Urgent Care -> Hospital -> Back Home

KarenC

Registered User
Jun 2, 2005
122
Los Angeles, USA
My mom has had a rough week. Last Friday (8 days ago) she fell. At the time it did not seem like a big deal. The dementia home got her up and walking, so it appeared nothing was broken. She was real tired, but that's happened before when she has fallen.

The next day she was "lethargic" per the home; we went to take her to the doctor and she was really sick by that time. Getting to the doctors' office was horrible; she was squirming, obviously distressed, saying "I can't, I can't, I can't, help me, help me, help me...." over and over. Previously, while not really able to carry on a conversation, I think she could adequtely express physical pain, like "My knees hurt." On this occasion, however, asking her if/where she hurt was not getting any coherent response.

Fortunately the doctors' office we went to had an Urgent Care unit, where we spent a very long afternoon. The diagnosis was urinary tract infection, dehydration, but nothing broken. The doctor admitted her to hospital.

The hospital did more X-rays, and here things got real confused. We got varying reports about whether or not she had a broken hip (an "old" fracture ... did that mean one week old? years old? ) and whether surgery was indicated. Yesterday after quite a few phone calls amongst me, my husband, the floor doctor at the hospital, and the nurses at Silverado (Mom's dementia home), the doctors were saying surgery was a bad idea and the nurses as Silverado were afraid they were writing Mom off too easily. But we got the orthodaedist at the hospital and the head nurse at Silverado talking directly to each other (without the medically uneducated like me in between), and while it is still not clear exactly what's what with Mom's bones, all were in agreement that she should not have surgery.

I'm relieved at this, as was Mom's GP. Putting her through a major surgery at this point seemed too much to risk more pain and distress.

So yesterday afternoon she was released back to Silverado. She's mostly been sleeping since she's been there. (They have her on constant pain medication, which is probably part of the reason.) So far no major problems. Time will tell how well she bounces back. The Silverado nurses seem optimistic of getting her on her feet again. The floor doctor at the hospital was more pessimistic, telling me to be prepared for this being the beginning of the end.

I don't have kids so don't have experience with sick babies, but I have had several dogs. Same sort of frustration when they are sick or in pain, but can't tell you what hurts or what happened.

Karen
 

Sheila

Registered User
Oct 23, 2003
2,259
West Sussex
Dear Karen, a very worying time for you right now. As you say, it is like a child or an animal, you can tell they hurt, but as they are unable to communicate well, it is frustrating to want so much to help but be unable to suss out how. If it is a UTI, then the medications should soon sort it. An old fracture too, would be less painful in time. The mobilising, well only time will tell. I do hope she soon feels much better and that you can also soon feel easier about things. Love She. XX
 

Kriss

Registered User
May 20, 2004
513
Shropshire
Hello Karen

The doc and staff are probably worried that if she remains immobile for too long a chest infection will set in. I think its one of the reasons that these days whatever operation people have they are encouraged to be out of bed and moving around as soon as possible.

If the UTI is the main problem then you could find she will suddenly improve and be back on her feet. Our doctor told us years ago that dementia is rarely a cause of death it is usually the complications that arise from other problems. They are probably trying to prepare you in case the worst should happen.

Thinking of you
Kriss
 

KarenC

Registered User
Jun 2, 2005
122
Los Angeles, USA
We are cautiously optimistic at this point.

The UTI seems to have been cleared up with antibiotics at the hospital. After two days back at the home, Mom is not back to "normal," but is doing OK. Kaiser (her HMO) sent a therapist out right away to start working with her, and they were able to get her walking a few steps. At this point the Silverado nurse says she seems to have the most pain (in her back) when sitting, is relatively OK standing, but naturally is lying down most of the time.

If she were totally bed-bound there would be more concern about everything from bed-sores to pneumonia. I think a lot of the difference in outlook between the Silverado nurses and the hospital doctor is personality and general professional outlook. The staff at Silverado seem to take an optimistic view of things, which probably works best with folks with dementia. They try to keep everything happy and non-confrontational, so probably people who work there have to be of generally cheerful dispositions. Doctors on the other hand are geared to preparing patients and families for the worst.

They have her on a pain patch, but Silverado was concerned about keeping her so doped up she couldn't eat, etc., so the doctor said to cut it in half. That seems like a good compromise. She also still has a urinary catheter, which they'll leave in for a few more days. They'll just go slow with the physical therapy, and see what they can do.

Karen
 

Sandy

Registered User
Mar 23, 2005
6,847
Hi Karen,

I'm glad to hear that things are on a better track. The nurses at Silverado sound like excellent people. The insights of professionals who work with those with AD are so valuable and especially when medical problems like your mom's arise.

Take care,

Sandy
 

KarenC

Registered User
Jun 2, 2005
122
Los Angeles, USA
We visited Mom today. She is looking a lot better than when she went into the hospital, but of course that isn't saying much. She had been acting restless like she was uncomfortable again a couple of days ago, so they increased the pain medication patch back up to the original strength, which seems to be keeping her pretty comfortable at least while in bed.

When we were there, they got her up in a wheel-chair for lunch. She sat there a few minutes, ate about two bites, then was squirming around like she couldn't get comfortable. So we took her back to bed, propped the head up (she now has a hospital bed), and she ate a couple more bites. The appetite has been a problem, which may be caused/exacerbated by the pain medication.

She got out a few coherent short sentences; most was rather incoherent mumbling. This is a considerable step down from where she was before this adventure started a few weeks ago. Then she mostly said grammatical sentences, they were just non-sequitors most of the time (out of context of the conversation).

So overall there seems to be progress, but slow. Hard to tell how much the lack of appetite and increased confusion are due to medication. I guess time will tell how much she can bounce back to where she was a few weeks ago.

It was good to see her at least looking comfortable and glad to see us.

Karen