously about them to anyone and everyone. We think she actually believes that she can. For example, she’s ok with the basic ADL’s (bathing, dressing, feeding,…) but the independent ones, not so much. My father had to take over paying the bills because she could no longer organize them or use the computer; she cannot navigate her cell phone to make a call unless he opens it for her and navigates to the phone app; if she opens her iPad and it doesn’t open to “the Facebook” (e.g. the app closed since she uses it last), she flies into a rage and insists that “someone is using her iPad”.

She cannot drive (my father quietly took her keys) but believes that she still can and confabulation is regular fare at family gatherings.

My siblings and I are not on her “approved” HIPAA list so I can’t get any providers to listen to us, and my father has been subservient to her rages and moods throughout their marriage so he’s reticent to challenge her.

How risky is this procedure if we can’t get the doctors to understand these 2 main issues (likely LBD and frailty)?

Thanks in advance.

I had been having connection issues for a while and ended up needing a technician visit. I’ll be honest; I was considering moving to another carrier, but that didn’t resolve my immediate need for Internet service so I went ahead and scheduled the technician visit.

The guy was awesome! He explained what was wrong, answered all my questions, told me what to look for (e.g. real issues vs. temporary blips), and what to check before calling Help Desk.

My issue was resolved and my infrastructure was upgraded to current standards and equipment (the issue wasn’t with my equipment but the lines from the pole to the house).

We often rant on social media when we’re cranky. We should also call out excellence in service.

A company that has someone this skilled with a long tenure with that same company is doing SOMETHING right. Are they always right? No. But good luck finding a company that is.

Thanks Xfinity for an excellent resolution to my issue.

Over the past couple of weeks, my internet. Connection has been unreliable, at best. I was on with Tech Support for over an hour yesterday and they “reset my account on their end”.

After that, it worked great. I completed the text inquiry about how happy/unhappy I was with my tech support service (gave glowing/high scores and praise),… and an hour later it went back to being unstable.

I’ve never had this issue. Did something change?

I work from home and teach online. This is not sustainable. 😕

Since the $1.8b (ish) fund was set up to be a resource for people who have been harmed by weaponization of the federal government, I think everyone who was returned to an office after being on remote or telework agreements, ought to file for reparations!

What do you think? 😬

A hypothetical (somewhat) scenario:

An elderly patient begins voiding large amounts of blood when they use the bathroom. They are in the mid to moderate stages of dementia, and very secretive and paranoid about sharing anything around their health with their family. The dementia has caused perceptual, disruptions, and the patient believes that the blood in the toilet is her “special ability” to make colorful urine, and a special trick that she can do.

This belief causes her to brag to her family about the pretty “tinkle” in the toilet. When she does, her adult children immediately realize that there’s a problem, and ask her if she’s talked to the doctor about it. She insists that the reason that she is putting all that lovely color into the toilet is due to being special, and accuses the family members of being jealous.

She will not listen to their requests that she call her doctor, and discuss it with him, and gets angry when they insist that she needs to be evaluated.

The adult children have attempted through multiple avenues to get this information to their mother’s PCP. They have been blocked at every avenue, have called the patient safety line and left a message, have submitted an online form for the patient safety portal, have called the office and been blocked (by people who clearly don’t understand HIPAA), and so the blood in the urine continues, the patient ends up with pain and is eventually evaluated and diagnosed with Stage 3 bladder cancer.

Wouldn’t the system have some liability for refusing to listen to family members’ concerns early enough to treat it without as many complications? (especially if there’s lots of documentation that attempts were made to get the information to her provider,…)

I just picked up a dark roast, tall coffee, where I had ordered remotely and requested a splash of cream. When I picked it up, I thought maybe I had walked into a Dunkin, because there’s more cream in this cup than coffee. Keep in mind I ordered a dark roast, so if it looks bad, it’s worse than it seems. And it looks bad.

I really just needed a boost of caffeine, because I didn’t sleep well last night; and they are extremely busy, so I didn’t complain, but what happened to being able to rely on Starbucks for a splash instead of a tsunami of cream!?