Recurring UTI in 93 yr old mom with dementia, is urologist worth it?

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Recurring UTI in 93 yr old mom with dementia, is urologist worth it?

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My mom has vascular dementia. She wears depends and won't drink sufficient water. She has had 2 UTIs in the past 6 months...both times she knew she had them! First time she said she was urinating a lot, second time it burned once. The first was diagnosed by her PCP in office, so I assume they used a quick test. 2nd time by urgent care with culture.

Her PCP now wants her to see a urologist.

I can take her to the practice where my dad is seen for prostate cancer, but I am not sure it is worth it. She won't cooperate with prevention strategies like changing depends more often, drinking water, using bathroom on a schedule, etc., so not sure of the point.

She lives in AL facility with my dad. They try to get her to follow a prevention routine, but she says no, so they cannot force her. If dad tries, she gets mad and says he is bossing her around. When doctors tell her, she says she never heard it before.

The one thing I can probably get her to do is drink cranberry juice regularly.

Thoughts??????

Incontinence Urinary Tract Infection (UTI) Vascular Dementia

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Stop the depends. We did in 2013 after constant and re-occuring UTI.
Christy sits and sleeps on cotton sheet NOT POLYESTER covered washable bed pads. We cut a cotton bedsheet in quarters for the seat pads because they are sometimes polyester faced.
Polyester is toxic and it holds body heat and moisture, inviting UTI.
No underwear. She exists in long skirts, or nightshirts.
100% COTTON. NO BLENDS. Polyester is toxic which invites scratching and infection. Nylon and rayon are not toxic but they hold body heat and moisture.
We toilet Christy every two hours and watch for sign of need in between.
Washable bedpads are more convenient, better for the environment and I would wash a thousand of them rather than deal with one UTI,
We monitor her urine with reagent test strips from Amazon. We place a urine capture hat in the toilet whenever we suspect a UTI is developing or just because.
No UTI's since 2015 and that was caused by an ER catheter catch.
One dose of Ciproflaxin killed a lurking bacteria that she had carried for years.
Never TP or wipes.
Wiping spreads bacteria, so have had a computerized bidet seat from Brondell since 2013. It sprays the undercarriage and blow dries.
The spray jets can also provide stimulation for stubborn bowel movements.
$300 - $700 but so worth it.

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cherokeegrrl: Absolutely correct.

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Judy, just because your mom hasn't had swallowing issues in the past is no guarantee that she's not having them now.

My mom nearly died from "impacted tuna fish". Really! No prior swallowing issues.

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Update! So, no urologist, but while I was on vacation and just about to board a plane to go out of the country for 7 days, my dad called to tell me mom was in hospital with a UTI. Turns out it had also infected her blood. So the hospital is now trying to isolate which bacterial strain has infected her blood. After 3 rounds of antibiotics in the past 4 months, who knows how effective any more can be unless they isolate the exact cause. Fortunately dad took her to the hospital when Tylenol did not bring down her fever so I spoke with the nurse who said she is not in any sepsis danger now.
This is hard to manage from out of the country, but am doing my best by phone.
The big issue is that she got indegestion from eating French toast, so now they are monitoring her heart and doing swallowing tests. Ridiculous, she has had swallowing tests and was fine...she eats like a longshoreman and has had indigestion problems for 30 years.... And now they want to do an crazy to see if blockage ...mostly likely a large wad of French toast. If I was there, I would say no, but dad can't do it.
A lot of unnecessary tests.
But I am guessing a urologist is in the future plans.

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Christy had constant low grade UTI for years. Ciproflaxin single dose cured.
Started again when I was hospitalize and caregivers were too busy to watch. They had her wear depends.
Say no to any genital traps. No depends, no panties. Christy wears long cotton shirts/skirts during the day, commando at night.
Washable bedpads are cheaper than UTI, financially and for peace.
We hydrate her with a turkey baster and add water to her food.

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I saw you say, part of the reason you want to treat the UTI is so there are no emergencies. I had this same problem with my dad. I would find his cardiac meds in the trash. We discussed his wishes and thoughts of his future. On Being Mortal by Atul Gawande is a good book to read before having the discussion. After our discussion I told him we are not doing the hospital merry-go-round. So if he started with worsening cardiac issues we would go to the doctor and do only what would make him comfortable. He has lived 8 years with that approach. I did take him to the ER one time. That was because his defibrillator went off 10 times one day and his Cardiologist got the report and insisted he go to the ER. We had a doctor appointment in the next hour. It was a routine visit, but we were going to talk about a plan. My dad knew his defibrillator went off several times, the day before and passed out, twice. He baked to distract himself, and did not tell me until I arrived at his house for the appointment. At the hospital they admitted him to increase a medication he had started the week before, because his defibrillator went off once. The next morning the med was up to therapeutic dose. We turned off the defibrillator and he is now on hospice, and turned 90,2weeks ago. The medication has kept his heart out of a lethal rhythm for 3 months, outliving his prognosis. He is beginning to have the shortness of breath and fatigue of CHF. So maybe the next thing is to talk about whether or not he wants to stop the medication and allow a natural death, sooner than later. I think he is waiting for my mom to pass. She’s in the final stage of Alzheimer’s. You both have to be in agreement with the plan. It is hard at the time of crisis to not let emotions take over. I cried when he told them he wanted the defibrillator deactivated, even though I tried to convince him to replace with a pacemaker only when it needed replaced 2 years earlier. I had also done this with my FIL, and my MIL caved at the last minute. He knew that would probably happen, that is why he made me his caregiver.

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My mom with dementia doesn't drink much and has had many UTI'S. We are waiting for results of lab from test on Friday. We took her to a urologist and he told us to use a vaginal cream he prescribed. Problem is she can't do it and I can't do it. She lives with us and is 90. We try to give her watermelon year round. Any suggestions for cream appreciated.

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I wouldn't, waste of time. The specialist will want her to take a test will a full bladder. Frustrating, since the individual has to drink lots of water prior to the test then hold it, while the test is being conducted. Post results of test, then write a script for incontinence. My mom (who has dementia) was prescribed oxybuturin (excuse the spelling) which really had bad side affects with hallucinations. She was taken off that right away. They tried other medication which had side affects as well. No medication any longer from specialist and we do not see the specialist any longer. I have the AL help my mom, as much as possible, since she doesn't wipe properly, and keep her dry as much as possible. I

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I can assure you that no matter what doctor sees her or what is prescribed to her to do, she is NOT going to do it - end of discussion. It doesn't matter if it is dementia or stubbonrness. Unless you are watching her 24/7, nothing is going to change. If she refuses to cooperate, let her be before she makes you lose what sanity you have left. Leave her in peace and face what is coming perhaps sooner than later - but it is not going to change.

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It's only been a few days, but my dad reports she is drinking more water and washing every day. Still not going to bathroom enough, but one step at a time.
Honestly, I would let her be, but I am trying to save myself from trips to hospital and urgent care. Maybe I'm being selfish, but I am getting tired of having to put myself out because she won't cooperate.
My dad won't even go to the hospital with her anymore because she won't cooperate with her care.
I totally get it.

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My 93 year old mom had recurring UTI's that sent her to the hospital because she showed no symptoms before turning septic. Urologist finally controlled situation with vaginal hormone cream, daily, low-dose antibiotics and me constantly pushing her to drink more liquids. She has not had a problem in a year now.

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Who applied the cream?

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The holistic approach has always been cranberry juice. My mom corrected her own UTIs with this drink.

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Pure 100% cranberry juice, NOT cranberry juice cocktail.... works very well but please read the label....

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I am going to speak toward our locale which is Cleveland and holds the majority of us held captive by one of two health care systems. THey have some wonderful and outstanding people working within them, but never underestimate the powers that be. So while on the surface it looks like a reasonable request, at the same time the PCP is covering their you know what while at the same time (if it were here) generating more income. More follow up, more facility fees etc. You have already indicated mom is not going to be compliant, so to what end will all this effort lead. A UTI is not a good thing either...and can probably contribute to a dementia issue being or appearing worse...I would want the infection treated and recheck could be done by you or someone getting a sample in to see if meds should continue...That's what I would do. SOmetimes the systems need to understand what hell a whole family goes through JUST to get to the appt.

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You should give cranberry pills

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She has been doing that for years...still is. Does not work.

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If she has dementia, it's really not up to her as to how often her Depends are changed. It's a safety, hygiene issue and if her mental ability does not work well enough, then others would need to intervene. Are the staff at the AL able to do this? But, that would not guarantee that she would not get UTI's, but, it might help.

And, if she refuses water, there's not much that can be done. Some people may have success with a regular antibiotic they take to ward off the infections, but, it has its own risks. Does she have any other issues? My LO used to have them occasionally, and now that she is on Hospice in MC, they monitor her behavior and treat her if it seems she needs it for pain relief. The stress of testing in the ER with catheter was just too upsetting for her at the end stage dementia.

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I am an RN who doesn't believe in supplements; completely a western medicine girl. BUT, that said the one thing that save me and friends thereafter from constant bladder infections is one capsule daily of D-Mannose. I use Source Naturals capsules once daily. Inexpensive and worth a try as I was getting four a year, and threatened with cipro once daily as prophylactic. Now not a bladder infection for many years. Only about 30.00 for 100 on amazon so very inexpensive and worth a try. I have recommended to two women at the dog park and they have had the same experience I have. I have seen it recommended by others on AgingCare site in the past. Good luck. Not sure she will take it, but it is a simple sugar (can be taken by diabetics and works in same way cranberry does, but much better (prevents bacteria from adhering to the bladder wall).

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AlbaDeer: A geriatric doctor I know prescribed D-mannise for my friend who suffered from UTIs. My friend says it solved her problem and she recommends it too.
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My Mama was in a NH and had repeated UTIs, back to back to back. The doctor finally put her on a low dose daily antibiotic. That did the trick, she never had another one. She took it daily for 2 years. It was the only solution left.

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My mother, with AD, suffered from UTIs for years. In fact, it got so bad, that she began having seizures. Finally, after an especially bad seizure, we had her hospitalized.

The hospital doctor was wonderful. He said, "I don't think we are going against her living will to insert a catheter, get a clean catch, and remove it. That is what they did, and were able to find out, after doing a culture, what specific bacteria we were dealing with. It was an unusual one, and was easily treated. They had been treating it with the wrong antibiotic for all those years. We have had to use this method, done by the Hospice nurse, only once, since.

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Why not try those azt pills? They are over the counter, somewhat cheap, and help reoccurring uti's. Of course check wth a nurse/doc first so they know, and dont interfere with any meds. Might have to grind them up and put in food. Good luck.

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I give my mother cranberry extract in pill form. She hasn't had a UTI since.

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Cranberry extract pills can be helpful, but please make sure that there aren't any negative interactions with other medications, like coumadin.

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Not saying you do this, but handing someone a large bottle of water isn't very appealing and the full contents will probably be there 2 hours later. BUT, have you tried the small 6 or 8 oz bottles? Also, there are many 0-calorie water flavorings that can be added to enhance the bland flavor of water.

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Have tried flavors, adding g a little diet 7 up to water, cups, small bottles, none of it helps. She says she drinks when she is thirsty, but she 1. Forgets and 2. Does not want to drink because then she has to pee, which is too much work.

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My mom likes Vitamin Water. She’ll drink a whole bottle whereas plain water not so much.

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Yep, tried that. No better.😣

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Water alone is not the only liquid she could consume to keep her hydrated.
What is for breakfast? If she is eating eggs, toast and things like that switch to oatmeal, cream of wheat or other more high moisture foods. Same thing for lunch more salads, fruits, soup, same for dinner. Jello, or other gelatin type "treats" I use to make my husband gelatin using unflavored gelatin and fruit juice and fruits. Desserts or other treat Popsicle, ice cream again more fruits.
This is all if she is swallowing properly while a Popsicle is great, if the liquids have to be thickened a Popsicle will not be a good thing. Watch fruits those that are slippery can slide down the wrong way things like peaches, nectarines (learned this the scary way after my Husband grabbed a peach slice from my plate and nearly choked)
For some water just is not appealing as there is little/no flavor so flavoring water with juice, or serving tea might actually get more liquids into the system.

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She eats some fruit and coffee and tea, but products with caffeine actually cause dehydration, so they are not as good. Popsicles would be good, but in AL, she does not have enough freezer space to keep a box.

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We had some success by “serving” my LO an 8 oz glass of water every hour. She was pretty cooperative with drinking it(sometimes!)
For her, the “drink two bottles of water a day” sign would have been too easy for her to dismiss or ignore. I think maybe she liked being waited on.

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She is given water, but she takes a small sip and won't drink more. Staff can't force her.
She actually likes the signs because they remind her what to do without someone having to tell her, or at least this is what she says.

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I would be concerned about her comfort at this stage. Not taking her to the Urologist will prolong unnecessary discomfort for her. I wouldn't think this is interfering with not prolonging her life if she is at that stage. It is our job to make sure they are comfortable. This doesn't mean that "end of life" wishes aren't being kept. At 93, God bless her, it is about her comfort.

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I was also going to recommend D-Mannose. My MIL in AL was also getting recurring UTI’s for the same reasons. My urologist put me on D-Mannose, and 1000 mg of vitamin C 2 years ago when I started having chronic UTI’s. I take it in powder form with probiotics, but we got the capsules for my MIL. Has worked like a charm! No more UTI’s. We get it from Amazon. https://www.amazon.com/D-Mannose-Fast-Acting-Infection-Probiotics-Vegetarian/dp/B01N6X9YBS/ref=mp_s_a_1_7?keywords=dmannose+powder+now&qid=1560512201&s=gateway&sprefix=dman&sr=8-7

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Thank you! Will discuss with her PCP.

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Nature's Answer UT Answer with D-Mannose sold at Amazon.

This works! You may have to administer two bottles and then but her 1 tsp daily maintenance.

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I think you might find she needs more active prompting than a sign when it comes to drinking enough, because of the loss of initiative in vascular dementia. Is your father with her most of the time? - it's boring for him, but reminding her at frequent intervals would work better.

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He does remind her, but she gets mad at him and says he is bossing her around, then complains to me he is mean to her. He has given up. I can't blame him. They are in AL so dad does not have to do so much care giving. It is too hard for him as he has more serious medical issues than she does.

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I've seen D-mannose recommended on the forum, in an AL you would need to have it approved and added to her medication routine.

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Yes, my Mom takes d-mannose and Ellura, which is a concentrated cranberry supplement. It's not cheap but there is a generic on Amazon, which is cheaper. Both have helped my Mom with recurrent bladder infections.

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Thank you all for all the input. I spoke to my mom today and told her what could happen if she continues to get the UTIs. Though she has dementia, she understands more doctor visits and going to the hospital....
I made signs for her side table and the bathroom that tell her to
1. Drink 2 bottles of water a day
2. Go to the bathroom every 2 hours when staff reminds her... if she can't pee, she needs to check her pad to see if it is wet and change it if it is
3. Wash her private parts with a wet washcloth every morning and every night
4. Look at her pee in the toilet...if it is not pale yellow or clear, drink more water
Her understanding of visual information is way better than info she get orally.

We will see. I took on the role of bad cop because she gets mad at my dad when he reminds her to drink and use the bathroom. She does not want to drink because going to the bathroom is a chore.
Fingers crossed.😉

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This is so so typical of elderly! Don’t want to drink because then they will have to get yo and use the toilet. It’s a broken record. I hope your signs help. So frustrating I know!
do not let the urologist put her on any prescription for incontinence as they are implicated in causing dementia too.

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Cranberry juice is not good. It has sugar in it. My Mom was put on cranberry tablets. Also, a probiotic while on antibiotics which cause yeast infections. The probiotic was continued beyond the antibiotic. She was hospitalized in Oct for a UTI. They catherized her to get all the urine. Started her on antibiotics and the other things I listed. She passed the next Sept. not showing signs of another UTI.

It has been said here, to make sure her urine is cultured so she gets the right antibiotic.

A urologist may not hurt but I would not recommend a scope. My Mom had dementia and I refused to put her thru anything like that. She had no idea what was going on and it all frightened her.

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Thanks for the heads up on the scope. Think I will ask the urology place my dad goes to for a consult...my mom has very low pain tolerance.

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Recurring UTI in 93 yr old mom with dementia, is urologist worth it?

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