Recovering from anesthesia; we're not seeing improvement as fast as we thought we'd see. Any thoughts?


I'm not sure where this goes as it's quite a complex issue. Mom is 80 and has some dementia. She's also been having chronic UTIs the last few years. Mom had to go to the hospital on New Year's Day with a bad UTI. Once released a week later, she went to rehab only to have another UTI. In the last 60 days, she's had four UTIs (or one they can't get rid of) and is now back in the hospital. The other issue is that she has a compression fracture in her lower spine causing her great pain. They found this by doing a MRI where she had to have anesthesia because she moved around too much when they tried it the day before. Since that time, she's been very lethargic. She sleeps most the time, has no appetite and crys a lot. We're now four days removed from the time she was on anesthesia for her MRI. The docs say her UTI is gone after three days of IV antibiotics. She was on morphine a few days due to the intensity of her back pain. She was taken off it three days ago. She hadn't eaten anything for five days until last night when she had a Ensure-like product and a popsicle. She still has no appetite. Can't talk (but babbles sometimes). She totally looks out of it for most of the time. We're not seeing improvement as fast as we thought we'd see. They won't put her in a back brace until she's more cognitive. She's got to eat more soon or they will use a feeding tube. She won't take her usual meds either (diabetes, cholesterol, blood pressure). Anyone have any thoughts on this? We're very worried.

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She has been in and out of hospitals in quite a rapid pace "revolving door" At her age she may be suffering from delirium or she may be in the state of "failure to thrive". She may need high pain meds that make her too sleepy. Can the fracture be fixed Or improved with rehab? Feeding tubes are big decisions that can be temporary or permanent. Three months have passed which may mean very long rehab time for which she may max out and may require nursing home or 24 hour care at home with the feeding tube present. You might want to ask for a palliative care consult which is not the same as hospice. Then ask for a family meeting for long term goals of care
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Reply to MACinCT

I would not do the feeding tube at all. Once it is inserted, it can take a court order not to use it. Not for me! I myself don't want a feeding tube as it is the beginning of a cascade of interventions to prolong my life. When I quit eating, let me go! She may be at the beginning of dementia, but she's making the decision to refuse her meds. Listen!
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Reply to surprise

Hi Jeff,
I really encourage you to seek a palliative care consultation. I am a Nurse Anesthetist and I can tell you that even the kyphoplasty will require sedation and the positioning for it is extremely difficult and painful. Sometimes less is more. And the treatments are causing more harm. Comfort care can even get you more days together, interventions can hasten decline.
Best of luck
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Reply to Margaret916

Anesthesia is very difficult on elderly people and they don't often bounce back to where they were prior to the anesthesia. I think she'll need to be assessed for a new baseline.

And I agree with Barb. Get her pain under control. That can only help.
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Reply to Eyerishlass

She's in pain from a compression fracture. Start out by treating the pain (patches, injections, kyphoplasty) and see if she comes back to baseline.

Dementia patients are notoriously bad at reporting pain.
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Reply to BarbBrooklyn

I can tell you from experience, it can take weeks for anesthesia effects to be gone. Although you didn’t say what kind she had..I doubt it was general anesthesia but more likely a sedative like Versed. You should find out. Versed can really mess with the memory of elderly...I’m including my 65 yo self in that and refuse to have it.
If she is babbling have they assessed her for stroke? When my dad was on a narcotic for pain after falling and surgery he also was out of it. We need a bit more info. But agree that care conference is needed assuming she’s still in rehab or skilled nursing.
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Reply to Harpcat

Thanks to all of you for your advice. I wanted to post an update...

Mom still barely eats or drinks. An IV is keeping her hydrated but they want to send her back to rehab today.

Her compression fracture has been painful but they have fitted her with a back brace. They backed off the strong pain meds and are now using Toradol which, I understand, is more an anti-inflammatory. She's six days removed from the morphine. She's not a candidate for surgery.

We tested her again for a UTI and it came back negative. We're a week since the anesthesia used for her MRI (I don't know which one it was but will ask). She's still very confused and sometimes hallucinates but, at times, carries on a decent conversation. It's almost like you can see a light come on in her only to dim again in a few minutes. She does things like fold and refold her pillow cases and rearranges the little table beside her bed. Lots of mood swings. She gets very angry and frustrated at my sis and I only to smile at another visitor.

Mom has a living will which states she doesn't want a feeding tube.

I've been reading a lot about palliative care and hospice. I think our first goal is for Mom to be comfortable before looking to rehab her back. If she's hurting, I can't imagine she'd have the will to rehab. And rehab might just send her right back to the hospital. She's much worse now than when she went in 11 days ago.

I also saw some articles about the late stages of dementia and she has most of the symptoms. Thanks again for all the advice.
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Reply to jeff62

Jeff62: My dad had heart bypass surgery when he was 85 & he was a mess afterwards due to the anesthesia - forgetful, seeing/ hearing things, unable to eat or sleep. Characteristics very unlike him. It took about a month before he was himself.  You're mom's been checked for UTI (plumbing #1), but has plumbing #2 been assessed? Even if she hasn't been eating, she may be constipated which can have very negative effects on the elderly.
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Reply to nature73

I agree with Margaret -- sometimes less is more, as in giving you both more quality time. And I too would call for a palliative care assessment.
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Reply to talkey

Sorry to not have followed up on Mom but it's been crazy.

She was taken back to rehab on Monday only to go back to the hospital on Wednesday. The rehab told me they feared she was having a stroke (face droopy, very disoriented). She was rushed to the ER.

When I got there, I saw her state and I too thought she might have had a stroke. But, within an hour of being on an IV, she starts improving. Her tests come back showing she was dehydrated and has a slight UTI. She'd only been in rehab less than 48 hours after being on an IV in her previous hospital visit. The doc said dehydration does add to the severity of dementia but usually not to the levels we were seeing.

I call the Care Manager at the rehab and, sure enough, she'd been given a opioid for pain relief after I had spoken to her the day before saying that we needed to find alternative ways to relieve her pain as she had a reaction previously when given opioids.

Fast forward to now...

Mom is back in rehab. She is eating well. We have a lot of her favorite drinks now in her room. She was on Lasix (I think) because of swelling and we've removed her from that. We're treating the pain with Tylenol and another arthritis meds. Her primary care physician is supposed to meet with her rehab doc and a pharmacist to work out some pain relief options that agree with the long list of her other meds and Mom's reaction to opioids.

24 hours later back in rehab and all is good so far. I'll follow up once I get information on the pain meds they recommend. Thanks to all for the advice.
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Reply to jeff62

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