Dementia or Drugs?

So, my mind rolled all night wondering does Mom now have Dementia or is it a drug or something else? We owe it to her to investigate and not just ignore these symptoms -- I cannot do that to my Mother -- I wouldn't want someone to drug me and cause me to appear I have dementia when it was really a drug!

So, 6:30 am I send the following email to the Administrators and nurse at the facility:

This has rolled in my head and I got up this morning and did more research.

Folks

I’ve been worried about my Mom’s confusion ALL NIGHT. I’m an analyst at heart and have spent about 30 years (my entire career) having to research and learn all kinds of things – so I have a LOT of experience at researching and analyzing and learning. I also know my mother – I know her well and so does Sister.

I just read that early studies of Remeron did note that the drug did cause Dementia in some patients.

Until Mom was started on Remeron WE did not see the confusion that we (mostly Sister since I’m out of town) see now. I understand that you all stated you experienced some confusion – I understand that – but not to the level we see now.

I saw my Mom get TOTALLY confused one evening back in November – and it was COMPLETELY a reaction to some cough syrup her doctor prescribed for her. Once that got out of her system – next morning – she was back to normal. So I have SEEN drugs throw her into a tail spin.

I realize that what we are seeing may in fact be some dementia – I’m accepting where we are with our mother and the various things we may experience. I do accept that.

However, WHAT if Remeron or carbon dioxide IS the cause of her confusion? We would be doing that woman a TERRIBLE INJUSTICE if we did not figure that out – wouldn’t we?

Is oxygen still required 24x7 for Mom? If so, why? She didn’t need oxygen before her lungs started filling with fluid from the heart failure. When she was admitted to Regency she still had fluid in her lungs. Does she still have fluid in her lungs? Does she need the oxygen full time? WHAT if there is a build-up of carbon dioxide in her lungs causing the confusion?

What are the ramifications to stopping Remeron for a few weeks? What do we have to do to get her blood gases checked?

Please help us out with this and help us at least investigate whether there is something causing the confusion.

Thanks!

Well, what do you know -- Sister goes by facility at lunch time -- Mom is very confused again. Talks to the Nurse Practitioner and last Monday they did check Mom's blood gases and found it was at 35. Normal is 20-29. "Hypercapnia" is when the CO2 level is greater than 45 and that is life threatening! A little more about Hypercapnia:

* The blood contains carbon dioxide, a "waste product" of cellular metabolism that is exhaled by the lungs at the same time that oxygen is taken in. The normal concentration (partial pressure) of carbon dioxide in the blood is 40 mm Hg. Hypercapnia is when the carbon dioxide level goes above 45 mm Hg. (though it usually needs to be higher than this for symptoms to occur). * Hypercapnia commonly occurs in severe Emphysema. Oxygen given to patients with Emphysema may reduce their ability to breathe, resulting in Hypercapnia. This is why exact doses of oxygen are usually figured out for those with Emphysema so that they receive neither too little nor too much oxygen. Note: if a patient is actively short of breath, never withhold oxygen from him.

Now -- note that Mom was classed as having COPD but she was NOT having breathing problems prior to December 30th. As far as we know, the oxygen level has not been adjusted since December 30 and note that above information states oxygen level must be set just so -- not too much and not too little. Really? Wonder who is monitoring that??

So the Nurse Practitioner does 'assessments' 3x week -- I think that is what Sister said and then the local medical conglomerate comes in on MWF to collect blood for various tests. So, if they check Mom's blood gases again it won't be until tomorrow.

Also learned that Mom has on same clothes for the 4th day now. Could be she is requesting those?? So, I called the asst. Administrator this afternoon and asked about blood gas check -- results of nurse's assessment and about clothing/bathing.

The Nurse Practitioner has decided she wants to assess Mom tonight -- sometime. Maybe even wake her up to assess her. She said Mom may have had Dementia (D from now on) for some time but able to control it or catch herself and now not in her normal environment she cannot catch it.

So -- how about being at home? Time now to research IN HOME CARE SERVICE PROVIDERS. Find our options, check the companies and people out and compare company and pricing (not that pricing take precedence -- it doesn't but we certainly have to be able to afford it). Then assuming we find suitable care -- will Mom agree to someone in the house with her? This could take some time, but we want to do all we can and it is would be better if she could be in her own home but it depends on whether she will be cooperative or not. This is tough.

This is so not where this woman wanted to be...............But......God has a plan and we will survive and learn. We can only try to do the best we can for her every day -- one day at a time.

To Be Continued................................

Cause of Confusion?

I emailed the facility administration this morning about that shower schedule. They have made a "process improvement" to better monitor and audit the schedule YAY! So, Mom's getting a real shower today and then is scheduled for every Tuesday and Friday -- bathing between showers.
The CNA approached Mom before lunch today about a shower and Mom responded that she didn't want one. The CNA got the DON (Director of Nursing) and she talked to Mom and again Mom said No. The DON said "your daughter wants you to get a shower" Mom responded,"I don't want one, I can make my own decisions and I don't care what she says". Well, now...hmmmm.......

We were also informed that the urinary analysis came back negative. Hmmmmm. So why is she confused? Mom didn't have this confusion prior to going into the rehab facility. She was naturally somewhat confused but all that was normal considering what she had been through and slept through in ICU and the hospital. She exhibited real confusion ( and delirium per her roommate) on her third day of taking "Remeron" -- an antidepressant. We asked the nurse then to STOP the drug but she suspected a UTI being the cause of the confusion, not the Remeron.

Well, since there is no UTI -- we must suspect the Remeron. So, I emailed the administrator again and asked that he investigate this with the Doctor and maybe Remeron needs to be discontinued. We don't want Mom being so confused -- and drugs can really play havoc on the elderly.

Man -- this is a full-time job to keep track of everything that is occuring with your parent in one of these facilities -- but also demonstrates why you HAVE to be very involved. Otherwise, these folks -- each nurse, therapist, etc -- look only at their schedule and muddle through their day -- they would continue current actions and those actions could drastically change the outcome of the elderly patients.

Well -- talking with a friend this morning about this confusion and lo and behold, she is going through something similar with her mom! Found out that

a build-up of carbon dioxide is likely in elderly that are on oxygen and have heart issues because the body cannot expel that carbon dioxide from the lungs and a bi-pap machine at night can take care of that and will completely clear up the confusion!!

So, I emailed the staff (administrators and nurse) about checking Mom's "blood gases" to ensure she does not have a build-up of carbon dioxide from the continuous oxygen! This email was sent to them before noon today -- hopefully getting this blood test won't take the week that the urine analysis required!

Sister went by this afternoon and Mom was doing good -- clear minded and even conducted some business. Then when they were leaving the dining room -- Mom says, "I need to use the bathroom before we head home." Sister guided her back to her room and she went to the bathroom. Mom's roommate told Sister that Mom gets real confused at nighttime. Sister asked if it was after any particular medicine, and asked if roommate could see if that might be the case.

What about drugs and the elderly? How much are these drugs doing to an elderly person's brain? How do we ensure that something that is prescribed to an elderly person is not making them confused? Think about how awful this would be and what path this could put a person on!! How do we prevent this?

Unfortunately not so. Mom came out of the bathroom and was very confused and started talk about needing her purse and coat. She again brought up about not staying there and about going home. During this Sister said some nurse/aide came in and asked if Mom had on her shoes and then came back and asked her roommate if she had on her socks. The roommate turned to Sister and said "see why we're crazy". Soon they brought in the dinner tray and once Mom started on that Sister departed.

So many feelings and thoughts about this journey. So difficult and you are faced with so many decisions. I know how difficult this is for me and for my sister and we are so thankful we each have the other to help in this -- but, Lord, what about all the elderly that don't have family involved?

I never wanted to see my Mom without a clear head -- she never wanted to be 'confused' or have Dementia. But, there IS a plan and through this we all learn much and our faith gets stronger.

One day at a time.

To Be Continued....................