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'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.
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.
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.
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.
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.