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Hi all, my mother had a stroke in October of 2010 which left her with short term memory issues and poor balance. She can walk with a walker. She is 89. She refused to do physical therapy or leave the house and as a consequence sits all day and is extremely inactive. Her condition has slowly deteriorated and this past December she contracted shingles and has since recovered, but just hasn't seemed to be able to bounce back. In the past 2 weeks she is sleeping almost constantly. She wakes up during the night and dozes in the chair. She is groggy for the short periods of time she is awake. She lives with my brother but I spend 2 nights a week at her house to help out and give him a break. On this last visit she slept the entire day and into the late evening both days I was there. I had to wake her for meals. She seems to have a semi-alert period from about 9 to 12 at night, and then starts to fall asleep again. In addition to this, she has swelling in her feet and legs, and one leg is worse. I also suspect she that she might have a urinary tract infection because she frequently has the urge to go but doesn't actually have to. Her appetite has also decreased a little. She seems to have become more frail and weak in the past few weeks. She was at the doctor last month (was doing better then compared to now) and at that time everything was within normal limits . She doesn't have any health issues. She takes Aggronox, vesicare, synthroid, and folic acid. I am shocked she is doing this badly, because other than the stroke she hasn't had any other health problems. She has been taking Lexapro for about a month and a half and it seems to have improved her mood. The problem is she can't stay awake long enough to be in a good mood!

She has a doctor's appointment on Monday but I am very afraid she will not be awake enough to make it. In addition, I fear the doctor might want to hospitalize her and he has privileges at a hospital that I feel is of poor quality and that I dread going to. She was there for 2 days after her stroke and it was a nightmare.
I think I would prefer to take her to the emergency room of another hospital that is closer and in my opinion of a higher caliber. We could take her at night during her semi-alert period. I am thinking that she might be admitted to that hospital because I can't help but think further tests are going to need to be done to determine what is going on with her. Is this acceptable? Will it be an issue if we break rank with her primary care doctor? Frankly, I have not been that happy with this doctor and think it might be better if we get another medical opinion of her condition. Thank you very much for reading this and I will greatly appreciate any thoughts, opinions, and advice that any of you have to offer as to what could be causing this excessive sleeping and the correct thing to do to get her medical care. Oh, another concern I have is what to do if she refuses to leave the house to get medical treatment.

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I don't know what state you live in but Medicare has revamped it's care and is asking people to choose a primary care doctor that is within their program. This greatly reduces share of cost should that apply and is oftentimes fully funded by Medicare. You can follow your plan to take her in to the ER but if it's by ambulance, plan to receive a hefty bill. They will take her most probably immediately however. If you bring her in yourself, plan on a long wait. Our hospital here it seems the ER is always packed 24/7. I'm not much of a fan of pharmaceutical drugs. They fix one thing but make problems with something else and could be interacting with other drugs to produce a negative reaction. Maybe the sleep is her way of winding down her life. I would just let her sleep but you must have her looked after. Maybe it's time for assisted living for your mom where she will be monitored at all times.
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I would insist the hospital run tests for sepsis. My mother got sent home from an evaluation on a Friday, after getting a little hydration fluid, feeling pretty good. The following Monday was rushed to the ER with a temp of 102. She had an infected Parotid gland, they missed with bloodwork, CT scan and chest xrays. By that Friday, her kidneys couldn't keep up with all the fluids they were giving her, it backed up into her lungs and I lost her.
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I would insist the hospital run tests for sepsis. My mother got sent home from an evaluation on a Friday, after getting a little hydration fluid, feeling pretty good. The following Monday was rushed to the ER with a temp of 102. She had an infected Parotid gland, they missed with bloodwork, CT scan and chest xrays. By that Friday, her kidneys couldn't keep up with all the fluids they were giving her, it backed up into her lungs and I lost her.
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And Jayne, you are thinking this is overwhelming now, and it has not begun yet. Wait until it does. If she comes home it will become very overwhelming to say nothing of increased difficulty much more to find appropriate placement.
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Jayne, because of insurance, she should be admitted, not under observation. I do not understand the impacts but maybe someone else here does. They may be doing that because she was just in last week.

If you cannot handle her, this is the time to tell people at hospital that you are not able to provide the care she needs. STAND YOUR GROUND! They will have to find placement for her.

If you think your brother will not be able to handle it, you are probably right, you know him very well.
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Thank you all - LearningCurve, thanks for the tips, been pushing the fluids luckily she likes cranberry juice.

Thanks Cyn111 - yes, I believe my mother qualifies for this because she's been prescribed oxygen.

Crazy time here - my mother declined each day she was home - by yesterday she couldn't stay awake for any length of time - extremely weak and unresponsive. Can't walk. My poor brother still managed to get some food and liquids in her, bless his heart. He had to feed her. She's so weak she can't do anything for herself. I arrived at her house this morning and she was so unresponsive we called an ambulance. Did a bunch of tests and there's nothing physically wrong with her. Not even evidence of a UTI. We're shocked - we thought she'd be doing better after getting treatment for the infection. I think the hospital was going to send us home. I have no idea how we would even manage that right now. Now they're going to keep her overnight for observation. But bottom-line is we are going to have to take her home, and it is overwhelming. My brother is willing to care for her, with me coming two times a week, but it just seems like too much for one person. We're thinking a hospital bed for the living room, and using a bedpan. But how are we going to bathe her? Obviously we are going to have to have help come in. I can't believe this, it's such a mess.
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Jayne30: It takes 2 days (48 hours) for a proper culture to develop and determine a UTI. The UTI your mom had may not have completely gone away and has resurfaced.
I have heard that a low dose antibiotic for an extended amount of time works well with UTIs that will not go away but doctors are reluctant to use this cure because they and the Hospitals don't make money on it.
Regarding hydration: Try a straw....my mom has trouble holding onto a cup/glass and is embarrassed by it. When we use a straw her pride doesn't keep her from drinking fluids. Of course my mom likes being babied too and your mom may be offended, so ask her if she would like a straw/if it might make it easier for her.
Cranberry and tomato juices have uric acids to keep the bladder clean so push those.
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Ask your Mom's doctor for a visit from a home care nurse for an evaluation of needs that can be met at home… my Mom had eval after I called Mom's primary care dr and spoke with her triage nurse… he got ball rolling so fast! Home care orders for eval signed by dr that morning and nurse in our home for eval 2 days later (had to wait over weekend as talked to triage nurse Friday morning)… Mom qualified for nurse visits 2x week for eval of her… home health aide 1x week to help with bath… physical therapy 2x week to help with balance and other issues… speech therapist 2x week for swallowing issues… social worker 4 visits to help identify other needs… ALL for up to 16 weeks paid by Medicare as they termed my Mom as "house-bound" temporarily… all this was a HUGE help as I was at wits end and badly burned out… and all it took was phonevcall and tears with the right NURSE… have been a nurse for 25 years and have set up same for other families… nurses are great resource as they have a bit more time with patient/family and doctor's ear… good luck!
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Thank you all!

Loridtabbycat, I agree, people on the site really know their stuff! Good luck, hope your mother's recovery goes smoothly.

Thanks blannie - I've noticed that my mother definitely perks up even just riding in the car - I have tried for years to get her to out and she just refuses. Right now she is still so tired and weak I don't think it's an option. In fact, I'm supposed to take her to her PCP on Monday and am nervous about getting her there. I feel like I'm back to square one. I agree, it's amazing how elderly people can "turn on" when they are around other people. Thanks for the link on the cameras, am checking it out.

Bamboo, you are probably right, she probably just can't generate enough energy on her own.

Not sure what to do here, she's very weak, groggy, and sleepy - not sure how we're going to manage bathing and just basic daily functions. Quick question - is it possible she's recovering from the uti and that's causing this weakness and sleepiness, and she'll feel better once it's completely cleared up? Not sure what's causing it - dehydration, the uti, a combination, or something else. Should she be doing better at this point? We're getting her to drink as much fluids as possible. I don't know, I have a feeling we're going to be heading back to the er. But I'm afraid the same pattern will just repeat itself.

Is at home intravenous fluids an option for us?

Also, anyone use a bed alarm or have recommendations for a good one?

A major THANK YOU to all!
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My grandma who suffered from Parkinson's is going through similar situation. She's very weak and sleeps most of the day. One day my mom took her to hospital where she got fluid with drugs and nutrient, she found her energy back for the next 2 or 3 days then fell back to the long sleeping pattern again. I think the fluid and oxygen was probably the reason why your mom felt so energetic the next day. Unfortunately, her body can not produce enough energy itself. It's sad but I think it's how it's gonna be when people get older
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Jayne, so a UTI?! It sounded possible. Symptoms from a UTI in the elderly, especially those with dementia, run the gamut. My mom was hospitalized almost a year ago with stroke symptoms, couldn't walk, and speech was very garbled. I called 911 they thought a stroke, EMT's when they arrived, saw her, also thought a stroke, ER staff also thought a stroke. It was not a stroke, but a UTI that required hospitalization for three days.

Do not hesitate to get your Mom back to the ER. Maybe they discharged her too soon. If she is readmitted within three days of discharge Medicare will ding the hospital because of discharge too soon. A new way to increase hospital accountability.
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Here are the threads about putting cameras in rooms - lots to read!

https://www.agingcare.com/search.aspx?searchterm=camera
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Yes, you should be able to set up a camera that you can watch. If you do a search of this site, you'll see some threads about this topic. I'm not sure about setting up some kind of communication system where you could talk directly to her if she starts to get up - others might have more info on that.

I had a situation with my 94-year old mom where she was sleeping a LOT and her appetite had gone to nothing. It was a vicious circle. I told my brother and cousin that we were nearing the end, that mom would be gone in three months. We wound up in the ER and she was dehydrated among other things. So keeping your mom hydrated is critical. Now I fix my mom a big glass of water each day that she has to drink and we talk a lot about drinking enough water, because she has no short-term memory. She also gets a lot of fresh fruit, which has natural water in it.

In the eight weeks since her ER visit, she's gained 14 lbs and is back to being her normal alert self. But I had to get enough good food in her and keep her rehydrated to get this far.

I have also started taking her out. I use a companion chair, so we can go to restaurants or to the Dollar Store. I always see a tremendous mental boost when I get mom out of her apartment, even though she's "happy" staying at home. Just being around other people and kids and seeing trees and cars, etc. is a nice change of pace for her. So even though your mom wants to sit around, see if you can cajole her into getting out more - it should improve her mental outlook.

Also make sure she elevates her feet as much as possible to help with the swelling.

It can be frustrating and hilarious sometimes how much better our loved ones are when they're at the doctor's office or in the hospital. It's "show time" for them and they can put on quite the show. Once they get home, they're immediately back to having the issues you took them there for in the first place. When I took my mom to the ER (because she'd called me to go), by the time we got there, the nurse asked mom why we were there and mom turned, pointed to me and said, "I don't know, ask HER." Whaaaaaaa? I just had to laugh. Good luck with your mom and keep us posted.
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Wow, a simple UTI can cause all this!! Thank you for the information it may come in handy in the future. Right now I'm just dealing with Hip Replacement recovery with a Mom that is 76 yrs. You folks sound like professionals!
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Can't edit, didn't mean while he's sleeping, meant while he's out running errands, sorry.
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Thank you so much for your comments LearningCurve, very helpful information. Yes, I wish us all well too, and that we can all reach a place of peace and that things are taken care of to the best of our ability.

Am finding myself very worried about my mother not being supervised while my brother is out. Was talking to my daughter (younger generation is so tech - savvy) and she suggested a video camera so that I can at least watch my mother when I'm at my house and make sure she doesn't get up while he's sleeping, she said there might even be a way to set up a speaker so I can talk to my mother and tell her to stay put - I know they do this for babies and kids, what about old people? I know it sounds crazy but it would give me peace of mind. My daughter also suggested a bed alarm for night. Off to research, but is this an option do you think?
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A rollercoaster of good and bad days I know all too well.
Sleeping in her chair can cause the swelling in her legs also. Try to elevate them. Beware of hyponytremia with Lasix. It can cause a vicious circle with Thyroid/Kidney and loss of Sodium retention. The sodium # should be in the 130s, any lower is a problem.
Signs I've learned for UTI:
Dehydration - If you lightly pinch/pull up the skin and it doesn't bounce back.
Sleepiness - excessive
Lack of appetite
Weakness - Overall & unexplained.
Forgetting to hydrate - Minimal fluid intake
Loss of bladder & fecal control - extreme
Low Blood Pressure - Usually from dehydration

Medications are such a delicate balance & are subject to regular tweaking. Because BP is so affected by UTIs, the meds are difficult to adjust. If a doctor uses the "puppy mill" approach to medicine it's time to find a new one. I recently had a rehab facility report back to me within hours that my mom's UTI was negative. I now know it takes 48 hours for a proper culture & she may well have had the same one lingering for the last three months.
I pray divine intervention, peace and protection for us all.
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Jessie, she is on 10 mg.

Everyone was so kind to respond to my question that I wanted to post an update, and also would like to hear any comments or advice you might have about the current situation with my mother.

I has turned out to be a crazy week - we ended up taking my mother to an urgent care facility on Monday, late afternoon. A compromise on my part, I wanted to go straight to an er but I did what my brother and sister were leaning towards (in hindsight it worked out ok, doctor there advised going to a specific hospital) I won't go into the details of how difficult and stressful these past few days have been, I'm sure many of you are all too familiar with that. It was determined at urgent care that she had a UTI and we were told to take her to the ER and the docs there felt she should be admitted. One doc felt that a small cut on her leg could be infected and causing the swelling in her leg and foot, so bottom line is they but her on intravenous antibiotics and fluids (also determined she's dehydrated). One doc also picked up a slight heart murmur, which is a first, have never had any indication of this the whole time I've been caring for her. They didn't seem overly concerned and said it happens in elderly people sometimes. She was supposed to be released on Tuesday but when we arrived at the hospital were told doc was concerned about oxygen level (87 without oxygen) so she was kept overnight for observation and it was determined that she needs oxygen, which has proved to be an added complication to everything but obviously she needs it.

When I arrived at the hospital on Wednesday I could not believe the positive change in her - alert, laughing, conversing, engaged, and frankly just acting normal. I have not seen her like this since she's had her stroke. I was glad to see it, but honestly it was a little surreal because it was such a big change. My brother and I brought her home and I stayed overnight. Unfortunately, the next day she was back to being very groggy and she seemed confused upon wakening. Extremely disappointing after seeing how well she was doing the previous day. She also seems weak and wobbly to the point where we're afraid to leave her alone. (she uses a walker). She also seems kind of unaware as to how badly she is doing and is getting up at night and moving around. I came home late yesterday (I live a little over an hour away) and am very anxious about my brother handling all of this. We're all feeling very overwhelmed by this change of events and I am completely stressed out. I don't handle stress very well so I am not well-equipped to deal with all of this, haven't been eating but am trying to take of myself so I can be a help instead of a hindrance. Unfortunately, my brother has been having trouble sleeping so I feel this is all just one big mess right now. Don't know if my mother's decline is just due to recovering from this uti, and perhaps as time goes by she will regain some strength and be able to get around better. I just don't know.

I am pushing to have a health care aid for a part of the day- as is typical of these situations money is an issue, my mother has a small amount in savings, would probably last a few months. I am frustrated as to why we're not doing this, my brother is fighting doing this for some reason but he might change his tune after he's on his own with her. Siblings are willing to pay after that. Putting her in a nursing home is complicated because unfortunately my bother's life savings has been in her name up until recently and is subject to the medicaid look back period. I know, I know, extremely stupid on our part, we were so ignorant, but that is the reality of the situation.

Oh, with regard to anti-depressant, we were told to stop giving it to her for now, but due to miscommunication she was given it in the hospital anyway. I guess we'll stop for now and see what happens.

Thanks to those who read this whole tale of woe, any comments or thoughts would be greatly appreciated. What a great site this is.
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I forgot to ask. Is she on 10 mg Lexapro a day?
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Thank you for the tips gardenartist, she won't want to do exercises but I am going to put my foot down if they are recommended. Very frustrated - she wasn't willing to do any exercises or PT after the stroke and unfortunately and I think she is paying the price now. Her stroke wasn't severe in the sense that she suffered no paralysis and can walk with a walker. Her speech wasn't affected and she could do basic things for herself. But I think she suffered from depression right off the bat and just could not seem to accomadate the effects of the stroke. We tried very hard to keep her active but as time went on she got more resistant and eventually just refused to do anything. She would look at the walker and say "I don't want to go anywhere because I have to use THAT thing". Sigh. That's why she eventually ended up being prescribed the anti-depressant.
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Jessiebelle, I have been thinking that perhaps my mother is nearing the end of her life. Not sure about the blood pressure, but it was within normal limits last month at the doctor. She is mentioning she feels cold a little more often and her appetite has decreased a little. Ironically, she is in a good mood for the short period of time she is awake. She likes watching Jimmy Kimmel and laughs during it. I have to accept the possibility that she might be beginning the dying process. One thing is for sure, she needs a decent evaluation to find out what the heck is going on. We might have to resort to calling an ambulance, if she agrees to go. She refused an ambulance while she was having her stroke. (my brother wasn't home but called one) Thank you for your help!
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Jayne, antidepressants take awhile to build up in the system. Maybe the sleeping is a result of that and once her system has adjusted to it she will be less sleepy.
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Jayne, you might ask the doctor if he'll prescribe home therapy for your mother so she can exercise her legs.

If she's not on Warfarin/Coumadin (and I don't think you mentioned it), some foods (with vitamin K) are also diuretics - parsley and celery are two. Just don't give her celery before bedtime; eat it during the morning or early afternoon.

livestrong/article/84264-foods-drinks-natural-diuretics/
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BTW, I just compared the structures of Lexapro and Celexa. She would probably have the same outcome with Celexa. They look like siblings with a different hair-do.
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Jayne, one of the problems with elders leading a sedentary life is that fluids can pool in their legs. Veins are not as good when people age, so they need the muscular movement of their calves to help massage the fluids back in the right direction. Older people who sit all day often end up with edema in the feet and ankles. Two things can help -- exercise and Lasix, though I don't know if her doctor will want to try the Lasix.

Something else that occurred to me is that your mother may be approaching the end of her life. It is fairly normal for elders to sleep more as they approach the end. However, there are other signs as well, such as lower bp and temperature and depressed appetite. You didn't mention these things, so Lexapro sounds like the primary suspect. Has it helped to elevate her mood yet in the little time she is awake? Having an antidepressant that just makes her sleep all the time doesn't sound useful. I wonder if another, e.g. Celexa, would set with her better. Talk with her doctor and see what he/she thinks. I have a feeling both of your concerns are linked to the same problem -- her recent inactivity.
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Thank you all for your help and thoughts!!!

Gladimhere, the Lexapro is a possibility - I knew that drowsiness and sleepiness were side effects, but I guess I assumed we would see that early on and she would get used to the medication. She's been taking it for 6 weeks. We give it to her at night - you would think it would help her sleep at night, but she is awake on and off throughout the night. But elderly people react differently to meds, and maybe it's building up in her system. I feel dumb, and I really don't know - I will certainly explore this with the doctor. Thank you!

Elaine, I kind of thought she wasn't on that much medication! Aggronox to prevent stroke, vesicare for bladder control, synthroid for thyroid which she's taken since she was 25, folic acid - also stroke related, and lexapro for depression. She has no other health issues - no heart problems, no diabetes, hypertension, blood pressure is good. Of course, it looks like something is going on with her legs, possible circulation problems. As I've said, she sits all day and all night and I think it's taking it's toll . But I will look into her meds with the doctor, thanks for your help!

Thank you all, you have given me very helpful advice and I will let you know how this turns out.
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Flyer, I thought the doses were already supposed to be based on age and weight??? (Where are those emoticons when I want a grinning face???) This is the first site I've been on that doesn't have emoticons.

Isn't it strange that something that was normal decades ago is now considered organic? I understand there's even a category within organic to differentiate, but I'm not sure what the distinctions are.

I wish I could find the video shown at the hearing I watched a few years ago of the conditions at emerging market plants. The sites were horrific. I couldn't even think of being around them let alone buy medicines that may or may not have been sourced there.

That's another issue - I think pharmas should be required to list all the ingredients in their meds and the origin of those ingredients. But that will never happen.
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GardenArtist, maybe it doesn't mean anything, but for a long time I thought people should be given dosage depending on their age and weight.... should a 90 year old woman who weights 95 pounds be given the same dosage as a 35 year old man who weight 220 pounds? Any time I get a new prescription for anything, I cut it in half for the first week, with doctor approval.

I've been trying to get my Mom and Dad to eat more organic food.... it was a struggle at first because the sound of the actual word "organic" didn't sit right with my Mom.... eventually I was able to convince her that organic is how her own Mother use to cook back in the early 1900's back on the farm.
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Flyer, you also make a good point. I've thought for years that people in general, especially the elderly, are overmedicated. The SNFs that I've had experience with are guilty of that - the number of meds prescribed doubles after intake. I have to negotiate with the nurses to ask the doctors why all this stuff is needed, which it's not.

Western medicine has benefited by the advance of medications for almost every purpose, but the question of how much is really necessary vs. what could be addressed more safely by food and nutrition is an issue that's long overdue for consideration.
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Elaine14, you make a good point. I really believe that we all, no matter what our age, are taking too many prescription medicines, and too many unnecessary vitamins.

After a recent visit to the ER and an over night stay, my Dad was taken off one of his blood pressure pills.... he is still on BP meds but not so many.... in just one day it seemed like his mind was thinking clearer. After seeing that, I decided to reduce my own BP dosage just a tad and noticed I felt better... I can always go back to the required dosage if I "feel" I need it..... my Cardiologist is ok with me doing that as long as I see her every 6 months.
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