Quick but practical advice - DM unwell (*TMI*)

[Blutopia]

DM is 81, 3 years into Alzheimer's, and has been poorly for a week with severe back pain which she put down to a fall (but I don't really know what started it). She was virtually immobile for 2-3 days but improved, and GP (who visited on Tuesday) felt it was muscular as she had no temperature and wasn't otherwise unwell. The pain improved with co-codamol, and she has emergency "enablement" carers for the mornings lined up for the next week.

She's been a little better but was terribly confused, much worse than usual for her Alzheimer's, Friday and Saturday. I had a call from the surgery late on Friday to say her dip test from Tuesday revealed a UTI, which explains that, so she started antibiotics yesterday afternoon.

I was hoping she'd be much better today after a couple of doses, but although she is noticeably less confused, she seems so terribly exhausted. She didn't even flirt with DH which is out of character. In the kitchen I found (TMI alert) a pair of knickers which she had thoughtfully put into cold salt water, with some blood in them. Only a little, I suspect the water had made a small amount look a lot worse - I reckon a teaspoon.

I asked her about it and she remembered wondering why she was "having a period" - I asked her if she was still bleeding now and she said no. I did all of the washing in her linen basket last week, and amongst 14 perfectly normal pairs of worn knickers, I did find one pair that had such heavy staining (from something that had been soaked off?) that I chucked them away. So perhaps she's had a bleed in the last 3 weeks.

She wanted to doze and asked me to leave her to it, she was quite happy with the TV and a cool drink, had been up for a wee while I was there and seemed fairly steady on her feet. Just so so very tired.

I've had to come back home, I live a little way away, but the more I thought about it - back pain with UTI but no fever, started penicillin yesterday, small amount of vaginal bleeding and very weak and drained - the more I think she should be assessed. But is it an emergency?

I called 111 but they won't assess her unless I'm in the room with her. She's not haemorrhaging pints or anything (I did check everywhere) and I don't want to scare her unnecessarily - shall I leave her in peace for tonight and organise a home GP visit in the morning, or go back and instigate an out of hours assessment?

Could the blood be from the UTI?

The bleed could well stem from the UTI.
My dad has mixed dementia, and in all honesty, in your shoes I’d wait till tomorrow and get her regular GP out....however we have an Anticipatory Care Plan in place so that affects how we deal with these kind of things

I suppose it could be?

I've just done the interactive 111 online thingy and it suggested seeing a GP within 3 days. Although I only put bleeding as a symptom, not the exhaustion.

I mean, I suppose she would feel drained after an infection and starting antibiotics - she always said that they make her feel horrible. Plus her wee smelt strong, so she may be a bit dehydrated - I left her with a big glass of cranberry (she likes it so will drink it), and a big glass of water with bottled water beside it. She probably won't touch it though.

She's eaten a full meal - meals on wheels came when I was there. She ate it slowly but ate it all, which is a good sign I guess.

Thanks Minder - needed some perspective!

Anticipatory Care Plan, what's one of those? I have spent the last few days organising some care at home, telling mum it's just temporary while she gets better - she'll fight it otherwise. I did speak to adult social services last week and they were singularly lacking in dynamism, so I got on to some private companies.

I had quite bright blood in my urine from a recent UTI, if she's slightly incontinent she could have confused it with a period

Could it be piles?

She is more continent than I am. Of all her issues, she doesn't suffer from incontinence...not yet. Me, I leak whenever I laugh and I'm 46.

But yes, although I've had a gazillion UTIs and never had bleeding like that, I suppose it's possible - there was (sorry) a tiny amount of "material" there, like a tiny clot, but again maybe not unusual with an infection.

Doubt it's piles - I've also had a thrombosed haemorrhoid and jeez that thing bled like a geyser, not just a little. Anyway, I checked the, erm, "location" in said garment and it's too far forward.

I've decided to call her at 6 ish to remind her to take her tablets and see how she is - that's if she remembers how to answer the phone or can be bothered to pick it up.

there was (sorry) a tiny amount of "material" there, like a tiny clot, I used to pass tiny clots with UTIs. Though I didn't pass enough blood in total to stain knickers.

Even if she is normally continent, that all breaks down with a UTI.

It may be worth asking for a scan. Without wanting to alarm you, my mother had a couple of episodes of bleeding and the GP more or less dismissed it as she had no other symptoms. Some time later, when she was being scanned for something else they discovered she had a bladder tumour.

Hmm. No more blood this morning, she wasn't wearing any undies overnight but there was just the tiniest smear of blood on the bed sheet. I've called the doctor and they are making a housecall, sometime between 11 and 2pm I believe.

She was fairly bright first thing, but by the time she'd washed and dressed and had breakfast she was exhausted again and has nodded off in the chair. I'm sitting with her now, waiting for the doctor. I wonder if she just sleeps all day, left to her own devices.

I've also got a private care agency coming to assess her this afternoon (at an extortionate price, but they come highly recommended). Have no idea how I'm going to get that past her, even though she has been very amenable to the HCAs coming in from the enablement team. But she's not really recognising her flat anymore, she keeps saying she's worried that she's ruining everyone's holiday!

Part of me wonders if she wouldn't be happier in residential care. Before she lost capacity she always said she wouldn't mind, but since her Alzheimer's she's been more anxious about being "sent away".