Stroke, Bladder Infection or Medication side effects…

My client, an 89 year old retired physicist-astronomer, has had four urinary tract infections in the last 18 months.

Now, with Parkinson’s- related dementia, he’s had a few hallucinatory bouts over the last 18 months, like the time he thought a Poinsettia was a real dwarf- but normally these episodes are short and not very dramatic.  He has Parkinson’s dementia, a much milder version than Alzheimer’s dementia in most cases. With 5 million people in the United States with dementia (50 million worldwide), acute illnesses and infections can strongly exacerbate their underlying chronic condition. This is important to understand.

Recently, on one of my off days, his wife noticed sudden and severe changes in my client’s emotional and neurological function. He was confused, hostile and near to delirium.  She rushed him to Urgent Care, thinking he’d had a stroke.  My client’s wife was triggered emotionally by his sudden change and forgot that he has gone through this pattern before, the last time 5 months ago.

The Urgent Care people did a CAT scan and found nothing. He had signs of an acute ailment and they soon isolated the issue- a urinary tract infection.

The telltale signs of bladder infection (typically from the E Coli bacteria and normally treated with a course of antibiotics) is frequent and painful urination but these do not always apply to the elderly- especially when one has a form of dementia, in his case Parkinson’s-related.  I asked my client during his last infection if he was having painful urination and he said no, twice. Finally on the third time, he admitted that it was painful!

The danger comes- in these chronic cases- when the bacteria invades the upper urinary tract, that is, the kidney area.  This can lead to life threatening urosepsis.  The early signs of a UTI invading the kidney area and heading towards urosepsis are:

  • patches of discolored skin.
  • decreased urination.
  • changes in mental ability.
  • problems breathing.
  • abnormal heart functions.
  • unconsciousness

My client’s wife asked me to limit his fluid consumption over previous two weeks before the infection, since he also has urinary incontinence.  She had not been sleeping well, forced to get up many times during the night.  It was a perfectly understandable request in a difficult situation.  She was trying to manage one condition but the side effects: dehydration and constipation, may have been the bladder infection precursors.

We are back to our full water plan which means that she will be in chronic sleep deficit and living off power naps.  This is what millions of saintly women do as they care for their beloveds at the end of their lives.  God bless them!

(*Weeks later it was found (per lab tests) that my client never had a bladder infection and the issues and symptoms he experienced were thought to be part of an escalation of his Parkinson’s-related dementia–when in truth they were SIDE-EFFECTS from his Parkinson’s medication.)

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