86 yo man with COPD, CHF and Stage 4 kidney disease
My father had a minor M.I. in December 2014. He has had Stage 4 kidney disease for years secondary to hypertension. He has taken medications for the hypertension including Coreg and Clonidine. He also has congestive heart failure although he seems to have a good ejection fraction (40-50%) and his enhanced stress test showed only some minor reversible ischemia and the old M.I. He also has COPD, probably in part from smoking cigarettes 60 years ago and from asbestos and other pollutants in construction for 55 years. Although he is better than he was when he had the M.I., he is still very s.o.b. with exertion and has a persistent cough. His B.P. is sometimes off the chart and sometimes very low. His HR is usually low and has been in the 30s in the past - normal now in the 50s and 60s. His quality of life has gone downhill, but everyone says he looks good - which he does. He has lost considerable weight and is now down to 143 and his height has decreased as well over the years to 55". He has moved in with us and we are helping him with a low sodium, low potassium and low phosphorus diet. His EGFR is at about 17 now but we are not considering dialysis, as I am not sure it is necessary at this time nor do I believe it would significantly prolong his life. My question is: is there anything else we can do to help him live more comfortably and function better?