Yet another visit to A & E

Discussion in 'ARCHIVE FORUM: Support discussions' started by germain, Sep 24, 2007.

  1. germain

    germain Registered User

    Jul 7, 2007
    342
    Hello all,

    Just as things were settling after the latest UTI, Mum's had another fall ! This one happened late Saturday night and hubby and I were summoned as the carers are "not allowed to lift because of health and safety !" (assisted living complex - not a care home)
    Yesterday Mum refused to get out of bed, even for the toilet,and wouldn't even sit up- in the end - as she couldn't or refused to weight bear on her legs at all and was yelling her head off every time someone came near her, we called for an ambulance.

    A & E was quite efficient and she was seen, xrayed and blood tested quite quickly. (up to ward within 5 hours ) - still yelling when touched anywhere and managed to pull out her IV line. Absolutely nothing found !!! BUT she's totally "out of it" - long garbled monologues, obviously having conversations with people not there etc . This is very worrying as it has come on very suddenly.
    Hospital have kept her in overnight just in case for a scan but don't expect anything much to show.

    Recent history is increased Reminyl which improved her moderate loss of words etc - and she was due for a review with the consultant tomorrow - we were going to comment on the improvement.

    She's a bit chesty - could it be a chest infection could cause this havoc ?

    Anyone got any ideas ? Could it just be shock from the fall etc. We're going to try for a walking frame as she's increasingly objecting to using her legs !

    Another worry is that she was seen by two surgeons and has been placed on a surgical ward - I think someone has previously posted about the effects of anaesthetic on dementia - how do we approach this if it comes up ? I digress now but there were hints of bowel probs. and possibly gall stones !
    My perception was that the surgeons were covering everything they could possibly think of !

    To end with a big compliment - she was initially assessed seen by a student doc. called Rob- this very young man was absolutely wonderful with her - lovely to see someone who very obviously has a star career ahead of him as a caring doc.

    regards
    Germain
     
  2. Margarita

    Margarita Registered User

    Feb 17, 2006
    10,824
    london
    sorry to read that you mother has had a fall .

    as when you say
    with my mother I felt it did set her back with her AZ for a few weeks , she was so very much more confused then before . would not get out of bed , tried getting her up to go to Day centre to get her up mobile , she did not want to go but then after a few days she did they even notices the change in her , must say lucky for mum after a good few weeks she did settle back down .

    My mother was also assessed by student doctor , they where so good when they did a memory test on her , also a CTC to make sure they was no bleeding in her brain after the fall , because she took the fall right bang down on her head .
     
  3. CraigC

    CraigC Registered User

    Mar 21, 2003
    6,630
    London
    #3 CraigC, Sep 24, 2007
    Last edited: Sep 24, 2007
    Firstly, please take note of my signature before reading this ;)
    All I can say is mum has been in hospital with a chest infection recently. They could tell from the blood test (white cell count) and xray that is was an infection. My tip is to ask loads and loads of questions of anyone dealing with your mother. You rarely get to see the consultants due to their varied visiting times, but the doctor in charge needs to keep on top of things.

    Just suck them for all the information you can. Also ask for copies of anything that is going to the GP - they should not have a problem with that.

    Like you, I was so impressed by the AndE, the hospital generally and many staff that I met. So many kind, caring people at all levels. My only complaint would be bad communication and that was down to resources really. By the way, mum does not have dementia, so we did not have the added complication.

    It is just such a struggle to get clear answers.

    good luck
    Craig
     
  4. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Hi Germain

    Your story sounds very like my husband's. He's been in hospital for three weeks now after being admitted with a UTI, and the effect on him has been horrific. From being totally fit physically, and enjoying daily walks, he how cannot stand unaided, and fights anyone who tries to touch him. He was the gentlest man you could ever hope to meet.

    Craig's right, keep asking questions, and get your SW involved too. Mine has been brilliant, and is fighting for us all the way. You can also ask for an appointment to see the consultant, though I've found the ward doctor just as helpful, as she sees John every day. I've also found the ward staff wonderful.

    I was told that any infection causes increased impulses in the brain, and it can take a while for them to settle down, and the patient may never get back to where they were before. I'm afraid this seems to be the case with John. His infection has returned.

    I hope your mum manages to kick the infection. Please let us know how you get on.

    Love,
     
  5. candymostdandy@

    candymostdandy@ Registered User

    May 12, 2006
    81
    west sussex
    Hi Germain

    I am in a very similar situation with mum. After a fall in April, and the first UTI we have been to A&E on 4 occasions.

    She has been treated for UTI's at hospital but they never seem to be able to put their finger on what is actually wrong with her.

    When she gets an infection like your mum she screams when anyone tries to touch her, and is far more confused than normal, and also is unable to bear any weight on her legs.

    Her last trip to hospital was in June, she had been perfectly fine in the morning when going to Daycare, but on coming home on the bus we were unabale to get her to stand, and walk off the bus, we eventually got her into a wheelchair and got her off the bus. Unfortunately I didn't have a ramp to get her into the house, and had to call ambulace for assistance.

    To cut long story short, in hospital for 10 days, totally out of it, unable to bear weight on legs, and taking two nurses to turn her in bed and to wash her.

    She was discharged form hospital and she started to get mobility back, but only two days after being discharged we had another episode, at which point her GP decided to put her on a low dosage long term antibiotics.

    Mum lives with me so she eats well, gets plenty of fluids and I have carers who shower her every morning and she is washed before going to bed, and low and behold last week we had another episode, her temperature had risen to 38c and we were unable to move her.

    She is on antibiotics again, and back on her feet, I don't know if we will ever get to the bottom of what is actually causing it
     
  6. germain

    germain Registered User

    Jul 7, 2007
    342
    Good morning all
    Thanks for your replies - what is it with infections ? - why can't they be identified ?

    Mum has had blood tests, xrays and a scan. Found a little constipation and a very small pile !! BUT "they" forgot to xray her hips so she has to have that today - can you believe an xray dept who wouldn't do hips on an 85 year old after a fall ?

    She's still mainly delirious (sp?) and on a saline drip. Worrying tho' that her BP is really high and pulse very erratic - when all her life she's suffered from the opposite . I'm concerned that they are still giving her her steroid which is meant to keep her BP up- when its already sky high !

    Thanks for your suggestions re questions - I'm starting a list to take with me this afternoon as its very easy to forget when faced with very busy Dr's and nurses.
    Am also going to try to speak to her AZ consultant on the phone this morning - as a very nice ward SEN told me yesterday - "this sudden decline is just a feature of Alzheimers" - not in my book its not and I'm worried that they will just dismiss her very real physical probs. as simply dementia related !

    (its strange that I feel like the AZ expert when talking to the ward staff etc )

    Am also going to try to insist on some kind of scan/test for strokes - it can't be normal for a person suddenly to lose use of legs without cause - can it ? but as said before - if its an infections why can't they tell ? Last course of antibiotics was just finished on Sept 7th so if its is an infection its come back again really quickly!

    OK - sorry to seem to pose medical questions - appreciate no-ones really qualified to answer but we're all experts on dementia in our own ways and also some seem to be more expert on getting the best out of medical staff and hospitals.

    regards
    germain
    ps because she's on a surgical ward with possible fracture/dislocation she's been classed as nil by mouth - this means no food since saturday tea time - wouldn't this cause deterioration in a very old person as well ?
     
  7. Nell

    Nell Registered User

    Aug 9, 2005
    1,170
    Australia
    I would definitely start insisting she be fed if there is nothing to show on the hip Xray!! No food for such a long period cannot be helping and if there is no need for an operation,why not feed her???

    Have they definitely tested her urine for a urinary tract infection (UTI)? I wouldn't ask such an obvious question except that they "forgot" to xray her hips!! :eek:

    Your poor Mum - and poor you too. Caring wishes coming to you both.
     
  8. fearful fiona

    fearful fiona Registered User

    Apr 19, 2007
    723
    London
    Dear Germain

    Had to read your thread because I nearly posted one with the same title last week as my Dad has been to A&E three times in the space of two weeks. Same problem with UTI which he seems to be constantly battling.

    I haven't anything new to add to what everyone else has said, but maybe I can just send you a word of support. Like you I have found there are some amazingly dedicated student doctors out there, my really elderly father (90) has been treated with such dignity and respect.

    I do hope you get your Mum sorted out, it's such a battle isn't it?

    Much love
     
  9. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    I do not want to make myself out as a "know it all",that isn't my intention or belief.From what training i have had in A/Z/Dementia care.i am led to believe that sufferrers don't feel "mild" pain.However,moderate to severe pain is felt.Can i be so bold as to suggest that the X-Ray is wrong.I have known it to happen many a time.I have had residents walking with a broken hip!It's was only on another fall that it was detected as a previous fracture.Sorry if i have over stepped the mark with anyone.take care elainex
     
  10. germain

    germain Registered User

    Jul 7, 2007
    342
    Hello all and thanks again for all the useful responses.

    Yesterday was as if a miracle had happened - Mum was sitting in a chair , quite bright and seemed pleased to see us. --- (Elaine02) Hips have been done again and nothing found. Mum had refused to get up for the nurses but when she suddenly decided she wanted the loo, my sister and I didn't make any fuss but just took her there ! - she was wobbly but managed - have a feeling that if we'd offered a bedpan she would have just assumed that this was normal.

    Our lovely dementia consultant had rung the ward to flag up her concerns about the almost delirious state - but this seems to have cleared. When I spoke to her in the morning she immediately said it sounded like a mini stroke or a severe infection.

    The only treatment so far has been senna and paracetomol - we have pressed now for a UTI test (not yet done) and the staff nurse said they would also look at her bloods again for infection BUT they wanted to send her home as she was occupying an acute bed ! (not by our choice at all !) We are going to hold firm for a proper assesment before she goes anywhere. At the very least we want a walking frame .

    By the way - read the post that said their GP gives continuing antibiotics but our GP doesn't believe in this !" Any ideas on how to press for this - if it keeps the UTIs at bay surely it would be useful (can't imagine how one 85 year old could affect the growing resistance of bugs to antibiotics in the general population)

    So its better news for today - hopefully she'll be home by the end of the week.
    (sister and I will then move into the bed for a rest !) Can't believe the stress levels - one day we think that she's dying and the next she's right as rain again.
    Don't think this will ever improve at this stage of her AZ.

    One fun moment - she's in a ward with the loveliest caring lady patients you could ever ask for - one offered her a chocolate and she took the box saying it was her's!!!! Fortunately they saw the funny side.

    Best Regards
    Germain
     
  11. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,704
    Kent
    Good news Germain, thank you for the update.

    It`s impossible to keep up with the changes isn`t it.

    I hope things continue to improve , physical health wise, something`s better than nothing.

    I love the story about the chocolate.

    Love xx
     
  12. Petrus

    Petrus Registered User

    Aug 7, 2007
    61
    Northumberland
    Pain & UTIs

    For what it may be worth:
    1. GP and consultant tell me that any pain is difficult for demented person to handle. In J's case a simple stiff neck caused 36 hours of hallucination until the pain was dealt with. GP has said that any pain or discomfort from whatever source (injury, infection, illness - even as simple as a cold) needs to be managed immediately (I learned my lesson; fortunately J's physical health is excellent). It was explained to me that having lost the part of the brain that references and manages pain, receipt of pain sensations results in the brain going haywire. (J. bumped her arm in the shower yesterday - cannot remember how. There is a modest bruise on her bicep the size of a 50p coin. This has dominated her conversation for 24 hours - the brain cannot dismiss the issue).
    2. J. has had chronic cystitis for 40 years with attacks on average every 2 months. 12 years ago an English Dr. in Brussels (where we were living) put her on a daily dose of methenamine hippurate (I can provide brand name by private e-mail if needed - or simply google the chemical name); since then she has had 1 attack. UK GP was not aware of this approach but she agreed to continue with treatment.
    3. There is no antibiotic abuse issue with the methenamine hippurate approach provided the medication is taken religiously - correct amount every day. (The resistant bacteria problem is a human behaviour problem - not using the bacteriacide in the correct way).
    Bacterial mutation can occur only if there are breeding colonies of bacteria. Mutation occurs most commonly when bacteria are exposed to a quantity of the bacteriacide (aka antibiotic in pharmacy) that is too small to kill the bacteria and this over a prolonged period (at least days). Selection of the fittest then means that bacteria survive which have adapted to live in the presence of a small amount of the bacteriacide - an amount too small to kill them before they can breed giving them the possibility of mutation. If the mutation in their DNA enables them to cope with normal doses, they become classed as resistant.
    So whether or not to prescribe an antibiotic to a specific patient is a risk evaluation - the benefit to be derived vs. the risk that the medication will be used improperly (i.e. abused). Using this argumentation with GP can help him/her favourably assess the risk of prescribing.
     
  13. germain

    germain Registered User

    Jul 7, 2007
    342
    Thanks very much for the info Petrus

    Hope you don't mind if I print out your post to act as a "prompt" when we next see our GP ?
    Regards
    Germain

    ps progress has been maintained - and the nurses are teaching her how to "march" her feet rather than shuffle - they tell us this may help with the fall situation and have recommended physio to try to get the unsteadiness improved.

    In fact so much progres has been made that she's starting to get awkward with us again re eating ( lovely to see our old Mum back ?????) Decided to give up the battle and offer her a lovely new young peoples fashionable banana milkshake - which was actually the old protein shake in a carton - aaagh - lies again- but she loved it and drank it all up so todays nutrient target has been met !
     
  14. Petrus

    Petrus Registered User

    Aug 7, 2007
    61
    Northumberland
    By All Means

    Germain,
    Please feel free to use the info. in whatever way you feel helpful. Glad to hear there are positive signs.
     
  15. germain

    germain Registered User

    Jul 7, 2007
    342
    A Disaster

    Mum's now been in hospital for 10 days. Up until Monday she was improving and we were looking for rehab for a couple of days - even took her clothes in.

    Then suddenly Monday p.m. she deteriorated so badly that the doc was called to the ward - and more ECGs (very erratic heartbeat) , blood tests , scans & Xrays (all clear). Yesterday and today she's only been semi-concious.

    Spoke to the Doc who changed her antibiotic (for chest and UTI) and ordered a drip - no food or meds for last 24 hours as she hasn't been awake to take them.

    Sister and I were about to leave but decided to check her meds chart as we were unsure if she was getting her Slow k supplement (potassium) - well she wasn't but what she has been getting for last 10 days is fluoxetine (PROZAC) to which she is allergic !!!!!!!!!!!!!!!! Every sign of deterioration over the last week or so is a classic side effect !
    Hospital wouldn't or were unable to say who prescribed and why but it is possible that the meds confirmation has come from the GP on-line and the old Prozac prescription has somehow appeared on this. We are also worried that she may have been having Prozac in her medi pack from the pharmacy - hence the falls - as of tonight we have no way of checking ! (She was originally given Prozac for depression but the side effects were so severe she had to come off it after 3 weeks)

    We've insisted the Prozac be stopped with immediate effect but nurses were reluctant to go against the docs say so - we are going in to scream the place down tomorrow.

    I've Googled prozac contra-indications and found one side effect can be recurrent UTIs !!!!!!!!!!! (and falls and bronchitis and erratic heartbeat and stopping eating)

    Why is it always such a struggle with AZ understanding - why won't hospital staff believe us when we say - heart probs, semi-coma and hallucinations are NOT typical of OUR Mums current stage of AZ ?

    Boxing gloves on tomorrow I think - you may see me on the news "Saga lout decks doctor !!"

    Regards
    Germain
     
  16. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,437
    #16 jenniferpa, Oct 3, 2007
    Last edited: Oct 3, 2007
    It's appaling Germain, but unfortunately, not unheard of. You go in and sort them out in no uncertain manner.

    Medication errors are particularly problematic for people with dementia, as they have no idea most of the time what they are taking and why they are taking it.

    Best wishes

    P.S. Would not a lack of potassium produce similar symptoms? My mother had some seizures triggered by this. See here http://www.emedicinehealth.com/low_potassium/page3_em.htm
     
  17. germain

    germain Registered User

    Jul 7, 2007
    342
    It wasn't the hospital

    Another update

    Have to say that typing calms my nerves a bit which is probably why I go on for so long !

    Mum was getting her meds via a sealed medi pack which started on 14 June. We checked the contents of the first couple to see all OK and then left it at that.

    After speaking to the pharmacy and her GP this morning - it appears that the prozac was re-started by accident - the original scrip had never been wiped off the records after her bad reaction.
    Dates of since 30 July from the pharmacy and since 14 sept from the GP have been mentioned.
    All assure us that side effects are reversible once drug is stopped but don't know what timescale in an AZ patient.
    Has anyone else any experience of this drug ?
    Am soon off to the hospital - not to deck the doctors as earlier promised but just to climb into a spare bed and pull the covers over my head !!

    Germain
     
  18. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,704
    Kent
    Words fail me Germain................I read your post in disbelief. I hope you see some very red faces today and receive an abject apology.

    Love xx
     

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