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User Topic: Sick mother - hallucinations. Help!
truthsetmefree
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Member # 7168
Default  Posted: 8:46 PM, December 30th (Monday)

My mother went into the ER a little over two weeks ago, thinking she was having a gallbladder attack due to pain. She is 73 and relatively healthy/active though she was fairly recently diagnosed with Crohns.

Fast forward about 5 days and a multitude of tests and the doctors can find nothing wrong - despite the pain not subsiding. Ultrasounds, cat scans, bloodwork - nothing. No fever, nothing to suggest inflammation - though they did find an aneurism leading to her heart - but nothing they consider to be the cause or even urgent. They sent her home with hydrocodone.

She's no better - according to her.

She will not eat. Hasn't for two weeks.

The pain radiates all throughout her digestive. Never in one spot.

She's not a good patient. She has a low threshold for pain.

My dad has tried to manage her pain by giving her the hydrocodone as well as her Xanax. But she has become extremely weak in the last two weeks as well as frequently dizzy. Add to that delirium, confusion, and hallucinations - and he is not well enough to manage her (nor is she very compliant even on a good day).

So last night she gets up without help - and we are back in the hospital with a broken wrist now.

I had made up my mind last night that the pain med/Xanax concoction had to go - hell or high water.

Now I don't know. But ironically she's not complaining with wrist pain. It's still the stomach - though now it's even the legs. (???). My gut is still saying basically two things - too much meds, not enough food. But I'm not a doctor.

Now...to the main point - the hallucinations. OMG. Out of her head - hands me stuff though there's nothing there, seeing things, asking nonsensical questions, cannot comprehend the broken wrist/pulling wrap off, fidgeting - wanting up, etc.

Is this detox from meds?

Is this a pain response - and I'm making it worse by holding off meds?

This is like sugar to shit in no time - and I am completely bewildered. I have no idea what to do but I can say we are definitely headed in the wrong direction.

ANY help is appreciated.


Posts: 7682 | Registered: May 2005
nowiknow23
Guide
Member # 33226
Default  Posted: 8:52 PM, December 30th (Monday)

Is she impacted, truth? I ask because years ago my mom had the EXACT same symptoms. Turned out she was seriously impacted.


You can call me NIK

"Sometimes it takes a good fall to know where you really stand."
-Hayley Williams


Posts: 25296 | Registered: Aug 2011
nowiknow23
Guide
Member # 33226
Default  Posted: 8:59 PM, December 30th (Monday)

A bit about impaction that might help. I bolded some parts that stuck out to me given what you wrote about your mom's condition:


------------------------
What are the symptoms of fecal impaction?

Symptoms of fecal impaction are similar to those of constipation, but are complicated when the impacted stool presses on other tissues. Solid stool and other materials can back up in the colon, while liquid stools moving past the impaction can cause diarrhea or uncontrolled leakage of stool.
Common symptoms of fecal impaction

Common symptoms of fecal impaction include:

Abdominal pain or cramping
Abdominal swelling, distension or bloating
Back pain
Blood-streaked stools
Change in bowel habits
Diarrhea (can be explosive)
Difficulty urinating
Fecal incontinence (inability to control stools)
Feeling of incomplete emptying of the rectum
Loss of bowel control
Small or thin, semi-formed stools

Serious symptoms that might indicate a life-threatening condition

In some cases, fecal impaction can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

Change in level of consciousness or alertness, such as passing out or unresponsiveness
Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations or delusions
Greatly reduced or no urine output
Inability to pass stool or gas
Rigidity of the abdomen
Severe abdominal pain
Severe vomiting
Vomiting blood, major rectal bleeding, or bloody stool


You can call me NIK

"Sometimes it takes a good fall to know where you really stand."
-Hayley Williams


Posts: 25296 | Registered: Aug 2011
metamorphisis
Administrator
Member # 12041
Default  Posted: 9:00 PM, December 30th (Monday)

That or a bladder infection? Have the tested for urinary tract issues? I know in the elderly they can cause hallucinations and what would appear to be dementia.



“We don't see things as they are; we see them as we are.”... Anais Nin

Posts: 44680 | Registered: Sep 2006
metamorphisis
Administrator
Member # 12041
Default  Posted: 9:01 PM, December 30th (Monday)

Also, with what NIK is saying, the pain meds could really be constipating her which would just make it worse and worse and she wouldn't want to eat either. Is she drinking or eating ok?



“We don't see things as they are; we see them as we are.”... Anais Nin

Posts: 44680 | Registered: Sep 2006
unfound
Member
Member # 12802
Default  Posted: 9:08 PM, December 30th (Monday)

Is she impacted?

My first thought when I saw the symptoms plus pain meds.

She needs to be seen by a physician so they can see this reaction/action first hand. Whether it be mental or due to an illness.

Scary stuff

((tsmf))


ka-mai
*******************
From time to time, I do consider that I might be mad. Like any self-respecting lunatic, however, I am always quick to dismiss any doubts about my sanity. DK

Posts: 14844 | Registered: Nov 2006 | From: mercury's underboob
metamorphisis
Administrator
Member # 12041
Default  Posted: 9:19 PM, December 30th (Monday)

Bleh.. sorry tsmf, I see where you just said she wasn't eating. I think unfound and nik are on to something here. Sending mojo and love to you both. My grandma is staying with my parents and is falling all the time just recently too. I know how scary and sad it is. I hope you get this figured out quickly.



“We don't see things as they are; we see them as we are.”... Anais Nin

Posts: 44680 | Registered: Sep 2006
truthsetmefree
Member
Member # 7168
Default  Posted: 9:26 PM, December 30th (Monday)

Thank you all for the quick replies. Theyre comforting because, right now, I feel like there is nothing I can do.

Impacted - they did upper and lower GI in the original tests two weeks ago. Would they have found that then? She hasnt eaten since then - very, very little, anyway.

She does have a UTI. Had a minor one two weeks ago - given antibiotics - but still has it now. They also found fluid on one lung that had increased this time - almost a liter - which they removed this afternoon.

Shes just recently slept some - and seems to be mostly easy though shes still having full conversations. But the moment shes awake, shes asking for pain pills and her xanax.

I just wish I could know if holding off on giving her those is the right thing to do. (She can be a bit of a "baby" so its hard to judge.) She has definitely gotten worse since starting all the meds (weak, not eating/drinking, hallucinations). She had NO symptoms the day before going to the hospital.


Posts: 7682 | Registered: May 2005
lemony.2008
Member
Member # 20125
Default  Posted: 9:27 PM, December 30th (Monday)

So sorry to hear that truth, it must be so distressing!

Sending your mother healing thoughts and keeping you all in my prayers.

(((((truth)))))


Feel the feelings and drop the story. - Pema Chodron


Posts: 2243 | Registered: Jul 2008 | From: Canada
Mama_of_3_Kids
Member
Member # 26651
Default  Posted: 9:38 PM, December 30th (Monday)

UTI's will cause these types of symptoms, in the elderly. A few other things come to mind, as well...impaction, as previously mentioned. She could have become impacted, as a result of the meds, even if she's not eating much. Additionally, did they do any type of pancreatic enzymes?


Me: FBW/30 Him: FWH/33 The kidlets: DS13, DS10, and DD8 The hounds: Four Shih Tzu's
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Clothed in strength and dignity, with nothing to fear, she smiles when she thinks about the future.~Proverbs 31:25

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jo2love
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Default  Posted: 9:47 PM, December 30th (Monday)

(((truth & mom)))

Posts: 35137 | Registered: Mar 2011
truthsetmefree
Member
Member # 7168
Default  Posted: 10:14 PM, December 30th (Monday)

Pancreatic enzymes - yes. According to hospital values, they were fine. According to her PCP, they were slightly elevated. We withheld food for a couple days then modified for several more...but nothing has eased the pain itself.

Any opinions on withholding the hydrocodone and xanax? The dr has ok'd valium for the hallucinations. Is that a better option? I absolutely do not want her to hurt....but im also really bothered by how much worse she seems to be getting since "treatment".


Posts: 7682 | Registered: May 2005
gonnabe2016
Member
Member # 34823
Default  Posted: 10:15 PM, December 30th (Monday)

UTI.


"Oh, what a tangled web we weave when first we practice to deceive." - Sir Walter Scott

In my effort to be *concise*, I often come off as blunt and harsh. Sorry, don't mean to be offensive.


Posts: 8002 | Registered: Feb 2012 | From: Midwest
ItHappened2Me2
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Member # 32503
Default  Posted: 10:32 PM, December 30th (Monday)

I have Crohn's Disease. During flare-ups it can be VERY painful and I don't like to eat either -- whenever I eat, I have pain. And the "tests" didn't necessarily show signs of inflammation.

If she successfully had an Upper GI and Lower GI, then she was NOT impacted at the time. If she has had little to eat (especially roughage -- like popcorn, apples - with skins, stuff like that) then I would say it probably isn't that.

One of the problems I've had is blockages (I've had partial and full) If it's a full blockage, she would probably be throwing up. Partial blockages are EXTREMELY PAINFUL. My blockages are usually cause by a combination of inflammation and what I eat (see above).

Is she seeing her GI? Sometimes the docs are conservative when it comes to hydrocodone because it can slow down the digestive track. So, that could be a contributing factor.

I'm sorry I don't have a lot of help on the hallucinations. Could dehydration cause that. I also tend to get VERY dehydrated when I have my Crohn's problems.

Sorry to be so long winded -- I've had Crohn's since I was 17 years old and had a full ileostomy when I turned 36. PM me if you'd like more info.


BS - me (52); WS - him (52)
DD 15yo, DS 11 yo
Married 25 years (together 27+/-)
DDay #1 - March 18, 2011
DD #2 (after 3 + month TT and false R -- the affair had gone underground) - June 28,2011
DD3: June 19, 2013 - he started up again with the

Posts: 241 | Registered: Jun 2011 | From: Texas
truthsetmefree
Member
Member # 7168
Default  Posted: 10:47 PM, December 30th (Monday)

She has been seen by her GI dr, a heart doctor, and then her PCP. No one seems to have any idea whats wrong - and worse, what to even test next. This whole system here is now so screwy because they have what I think is like a hospice (?) type doctor that is suppose to manage all the care while in the hospital (eyes & ears type of thing that keeps doctors from having to make rounds I guess). There seems to be lacking any follow-up/sense of responsibility that wwould come from having a doctor involved directly in your care. When she was sent home after the first 5 days, we were all like - What are we suppose to do now?

When I met the dr on duty today and asked him questions in relation to the last time she was in the hospital, he basically told me that the brroken wrist had no connection to the issue from last week. I almost punched him.


Posts: 7682 | Registered: May 2005
jadedangel
Member
Member # 26979
Default  Posted: 11:04 PM, December 30th (Monday)

I would have thought of impaction too. You would be surprised how a good BM helps the older folks. It makes their blood pressure rise, increased temp, heartrate and confusion. (Slight T/J My bro in law Crohn's disease and it seems like a pretty tricky disease to deal with...his joints in his fingers had inflamed...and it was finally determined that it was Crohn's related.)

Anyway, Narcotic medications can metabolize differently in geriatrics. And with her having an UTI, then she is not flushing her kidneys like she should which would let a build up of those medications in her system. I work as a RN supervisor/MDS in a nursing home. I see it a lot.

Encourage her to drink! At least while in the hospital, she has the IV to help pump her with the fluids.


DDay: I can't remember but there were more than one

Divorced 06/2007

EXWH passed away 8/31/2011


Posts: 423 | Registered: Dec 2009 | From: AL
purplejacket4
Member
Member # 34262
Default  Posted: 11:08 PM, December 30th (Monday)

One thing to consider is mesenteric ischemia. That's a fancy way of saying your guts hurt when you try to eat. It's the equivalent of chest pain from coronary artery disease or stroke symptoms from small vessel disease of the brain. Doctors miss it a lot because although it's the bowels causing pain they look normal in imaging pictures and camera studies. You have to order special tests for it.


Me: BS 45
Her: fWS 48 (same sex partner)
Together: 18 years now (both MDs)
OW: meh so what 40s PhD
DD1: 10/30/11EA; DD2: 11/10/11 Had ONS; TT until 12/26/11; broke NC 6/12; NC again 7/12; R-ish

Posts: 2181 | Registered: Dec 2011 | From: Great Southwest
truthsetmefree
Member
Member # 7168
Default  Posted: 11:30 PM, December 30th (Monday)

Purplejacket - Would the pain move with this condition? Its largely across what would be the area in her upper stomach but then it moves lower, to her navel, etc. I do know that there is a 4 mm (?) aneurysm in her aorta but they said it wasnt a concern until it got to be at least 6. Related?

Would they catch this in a ct looking at digestive, etc? Shes had two scans.


Posts: 7682 | Registered: May 2005
ItHappened2Me2
Member
Member # 32503
Default  Posted: 11:45 PM, December 30th (Monday)

UGH -- I hate it when they have all sorts of docs and they don't seem to talk to each other! BTDT! I won't bore you with the scary details of some of my issues with multiple docs. I actually did have some luck with a hospitalist while in the hospital -- but the follow-up afterwards left a lot to be desired.

I get why they have set ups like that -- it's not a knock on the docs -- it can just be hard to deal with when there are multiple specialties.

I second the advice on drinking lots of fluids. Especially if she has a UTI.

Does she tolerate drinks like Ensure?


BS - me (52); WS - him (52)
DD 15yo, DS 11 yo
Married 25 years (together 27+/-)
DDay #1 - March 18, 2011
DD #2 (after 3 + month TT and false R -- the affair had gone underground) - June 28,2011
DD3: June 19, 2013 - he started up again with the

Posts: 241 | Registered: Jun 2011 | From: Texas
Sad in AZ
Member
Member # 24239
Default  Posted: 12:17 AM, December 31st (Tuesday)

My mom had a raging kidney infection that resulted in a lot of pain and dementia. Did they test her creatinine (sp?) levels? Turns out she had kidney stones over 1 cm in size--too huge to pass. She had to have lithotrypsy (sp? again )


I solemnly swear that I am up to no good.

Posts: 20150 | Registered: Jun 2009 | From: Upstate NY
purplejacket4
Member
Member # 34262
Default  Posted: 12:08 PM, December 31st (Tuesday)

Mesentaric ischemia is part of peripheral vascular disease (lay men's term is hardening of the arteries). The fact that she has a heart doctor and an aortic aneurysm indicates she does have vascular disease. You can suggest they look into this by ordering an abdominal angiogram.


Me: BS 45
Her: fWS 48 (same sex partner)
Together: 18 years now (both MDs)
OW: meh so what 40s PhD
DD1: 10/30/11EA; DD2: 11/10/11 Had ONS; TT until 12/26/11; broke NC 6/12; NC again 7/12; R-ish

Posts: 2181 | Registered: Dec 2011 | From: Great Southwest
TrulyReconciled
Member
Member # 3031
Default  Posted: 1:13 PM, December 31st (Tuesday)

We've seen pretty bizarre symptoms in my elderly MIL from a UTI.


"In a time of deceit, telling the Truth is a revolutionary act."

Posts: 21098 | Registered: Dec 2003 | From: Hell and back, way back :o)
solus sto
Member
Member # 30989
Default  Posted: 6:30 PM, December 31st (Tuesday)

I haven't read all the answers--but will after I post.

While the hydrocodone can cause hallucination (and does sometimes, particularly in seniors), constipation can be a HUGE concern. It's not the mild joking matter of TV commercials for Dulcolax.

It's the culprit, for example, in a very dangerous condition called hepatic encephalopathy---in which ammonia (a breakdown product of protein metabolism) accumulates in the blood and causes confusion, then hallucination, then eventually coma and sometimes death.

Relieving the constipation is of paramount importance. To that end, narcotics should be avoided and SERIOUS discussion about cleaning out the bowel (and preventing a recurrence of constipation) engaged in.

A good gastroenterologist is imperative.


BS-me, 52
WH (Trac-fone), 52, PD
2 kids-DD25, DS18
multiple d-days
DIVORCING
Alone, most strangely, I live on~Rupert Brooke

Posts: 8678 | Registered: Jan 2011 | From: midwest
truthsetmefree
Member
Member # 7168
Default  Posted: 7:09 PM, December 31st (Tuesday)

Thank you all so very much for taking the time to help me through this. This has been very frightening to me - and especially so last night feeling so alone in all this at the hospital while watching her just seeming to slip over the edge.

Last night was extremely difficult. The valium was clearly and readily apparentt not a good option - delirium greatly increased. We tried the hydrocodone about an hour later, she got easy for about 30 minutes but then started right back. The nurse was goinv to try morpheine 4 hours later but refused it when she witnessed first hand all the delirium. Shortly after and for what I will accept as answered prayers, she got easy.

And that has been the last pain medicine she has had - now almost 24 hours later.

Laxative from earlier appears to have brought some relief. As well as antibiotics for the UTI (frequency, straining, etc all relieved).

After I asked the doctor some questions relative to purplejacket's suggestion (dont remember technical term and didnt even use it in my questions), an u/s for the aorta was done and a second one for those specific veins is now being done (*they* did use the technical term). So thats encouraging.

For the first time in over two weeks she actually stated, "Im not really having any pain now." Right now, EVERYTHING is looking better. She's actually been up and walked the halls on two occasions and has sat for a few minutes several times in a chair. And she's sleeping calmly - still talks but none of the thrashing, picking cast, smashing bugs, etc. And once she's awake, shes coherent immediately - even when it takes me a moment to realize that what she is talking about is actually lucid.

I know this is a long update but I wanted you all to know that I thing the suggestions were spot on. It helped me to stay the course and not just chase the quick "band-aid".

My sincerest and deepest gratitude....much love SI peeps.

ETA: Please forgive the typos. Im on valium and hydros. JK! - Tired and deliriously relieved.

[This message edited by truthsetmefree at 7:12 PM, December 31st (Tuesday)]


Posts: 7682 | Registered: May 2005
nowiknow23
Guide
Member # 33226
Default  Posted: 8:43 PM, December 31st (Tuesday)

I couldn't be happier to read your update, honey! Continuing to send healthy mojo to your mom and strength and comfort to you.


You can call me NIK

"Sometimes it takes a good fall to know where you really stand."
-Hayley Williams


Posts: 25296 | Registered: Aug 2011
ItHappened2Me2
Member
Member # 32503
Default  Posted: 8:49 PM, December 31st (Tuesday)

What a GREAT update!!! Thank you for letting us know.

You and your mom will be in my thoughts!


BS - me (52); WS - him (52)
DD 15yo, DS 11 yo
Married 25 years (together 27+/-)
DDay #1 - March 18, 2011
DD #2 (after 3 + month TT and false R -- the affair had gone underground) - June 28,2011
DD3: June 19, 2013 - he started up again with the

Posts: 241 | Registered: Jun 2011 | From: Texas
little turtle
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Member # 15584
Default  Posted: 11:58 AM, January 1st (Wednesday)

Glad to see things are looking up!!


Failure is success if we learn from it.

Posts: 4165 | Registered: Aug 2007 | From: michigan
Deeply Scared
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Member # 2
Default  Posted: 8:45 AM, January 2nd (Thursday)

(((Truth)))


"Don't give up, the beginning is always the hardest." My Mom:)

My tolerance for stupid shit is getting less and less.


Posts: 197731 | Registered: May 2002
tushnurse
Member
Member # 21101
Default  Posted: 12:24 PM, January 2nd (Thursday)

I just saw this post, and wanted to add a few more thoughts to this.

I am so very happy that she is doing better, but Please PLEASE PLEASE do not let them give her valium ever again. It is not well tolerated in the elderly, and chronically it, of which she is both.

While her UTI was probably the largest contributing factor her delerium also please ask and keep track of her sodium levels. You mentioned a heart doctor which in my mind tells me she has heart issues, so she is probably on a diurectic which will dry her out, and cause her sodium to be too high or too low depending on the diuretic. This can lead to Super Crazy behavior and tag it with a UTI and you get all kinds of loony toones. Lastly if she was on steroids which is a common thing for a "flare" of Crohn's and Colitis it can cause confusion and extreme mania (which looks different in older folks).

The Dr that is managing her care is call a Hospitalist, not a Hospice Dr. He is taking the place of her PCP while she is in the hospital, and if he is worth a dang is updating her PCP daily or every other day. This is very common now due to the extreme shortage of PCP's, and the time constraints placed on them. If the Hospitalist is NOT doing this that is a conversation you need to have with her PCP at follow up. They choose what Hospitalist company and Dr's that she gets assigned to. If they don't get the feed back they assume all is well.

Next I would also push for the angiogram. If she has decreased blood supply to her gut causing the pain, and suspected Crohn's, which I question how was it diagnosed, because it's really odd for folks that old to get that diagnosis, and have that disease just rear it's head. If she has decreased blood flow causing ischemia in her gut it can look a lot like colitis in colon and crohn's in small intestine. But this can also be fixed by stents sometimes, and other times with surgeries. So unless they diagnosed the Crohn's with biopsy question it.

And even though she is doing better now, go ahead and pursue this stuff because if it is an issue with ischemia/blood flow it's going to happen again. If it truly is Crohn's then she has probably failed the first line of treatment, and needs to be bumped up to the next line of drugs for it.

Part of what I do is help manage these types of patients for the PCP, I see them at the hospital, and communicate with the Dr's and advocate for the patient, and help the hospitalist along wit ordering appropriate tests, since I know that person fairly well.

I hope she continues to improve and get well.


Me: FBS
Him: FWS
Kids: 15 & 17
Married for 22 years now, was 16 at the time. .
D-Day Sept 26 2008
Fully R'd, and Happy Happy Happy

Posts: 8463 | Registered: Oct 2008 | From: St. Louis
ICouldntFixIt
Member
Member # 15326
Default  Posted: 1:38 PM, January 2nd (Thursday)

Unless she was weaned off her Xanax by a doctor, she could be having the hallucinations from that. Besides it being AWFUL for elderly people, just stopping can cause serious side effects, including death. I tried to take an ironing board out of a second story window because my mother just took all my meds away suddenly. Sadly, I have no idea about her stomach pains. I have the same issues and there is nothing there. Been dealing with it for almost 3 years now.


"Don't settle for a spark...light a fire instead."

Posts: 165 | Registered: Jul 2007 | From: Harrisonburg
truthsetmefree
Member
Member # 7168
Default  Posted: 3:40 PM, January 2nd (Thursday)

We have an answer!!

It's pancreatitis....caused by stones and sludge in the gallbladder. Surgery tomorrow or the next day. We all feel so relieved though a little frustrated that it has taken all of this. I know sometimes these things take some exploring but there have been several issues in her care that have left some questions/concerns.

Thank you all again for your responses. I'm certainly no doctor (though I do have a medical degree from google) but I have felt such a HUGE responsibility to try to oversee her care. It has been a comfort to have your experiences and knowledge to see me through.


Posts: 7682 | Registered: May 2005
TrulyReconciled
Member
Member # 3031
Default  Posted: 3:57 PM, January 2nd (Thursday)


"In a time of deceit, telling the Truth is a revolutionary act."

Posts: 21098 | Registered: Dec 2003 | From: Hell and back, way back :o)
truthsetmefree
Member
Member # 7168
Default  Posted: 4:06 PM, January 2nd (Thursday)

I had the first nurse to tell me just last night about how a UTI shows different symptoms in elderly patient. I thought, yeah...my SI peeps told me that two days ago!

As they were trying to explain about looking at the blood supply for the digestive organs, I was able to ask important questions *at the time* since I had already been advised and had had time to research it.

The Valium thing -
How meds affect elderly differently - I had yo hold my ground pretty strongly with one of the nurses last night and we resolved the issue simply with a heating pad!

I've held long and firm on refusing the Haldol that was still being pushed despite the delirium subsiding after the first night.

It took awhile but I realized yesterday that she hadn't been receiving her cymbalta or the low dose steroids that she has been taking for years since admission (and maybe even earlier since my dad had been managing her meds the last week at home). Getting those two doses last night almost immediately relieved the nausea and her blood pressure also has returned to normal range.

Feedback from you all helped to give me perspective that maybe she wasn't on her death bed so I was able to push/reinforce the PT efforts to get her up and moving regularly - which had amazing effects on almost everything.

I'm just so very thankful to all of you.


Posts: 7682 | Registered: May 2005
Topic Posts: 33