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UmbraRyu Asked November 2022

My 70 year old mom is in rehabilitation after Covid and possible ketoacidosis. She was fine and now a sudden decline. Any advice?

We got Covid in October and the medicine they gave her shot her blood sugar to 890. I took her to the hospital and she had dehydration and low potassium. (Also her cortisol levels were low) She was in the hospital for about a week and then released to a nursing home/rehabilitation center to help her and then she was coming back home. She did have small confusion (she couldn’t remember how to answer her phone) and struggling to come up with words, but that was contributed to brain fog from Covid. She scored a 21 out of 30 on her MoCA test but they said that should improve with speech therapy and as the brain fog clears. She had a couple hallucinations and a little paranoia. (Was concerned if that might have been delirium) and she was about to be released in a couple week. Last Wednesday, her phone feel under her bed and she tried to get it and fell out of the bed and hit the floor. All she complained about was her elbow and she said she didn’t hit her head. The next day (Thursday) she had a little more confusion and some hallucinations but I didn’t think too much because I keep chalking everything up to brain fog. The next day (Friday) I get a call saying she is out of it and when a nurse tries to take her blood pressure the night before she screamed and hit at her. (She has never done this kind of behavior before.) I went up there and they were having to feed her her lunch because she couldn’t even bring the fork correctly to her mouth. I finished helping feed her and she couldn’t even speak in a complete sentence and struggled to talk. I took her to her room and she went to bed immediately and slept most of that day. The next two days (Saturday and Sunday) still bad. I asked them since she started this after her fall, could she have hit her head and have a concussion and need a CT scan. They said she didn’t hit her head and she didn’t complain about that. They checked her for a UTI and it was clean and her blood work shows normal. The next two days (Monday and Tuesday) she would be okay in the morning then after her medicine about and hour and a half later, she would look drugged out and can’t barely hold herself up. She also said she is having depth perception problems and dropping things. (I took some videos and everyone says she looks drugged out and on something.) After again asking for a CT scan they finally agreed (though it sounded like their idea.) but their doctor said he doesn’t think that is it and it is probably be dementia. (Her mother died of dementia about three years ago and I have feared my mom might get it.) The only other time I seen her like this, but not this bad, was when she was in another Skilled Nursing Facility last year and they kept trying to get me to admit her saying she had cognitive decline, we think they were drugging her because she would act confused and paranoid and once she got home, she had one more episode of that a week later then was fine until now. So I don’t know what to do or think. Several nurses and nurses assistance said they noticed a huge change and decline after her fall. It makes me upset that I have been saying this and asking for a CT scan for almost a week and now they suddenly want to do it. I don’t know if I can trust them here or if they are even going to give me the correct results or are they going to try to make me put her in permanently, which I am not because both of us want her home. Any help would be much appreciated because I don’t know where to turn.

MJ1929 Nov 2022
In my opinion, rehab is never the place to get a diagnosis of anything. Medical care in rehab is not top-tier and instead is kind of like bringing up the back end of recovery after diagnosis and treatment has already occurred.

I'd say your mom needs to go back to a real hospital to determine what exactly is going on.

UmbraRyu Nov 2022
(Update) She is getting a CT scan tomorrow, but there is something odd I found out. She is supposed to take Wellbutrin SR 150 mg in the morning and 150 mg in the afternoon. Suddenly either the hospital or rehabilitation places changed it to Wellbutrin Extended Release 300 mg in the morning and Extended Release 300 mg at night. I call her psychiatrist and they said no they didn’t change it and that is way too high. All that extra in the course of a month can explain a lot of this decline and that they want a copy of the CT to see if there is a build up of Wellbutrin or if it is old age changes. I am wondering who changed her medicine and why they didn’t consult with her psychiatrist. She has a appointment to see them next week.

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lealonnie1 Nov 2022
How does the SNF know she 'didn't hit her head' in the fall? Off to the ER she goes, that decision gets my vote too. Although it's quite possible she's declining mentally due to Covid and other criteria, but first you need to eliminate OTHER organic issues at play.

BTW, the SNF cannot 'make' your mother stay there permanently, so remove that thought from your mind. If she's not capable of coming home safely, THEN you have a decision to make, but don't put the cart before the horse.

GOOD LUCK!

BarbBrooklyn Nov 2022
Umbra, I have to agree. Get her to the ER now if this was an unwitnessed fall.

JoAnn29 Nov 2022
You demand they send her to a hospital if they refuse, you call the ambulance and get your Mom to the hospital. Rehabs are not skilled nursing. I was told by the Nurse at Moms LTC that if she fell and it was not seen by a staff member to verify that she had not hit her head, its assumed she did hit her head and would be sent to the hospital. I am really surprised she wasn't sent when she seemed to get worse.

When Mom is released to Rehab again, request another one. Do not send her back to this one. Oh, make sure they test for a UTI too.

NYDaughterInLaw Nov 2022
I've seen this in several frail and elderly neighbors who got COVID and it was the beginning of their significant cognitive and/or physical decline. Some never made it out of the hospital and some ended up in a nursing home. The ones who did make it back home had aged significantly and it was shocking to see them again. On top of COVID, your mother has diabetes, which is known to increase the rate of aging in many ways. The sudden decline you see in your mother may not be reversible. She definitely needs more care than you can give.
Fawnby Nov 2022
I've observed exactly the same thing in elderly who had Covid. I wish this was discussed and made known more widely. This isn't a political feeling, it's what IS, and the reality is getting buried under "we're over it." I'm not "over it" until my friends stop being buried.
Fawnby Nov 2022
Well, this is an object lesson about why we and our loved ones should all be doing our best to avoid getting Covid. It is very dangerous for the elderly and brings on the difficulties that are described here. I've seen it in friends and relatives, some of whom have died of either Covid or the complications in the aftermath, which can ultimately cause death.

What we have here is a seriously ill person, and Umbra, I don't believe you should even think about bringing her home. My sympathies to you; it's sad. Yes, there can be a huge decline after a fall, particularly with all the things your mom has going on. You can't possibly be prepared to take her home at present. The kind of care she needs is hands-on full-time care. That's almost impossible for one person to do even with help. And about falls in the elderly - it doesn't have to be a direct head blow or concussion to cause confusion, depth perception issues or other things you describe. She may have other diseases or issues that you don't know about yet. Faulty vision, faulty hearing, balance problems etc., so she should be checked for those. If her doctor isn't a geriatric specialist, she should switch to one now.

Look at the facility's consent to do a CT scan as finally getting your own way, so believe that they listen to you. Why wouldn't they give you correct results? Why wouldn't they have the patient's best interests in mind? What I learned in taking care of multiple LOs is that I don't have the medical knowledge of those in the health care profession. There is so much to know, and they have trained for it. I haven't. I learned to trust, though I've done a lot of Googling also, and it's good to confirm what they say.

Good luck with your mom - but please don't take her home even though you think you both want that. She needs a higher level of care than you can provide.
UmbraRyu Dec 2022
Sorry but we took every precaution to prevent Covid, we didn’t get it for over two years. I can’t force people at my work to wear masks, I can’t force people at her doctor’s appointments to wear masks. Please don’t make it sound like we didn’t take precautions because we did, I still wore a mask even without with being mandatory. Also and update, they have been overdosing her on Wellbutrin for over a month with a dangerous dosage. I worked several days to get this corrected and even though she is now going through withdrawals, she is getting back to her old self. Hard to trust a place that is overdosing.
babsjvd Nov 2022
Is there a primary doctor in the picture ? Call Dr s nurse and have a conversation. A lot more than Covid is probably going on…
UmbraRyu Nov 2022
No I called them and they didn’t know anything about here being admitted or anything.

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