Hi all, my mother had a stroke in October of 2010 which left her with short term memory issues and poor balance. She can walk with a walker. She is 89. She refused to do physical therapy or leave the house and as a consequence sits all day and is extremely inactive. Her condition has slowly deteriorated and this past December she contracted shingles and has since recovered, but just hasn't seemed to be able to bounce back. In the past 2 weeks she is sleeping almost constantly. She wakes up during the night and dozes in the chair. She is groggy for the short periods of time she is awake. She lives with my brother but I spend 2 nights a week at her house to help out and give him a break. On this last visit she slept the entire day and into the late evening both days I was there. I had to wake her for meals. She seems to have a semi-alert period from about 9 to 12 at night, and then starts to fall asleep again. In addition to this, she has swelling in her feet and legs, and one leg is worse. I also suspect she that she might have a urinary tract infection because she frequently has the urge to go but doesn't actually have to. Her appetite has also decreased a little. She seems to have become more frail and weak in the past few weeks. She was at the doctor last month (was doing better then compared to now) and at that time everything was within normal limits . She doesn't have any health issues. She takes Aggronox, vesicare, synthroid, and folic acid. I am shocked she is doing this badly, because other than the stroke she hasn't had any other health problems. She has been taking Lexapro for about a month and a half and it seems to have improved her mood. The problem is she can't stay awake long enough to be in a good mood!
She has a doctor's appointment on Monday but I am very afraid she will not be awake enough to make it. In addition, I fear the doctor might want to hospitalize her and he has privileges at a hospital that I feel is of poor quality and that I dread going to. She was there for 2 days after her stroke and it was a nightmare.
I think I would prefer to take her to the emergency room of another hospital that is closer and in my opinion of a higher caliber. We could take her at night during her semi-alert period. I am thinking that she might be admitted to that hospital because I can't help but think further tests are going to need to be done to determine what is going on with her. Is this acceptable? Will it be an issue if we break rank with her primary care doctor? Frankly, I have not been that happy with this doctor and think it might be better if we get another medical opinion of her condition. Thank you very much for reading this and I will greatly appreciate any thoughts, opinions, and advice that any of you have to offer as to what could be causing this excessive sleeping and the correct thing to do to get her medical care. Oh, another concern I have is what to do if she refuses to leave the house to get medical treatment.
I think you're wise to be concerned about admission by a doctor to a hospital which is sub-par. I think you have a few options:
1. Keep the Monday appt. with the doctor and see if you can get a better idea of what's going on. Then go to the ER of a better hospital after the appt.
2. Go to the ER of another hospital now. But don't go at night, because the ER staff would assume she's sleeping because, well, that's what people do at night! Go during the day so they can see the extent of her drowsiness and weakness.
The edema in her legs is a justification for an ER visit, combined with the excessive sleepiness and possible UTI. And given that it's a weekend, you can't get in to see a doctor immediately. You don't have to mention the planned Monday visit.
If you try to find another doctor affiliated with a better hospital, it may be a few weeks before she can be seen. But if you have confidence in the existing PC doctor, you can try to get an idea of what's going on now.
As to breaking rank, you have every right to seek a doctor who meets your standards and who is affiliated with a hospital that does as well.
On the issue her possible refusal to go, would you have any justification to call EMS to take her to the hospital? The edema in her legs would be a real concern to me, especially since she's basically inactive.
I didn't check out the meds she's on so I don't know what they're for (other than folic acid). If she's not on a diuretic and is inactive, I'm assuming that excess fluid isn't going to exit quickly.
I can think of a number of potential causes for her excessive sleeping, including lack of proper diet because she just isn't hungry, medication conflict, depression, and I'm sure other posters can identify even more.
But the edema in her legs is something that should be addressed one way of the other, and the sooner the better. You might do as home care nurses do: get a tape measure and measure her ankles daily to determine if there's any change, for better or for worse.
The edema in her legs is a concern and would justify calling an ambulance for transport. But make sure you tell them that you would not be able to get her in the car unless there is an actual emergency. It is possible that she may have had a stroke. The aggrenox is supposed to help with curbing them. But, L is also on Aggrenox because he had a series of mini strokes early in the year, it was obvious to me because of the decline of his cognition and then confirmed by CT scan.
If you plan to go to the ER, make it early Sunday morning around 8 a.m., you will receive much quicker service be it by ambulance or if you drove your Mom to the ER. Weekend nights at the hospital ER are extremely busy. Check the hospital website, some have an ER "wait time clock" that is in real time.
Curious, did your Mom get any new refills for her medicine? Sometimes a change in manufacturer of the pills can cause new side effects because of the fillers that are used in pills... fillers make the pill large enough to handle and fillers are used to bind and coat the pills. Check the old pill bottle against the refill bottle to see if the mfg name is different. Same with vitamins.
Oh, that reminds me, bring along to the ER all the pills that your Mother takes... bringing in the pill bottles is recommended.
Gardenartist, you have made some good points. My mother has been dozing on and off all day for a while now, but yes, the situation has worsened in the past 2 weeks. Good suggestion about the meds - the only thing that's changed is the Lexapro for depression, she's been on it for 6 weeks. I'm wondering if this fatique is at least partly due to boredom and depression. I'm also wondering about dehydration? That's why I really want her to receive a decent evaluation. In prior visits to the doctor she always "perked up" and appeared to be doing better than she was. I would describe how she was at home (listless, tired, depressed) but he never took me seriously. I'd take her home and we'd be back in the same boat. However, I have a feeling she won't be able to put up a front if we make it to this visit, and that's why I'm thinking he might want to hospitalize her. I do think I have a better shot at getting her to go to the doctor as opposed to the ER, so I'll have to mull that over for a bit. And yes, I've thought about calling EMS as a last resort, because she really needs to be checked out. Good idea about the tape measure, thanks! Oh, and good point about taking her during the day so they can see what she's like. I only hope we can rouse her enough to get her out the door and into the car. And I agree - as soon as I saw the edema I knew we had to get her medical attention for it.
Thank you for the info about the hospitalist gladimhere, and for the heads-up on the mini-stroke. Very helpful! We would be able to transport her in the car, but I am so afraid she will just refuse. And I didn't know a UTI could cause such severe problems, definitely looking into it.
Thanks for the tips on the ER freqflyer, and for the info on the pills - I'm going to check into that. Oh, and thanks for the heads-up about taking her medications.
I'm not familiar with Lexapro and/or its side effects or interactions. But some meds do take a while to reach "critical mass" before they're effective and/or could potentially interact with other meds.
If the doctor you've taken her to doesn't take her seriously, I'd say it's time for him to be phased out of the picture. Any doctor that doesn't at least offer a possible explanation of an issue should have the opportunity to find other patients.
Please let us know how this works out. Something like this could help others who may eventually have a similar problems.
After a recent visit to the ER and an over night stay, my Dad was taken off one of his blood pressure pills.... he is still on BP meds but not so many.... in just one day it seemed like his mind was thinking clearer. After seeing that, I decided to reduce my own BP dosage just a tad and noticed I felt better... I can always go back to the required dosage if I "feel" I need it..... my Cardiologist is ok with me doing that as long as I see her every 6 months.
Western medicine has benefited by the advance of medications for almost every purpose, but the question of how much is really necessary vs. what could be addressed more safely by food and nutrition is an issue that's long overdue for consideration.
I've been trying to get my Mom and Dad to eat more organic food.... it was a struggle at first because the sound of the actual word "organic" didn't sit right with my Mom.... eventually I was able to convince her that organic is how her own Mother use to cook back in the early 1900's back on the farm.
Isn't it strange that something that was normal decades ago is now considered organic? I understand there's even a category within organic to differentiate, but I'm not sure what the distinctions are.
I wish I could find the video shown at the hearing I watched a few years ago of the conditions at emerging market plants. The sites were horrific. I couldn't even think of being around them let alone buy medicines that may or may not have been sourced there.
That's another issue - I think pharmas should be required to list all the ingredients in their meds and the origin of those ingredients. But that will never happen.
Gladimhere, the Lexapro is a possibility - I knew that drowsiness and sleepiness were side effects, but I guess I assumed we would see that early on and she would get used to the medication. She's been taking it for 6 weeks. We give it to her at night - you would think it would help her sleep at night, but she is awake on and off throughout the night. But elderly people react differently to meds, and maybe it's building up in her system. I feel dumb, and I really don't know - I will certainly explore this with the doctor. Thank you!
Elaine, I kind of thought she wasn't on that much medication! Aggronox to prevent stroke, vesicare for bladder control, synthroid for thyroid which she's taken since she was 25, folic acid - also stroke related, and lexapro for depression. She has no other health issues - no heart problems, no diabetes, hypertension, blood pressure is good. Of course, it looks like something is going on with her legs, possible circulation problems. As I've said, she sits all day and all night and I think it's taking it's toll . But I will look into her meds with the doctor, thanks for your help!
Thank you all, you have given me very helpful advice and I will let you know how this turns out.
Something else that occurred to me is that your mother may be approaching the end of her life. It is fairly normal for elders to sleep more as they approach the end. However, there are other signs as well, such as lower bp and temperature and depressed appetite. You didn't mention these things, so Lexapro sounds like the primary suspect. Has it helped to elevate her mood yet in the little time she is awake? Having an antidepressant that just makes her sleep all the time doesn't sound useful. I wonder if another, e.g. Celexa, would set with her better. Talk with her doctor and see what he/she thinks. I have a feeling both of your concerns are linked to the same problem -- her recent inactivity.
If she's not on Warfarin/Coumadin (and I don't think you mentioned it), some foods (with vitamin K) are also diuretics - parsley and celery are two. Just don't give her celery before bedtime; eat it during the morning or early afternoon.
livestrong/article/84264-foods-drinks-natural-diuretics/
Everyone was so kind to respond to my question that I wanted to post an update, and also would like to hear any comments or advice you might have about the current situation with my mother.
I has turned out to be a crazy week - we ended up taking my mother to an urgent care facility on Monday, late afternoon. A compromise on my part, I wanted to go straight to an er but I did what my brother and sister were leaning towards (in hindsight it worked out ok, doctor there advised going to a specific hospital) I won't go into the details of how difficult and stressful these past few days have been, I'm sure many of you are all too familiar with that. It was determined at urgent care that she had a UTI and we were told to take her to the ER and the docs there felt she should be admitted. One doc felt that a small cut on her leg could be infected and causing the swelling in her leg and foot, so bottom line is they but her on intravenous antibiotics and fluids (also determined she's dehydrated). One doc also picked up a slight heart murmur, which is a first, have never had any indication of this the whole time I've been caring for her. They didn't seem overly concerned and said it happens in elderly people sometimes. She was supposed to be released on Tuesday but when we arrived at the hospital were told doc was concerned about oxygen level (87 without oxygen) so she was kept overnight for observation and it was determined that she needs oxygen, which has proved to be an added complication to everything but obviously she needs it.
When I arrived at the hospital on Wednesday I could not believe the positive change in her - alert, laughing, conversing, engaged, and frankly just acting normal. I have not seen her like this since she's had her stroke. I was glad to see it, but honestly it was a little surreal because it was such a big change. My brother and I brought her home and I stayed overnight. Unfortunately, the next day she was back to being very groggy and she seemed confused upon wakening. Extremely disappointing after seeing how well she was doing the previous day. She also seems weak and wobbly to the point where we're afraid to leave her alone. (she uses a walker). She also seems kind of unaware as to how badly she is doing and is getting up at night and moving around. I came home late yesterday (I live a little over an hour away) and am very anxious about my brother handling all of this. We're all feeling very overwhelmed by this change of events and I am completely stressed out. I don't handle stress very well so I am not well-equipped to deal with all of this, haven't been eating but am trying to take of myself so I can be a help instead of a hindrance. Unfortunately, my brother has been having trouble sleeping so I feel this is all just one big mess right now. Don't know if my mother's decline is just due to recovering from this uti, and perhaps as time goes by she will regain some strength and be able to get around better. I just don't know.
I am pushing to have a health care aid for a part of the day- as is typical of these situations money is an issue, my mother has a small amount in savings, would probably last a few months. I am frustrated as to why we're not doing this, my brother is fighting doing this for some reason but he might change his tune after he's on his own with her. Siblings are willing to pay after that. Putting her in a nursing home is complicated because unfortunately my bother's life savings has been in her name up until recently and is subject to the medicaid look back period. I know, I know, extremely stupid on our part, we were so ignorant, but that is the reality of the situation.
Oh, with regard to anti-depressant, we were told to stop giving it to her for now, but due to miscommunication she was given it in the hospital anyway. I guess we'll stop for now and see what happens.
Thanks to those who read this whole tale of woe, any comments or thoughts would be greatly appreciated. What a great site this is.
Sleeping in her chair can cause the swelling in her legs also. Try to elevate them. Beware of hyponytremia with Lasix. It can cause a vicious circle with Thyroid/Kidney and loss of Sodium retention. The sodium # should be in the 130s, any lower is a problem.
Signs I've learned for UTI:
Dehydration - If you lightly pinch/pull up the skin and it doesn't bounce back.
Sleepiness - excessive
Lack of appetite
Weakness - Overall & unexplained.
Forgetting to hydrate - Minimal fluid intake
Loss of bladder & fecal control - extreme
Low Blood Pressure - Usually from dehydration
Medications are such a delicate balance & are subject to regular tweaking. Because BP is so affected by UTIs, the meds are difficult to adjust. If a doctor uses the "puppy mill" approach to medicine it's time to find a new one. I recently had a rehab facility report back to me within hours that my mom's UTI was negative. I now know it takes 48 hours for a proper culture & she may well have had the same one lingering for the last three months.
I pray divine intervention, peace and protection for us all.
Am finding myself very worried about my mother not being supervised while my brother is out. Was talking to my daughter (younger generation is so tech - savvy) and she suggested a video camera so that I can at least watch my mother when I'm at my house and make sure she doesn't get up while he's sleeping, she said there might even be a way to set up a speaker so I can talk to my mother and tell her to stay put - I know they do this for babies and kids, what about old people? I know it sounds crazy but it would give me peace of mind. My daughter also suggested a bed alarm for night. Off to research, but is this an option do you think?
I had a situation with my 94-year old mom where she was sleeping a LOT and her appetite had gone to nothing. It was a vicious circle. I told my brother and cousin that we were nearing the end, that mom would be gone in three months. We wound up in the ER and she was dehydrated among other things. So keeping your mom hydrated is critical. Now I fix my mom a big glass of water each day that she has to drink and we talk a lot about drinking enough water, because she has no short-term memory. She also gets a lot of fresh fruit, which has natural water in it.
In the eight weeks since her ER visit, she's gained 14 lbs and is back to being her normal alert self. But I had to get enough good food in her and keep her rehydrated to get this far.
I have also started taking her out. I use a companion chair, so we can go to restaurants or to the Dollar Store. I always see a tremendous mental boost when I get mom out of her apartment, even though she's "happy" staying at home. Just being around other people and kids and seeing trees and cars, etc. is a nice change of pace for her. So even though your mom wants to sit around, see if you can cajole her into getting out more - it should improve her mental outlook.
Also make sure she elevates her feet as much as possible to help with the swelling.
It can be frustrating and hilarious sometimes how much better our loved ones are when they're at the doctor's office or in the hospital. It's "show time" for them and they can put on quite the show. Once they get home, they're immediately back to having the issues you took them there for in the first place. When I took my mom to the ER (because she'd called me to go), by the time we got there, the nurse asked mom why we were there and mom turned, pointed to me and said, "I don't know, ask HER." Whaaaaaaa? I just had to laugh. Good luck with your mom and keep us posted.
https://www.agingcare.com/search.aspx?searchterm=camera
Do not hesitate to get your Mom back to the ER. Maybe they discharged her too soon. If she is readmitted within three days of discharge Medicare will ding the hospital because of discharge too soon. A new way to increase hospital accountability.