Doctors Lounge - Nephrology Answers
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Forum Name: Miscellaneous Nephrology Topics
|Sage1225 - Tue Sep 02, 2008 9:17 pm||
Please help my grandmother: She's been very sick lately and I need a second opinion about what we should do to help her. Grandma is 79 and has severe arthritis. She's visited a pain specialist and has tried many things to dull the pain: epidurals, morphine patches, pain meds, even a type of electro-shock therapies. She hurts all the time and especially has problems in her hips, shoulders, and ankles. She has recently developed a pressure/bed sore that is being treated with antibiotics, a daily saline rinse, and a simple gauze padding. Since her bedsore has developed, its gotten harder and harder for her to get up and down out of her chair. This, of course, makes the most simple tasks, like taking her medication, preparing meals, and using the restroom much more difficult. Grandma normally takes lasix to keep the swelling in her feet and ankles down, but due to the sore on her backside, she has since stopped taking her water pills because they cause her to have to get up to use the bathroom quite often. She's not drinking much for the same reason. She looks pale and I'm worried shes getting dehydrated. We recently discovered that one of her legs is about 1.5inches longer than the other. She has special shoes that balance her legs out, which makes it easier to walk, but the swelling in her feet and ankles is so bad that she can't fit into her shoes. We're not sure what to do to help her. Shes getting weaker everyday and this morning, she fell on her way to the bathroom. We're scared and need some advice. We're working on getting her a lift chair and we've had someone with her nonstop since the fall. We asked her doctor if it was possible to catheterize her until the sore heals a bit so she can increase her fluids and start her lasix again without having to "run" to the bathroom so frequently. Her doctor said she couldn't/wouldn't do this because Grandma already has a UTI (which we were unaware of...). Is this usual procedure? I work at a veterinary clinic and we catheterize cats with urinary infections quite often, but I do realize there is a vast difference between animal and human medicine. I need a second opinion because Grandma's doctor has been known to put off treatment of symptoms until she winds up in the hospital. Its amazing how fast Grandma's health has plummeted since this pressure sore has developed. Its so difficult to watch her suffer the way she does- she is 100% coherent and sharp as a tack mentally; but physically, her body is giving out on her. It kills me to see such a strong independent woman in such a feeble and dependent state. We thought the catheter would give her a chance to recover... any advice or suggestions would be greatly appreciated. I don't know where else to turn.
|Dr. Safaa Mahmoud - Sun Nov 09, 2008 10:15 am||
Sorry to hear about your grandmother’s illness.
It is really a complicated situation and any doctor would be challenged to chose the most convenient treatment approach that its benefit would overweigh the risks.
This obviously needs detailed information about her history and a thorough clinical examination. Identifying and understanding the morbidities she has would allow prioritization of her most distressing problems that should be focused on while treating her.
In my openion, your grand mother has 3 main problems, the bed sores, the UTI, the dehydration. These are critical situations that should be promptly treated.
I understood that she has oedema for which she is (was) on diuretics, at the same time she also has urinary tract infection.
Urinary tract infections is a common complication for urinary catheter thus catheter is indicated only if necessary and not solely for the convenience of patient care. However, one of the main indications for urinary catheterization is in palliative care for critically ill patients for whom bed and clothing changes are uncomfortable. A major problem would be from extending the infection into the kidney causing pyelonephritis which is also common to occur.
However, since UTI complication can be avoided using strict antiseptic rules in dealing with the catheter and if happened, can be treated properly, consideration of catheter insertion is possible to avoid more critical problems like dehydration and aggravation of bed sore by immobilization. Immobilization is a major risk not only for skin infections but other types of serious infections and vascular complications.
Starting the treatment for her UTI before the catheter is introduced then completing her antibiotic course would be an option.
I would advise you to follow up with her doctor and to discuss with him your concerns about her; he is in better position to evaluate her status properly and providing her the best treatment approach.
Please keep us updated.
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