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Mom has been having repeated "episodes" as the SNF staff call them. She will suddenly get weak, spike a fever and oxygen levels drop. One occurred early January then again early February. Negative for COVID/Flu, xray shows lungs are clear, blood work is normal, urine specimens return a 2+ bacteria initially but the extended cultures come back "contaminated". Not a UTI, right? Initial ultrasound of bladder in January showed a small lesion on her bladder. A second ultrasound on bladder and kidneys showed nothing abnormal in February. Antibiotic shot was administered in January, she rebounded in 24 hours. Two antibiotic shots administered in February but it has taken almost 10 days for her to get back to where she was prior. She was scheduled to see a urologist in January but cancelled the day before her appointment. Mom will soon be 90 and doesn't want any invasive procedures which I can understand. I'm at a loss of what this could be and if it may be something corrected with non-invasive means? Anyone had anything similar happen to a loved one?

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My mom kept getting UTIs until her gynecologist recommended a vaginal suppository and a probiotic called repHresh. Keeping the vaginal tissues moist and the pH balanced and somehow added up to no more UTIs.

She also strongly urged mom to use more care in hand-washing; I kept a look out and mom was just rinsing her fingers after using the toilet! Had EVERYONE in the family bring her easy to use liquid soap, which helped.

If she has another episode, try to figure out with the DON why they aren't getting a clean sample.
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Bumping for more answers.
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She's 90.

Perhaps her body is simply wearing out. They're not made to last forever. What worked once or twice for a mysterious illness wouldn't necessarily work a third.

We work so hard to find the causation of illnesses in our elderly LO's and often the answer is simply 'they're wearing out'.

Yet, I would also continue to pursue these odd symptoms.
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zmchipmunk21 Feb 2022
Thank you! I agree her body is slowing wearing out. I can see it happening over the past year physically and mentally. Just wait and watch, we may never know what is happening.
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Your Mom should follow up. There are some non-invasive treatments of things, yes, or invasive only in that they involve catheter-introduced medications that do a "wash" of the bladder. Your Mom perhaps could tolerate that. The urologist, unfortunately, was the best appt she could have; they could identify say an interstitial cystitis from a bladder infection. I honestly, as a nurse, haven't a CLUE as to what this could be, hence the importance of finding OUT what it is, and THEN making a decision as to what you can do that is not invasive, because I agree with your Mom on that, rather that would be MY decision. Best to you both.
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Isthisrealyreal Feb 2022
The diagnosis of interstitial cystitis can only be done by actually seeing the bladder, which means going under and having a urologist have a look. Day surgery and bladder wash are really invasive, IMO.
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“Being Mortal, Medicine and What Matters in the End” by Atul Gawande is helpful in understanding the end of life decisions on whether to keep treating.

It appears your mom’s care team believe the problem is one with her kidneys or bladder and mom doesn’t want to pursue that line of investigation by visiting a urologist or is it she doesn’t want to leave the facility for anything?

I had a mystery illness in the height of covid. Lots of tests, lengthy hospitalization. Nothing came of it except I got tests that show what I don’t have a problem with. Which was good to know. I know from personal experience. It is sometimes not easy to find the answer.

However, in your moms case, I think I would ask for a Urinalysis and culture in a few weeks to make sure she is clear of a UTI and not wait for it to make her so ill. After all they really didn’t get a definitive answer on the last one since it was contaminated.

Let us know what you find out. I’m hoping March is a better month for you and mom.
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zmchipmunk21 Feb 2022
Thank you! I've read that book! For now, it's just wait and watch...and hope for the best. Mom has told them no more ultrasounds (even tho they aren't invasive imo). Deep inside I believe Mom knows her body has been wearing down so we'll just keep her happy and comfy.
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Just an opinion here. If there is bacteria in the urine, I would say its a UTI. And maybe a 10day treatment is not enough. Sometimes IVs are better. A lesion in the bladder could mean bladder cancer. Which is easy to treat in early stages. But it means chemo being put directly in the bladder and then turning every 15 min or so. It also means a bathroom to herself or aides cleaning thoroughly with bleach after each bathroom use. This is because Tuberculosis is used in the chemo.

A fever usually means an infection somewhere. Does she take blood thinners. Over time they cause internal bleeding but this should show up in at least a bowel movement. With my Dad the blood thinner was stopped.
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zmchipmunk21 Feb 2022
Thank you! She is on blood thinner Xarelto. They recently cut her dosage in half at Mom's request because she had blood in her urine. I'm concerned about the lesion on her bladder being cancer as well, but I don't believe at this point she wants to consider the possibility. I know she won't agree to any treatment if it is cancer. Her choice of course, I'm just amazed at how quickly her health declines when one of this episodes happen. The only antibiotics she's received are shots, 1 shot in January, 1 shot for 2 days in a row in February. Kind of feel like even if her urine tests are showing as "contaminated", would a longer treatment with antibiotics really hurt for someone who is almost 90?
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Follow-up with the urologist.
Have her re-tested for
UTI (not just a dipstick urinalysis).
Yeast Infection
Bacterial Vaginosis (BV)

All these can be possible after antibiotic treatment(s).
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zmchipmunk21 Feb 2022
Thank you for your suggestions! I don't believe she will agree to see the urologist since she cancelled the appt in January. The urine has been collected with a cath catch (?) the last two times so I'm confused as to how it keeps coming back contaminated but I'm not in the medical field so I have to trust it's being done correctly.
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If there is something making her sick, it will show up sooner or later. If there's a hidden UTI, it will spread to her kidneys and it won't be hidden anymore. If there is a malignancy in her urinary system, other signs like blood in urine will appear. It's OK to wait and watch.
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zmchipmunk21 Feb 2022
Thank you! It will be a watch and wait scenario I believe. She has had blood in her urine previously but she believes it was from her blood thinner so she's had them cut her dosage in half now. No reports of blood in urine recently so we just hope for the best at this point.
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Thank you! The urine specimens were gathered using a cath catch(?). I don't understand how they could be "contaminated". Mom has mobility problems so she is transferred to a potty chair in the shower room and the staff cleans her afterwards. She is diligent in hand washing and has liquid soap available to her. I'm just mystified her bloodwork is normal with what I believe is an infection...again not in the medical field so I wanted to ask here. Love this group and know there's a lot of folks with much knowledge on many issues!!
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This is a false belief, a false conclusion:

"She has had blood in her urine previously but she believes it was from her blood thinner so she's had them cut her dosage in half now."

Also false conclusion"
"the extended cultures come back "contaminated". Not a UTI, right?"
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zmchipmunk21 Feb 2022
I honestly believe there is something more at play than her blood thinner causing the bleeding previously. Unfortunately in my Mom's mind, they cut her blood thinner dosage in half and there's no "visible" blood in her urine now so that was the problem. Couldn't convince her she may have a UTI either because in her words "I have no pain or burning" when urinating. She's sometimes her own worst enemy when it comes to her physical health decisions but she's still deemed competent so I can't override her health decisions at this point. It will take another near death experience before I'd be able to step in and find out what's going on....unfortunately by then it may be too late.
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FWIW, I had a bladder cystoscopy at the Urologist's office last year b/c I had blood in my urine on 2 separate occasions. It was painless and no big deal at ALL. Lidocaine was used before the scope was inserted, which is why I didn't feel any pain. The procedure was done in the office with no pre preparation necessary; he was able to see my entire bladder and scan for tumors or issues and I could see it on a monitor too. The whole procedure took about 10 minutes, nothing of consequence was found, and my mind was put to rest afterward that I had some horrible issue that would kill me.

Perhaps such a cystoscopy could be done for your mom which would reveal issues or put her mind to rest as well.

Good luck!
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Sendhelp Feb 2022
Same was done at gynecologist's office for me. Having my mind put to rest helped.
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Clicking unfollow. ✅

Best wishes as you go forward.
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A couple of questions:

Are you quite sure that the UTI specimen is being tested for every UTI? I once had a second one, not picked up the first test, which needed a different antibiotic. The litmus-type test in the doctor’s surgery is certainly not enough.

Also, we recently had a post about an elder ex-nurse who was self-administering fecal removal from her bowel. The problem was that she didn’t clean underneath her finger nails afterwards. Have you checked that as well as ordinary hand-washing?
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At her age, everything is wearing out. Sounds like she has gotten to a point where she is refusing further evaluations and is not as interested as everyone else might be to find a 'cause.'. A 'clean catch' urine is one that is collected using steps to decrease any contamination of the urine from surface organisms. You can find a detailed description on line.
Decreasing her dose of anticoagulant is likely a good idea...recent studies show that the risk of severe/fatal bleeding in the brain or other places inside the body after a fall increases with age. And as her body is wearing out, falling is more likely.
A 'comfort care' focus makes sense...there may be a medical practice that provides services to home bound patients and can see her at the facility when she has 'an episode.' See if the facility has one that already visits their residents.
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I am answering your reply here. I would ask that her blood thinner to be stopped just to see if her symptoms stop. There are natural ways to thin out the blood. Vit E, fish oil, and certain vegetables. Her blood has to be allowed to clot if blood thinners are the problem. She has blood in her urine because of the possible bladder cancer. This is how they found it in both my parents. I have never heard of an antibiotic in shot form. Seems not to be working so as u asked, needs maybe a 7 to 10 day regiment and a culture to determine the bactera so correct antibiotic is given. She should be on a probiotic when on antibiotics to keep her from getting a yeast infection. My Mom took a cranberry tablet and probiotic daily. She only lived a yr after starting this but had no recurrence of an infection. Alva suggests D-Mannose. It helps prevent UTIs and I have read may clear them up.

For my Dad, the internal bleeding showed up in his stool.
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Isthisrealyreal Feb 2022
You have never heard of a shot of antibiotics?

When I was young we would get a shot of penisillin when we had ear aches or tonsillitis.

Not being rude JoAnn, I am just amazed that you have never run into that.
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When does your mother have these episodes? Is it during activity? Or are they when she is just sitting down?
I had a homecare client who used to literally pass out unconscious after having a shower. Not during the shower, but when she was all dried off and dressed. I asked her doctor what was causing this. He said it was the activity of showering (she was nearly bedbound) would get her blood flowing pretty much and she'd be overcome. She was never unconscious more than a few minutes.
I stopped showering her and we did only bed baths. The fainting stopped.
Then she started passing out while sitting in the wheelchair. If she was in the chair more than 15 or 20 minutes or so, she would pass out. Her doctor said this can happen to people when they become elderly and feeble. He did every test available and found nothing other than what he already knew. This client lived for several years after these fainting spells or "episodes" started.
My mother's friend (85) has been having fainting episodes for about a year now. Her health is all right and her doctor said the same thing as my client's doctor.
Sometimes it's a phenomenon that just happens with elderly people even when their health is pretty stable and there's no crisis happening.
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KaleyBug Feb 2022
It happens when having bowel movements two. My mom passed out twice on the toilet.
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Just a thought-is she on any SSRIs, pain meds, or any other meds that can increase her serotonin levels?
our elders often have poly pharmacy and some are very sensitive to increased levels of serotonin which can result from that.
the fever brings it to mind but I would also expect her to be confused or unusually quiet.
fevers in elders are rare as they don’t often mount such a response to infection. Maybe have a pharmacist review her meds and good luck!
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Well sounds like maybe some type viral. SNF are not clean. Have her have personal body wipes for the days she doesn't shower (they do shower you less than needed) have her clean her hands and make the staff clean their hands. Seriously
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KaleyBug Feb 2022
I agree they do not wash hands of those that need assistance before meals.
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Ninety is a good long life. Cover the necessary things, keep her comfortable and just let Nature take it's course. Old people are the cash cow of the medical establishment and trust me they will keep the tests going until they find something to treat. Got to be your Mom's advocate and don't let them go overboard. I also am old and I find myself reining in my doctor when he goes too far.
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SonCaringForMom Feb 2022
I agree. Long life is great, but it has to end eventually. Making the end comfortable is what I hope for.
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I think a urologist is the answer. She might be having small bladder or kidney stones. These can also cause infections. It's possible that the first antibiotic in January was appropriate for that infection. The February infection may not have been susceptible to the antibiotic.
Convince Mom to go to the urologist and accompany her. Remind her that going to a doctor is not invasive. Some recommended procedures do not hurt and could be performed quickly. This could provide valuable information.
Best wishes.
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Is she having Kidney pain in the Back ? or any Kind of pain ? Someone mentioned intercystial cystitis - I had that the pain was excruciating . I got it from using foam in the Diaphragm . basically I changed My diet and ate simply - The white diet - Baked potatoes, rice and crackers - no spices or anything acidic , water and tea , no fats - eventually the intercystial cystitis went away but it was a painful few Months . The doctors really did Not help . I was allergic to the foam . My Mom Got a bad case of C-Fids ( Not sure if this is the name _ after being in a rehab and had a terrible open bedsore . Does she have any bedsores ? That could also be a cause of Infection - check her back . is she having any Diarrhea ? That is C-diff - it goes around in a Nursing home. I would respect your Mothers wishes at her age I would Not want anyone Poking and prodding me .
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KaleyBug Feb 2022
C-diff is the what you mean. Contagious also
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Dr. Ashley Winter, urologist,
recommends vaginal estradiol to keep all menopausal women UTI free. Ask your GP.
e.g. Vagirux
Estradiol (10mcg vagnal insert)

Check for aspiration.
Will cause oxygen saturation issues, fevers, muscle weakness as lungs are impacted. Comes and goes as body fights lung infection, then is re-infected by foodstuffs/liquids.
.
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JoAnn29 Feb 2022
This is an Estrogen. Can cause cancer in post menopausal women. Estrogen feeds tumors.
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A heart or blood pressure issue?
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Recheck for UTI.

My mom did exactly same--sometimes being hospitalized.

It was ALWAYS UTI.
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have a cath urine collected…
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Sendhelp Feb 2022
Zmchipmunk21
Feb 19, 2022
Thank you! The urine specimens were gathered using a cath catch(?). I don't understand how they could be "contaminated"
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I've seen this happen with so many people and in the end, Drs. recommended low doses of antibiotic daily. Basically, to ward it off before it has a chance to grow. Otherwise, I have no idea. I hope you can get some peace on this.
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towards the end of my moms life she kept having repeated infections. Repeated bacterial pneumonia .

she was not taking pills very well so I asked the doctors for IV infusion of antibiotics. she had daily infusion of meds. Not sure how much it helped her body was so weak by then. But maybe it’s another option that may help in your mom case.
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I had similar eposides while I was in a rehab facility after surgery for a broken foot. After lying down in rehab, when I got up and walked around for a while, lost stepping (almost fainted), and a cardiogist cut one of my heart medication in half (imdur). I was also prone to UTIs often, which finally stopped, by taking a capsule of 30,000mg of cranberry concentrate daily. Drinking cranberry juice and/or OTC cranberry vitamin didn't help at all (too small a dose). Have them do a urine culture...takes about a week. The UTIs wreck havoc on your body. And I've had no problem in 2 years. Here's hoping this helps. Good health to your Mom.
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JoAnn29 Feb 2022
Cranberry juice has sugar in it so not good. My Mom took cranberry in pill form.
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As many have said, I would check for UTI. My mother (85) gets a very similar issue - nondescript feeling of overwhelming fatigue, weakness, dizzy, no appetite. Turns out it is UTI related - doctor put her on Macrobid which perked her back up and she gets stronger each day. I am learning that the UTIs can wreak havoc and unfortunately many older women are very prone to them. The cultures can also be a bit murky in terms of helping interpret what's going on. We are seeing a urologist soon to see if there is anything we can do preventative - I think we have tried most of the suggestions here. Best of luck to you!
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zmchipmunk21: She should see her urologist posthaste for a complete urinalysis. Oftentimes cultures do get contaminated. She needs to see her specialist in case she may have a U.T.I.
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