Medical help please

[busywend]

Since we are at such a loss and have no idea what to think anymore, I thought I would bring this to you such wise women for ideas.

My BFs mother come down with a Baker's cyst behind her knee in Feb. They waited for it to go away on its own. She was in pain so they gave her pain medications at that time. Not sure which one. Your basic pain killer, I guess.
Within 2 weeks her back was killing her. I mean she was crying out telling us she had never had pain like this.
She had a back xray that showed a spinal fracture, but they were not sure if it was a new fracture and therefore were not sure it was causing the pain. Meanwhile, her Primary Care Physician (PCP) continued to prescribe different pain medications in an effort to manage her pain.

Fast forward to early June - still in pain. It got so bad she called an ambulance one morning. They pumped her full of DILAUDID (10x stronger than morphone) - I believe it may have been an overdose, but I can not get the family to ask more. She was basically drooling in her chair for the next few days in the hospital.

The hospital had an xray from the previous year and could see the spinal fracture was new and in fact a new xray showed yet another new fracture. They were going to do a Kyphoplasty (sp) which would basically put 'cement' in the fractures and patch her up. It would even straighten her spine a bit. The doctor decided that she was too high risk for surgery (Chronic Obstructive Pulmonary Disease (COPD) & Emphysemia) and also that since you could push on her side and have her cry out in pain, that it was unlikely the surgery would be the solution.

From the hospital she was sent to a nursing home for physical therapy with a Fentynal pain patch. From there she went home as she had family in town that could help take care of her for 2 weeks. Those 2 weeks were a roller coaster of sleepiness, drowsiness and alertness. Some days good, some bad.

She realized she could not stay alone - needed help to dress and use the bathroom. Went to stay with one of her daughters for a few weeks until a bed opened at the assisted living facility she choose to move to.
She moved in Mon July 21st. Since then she had a stomach bug, was found sitting on her floor in a daze and then one of the aids saw a bump on her head and they figured she fell.

Hospital again - Sunday 27th. Low blood sugar, blood way too thin (supposed to be like 2.5 and it was 13). Sleepy and confused.
Monday - the very next day - totally fine. The only medication change was to remove 1200mg of Neurontin (nerve pain medication that can make you sleepy). She was eating her spaghetti dinner and joking with her son about stealing a meatball.

Tuesday more confusion and sleepiness, not as bad as Sunday.
Weds they wanted to release her, she is crying out in leg and arm pain (this was a new thing) and the family protested the release. She stayed another day and was released on Thursday.
Last night she was drowsy, sleepy, confused. Now she is barely even giving us full sentences.

Back to the hospital last night when the nurse found her wandering the halls and having trouble breathing. They admitted her for an evaluation - we are planning to get her PCP to give a referral to a geriatric neuropsychologist as that is what the ER doctor recommended after hearing this story.

I would like to add that none of us are thrilled with her PCP doctor. She just gives her a new medication everytime she walks in the door or calls her. It has been the other doctors in that practice that were taking away medications when she would go into the hospital.

I know it is hard to get a good picture. I do know her gall bladder, liver and kidney function are all good - or at least they were in June.

Oh yeah, her back has deteriated so much. She is a hunch back now. In Feb she was driving, now she can not even sit up straight.

Thanks for reading!!! Any ideas?

 

[busywend]

by the way, she is only 72.

 

[hearts and roses]

My only initial thought was - GET A SECOND OPINION, PREFERABLY FROM A GERONTICIAN OR GERONTOLOGIST.

Her PCP sounds like an idiot and it sounds like her care is falling through the cracks. She needs some serious attention from a Dr experienced with the elderly to have her bones checked and her medications re-evaluated. I hope you can pursuade her family to do this with her.

 

[nvts]

Also, when was her last bone density test? A lot of medications can cause "powdering" (for lack of a better word) of the bone. If she had osteoporosis from the beginning (which could have been the cause of the spinal fractures), that could explain the additional pain and fractures.

The confusion could be due to many different things from medications to the blood issues.

Geriatric specialist is really the way to go!

Let us know how it goes, I'll keep her in my prayers!

Beth

 

[WhymeMom?]

Yeah, I was thinking osteoporosis too......get another doctor......this has gone on too long!

 

[busywend]

She does have osteoporosis and I have heard that her Aunt (I think) lived many years in pain from it. So, that could be the pain for sure. But, the confusion, sleepiness, drowsiness, not eating not sleeping - all have me stumped. I actually had thoughts of her perhaps hiding away some pain medications and taking them not as prescribed - I hate that I have had the thoughts, but I guess that is how stumped I am.

She has been refusing the new doctor because her PCP is soooo nice according to her and I am sure she is nice. Just not really paying attention, I think.

 

[slsh]

Busy - she obviously (in my humble opinion) needs a much better workup both for the rapid deterioration of the spine as well as the mental status changes. Is she on blood-thinning medications? While all those pain killers could be the root cause for the mental status changes, if her INR/pro-time is elevated again, I'd be concerned about TIA/stroke/bleeding in the brain too.

I'd point out to her that while PCP may be "nice", she's not doing a whole lot to proactively manage the health issues. Three hospitalizations in 3 months? Definitely time to see a new doctor in my humble opinion.

 

[DammitJanet]

One thing to be aware of is that these medications react differently in geriatric patients than they do in younger patients. My grandmother was given a very small dose of valium at the age of maybe late 70s or 80. It had her hallucinating. It wouldnt have even effected a 40 year old. I think they gave her a 5 mg pill.

 

[dreamer]

mental status changes definetly can be related to the medications..and yes medications do afect older people VERY differently, altho ALL people can have a vast difference in how they react to any medication. older ppl are more sensitive. And yes TIAs are a very real possibility....
ALl persons also react differently to pain itself. Pain alone CAN cause people to mentally withdraw, become confused, have no appetite, and pain medications can do all those things, too. and so can TIAs.
Gerontologist for sure, older persons bodies are different.....symptoms can manifest different,

 

[mom_to_3]

Definitely have her tested or checked for a urinary tract infection. That can also cause those symptoms in the elderly.


http://www.nlm.nih.gov/medlineplus/ency/article/000521.htm
Mental changes or confusion (in the elderly, mental changes or confusion often are the only signs of a urinary tract infection; possible spread to the blood should be considered)

Good luck, I know this is difficult.

 

[busywend]

UTIs have been checked.
She did have a catscan last hospital visit and the doctor said at the time no clots. However, we just learned today that it showed some mini-strokes. I guess their reason for not mentioning it is they do not know when they occured, could be a year ago. Sigh...
She did have a stroke about 8 years ago and she had surgery on her neck at the time. ( I was not dating boyfriend then so I do not know much more.)

She does take a blood thinning medication. She saw her PCP doctor on Friday before the last Sunday admit (7/27) and PCP told her to stop taking her Cumadin at that time. 2 days later in the ER the levels were still so far off they ended up giving her Plasma to thicken her blood.

 

[mrscatinthehat]

goodness, not much more to add except good thoughts that they get this under control.

beth

 

[susiestar]

Busywend,

Is it time for the family to talk to her, then push her into some decisions? Someone to monitor her medications for sure, someone to go with her to the doctor is also a good idea.

It may even be time for a family member to assume guardianship of her. She is very vulnerable right now. Physically, emotionally, and financially just for starters. With her slipping in and out of speech, sleep, etc... it may be that one of the family shoudl be court appointed as her guardian and then the family should introduce her to antoher NICE doctor, a gerontologist. Her PCP sounds scary, and is probably NOT getting the entire story, or listening to it.

I am so very sorry. This is a tough situation.

Hugs

 

[Star*]

Busy,

I'm sorry for you and your family -

I'm not a doctor or medically inclined but it sounds to me like she's having strokes. Not a full blown all out stroke - but smaller ones, seizures if you will. I think I would have them do eeg's to watch brain wave activity.
It could be also, a clogged artery that stops blood oxygen from reaching her brain. (still would check for stroke)

I would also ask them to check for MRSA. MRSA is a nasty infection of staph that needs a course of antibiotics (strong) to rectify. It's contageous as well - so watch the cyst.....wear gloves, glasses, protective clothing and throw away.

I think the days of Yes sir Dr. so and so you're a god dr. so and so are gone - GET IN THIS WOMANS FACE and tell her THINGS ARE NOT RIGHT and etiher SHE can Do something OR she can refer your S/o mom to a doctor that wants to take the time. PERIOD - DO I NEED TO COME THERE? argh.

Good luck - and after the bump on her head wasn't the procedure SOP to take her to the hospital for an xray or at the least a check up? At 70's she is TOO young to be going through this ****. Poor dear - sends hugs

Star

 

[house of cards]

"But, the confusion, sleepiness, drowsiness, not eating not sleeping - all have me stumped."

I don't know about much of what you are describing but my mother has alot of health problems and was in a huge amount of pain. She was rxed some very strong pain medications and was taking two different kinds at the same time. She also started to have memory problems and what looked like depression, slept alot, didn't eat, at the time she was taking percocet and ocytcotin together and not gettin any relief.She went to the emergency room because of the pain and was put on Dilaudin or elaudin, something like that and very strong. She got her color back and got better at eating, she still hurt but it wasn't overwhelming. hope this poor women gets some relief...I hate suffering/pain.

 

[flutterbee]

Has she been on steroids for the Chronic Obstructive Pulmonary Disease (COPD)?

 

[Momslittleangels]

Busy: Many people have mentioned the medications, which can create all sorts of side effects and behavioral changes, but I was thinking down another avenue. My mother-in-law had Chronic Obstructive Pulmonary Disease (COPD) and Emphysema about 20 years ago and as the disease progressed, her behavior started getting off kilter.

One day she would be fine, the next day she would be hallucinating and then the following day she would be fine again. The doctors attributed this to her lack of oxygen to the brain due to her Chronic Obstructive Pulmonary Disease (COPD). She eventually passed away at age 72 after fighting the disease for 5 years.

It was hard to watch and the doctor's did what they could to make her comfortable (i.e., full time oxygen and some medications, like steroids to open up the airways), but she didn't have to use significant amounts of pain killers, which was good.

I hope you get some answers and can figure out what is going on.

 

[Tiapet]

You said one day she is fine next day she isn't and it repeats the pattern. How about the fentynl patch? Overdose of it will produce the symptoms you speak of and it gets changed every 72 hours (or 48 hours as some people have had). It can depress the breathing, sleepiness, mental alertness.

Look it up on rxlist. If you mix it with other things in addition it will cause even worse symptoms (other medications that cause drowsiness) so even if the patch wasn't the main cause it could be the trigger instigating.

As for the blood, I am not sure on that unless she is on a blood thinner or something like plavix or such.

Just my thoughts.

 

[Hound dog]

If she was my family. First thing I'd have done is an MRI to check for TIA or stroke. (can cause blood thinning due to the bleeding involved) Then I'd have her kidney function tested. (whole different thing from Urinary Tract Infection (UTI))

The patch may just be too much for her. Drugged up to the hilt while it's working, and perky and fine just as it's about to be changed for the new patch. Could that be what's going on? Heck mother in law is down for the count with just a simple dose of phenogren (sp). Those medications can knock the elderly for a loop if you don't know how to prescribe them properly for that age group.

I was also wondering how much the Chronic Obstructive Pulmonary Disease (COPD) is contributing. Low O2 levels in the brain can also cause alot of the behavior you're seeing.

Get a 2nd opinion asap!

(((hugs)))

 

[klmno]

Just wanted to send HUUGS and support. I have no idea of the answer. When I was reading this, I thought you must be talking about someone in her 80's or 90's. When i read that she was in her early 70's, it made me want to cry. I hope they can find someone to help soon, this is very sad...