Last Wednesday my mom's sitter mentioned that mom complained of her foot hurting. We checked it and couldn't see anything wrong. She didn't complain with it anymore till Saturday. I took her sock off and her toes and under the ball of her foot was swollen and purplish. Today Sunday I checked her foot and it seems that the foot is purple and swollen all the way back to her heel. Could this be gout? We gave her pain meds yesterday because it was very tender. Today she is not complaining much but the foor looks worse. Has anyone experienced this problem and what was the diagnosis? Will call her doctor tomorrow and hospice. Thanks in advance for your reply.
Gout can cause that purplish skin around the joint but I have never seen it involve the entire foot. My first guess would be a circulation problem. Or perhaps an injury. Sometimes the bruising and swelling of an injury does not appear immediately. There is a similarity to what Mom did when she broke her hand. There was nothing to see at first, then a small area of bruising, and then half the hand was bruised and swollen. But my first thought is still some sort of circulation problem. Please do call Hospice and find out what is going on because it is out of the ordinary. I hope it is something simple and easy!
The Following User Says Thank You to Gabriel For This Useful Post: aras (08-29-2011)
Hospice and mom's gp have been called by the nursing home. They think it might be neurapathy(spelling?). They are going to give her some medication for it. The foot looked better today. It wasn't as swollen and the purple seemed to be lessened in the toes and tracking to the heel of her foot. It wasn't as angry looking today and she didn't complain about it as much. My daughter who is a nurse took a look at it today and didn't know what it was. We will see if it improves more tomorrow.
Neuropathy is a nerve condition which can cause pain, numbness, or tingling. The swelling and blue color indicate circulatory or cellular causes rather than nerve. I do hope the doctor can give it a name and they will be able to at least take away the pain
That's what I am hoping for also. When she hurts it hurts me too. They are giving her more water through out the day. She is on thickened liquids and they don't leave water in her room because it has to be mixed each time. Most times I have to ask them for water for her. Her sitters don't always remember to give her water. I don't know if that would cause her problem or not. She has had gout in the past.
I totally understand... when she hurts it hurts me too. We do our best to keep them comfortable and pain free. Remember that is all you can do... you best.. and it seems that you are doing just that.
Hydration is important and can cause a myriad of problems. Swelling can actually be a symptom of dehydration. The cells "horde" the water available within them if they don't think there is more to come. Yep, it sounds almost the reverse of what you would expect. Hydration is a major issue later in the disease. Being on thickened liquids does make it more complicated. I am dealing with Mom and hydration even though she is still ambulatory and on regular fluids.
There will also come a time when the circulation system starts to shut down and the vascular system can not take all the fluids from the extremities. The heart will take care of the brain and central body first.
Sometimes there is no answer. I have yet to come up with a sufficient answer for Mom's swollen ankles. We just love them through it all and manage the discomfort as best we can. Looking for good words on your Mom today after the doctor visit
Hospice and Her Doctor are trying neurontin and pain meds on a regular schedule to see if it helps. The thinking is still that she has neuropathy caused by poor circulation. They think also when she resist being handled and yells, that she is in pain and therefore needs the pain meds. Hospice has been wonderful and when they visit they give mom their full attention and never rush in and out. They take time to observe her and touch her and she responds. I am very thankful for the care they provide.
Deb, you are a treasure. I hope we always have you to lend your experience and words of hope and kindness.
Circulation... yep! Yep, dealing with a bit of that here as well with Mom's swelling in the foot, ankles, and lower legs. Pressure does cause bruising so she's in no socks and soft slip on bedroom shoes. She also has hydration issues and possible kidney issues. I just can't keep Mom off her feet (and really don't want to). When you look up wandering in the dictionary, my Mom's picture will be there!!! I guess I am lucky. Mom's ability to register pain seems to have been affected. I think I have mentioned before that she showed no signs of pain from her broken hand or infection on her back.. and very little from an episode of impaction that gave us a new hemorrhoid to deal with. She acted as if it was a little uncomfortable a couple of times but gezzz louise. I am just thankful that pain doesn't seem to register... yet it does make it a little difficult to understand what is going on with her.
Isn't Hospice amazing!! I have had the very same experience with them. They seem to be in no hurry. They take their time and investigate and use their extensive knowledge to find the best possible solutions. They also have a wonderful ability to evaluate and rethink if necessary. I am on my second round with Hospice and I can not recommend them highly enough. It amazes me how many don't realize Hospice can be called into a facility... and earlier than the last few weeks of life.
Gail, after all the years I have had Alzheimer's in my life... what makes it all worth while is just giving back a little bit that I have learned along the way. If I can help a little bit then it makes it all ok. This is the way I keep MY sanity!!!!! So thank you
Here we go again. Something else to stress me out. When I got to the NH yesterday, mom was up by the nurses station in her wheel chair as usual in the mornings. She had her hand on her head and said her head was hurting. When I looked at her face, she had a red bruise across her cheek and nose and a blue swollen area on her nose. I could not understand this as she is not ambulatory. When I asked the nurse on duty, she said mom had not fallen. She gave her some pain medication then. I then called the head nurse and she came and checked mom and tried to down play her injury. I said it looked like someone had hit her. The nurse said they would investigate and she would call mom's doctor. As a result they brought in an x-ray machine and x-rayed her nose. Her nose was not broken according to the nurse and she said that we might never know how it happened but that she would talk to the people on duty during the night. I am upset by this because she implied that because mom takes baby asprin it may have been caused by her holding her head in her hand. Not! She also had a scratch on her chest and seemed to be trying to say someone knocked her a good one. Of course you can't be sure what she says really happened.
On a lighter note her foot and leg are looking a lot better. She is not to sit in the wheel chair more than 2 hours at a time and the meds seem to be working.
Thanks for listening. Hope your mom stays as well as she can be.
Gail... first suggestion is to take a picture. Make sure it is documented visually so there will be no doubt what you have seen. You do have the nose x-ray as documentation as well. It does sound strange. A fall would explain it.... even a minor fall. A slip and hitting her face on the bed or chair as she was being transferred or maneuvered. I do know that some, if it seems minor at the time, don't document as they should. Then when the tell tale bruises appear they don't want to get in trouble for not documenting. Maybe the nurse will find out that is what happened. I would be very vigilant from now on in observing for other marks that are unexplained. Most times it's an explainable one time thing, and they do bruise easily. But they don't bruise for no reason. Dad had "onion skin" from age and all the blood thinners he was on. Grabbing his arm to keep him from tumbling over or even to pull him up from a seated position would create a bruise. But that was a known issues and didn't crop up just once in a while. It is right to investigate anything that is out of the ordinary, insist on some kind of explanation, and be very observant in the future
PS... sometimes you don't know.... never did figure out how Mom broke her hand ::shrug:::
The Following User Says Thank You to Gabriel For This Useful Post: aras (09-01-2011)
Yes, Gail...document it. Then let them know you document it. I would walk in mom's facility and if there was a new bruise of any kind they were greeting me at the door with the news. They knew that I checked mom head to toe daily.
And like Deb said..it could simply be from being moved from one place to the next. From chair to bed or bed to chair. My mom's ankle was injured during a move from her wheelchair to her bed. Two aids had her and one aid dropped her grip leaving it to the one aid to hold mom up the best she could..but in the meantime, mom's weight went on one foot and a bruised swollen ankle was the result. And like Deb said...the aids might be afraid to report it thinking they would get into trouble. By the way, the aid that caught mom when the other one lost her grip hurt her back in the process and had to take a few days off of work. The aid who couldn't hold on to mom was "repostioned" to another job somewhere else in the building.
My mom also had gout. I made sure she was never given shell fish of any kind and no asparagus. I don't know if your mom is still eating solid foods but if she is it may be somethig for you to look into .
Glad to hear the pain is getting better for her foot though. And yes, let me also shout out the halleluias for Hospice!!
OH!! and if there was one thing I wish I had done differently was insisting mom not sit in her chair for hours...( I found out it was in the evening when they left her sitting for up to 4 hours) ..once I knew it was too late. She had developed a bedsore on her tailbone. It was awful. She had to spend more time in bed after that. So, yes, insist that your mom is NOT left in the wheel chair for hours.
A good rule of thumb is that the patient be "repositioned" every 2 to 3 hours. More frequent if there is a possibility of pressure sores. Usually you will notice a darkening of the skin before the sores appear. "Repositioning" can mean moving from bed to chair to recliner.. or turning in bed. It is a good idea to watch any loved one that is not ambulatory very closely. Any red or darkened area should be addressed. Pressure sores are easier to prevent than they are to treat. Also be sure there are pressure cushions in the wheel chair and special mattresses or egg crate toppers on the bed. It is even more important if your loved ones has lost weight to the point of being frail. That last week Dad was just beginning to develop a pressure sore on his tail bone and his heels. They repositioned him every 30 minutes which seemed to stop the progression.... along with other standard treatment of wound dressing and cleaning. Like Meg's Mom... it was probably from sitting in the chair too much. Just something else we have to watch
Also watch the pattern of any injury. Mom's broken hand was probably caused by falling since it was on the outside of her hand. That is how you put your hand up to protect your face as in a fall. If you see a bruise around the wrist you know it is probably from the wrist being grabbed and pulled. If they hit their wrist the bruise is usually on one side or the other not all the way around.
And always document any injury. I found a picture of Dad's bad toe on my phone last week
Thank you Meg and Deb. I don't know what to think. The head nurse keeps saying that mom could have caused it by resting her face in her hand. That couldln't have caused her nose to turn blue and swell up. The nurse said she had talked to everyone who was working that night and still doesn't know what happened. She did say an aide was working with a broken arm in a sling and was since let go. At night, after a certain hour they only have one aide on duty I believe. Mom seemed to be doing a lot better yesterday but she has mentioned something about someone hitting her a couple of times since this has happened. I can't depend on what mom says a hundred percent, but it seems strange that she has said this more than once. I am keeping my eyes and ears open and writing everything down.
It means so much to me that you all share your experiences, as this is my first time having any member of my family with dementia. But I am an only child and have been caring for mom since 1994. Thank Goodness for the board.
Gail... yep document document document and especially in pictures. I am with you in that Mom's injuries were likely caused by her just laying on her hand. I doubt she did that kind of injury to herself in that way. If her skin and vascular system is that fragile you would have issues with pressure sores and bruising on other places. Just glad Mom is a lot better and hopefully you bringing it to the attention of the nurse will bring changes if changes need to be made. A twisted ankle, stumped toe, or arm bruise is more likely explainable than a pop in the nose. It could very well be an accident but keep that watchful eye
As for what they say to you... never discount what they say as all fantasy. You can't depend on it 100% either. But you can use it as a guide to be aware. Also watch her reaction to different people. Those with Dementia can not learn cognitively. They don't remember who did what or when. They can't tell you the facts of what happened. But they do maintain intuitive learning. This is a basic instinct that helps us survive and our loved ones do maintain this type of learning after the cognitive ability to learn goes away. They don't remember the facts and can't recall the incident but they do know how it made them feel. Over time they will shy away from what harms them and follow what makes them feel good. Just their facial expressions will give you a cue what they think of somebody. They may know something happened even if they can't tell you much about it.
The old Rem director in Mom's unit was amazing. She had a way of connecting with each and every resident. To this day, my Mom breaks out into a huge grin when she appears... no matter how bad Mom's day might be. The new Rem director who is relatively clueless brings a scowl to Mom's face.
I watch a caregiver tease a resident too many times. I don't think she was intentionally being mean. She just didn't understand the disease. She walked out of that resident's room one day saying... "I don't know why she doesn't like me!" When I explained the residents perception and intuitive learning... the teasing stopped! Now, after weeks of validation rather than teasing the caregiver had no problems getting this resident to bed.
Like you, I never found out how Mom broke her hand. It is one of those mysteries. But what you can do is let them all know that you are aware of what is going on with Mom, that you are documenting, and that you will continue to question and dig for answers.
The Following User Says Thank You to Gabriel For This Useful Post: aras (09-04-2011)