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Old 04-04-2016, 01:44 PM
 
Location: Southwest Washington State
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You have gotten lots of good advice here. Posters on this forum are compassionate and knowledgeable.

I just want to add a couple of things. I Googled the side effects of Zoloft and one of them is depressed appetite.

The other thing is about your inability to have a conversation with your mom. My mother had (most likely) vascular dementia, and she did become unable to hold a conversation. Talking to her on the phone became impossible because my mom could not converse. When I was with her in person, I had the best luck telling her funny stories, or talking to her about my adult kids. She always liked to hear about them, until close to the end when she had much more memory loss. My mom lost her ability to carry her end of the conversation later in the disease progression however. I wonder if your mom's surgery has accelerated her decline? If she was given regular anesthetic for her surgery, and if she spent some time in the recovery area before going to a room, she might have suffered effects. There is a known phenomenon of the elderly losing mental function after undergoing surgery.

I hope you are able to find a proper doctor for your mom. I think that is key, and I don't envy you in your search.
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Old 04-04-2016, 01:56 PM
 
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Meds or combination of Meds need to be reviewed in context.

Mom started getting debilitation headaches... she never had before... CT, MRI, Vascular Evaluations, etc. over the course of a year yielded nothing.

I took her to visit family for a couple of weeks and her Aricept and Namenda prescriptions were lost.

Her headaches went away and so did the dizziness and diarrhea.

The most common side effects associated with NAMENDA XR are headache,
diarrhea, and dizziness... exactly what had her down and why thousands were spent on tests.

I'm not a doctor and I can't speak to anything but a probable observed cause and effect and Mom having the exact side effects.

Her face would be physically in pain and she would have to lay down... something she never ever had to do as long as I remember.

Her Doctor said she needs to take it... so I guess the question of quality of life are secondary?
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Old 04-04-2016, 02:07 PM
 
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I just wanted to share with you - in my years working for my client with dementia - it was stated repeatedly by her doctors and caregivers that you often see a deterioration after a fall. Or after any trauma/drama. Or loss. Or surgery.

The person I believe the most is her charge RN who had many years psychiatric experience including at the prison.

My client fell on her face and damaged her teeth and got a face/jaw full of stitches. Prior to that she had what the family called early stage dementia. She leaped into mid stage with a vengeance. She NEVER broke a single bone in her life from decades of playing tennis with very strong bones.

Even my mother WITH NO dementia at all at age 72 had depression and cognitive problems after a somewhat routine but major heart surgery. My ex's wife, an RN Director in charge at an Ivy League University Hospital told me yes it's common in seniors. The anesthesia has longer term adverse reactions in them.

So now you have that, PLUS the trial and error game of psychiatric meds.

Yes get a geriatric doctor. BUT remember, lots of the GPs DO prescribe psychiatric meds and SHOULD NOT. IMO and IME it should ONLY be a psychiatrist who has experience in these things.

That happened to my client who quickly went downhill before her death with alot of drama. Which was going to happen anyway but it would have been nice to not have to deal with the confusion of all the med adverse reactions causing PHYSICAL PROBLEMS like complete IMMEDIATE loss of her muscle tone. Which then prevented her from walking and eating. AND PNEUMONIA because she aspirated.

The psych med was strong. AND not supposed to be given to dementia seniors. Right on the package insert and warnings. It was Seroquel. I googled it because her CHARGE NURSE didn't want her to have it but the doctor insisted. There were zillions of people online sharing their own psychiatric adverse reactions on it who demanded they come off it. Sometimes the BEST source of info on psychiatric med side effects are the patients themselves. They DO KNOW their bodies! Unfortunately for our dementia people, they can only give CLUES but when they say something and you listen hard...there is usually a basis you can discover behind their statements.
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Old 04-04-2016, 02:21 PM
 
Location: Wonderland
44,326 posts, read 35,852,560 times
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Originally Posted by silibran View Post
You have gotten lots of good advice here. Posters on this forum are compassionate and knowledgeable.

I just want to add a couple of things. I Googled the side effects of Zoloft and one of them is depressed appetite.

The other thing is about your inability to have a conversation with your mom. My mother had (most likely) vascular dementia, and she did become unable to hold a conversation. Talking to her on the phone became impossible because my mom could not converse. When I was with her in person, I had the best luck telling her funny stories, or talking to her about my adult kids. She always liked to hear about them, until close to the end when she had much more memory loss. My mom lost her ability to carry her end of the conversation later in the disease progression however. I wonder if your mom's surgery has accelerated her decline? If she was given regular anesthetic for her surgery, and if she spent some time in the recovery area before going to a room, she might have suffered effects. There is a known phenomenon of the elderly losing mental function after undergoing surgery.

I hope you are able to find a proper doctor for your mom. I think that is key, and I don't envy you in your search.
Thank you, silibran. Yes, this is such a helpful section of this forum. Great advice - and also it's helpful to remember that we're not in this alone.

Zoloft can either increase or decrease appetite from what I've read. It would be difficult for her to have even LESS of an appetite than she's had for the past year or 18 months! She's barely eaten enough to keep dragging herself around! I haven't noticed less of an appetite - just a continuation of zero appetite. Nearly all the mood stabilizers can cause changes in appetite. But the doctors think that the eating habits have their roots in her mental illness and I do agree with that. She''s actually on a very low dose of Zoloft because really - with the other stuff going on (stroke damage, dementia), the bipolar disorder which seemed so pressing just a few years ago really seems like the least of her problems now! And that is the sad truth. In fact, if we don't see some sort of positive change from the Zoloft in about 8 weeks, we are going to request that it just be removed from her regimen. What's the point, you know?

Yes, conversations with my mom are becoming increasingly difficult, and considering that she was such an articulate woman for so many years (and very well read) this is especially difficult to accept.

Yes, she did have surgery that she recovered well from physically - and she was in and out of recovery quickly and had no ill effects from the anesthesia. But I do think that the surgery and anesthesia and injury itself did have a pretty profound effect on her dementia - greatly increasing the pace and scope. The only good news about this is that if this is indeed the case, she may actually improve over the next few weeks or months. That would be great, since all we've seen is an accelerated decline.
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Old 04-04-2016, 02:39 PM
 
10,604 posts, read 14,132,083 times
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Originally Posted by KathrynAragon View Post
She''s actually on a very low dose of Zoloft because really - with the other stuff going on (stroke damage, dementia), the bipolar disorder which seemed so pressing just a few years ago really seems like the least of her problems now! And that is the sad truth. In fact, if we don't see some sort of positive change from the Zoloft in about 8 weeks, we are going to request that it just be removed from her regimen. What's the point, you know?

.
I totally agree with you. Sometimes the best thing is to use a medication that is "as needed" for times where you can see an anxiety ramp up. BEFORE it does. You get to know the signs, right?

My client had a life long psychiatric history, too. I think bi-polar.

THEN her shrink committed suicide so she had to start over post dementia - making impossible to diagnose her and treat her, really. Can you believe that.

Anyway....When my client went to Memory Care after the Seroquel nightmare....and her Dr. wrote the order for hospice nobody knew if she was terminal or anything in the near term but she had indications of leukemia.

So the hospice Dr. took her off the Seroquel and EVERYTHING that may cause confusion in RX and TX.

THEN they simply used good old standby Lorazepam (ativan) for her agitation symptoms.

Now by then she really couldn't walk much after the stupid Seroquel but the Ativan worked BEFORE the "new" geriatric doctor started messing around putting her on all these new meds. They also used the thickening agent for her swallowing that worked.

UNBELIEVABLY, the hospice nurse told us that all they had to do was compound her meds into a cream. Because as you know dementia people fight taking the meds. And it's illegal to trick them in most facilities like an ALF where she lived. You would have THOUGHT someone would have mentioned that after YEARS of battling her with meds every damn day. I mean REALLY battling.

So after ALL THAT NONSENSE, she actually had a couple of peaceful months off the bad meds and just getting Ativan rubbed on her back every morning before she passed away. She even made "friends" with the other ladies in the place who really loved her because she had a caregiver who would help them too - like getting food or whatnot. LOL. Believe it or not she died peacefully one night when she contracted a flu type of thing that everyone in the place had.

Last edited by runswithscissors; 04-04-2016 at 02:49 PM..
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Old 04-04-2016, 03:55 PM
 
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Originally Posted by KathrynAragon View Post
Well, as many of you know, my mother (who has reasoning and vision deficits due to a stroke ten years ago, untreated bipolar disorder, an eating disorder, and a broken hip) is home from the hospital and rehab. Physically, she has recovered well from the broken hip - she is able to walk with a cane now!

She broke her hip a month ago. When she was admitted, her blood work showed many imbalances and deficiencies due to her eating disorder. She is 5'10" and now weighs about 119. Her normal, healthy weight she weighed for decades is 155. While she was in the hospital and rehab, she was told repeatedly by every medical professional who met with her that she was malnourished and that she needs to gain weight. Nearly all of her prescriptions she left with are for various nutritional supplements. They also started her on Zoloft.

She is under the care of a general practitioner, an extremely unresponsive and aloof neuropsychiatrist, her surgeon (who is only concerned about the hip - period), and physical therapy.

Her general practitioner seems like a good guy, and competent, but I'm pretty sure that geriatrics is not his area of expertise. The neuropsychiatrist is extremely difficult to reach - the best way to reach him is through the general practitioner and I feel we're getting everything second hand that way.

My mom has mentally degenerated significantly since the fall, surgery, etc. I mean, the downward trajectory is alarming and isn't improving - in fact, she seems worse mentally every day. The good news is that she doesn't seem depressed or angry. The bad news is that her short term memory is failing so quickly that she seems at times to be in a pleasant enough but mildly confusing fog. She knows who people are, but she can no longer remember birthdays, or many pertinent happenings, and she ESPECIALLY can't remember things that have happened recently.

I have no idea what she does all day. She doesn't read anymore, she doesn't watch TV (she can't seem to follow any of that), she no longer gets online. She talks on the phone but she doesn't remember the phone conversations - and a phone conversation with her is getting more and more difficult. It's like she can't follow the usual pattern or something.

Me: Hey, Mom - what have you been up to today?
Mom: Ohhhhh, the usual. (long pause)
Me: Well, did you talk to any of your buddies on the phone today?
Mom: (Long pause) Ohhhhh, yes. I did. (Long pause)
Me: Well is there any interesting news from anyone?
Mom: (Long pause) Why do you ask? Should there be? What are you talking about?
Me: No, I just mean, did anyone have anything interesting to say? Any news from your hometown?
Mom: Well, let's see...Oh, I talked with Betty.
Me: OK - what news does Betty have?
Mom: (Long pause) OK, we talked about the funeral.
Me: Whose funeral? Did someone we know die?
Mom: Hmmmm, let me see....someone died. I can't remember who. Anyway, we talked about the funeral.
Me: Has it already happened?
Mom: Has what happened?
Me: The funeral.
Mom: I guess. I don't know. (Long pause)
Me: Well, have you watched any of the Call the Midwife series?
Mom: Should I have? I've seen them all.
Me: Well, there's a new season out. Remember, we watched the first one the other day together.
Mom: Oh, I don't recall that. No. I didn't know there was a new series out so of course I haven't watched any of them.

AUGH. AUGH. AUGH.

But the biggest issue is her eating, or lack thereof. Every meal has been an emotional drain. It is very tiring to try to get an adult who doesn't want to eat, to eat. Every single bite is a major production. In between bites she busies herself with food, but isn't eating it - tapping the plate, cutting things into pieces the size of a fingernail, moving things around. We say, after listening to this incessant tapping and scraping and watching the total lack of productivity for what seems like an hour, "Ok, pick that up and put it in your mouth," and she says, "I AM eating this - can't you see I'm eating?" "No, I see you pushing food around, but not eating." To which she replies to either my dad or me (or both of us), (heavy sigh), "I am trying to enjoy my meal. Clearly I am eating. I wish you wouldn't harass me. There is nothing wrong with the way I eat." At that point, she ups the drama level - dramatic gestures as she brings the fork (with a tiny morsel of food on it) to her lips, drops the piece of food, taps around on the plate again, manages to get a piece to hang on the end of a fork prong, slowly brings it back up to her mouth, grimaces as she puts it to her lips - OMG, it is maddening. It's as if we're trying to force her to eat toxic waste!!!!

My dad has been trying to cook good, fattening meals - he has really poured his heart into it, calling me from the grocery store for ingredients, or calling me after cooking something yummy - he's really discovered that he enjoys many aspects of cooking - until he tries to get my mom to eat. Then it's like his hopes are dashed. And he forces her to weigh herself once a week - and she's losing about a pound a week.

His blood pressure has been erratic - the stress is getting to him. Plus, he's just sad. He told me yesterday, "She slept all through Sunday School and church, and the people in the Sunday School class are treating her differently - I can see it. I mean, they're nice but they're talking to her differently. And she's confused - we always hold hands and pray at the end of class, and instead, she just suddenly woke up, grabbed her purse, stood up and pushed past people to get out the door. My wife is losing it!"

Well, she's BEEN losing it for a couple of years now but it really seems to have accelerated.

Which brings me to the point of my post. This sounds so awful, but I am beginning to think that she is never going to get better - that she is in a decline and after watching the agony of my mother in law's three year decline I'm not sure just what it is we're trying to accomplish here. I mean, does my mother WANT to keep her body going? I'm honestly not sure she does - and I'm not sure I would want to either if my mind was gone or going.

I asked her yesterday, "Mom, do you think you are eating enough food to regain your health?" She would not answer that question - instead, she would go into this long spiel about how much more food she's eating, which isn't even true - she's making a show of pretending to eat but the proof is in the pudding so to speak - in the scale. So I said, "But you're still losing weight, so whatever it is you're doing, it's not enough, right? In order to gain weight and get your health back, you need to eat more food - do you agree with that?" She wouldn't agree - all she would say is, "I am eating more. I don't see what the problem is." (She has been screened extensively for any other cause of weight loss - she just doesn't eat enough to maintain or gain weight.) My dad and I said, "We are tired of fighting with you and trying to force you to eat - but we're alarmed by your weakness and your weight loss. Do you understand that we're trying to get you to eat more out of concern and love?" "Yes," she said, "But I AM eating more, so I wish you'd leave me alone about it."

My dad and I were talking afterwards and I said, "Dad, one thing I think is pretty certain - she can't help this. So there's no point in being mad at her. Maybe instead of confrontations and finagling, we should just focus on helping her enjoy each day. And meanwhile, I think we need to get a referral to a doctor who specializes in geriatrics so that we can adjust our expectations and our approach based on what her abilities are and what her prognosis is."

Is this giving up? Are we just giving up on my Mom? Because that's what it feels like.

This SUCKS.
Nothing changes if nothing changes. If your loved one can't change then you have to if you want to make things better and solve problems.
I suggest you attend a caregivers' support group. There is a vast amount of knowledge and experience shared there and can transfer to your own home situation.
When you go ask the chairperson what literature/books they recommend and go to your library, read them or rent audio CD's.
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Old 04-04-2016, 05:34 PM
 
Location: Wonderland
44,326 posts, read 35,852,560 times
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Originally Posted by kitty61 View Post
Nothing changes if nothing changes. If your loved one can't change then you have to if you want to make things better and solve problems.
I suggest you attend a caregivers' support group. There is a vast amount of knowledge and experience shared there and can transfer to your own home situation.
When you go ask the chairperson what literature/books they recommend and go to your library, read them or rent audio CD's.
I don't expect you to know this, but we just went through three horrible years of Alzheimers and other issues with my mother in law and father in law. Both eventually died - my MIL actually died of Alzheimers - within a few months of each other last year. Believe me, I've been to support groups and read books - OMG - till I am sick to death of thinking about elderly bodies, lab work, tests, doctors appointments, UTIs, Depends, bed alarms, the ordeal of a shower, watching elderly people hold food in their mouths for hours, you name it. I am just so tired of all of it.

Of course, when it's my own mother, I am not able to be as detached! And I can't just say, "Mom, Dad - I'm tired of dealing with all this. You'll just have to wait."

I'm not saying I can't learn anything or don't need to continue to educate myself or trouble shoot. What I AM saying is that I seriously doubt if much I do will change the trajectory my mom is on. I think I was just so overwhelmed with taking care of my in laws and their tragic situation (no good plan for ANYTHING and subsequent legal battles with some horrible family members - ugh), that I was putting off acknowledging that my own mother was on the same path, just a few years behind them.

I'm just so sick of thinking about it all - I'm sick of groups, books, meetings, doctor appointments, researching, etc. And yet there's no escaping the fact that my mother is in a serious decline and that things are likely to get a lot worse before they get better. That doesn't mean I can't do some things to help the situation, and to help her have more enjoyment in life - but it does mean that I have to have this on my mind and as a priority for an unforeseeable amount of time - and then my dad will be next. And then probably my husband, who is a few years older than me and not in as robust health as I am. My gosh. It's a huge burden. I want to do the right thing and yet I am tired of living a reactive rather than proactive life.

And yet, it's life - and it's my mom, and my dad, and my family. There's no honorable way around that.
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Old 04-04-2016, 06:46 PM
 
Location: Hampstead NC
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Originally Posted by KathrynAragon View Post

My dad and I were talking afterwards and I said, "Dad, one thing I think is pretty certain - she can't help this. So there's no point in being mad at her. Maybe instead of confrontations and finagling, we should just focus on helping her enjoy each day. And meanwhile, I think we need to get a referral to a doctor who specializes in geriatrics so that we can adjust our expectations and our approach based on what her abilities are and what her prognosis is."
Well, yes, I think this is a healthier approach to her situation. Because in the words of Dr. Phil...How's that workin' for ya? (it isn't. you're making yourselves crazy and she isn't eating any more as a result.)

It isn't your job to keep her alive indefinitely. She will, regardless of your efforts, eventually die of something. This is what old people do, and eating less is a part of that process for everyone. (not just people with eating disorders).

When my kids were little a friend was fighting with her kids to eat what she thought was enough. She was even making me crazy over it. She found a great book that said "The parent decides what and when. The child decides if and how much." She put it on the fridge and the battles in her house lessened dramatically. and her kids grew at normal rates! Might be worth a try.
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Old 04-04-2016, 06:54 PM
 
5,362 posts, read 6,492,706 times
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Originally Posted by KathrynAragon View Post
I don't expect you to know this, but we just went through three horrible years of Alzheimers and other issues with my mother in law and father in law. Both eventually died - my MIL actually died of Alzheimers - within a few months of each other last year. Believe me, I've been to support groups and read books - OMG - till I am sick to death of thinking about elderly bodies, lab work, tests, doctors appointments, UTIs, Depends, bed alarms, the ordeal of a shower, watching elderly people hold food in their mouths for hours, you name it. I am just so tired of all of it.

Of course, when it's my own mother, I am not able to be as detached! And I can't just say, "Mom, Dad - I'm tired of dealing with all this. You'll just have to wait."

I'm not saying I can't learn anything or don't need to continue to educate myself or trouble shoot. What I AM saying is that I seriously doubt if much I do will change the trajectory my mom is on. I think I was just so overwhelmed with taking care of my in laws and their tragic situation (no good plan for ANYTHING and subsequent legal battles with some horrible family members - ugh), that I was putting off acknowledging that my own mother was on the same path, just a few years behind them.

I'm just so sick of thinking about it all - I'm sick of groups, books, meetings, doctor appointments, researching, etc. And yet there's no escaping the fact that my mother is in a serious decline and that things are likely to get a lot worse before they get better. That doesn't mean I can't do some things to help the situation, and to help her have more enjoyment in life - but it does mean that I have to have this on my mind and as a priority for an unforeseeable amount of time - and then my dad will be next. And then probably my husband, who is a few years older than me and not in as robust health as I am. My gosh. It's a huge burden. I want to do the right thing and yet I am tired of living a reactive rather than proactive life.

And yet, it's life - and it's my mom, and my dad, and my family. There's no honorable way around that.
KOA I think what she was saying is not that you may be able to change the trajectory she is on but the poster was saying you can change your behavior - which isn't getting you or your mother anywhere. Even look at your title tired of fighting. You can't fight it, her dementia is going to get worse and it is not going to get better. There is nothing you can fight. Just do things with her that she likes to do and chit chat about nothing important. Just be there.

I am saying this with my mother who has dementia and is now in a SNF and playing with baby dolls. it was an effort for me but I do treasure the memories of being with her on her terms as she slid downward

I wish it could be otherwise
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Old 04-04-2016, 07:02 PM
 
Location: Wonderland
44,326 posts, read 35,852,560 times
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Originally Posted by Stagemomma View Post
Well, yes, I think this is a healthier approach to her situation. Because in the words of Dr. Phil...How's that workin' for ya? (it isn't. you're making yourselves crazy and she isn't eating any more as a result.)

It isn't your job to keep her alive indefinitely. She will, regardless of your efforts, eventually die of something. This is what old people do, and eating less is a part of that process for everyone. (not just people with eating disorders).

When my kids were little a friend was fighting with her kids to eat what she thought was enough. She was even making me crazy over it. She found a great book that said "The parent decides what and when. The child decides if and how much." She put it on the fridge and the battles in her house lessened dramatically. and her kids grew at normal rates! Might be worth a try.
I totally agree with this! Thank you! I need to repeat Dr Phil's words every time I am tempted to cajole her to eat (to myself of course).

The bolded part is what I was trying to get across to my dad. It's her life, her body, she doesn't seem unhappy or distraught. She doesn't seem to WANT to "fight to live," but she doesn't seem depressed. Who are we to try to force her to do something she's been fighting for two years (eating a healthy, normal diet)? She has dementia and stroke damage. Her body is giving out and her brain is WELL on the way to giving out. Who are we to try to force her to live a few months longer if she doesn't seem particularly interested in doing so, and really, who could blame her? It's not like she's going to be able to save her own life if she makes diet changes. She certainly can't correct brain damage from a stroke by eating more food.

I mean, I want clarification from her doctor on what is reasonable to expect from her, but I have a hunch that she is subconsciously accepting her own decline. Not my style but then I'm not her and I don't know what I'd do in the same situation.
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