Clenched fists

[annie h]

My mum is in the advanced stages of dementia, and has deteriorated suddenly in the last ten days. She’s been this bad before after a TIA in January but then bounced back. But this time it’s different. There doesn’t seem to have been any obvious trigger. NH started saying about four weeks ago that she had “loose stools”, which she’s had before although it’s usually been possible to stop it. She doesn’t have an infection – she was last tested a few days ago. The GP has tried some medication options which haven’t worked but doesn’t know what is causing the loose stools, and says the only way of investigating further would be a colonoscopy – which doesn’t seem appropriate since she would suffer extreme distress having it and the GP confirmed (when I asked) that the things that would be looked for are things that it would not be sensible to put her through the trauma of treatment for.

In the last ten days she has virtually stopped eating and drinking and is mostly very unresponsive. In several hours with her today I managed to rouse her a couple of times and she took a few sips of water. But most of the time she just sleeps and it’s not possible to rouse her. She doesn’t seem to be obviously in pain, and in fact looks quite calm. However, she seems permanently to have her fists clenched hard.
I just wondered if anyone had any ideas/comments about what the clenched fists could mean. Whilst she doesn’t appear to be in any pain she has not been reliably reporting or describing pain for the last few months, so I’m wondering whether the clenched fists could be a sign that there is a problem that isn’t apparent in any other way.

Any thoughts anyone?

 

[lin1]

Hello Annie
I am sorry to hear about your Mum. I cant help with the loose stools, I agree with your decision not to have a Colonoscopy done. except maybe discuss with the Dr trying a weak dose of something to bind her a little.
When mum was being examined because mum was suffering retention, the GP found a lump somewhere in mums belly, we decided not to have it investigated, mum was in late stages of dementia at the time, even though this was several yrs ago, I never once regretted our decision.

Their came a time when my mum could not tell us or point to the area if she was in pain. Amongst other things Mum was riddled with Arthritis , so we knew she suffered pain.
Mum could no longer swallow pills, I believed the dissolvable Paracetamol was not sufficient, after talking to the gp, mum was put on a low dose Pain patch, which she tolerated well though at first it did make mum more sleepy. Their are different types, I forget the name of the one Mum was on but it was an Opiate.
My personal opinion is to assume their may be some pain and give painkillers on a regular basis, but that is just my view.

Some people who have dementia, have Contractures, my Mum's right hand closed up first, then her left hand started.
When mums Right hand started to close up a gp wrongly told us their was nothing available to prevent it closing right up and stop the nails digging in to the palm.
So I devised my own padding.

Eventually We found out we had been told wrong and another GP called in an OT
Who showed us several devices, some of which held the hand open more. I decided this would be too traumatic for mum, and chose a palm protector instead, (I will try to find a link to them for you so you can see what they are like)
I cant say whether your mum is clenching her hand because of pain or contractures
This disease is so bloomin hard isn't it .

This is what was prescribed for mum
http://www.euromedical.co.uk/section215/product2283/palm-protector.html

 

[annie h]

Thanks Lin, that's really useful. I've emailed the surgery to ask if GP can consider the pain relief patch option when he sees her tomorrow. Mum isn't really able to swallow and it wouldn't be a surprise if any oral pain relief was not going down anyway - she's a past master at fooling even the most expert staff into thinking she's taken medication when she hasn't. The fists were a bit better today with no obvious reason for the difference. It's so worrying when you know they can't tell you what's wrong isn't it?

 

[garnuft]

My personal opinion is to assume their may be some pain and give painkillers on a regular basis, but that is just my view.

I totally agree with this. Far better to be sure there is no pain than to wonder.
I would err on the side of caution I would want for myself, that would be pain relief.

Even if it is contracture, that in itself will cause discomfort and strain.

My Mam had patches, she was sleepy anyway, better to be comfortable.

Hope your Mum is more comfortable soon.