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Periodic day of dry heaves, no eating & headache?


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Old 07-13-2013, 12:21 AM   #1
Tcall
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Periodic day of dry heaves, no eating & headache?

Among those of you who care for an Alzheimers or dementia patient does your patient have a day or two every several weeks of remaining in bed, having dry heaves, being unwilling to eat or drink anything and mild to severe headaches?

Thanks!

 
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Old 07-13-2013, 10:59 AM   #2
Gabriel
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Re: Periodic day of dry heaves, no eating & headache?

T-call... it would help to know what stage of the disease your loved one is in now. It would also help to know if she is at home, at home with 24/7 care, or in a facility. Her general temperament can also be a factor.

Now to answer the question as best I can with out that information. Each person with dementia is different and how they respond to what is going on around them is different. By the mid stages they are unable to express their emotions and how they feel. Many years ago Mom started laying on the couch covered up... sometimes for an entire weekend. She claimed to be "sick". This frequently happened when there was a number of family members at home for the weekend. It was worrisome until that Sunday. My sister, her daughters and their children had just left after a weekend visit. Mom had been on the couch for 3 days. I walked back in the house alone and Mom popped up from under her covers asking if we could go for a walk!!! Then she gave me exactly what was wrong.... "I am not going to cook for all those people!!" In reality she was no longer able to cook but she had always cooked so she expected it of herself. We knew she couldn't do it but she didn't. So she went to bed to avoid what she could not do. Sometimes, especially in the mid stages, this can be an avoidance technique. Remember that pain, emotional or physical, is interpreted by the mind as pain. So emotional distress can be expressed in physical terms. A very interesting new study has been done that found Ibuprofen was as effective for mild psychological distress as anti-psychotic medication in many. So look at what is going on when she has these episodes to try to explain them.

You also have to watch what is around as far as lotions, cleaning products, and other products that are not to be taken internally. She is probably beyond distinguishing between what is food and what is not. Some products can cause stomach distress. Mom was in a care facility but had personal hygiene products in her room. The unit coordinator saw her with a med cup she had found filled with a white substance in it. When ask what it was Mom said it was her "energy drink". With a little investigation we discovered it was hand lotion! She really liked it added to her peanuts! So be vigilant as to what products are within her space and what she does with them.

In the later stages most dementia patients will eat less and sleep more. The brain controls everything, including digestion, hunger, energy level.... everything. As the dementia does more and more damage to the brain, even the vital processes of the body will be affected. Temperature regulation will be affected. Mom will be hot one minute and cold the next. She will be unaware of extreme external heat or cold. This is why you have to watch out for overheating or extreme cold.... without listening too much to what they say. They will go through a period when they eat everything they see, forget that they have eaten and want to eat again, and eat large amounts of food. It is like their full button is broken. At other times they do not feel hunger sensation. Their brain tells them they do not want to eat. It is difficult to get them to eat at these times. Also taste and texture sensations change. Foods they hated before are now favorites and foods they loved are not tolerated. Bitter is the last taste sensation that remains so they prefer very sweet or salty foods to cover up the overpowering bitter that we may not notice. As the end approaches the digestive system itself will not function properly. They may eat but still lose weight rapidly. This tells you that their digestive system is unable to extract the nutrients the body needs even if they eat. It is called Failure to Thrive and there is not anything you can do about this.

Hydration is much more important than food. We can live months without substantial food but we can't live a few days without water. The days she doesn't want to eat make sure she is getting plenty to drink. Experiment with different flavors and consistencies. Try one of the supplements that is a liquid but also had nutrients in it. Avoid coffee, tea, and carbonated soft drinks because all of these tend to dehydrate!!! If she is dehydrated you might want to try one of the sports drinks or baby pedialite.

Energy levels will go down. They will sleep more and more. This is common. Dad slept 8 hours at night, then 14 hours, then 20 hours a day. At the end he would sleep all day one day and then be awake just a few hours the next day. Mom was a night wanderer and walked incessantly. She would do this 20 or more hours a day taking a short 2 hour sleep and a few short naps in a chair a day. As time went on she would sleep more and more until she was sleeping most of the day. This is not an easy smooth transition. One day she would walk 24 hours and the next day she would walk 18 and sleep 6, the next day she would be up all 24 hours only to go to bed and sleep for 18 hours. They do not understand day and night and our normal cycles. Their circadian rhythm has been disrupted by the dementia. They sleep when they are exhausted and wake up when they are rested.

I found it was much better to go with what they needed rather than what I thought was "normal and customary". If they wanted to sleep I left them in bed. I would present food. If they wanted to eat it they did. I would encourage and even help them eat but never pushed it to the point of agitation (theirs or mine). If they didn't feel good, I looked for both emotional and physical reasons. I listened to what they had to say and validated their misery. Then tried to figure out the basis... emotional or medical... and my go to treatment was Tylenol. What I knew that I never said to either parent was... this is probably the disease taking it's course!

If these problems become more consistent and frequent you should mention them to her doctor. They will probably want to do test to determine the cause. Then you have to decide if these test are actually beneficial to your loved one. Is it going to change the course of the disease? Is it going to make you loved one more comfortable? Are you going to progress with treatment if some is discovered? I remember wrestling with Dad to get a CT scan. I was finally able to stay with him and keep him still enough with out major sedation. What they found was a minor brain bleed. Were we going to have brain surgery to correct this in an advanced dementia patient? Of course not! I lived it and learned. Mom's major grand mal seizure did not even get her a trip to the ER.

If your loved one is in the late mid or late stages you might consider a Hospice consult. The GP makes a referral and Hospice come out for an evaluation and consult. They were my angels!! Nurses visited frequently, doctor would come to Mom/Dad periodically, and there was an ancillary team of care givers, social workers, and volunteers that were ever present. They had all the information I needed to make me feel more comfortable about Mom/Dad's condition. They also supply most medications and some products that are needed in the late stages. It was nice to have in home/facility care and not have to take Mom/Dad out for treatment

Hope something in here helped! .... and hope to hear from you again

Love, deb

 
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