BarbBrooklyn Asked June 2013
Mom is 90, sudden on set confusion and memory loss, due, we think to a uti. How long does it take for the "fog" to clear?
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She is quite aware of the difference in her thinking and reasoning abilities. She has had two neuropsychs in two years, first one dxed mild cog impairment, due to a small stroke a few years back; this year (just a few weeks ago) follow-up testing showed no progression.
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Memory loss is often considered a problem with old age, but it’s a common and normal process of aging. As you grow older, it’s more difficult to use analytical skills and make mathematical calculations because the mind has more difficulties taking in new information and keeping it in the mind while it’s processed.
Multi-tasking becomes more difficult. Usually, an elderly person will be able to recall events from long ago, but the details may be selective and factually incorrect. For example, an 80-year-old woman may remember her first day of school, but not remember the name of the teacher or the students in her class.
An aging brain’s ability to retrieve information is not as sharp as it was during a person’s younger years.
And l think what Danna is talking about is it it's hard to tell the difference between the normal aging of an elderly dementia patient and how much residual "fog" remains from a uti. My mom was 94 and a half and we could never tell.
Jools .. we have almost exactly the same issue: stroke, followed slowly by vascular dementia along with recurrent, persistent UTIs. We've learned her signs at early onset of them: she weakens, physically first, then shows signs of aphasic speech, often accompanied by muscle twitches/tics. Rarely does she present with other symptoms like fever, burning while urinating, etc. So, we had to learn HER signs/symptoms.
We also follow a strict regime with diet, supplements to help keep her bladder flushed, exercise, hygiene, etc.
And yet, the UTIs keep coming back .. and with each one, after the 'fog' clears, there's some small decline, compared with prior to the infection and treatment. It *does* help to add some cognitive exercises to her regime: logic questions, memory questions, hand-eye coordination, etc. I turn every normal daytime activity into an 'opportunity' to learn or a physical therapy type routine.
An aside: among her other conditions, she has diverticulosis. Normally, this just means we control flare ups with diet. Very recently, one of them bled out. Wanna know scary?? Ugh. Simultaneous to the GI bleed, she had another UTI and while they were testing and diagnosing she began her antibiotics; . She ended up needing a transfusion because of the blood loss. After her hospital release, within less than two days, her cognitive functions improved SO much, I felt like we'd gone back two years. Dunno if it was the transfusion and/or this specific round of meds, but I'll take it.
and I will try to be more aware and talk to her and her dr about solutions.
Re the issue of antibiotics. One of the huge problems is administration of antibiotics prior to a culture being taken particularly for the elderly and where a UTI is suspected. Mum spent two weeks in hospital with not a real recovery, then a recurrence where we ended up taking her to the ED. I said to the ED doctors and nurses that they were not to bring an antibiotic near her until they took urine and blood for cultures. The upshot is that for about 4 weeks she was on antibiotics that had little or no chance against the specific bacteria she was fighting. She started improving about 3 days on the right antibiotics and needed two courses. This is the second time I have seen assumptions made on antibiotics in an older person that nearly cost them their life. (The bug Mum had has a 61% fatality rate in older women and boy was she ill).
I cant understand the hesitation in taking a urine sample by clinicians or nursing support. Its not costly and besides the normal dip stick that identifies if there is blood and white cells in the urine (not a definitive but pretty good inidication of infection) there is another dip stick can indicate pretty definitively that there is an infection (but not the type). That at least ensures that an analysis on the exact bacteria can be done in 24 hrs and the right antibiotic delivered. Given the incredible impact of UTIs on further cognitive damage Im going to talk to her doctor about regular urine tests. Certainly we have been told if we notice any change at all straight in for a urine test. On the issue of ongoing prophylactic antibiotics we have been told this is an option but not a great one - lots of issues with this apparently. And YES BGills probiotics are absolutely a must. While yogurt etc is great we use a one a day major dose of probiotics in capsule form - here it is called "Inner Health Plus" Easier to get Mum to take one or two of these a day than get her to eat the amount of yogurt etc needed.
Excellent discussion and so useful to hear about other's experiences and opinions.
Urine can be caught mid-flow or taken by catheter. If the patient is perceived to be bedridden, they'll typically take it by catheter. A 'straight cath' pull usually gives the most accurate readings, since it's being drawn directly from the bladder. The chances of other contaminants being present in a 'catch' is always possible.
So .. with that background, if you want, you can INSIST on a urinalysis and if you're concerned with the introduction of the the resistant superbugs, tell them you'll do the catch (if you can, and are unfamiliar with the process, have the visiting nurse supervise) and take it to the lab yourself.
And, yeah .. it takes a few days for the cultures to breed and get the test results, but we've learned that treating with an inappropriate antibiotic is completely counterproductive. It just encourages other superbugs. *sighs*
In addition, she has a long-standing wound that heals up, opens again, heals, etc. She recently contracted MRSA and has had VRE. The wound care doc sent us to an infectious disease specialist to review her care and antibiotic history as she felt there was a good chance that all the antibiotics given through the years have lead to the MRSA.
His answer: NO MORE ANTIBIOTICS for UTIs unless she's running a fever (I need to find out what to do when one results in cognitive difficulties - I truly can't imagine living with that for longer than a day or two or three).
He prescribed Premarin Vaginal cream as it helps (a) the urination pain and (b) "tightens" things up "down there" so bacteria is less likely to enter the urinary tract. I gotta tell you, this is a joy (NOT) to administer BUT after I did it a couple of times, my mom recalled how to insert a tampon from long, long ago and now she can do it. I just stand by to hand her the applicator, then look the other way.
So far...so good. She still complains of the pain (going to ask her primary care about trying the AZO painkiller, see if that would be okay for her) BUT we've had two clear urinalyses in the past month. I would love to take away that pain that the chronic cystitis causes her and (hence the AZO, if not that, then small doses of narcotics throughout the day - helps her wound pain as well), but if the Premarin is helping to keep her from getting the UTIs, then I'm all for it.
The problem will be convincing her that it's helping her - so far, the docs and I have been saying it'll help with the pain - it's not - so now we have to try to get her to understand that it's keeping her from getting sick.
AND, the infectious disease specialist is now consulted on any and all antibiotics to be given to her, in an attempt to stop over-antibiotic-ing her, and to try to keep her from picking up these super-bugs.
Whilst researching, I stumbled onto an article about D-Mannose (a simple sugar in many fruits, mostly derived from cranberries). Very briefly, apparently D-Mannose binds to the e-Coli from the bowels and allows it to flush right out of the bladder.
Most of the literature is by alternative health practitioners, though I did find references, along with anecdotal comments on WebMD.
Just puttin' it out there for consideration. Maybe this is the next, best way to avoid (or treat? *crosses fingers*) UTIs. I'm gonna go out and get some. I hope others find it and follow up. Love to know how it goes, if you try it.
Also, cranberry interferes with Coumadin/Warfarin, so it's vital that you get the doctor's okay before starting it - at a minimum, INRs will have to be checked frequently at the beginning, so that the Coumadin dose can be adjusted to accommodate the interference. And then, you have to continue to give the cranberry faithfully.
So, know what bacteria you're dealing with first - we've (doctor and I) made the decision to not give cranberry or D-Mannose since (a) it won't help and (b) we'd have to through a whole new round of Coumadin adjustments.
(and if it's consistently e coli you're dealing with, that can often be addressed somewhat successfully by hygiene changes, ie, wiping front-to-back instead of back-to-front)
Here we're dealing with e-coli almost exclusively; and almost no amount of correct cleansing (we're fanatical about it: we don't wipe mid to anything: we wipe from left to right since we have access beneath the toilet seat; use a different cloth or wipe at each of the anus, vagina and urethra) or pad/diaper placement (I keep a panty liner directly under her rectum to - hopefully - catch the errant and always present leakage from the anus, due to a prolapsed rectum - before we got a hold of her, she used to reach in and dig out her own constipation). Oh... and don't forget the explosive, uncontrollable bouts of diarrhea. *sighs*
Plus her system is so fragile, that all it takes is one lousy bacterium to find its way into the bladder, and poo-f* .. that's it. She's got a raging infection, again.
Also, after her stroke, part of the bladder no longer functions as well, so voiding completely is rare and is a contributing factor: unvoided urine is much more susceptible to infection.
The bottom line for me is, if there's something out there that the traditional medicines don't know about or acknowledge, I'm willing to do the research, and run some tests. With input from the doc, of course. As far as I know there's nothing to contra-indicate, with the possible exception of her sugar levels. We already monitor, so we'll be able to track how it effects her diabetes.
* (intentional spelling)
Home health has told me that findings that Coumadin and cranberry interact have been debunked. Her doctor's office has read the same research and disagrees, but they're now open to the idea of adjusting Coumadin to the interaction, where they never were before. As I say, though, it wouldn't be helpful to my mom, so why add yet another pill or drink to the mix, she already takes so many pills and potions already. I cringe every time a new prescription is written or supplement suggested. :-)
Good luck, I hope you find the D-Mannose helpful. When I first heard about it, I thought, this is what I've been looking for, but then I read that it seems to only be effective against e coli. Others have suggested there's research showing it's effective against other organisms, but I haven't found those studies. Yet. I keep looking. :-)
But it might be appropriate in your situation...