From NG to a PEG?

Hello again, everyone

I have posted here before and my husband (75) is now eight weeks out since his second stroke in six months. He currently has a NG tube and hates it, and the doctor at the SNF (that is, the Norwegian equivalent) is considering a PEG. She wants me to think about it and discuss it with my husband (not easy since he has expressive aphasia). I am worried about the risk of infection and also the procedure of getting it fitted, but maybe this could give my husband a better quality of life? I hoped he was heading for further rehabilitation but it seems we may need to prepare ourselves for a permanent place in a nursing home - which I find devastating. I haven’t even mentioned this as a possibility to him yet, as I don’t want to rob him of all hope.

Any thoughts on getting a PEG?

Kind regards, Anna

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Anna, I know you and your husband are going through a very difficult time. I guess if it were me, I would get opinions from 2 or 3 knowledgable people in the field , and if possible from some people who have had experience dealing with this situation, which I have not. Then try to communicate your findings to your husband. Perhaps communication about this might be easier with the use of each of you making drawings. (I’ve read this often works with aphasia patients). Then ask your husband which road he would like to travel. Sorry to say, as we get older, the final route leads to the same place, but we have a say in which road we want to take, and if the patient is able, I think they feel better having some control. If he is unable to decide, then you’ll have to make the decision on your own from the facts presented and knowing your husband. A nursing home placement, if it happens, is devastating to all of us, but you can choose to be with him and have many good moments as you are able. You and your husband will be in my prayers tonight. :heart: Jeanne

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Thank you! I will call the stroke association here and speak with a stroke nurse about this, I think. My husband has signalled that he is unsure, he can speak a little most days. Anna<3

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@AnnaC - this is a difficult time for you and your husband.

I think the below from @axnr911 's response is worth noting.

It might just not necessarily be just as you get older, but sometimes some health conditions that put constraints on the quality of life we are able to lead.

In terms of advice on NG to PEG, I expect it is something that has already been decided since this post is a bit old and as far as I am aware the NG is normally only a short term solution whereas the PEG is longer term solution.

If you still do require information on this, I believe this topic has been discussed previously on this site.

Wishing you and your husband all the best.

Peace and love :heart:

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Thank you, @Pea_WoS. This may not be relevant anymore: My husband was rushed to the ER yesterday and I was told to prepare for the worst. He has either a UTI or pneumonia and they are fearing sepsis. I can’t sleap or eat. He is my only family. But they are trying with lots antibiotics, so we’ll see.

AnnaC.

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Hello Anna - it’s easy to say, but please try to get some sleep and try to eat. Right now, things are difficult, but I think all things considered, your husband is probably in the best place he can be to get the care and support he needs.

Please look after yourself :heart:

:pray:

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Thank you, @ManjiB! My husband responding to the antibiotics, but he is weak. Rehab-wise this is a great setback, but we will see. I don’t really trust the SNF he will be returning to, but I suppose I have to.

Kind regards, AnnaC

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Hello AnnaC - It is pleasing to know your husband is responding to antibiotics and the weakness is to be expected. All things considered he has been through a lot and is currently fighting off a serious infection. Antibiotics help, but I think they also take a toll on the body.

I understand this is a setback for you and your husband from a rehab perspective but I guess there is not a lot we can do about this right now - the focus has to be getting him well again.

I can’t comment on the SNF but here in the UK I believe it is a similar situation with care homes/nursing homes. But sometimes we don’t have a choice as we have to go with what is in the best interest of the person being cared for, especially of we are the ones making the decisions on their behalf. If your husband can express his wishes and if they can be accommodated that is good, but sometimes even that is not possible for whatever reason e.g. availability of specialist care support teams/facilities or financial constraints etc.

Having followed your story, if I am not mistaken, you do not have much help from family or friends which must make it very difficult for you. It is important therefore to try to accept there are limits to what we as individuals can do and accept that if we are doing our best, there is nothing more we can do. I have been lucky to have support from family and friends whilst caring for Mum and even then it has been difficult at times. From this we have learnt that sometimes in life, things happen and there is nothing you can do about it. But also, as in the case of your husband and my Mum as they get older they are reaching the end of the life cycle and that is an inevitability - there is nothing we can do. If we are lucky we lead a healthy life and then when the time comes we go, but sometimes we have to face some difficulties.

I believe this is the case here - both your husband and my Mum were unlucky to have a stroke which left them dependent on others for help and it also changed the way they lived. When we talked about these things with Mum, she always accepted things as they were and she carried on doing the best she could. In her case, she felt she had done as much as she might have wanted to and when the time came (she believed in God) she said when God comes calling she will go), but at the same time she will go only when she’s ready. Perhaps, you may have had a similar conversation with your husband and he may have said how he feels.

Before her stroke, Mum had also indicated how she should like to be looked after in the event of an illness and so again we had guidelines to work with. That said, they were guidelines and we could only try to accommodate her wishes as there are no guarantees for reasons already mentioned above.

I guess what I am trying to say is that be aware of what is happening and try to be strong. At times you will feel helpless and sad and other emotions, but if you able or have had a chance to have the conversation with your husband then it will make it easier for you and him to accept what happens next.

There is more I can say on this topic, but I don’t want to over step the mark in case it is not something you want to read right now.

I wish you and your husband all the best.

:pray:

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OK Anna - that’s fine.

I note from a later post your husband is responding well to the antibiotics. That’s nice.
Wish you both all the best.

With peace and love :heart:

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Thank you, @ManjiB for your thoughtful comment and best wishes! Accepting that sometimes things happen in life and that we can’t do anything about it is a hard but useful lesson to learn. I am a planner and I like to have control, so these past eight months have taught me to let go of planning and predictability. My husband is on his way back to the SNF now, and I just hope they will take good care of him. They are understaffed and I have not been impressed by them. I need to be super alert when visiting. Our goal is that he soon will be well enough to move into a much better rehab place where he has been before and hopefully make enough progress there to eventually move back home again.

Kind regards, Anna C.

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Thank you, @Pea_WoS! Fingers crossed. I am hoping this hasn’t been too much of a setback for him in terms of his physiotherapy and speech/swallowing exercises.

Kind regards, Anna C.

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Hi,

I dont know your husbands exact circumstances but Pegs can be temporary or permanent depending on whether a swallow reflex comes back and the person can eat normally again. I used to put these in when I worked in the hospital, and it’s considered a minor procedure usually under sedation not anaesthetic. It takes about 20 minutes in total. With everything, there will be risks; but I’ve had people of all ages have them and they are much more comfortable than NG tubes. Plus they are hidden under clothing when not used. Hope this helps.

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Thank you so much, @Karin, for taking the time to answer! The doctors here seem to think a PEG is a big deal and must be put in under GA. Despite ending up in the emergency room last week after a UTI turned to sepsis (very scary, but he survived, thank God), my husband’s swallowing is slowly improving and he managed nine tablespoons of thickened water yesterday. I will discuss a PEG with his primary doctor at the SNF as soon as she returns from vacation and I’ll also have a word with his SLT.

Kind regards, Anna C<3

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I’m glad to hear your husbands able to have something orally. Pegs can help with building up a person’s health until they start eating properly. I’m happy that things are improving for him. Personally we only used to use GA if there were other issues with that person’s health. Kind regards.

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Hello AnnaC - I hope things are good with you and your husband.

@Karin has shared some very good information on the PEG. I note your husband’s doctors think a PEG is a big deal, but I wonder if this thinking is specific to your husband’s health condition and medical history. I am sure you can get some clarification on this when you discuss the options with your husband’s primary doctor.

Having said, that I would love to hear your husband is now coping well with swallowing and the SLT can give the all clear.

Wishing you and your husband all the best.

:pray:

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Thank you @ManjiB, for your kind words. Yes, I did see @Karin’s advice on PEGs and I am definitely going to discuss it with my husband’s doctor (she is on vacation at the moment).

This weekend he managed 12 teaspoons of thickened water (me feeding him), so that is progress. I will tell his SLT this, of course, though she only works with him two days a week regrettably. I try my best with him on the days she’s not there.

Kind regards from Anna C.

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I’m glad your husband is improving, and that I was of some help. I’m in the UK so not sure about the policy with your hospital. If there’s anything else you’d like to know I’d be happy to help. But ultimately it’d be your doctors for anything more complex. Regards. Karin

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