This question hits home for me. I recently sat down with the husband, and main caregiver, of a woman with advanced dementia. The woman eats very little and is losing weight despite her husband’s great efforts at encouraging her to eat. Under the care of another physician, she had been given megestrol acetate and there had been some improvement. Her visit to my office was an opportunity to continue an ongoing conversation with her husband about his wife’s overall decline, her advancing dementia, and the sorrow he was feeling over her failing health.
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Clinical practice guidelines recommend > 3400 anti-factor Xa International Units of LMWH subcutaneous daily (equivalent to > 34 mg subcutaneous daily of enoxaparin). For most patients, continue prophylaxis until hospital discharge; however, in patients that are considered to be at high risk (., > 60 years of age or a history of VTE), continue prophylaxis through hospitalization and for 2—4 weeks after discharge. Previous guidelines have suggested a dose of enoxaparin 40 mg subcutaneous 1—2 hours before surgery then daily or 30 mg subcutaneous every 12 hours starting 8—12 hours before surgery.