Hey it's me again with the ongoing saga of my 78-year-old mom (in our last episode, we were battling over birdseed). Well, the game has completely changed. She's suffered some kind of psychosomatic meltdown that seems to be being triggered (primarily) by my imminent return to full time office work. She is now barely mobile.
I was away from home on vacation this past week, but had to stop back home every few days to help medicate our sick cat (more below). During the week, she was complaining of bad diarrhea. I advised her to take some Imodium and drink water, and keep me posted. She seemed to be OK during the week though still having stool problems, but then Friday (the day I was due to return) she phoned my sister in a panic, saying she was weak and shaky and really ill. My sister figured it was dehydration and came over to make sure she was hydrated and then I came home and continued to get her to hydrate, checking her temp and pulse etc (all normal). She continued to NOT bounce back from this and her speech started to slightly slur, which she claimed was due to her weakness and unwellness. I didn't see any other signs of stroke but called her weekend nurse answering line anyway. In the meantime, she had an extreme emotional meltdown about many things, including:
--recent death of a longtime neighbor
--recent death of an Internet friend
--obvious end stage of our 15 year old sick cat
--death of her estranged husband two years ago
--every aging and death fear imaginable
etc. which was all sad.
During this conversation, her leg also began kicking wildly which she said she couldn't control (restless legs).
Nurse called back and, concerned about the somewhat slurred speech, advised we go to prompt care. On the way out, trying to get her into the car (rather iffy due to her balance issues, but we were trying to use the walker), she fell in the kitchen. Ambulance was called and she went to ER. No fall injuries. Chest scan, urine, blood work, EKG and CT were all done. We advised the doctor that she also had untreated anxiety and had refused to start the lexapro that her doctor prescribed some weeks before.
Every test came back normal. Stroke was ruled out, brain looked OK, no UTI, blood chemistry fine. Meanwhile, as she always does, she proceeded to be the worst hospital patient in the history of the world. Continual squirming off the bed, crying, sobbing, not following instructions, rambling roundabout answers to doctor's questions that were basically her life story (Doctor, to us: "Is this her baseline cognition, to you?" Us: "YES") As soon as nurse says she can get dressed, after 6 hours of drama hell, she was cheerful and right as rain. Then when doctor revealed tests showed nothing and asked about her Lexapro prescription, she tried to lie and said she had taken it but didn't like the side effects. Doctor was having none of it and basically advised her to start taking her anxiety med.
Today, after getting home at 3 am for 3 hours sleep, she insisted on walking around and doing a few stairs and of course, fell again (fortunately a mild butt fall and I was able to pick her up). She has no muscle mass in her legs, bad knees, and a massive spare tire around her middle due to her first and second waffle breakfasts daily. (This held her up until, apparently, this past Friday when her grand collapse began.) I told her she needs to lose weight. She insisted she needed some melatonin to sleep. I ran out and got some, she took one and then tried to climb stairs again.
So she seems to have just decided to quit walking and not enunciate her words too well. We are of course going to follow up with her own doctor, but they're the ones who prescribed the Lexapro in the first place so they already seem to know. (I need to add that her slurred speech disappears when she begins ranting and railing about all the terrible people in her life)
Just wondering if anyone has insight on (possible) psychosomatic immobility.
What kinds of investigation did they do to determine if she'd had a stroke or TIA? Did they culture her urine ? (that usually takes 3 days).
Please write down all the ways in which your mother's behavior has changed since she started putting out excessive amounts of cat food and bird seed. Take her to her PCP this week and get the word psychosomatic out of your head.
Take you mom to her PCP and talk about her recent decline in her ability to understand the consequences of her actions, i.e., overfeeding the cat and putting out too much bird seed causing problems with vermin.
She should probably also be seen by a geriatric psychiatrist who can prescribe meds to address her increased anxiety (that alone is a symptom of dementia) and explain to mom why she needs to take them.
Her behavior post CT could also possibly be an adverse drug reaction if they tried to sedate her for her CT.
Prior posts didn't indicate that the behavior she showed to the ED doctor has been her past baseline. I'm guessing that her physician must have prescribed the lexapro given the losses that seem to be stacking up?
Her provider should determine if she's competent, willing, and able to comply with her treatment plan at her next office visit.
Whether from a physical or mental source, her recent decision making is affected enough that there should be a plan to administer meds that doesn't rely on her. If her behavior changes are being driven by her depression/anxiety, then it becomes a catch-22. If she takes the lexapro her behaviors and compliance could improve, but without it she may continue to be non-compliant.
As I said in the prior thread, her changes with the cat food, etc seems to have elements of dementia to me, but my mom has AD, so I may see it everywhere. I do know that depression is ruled out when assessing for dementia but I don't have a grasp of how much they would look alike. The sudden debility is concerning.
https://10faq.com/health/what-is-conversion-disorder/?utm_source=google&utm_campaign=701-717-3049-11724579076&utm_medium=cpc&utm_content=117479440201&utm_term=conversion%20disorder&gclid=Cj0KCQjwraqHBhDsARIsAKuGZeFdkDuaG1nHUwuD9NDwog98x959YOEfDm5giArosNQbNkRgrFB0CXwaAgruEALw_wcB
We had a poster here who had a relative who was diagnosed with this. Let me see if I can PM her.
You need to get her seen by a geriatric psychiatrist for a proper workup.
And remember that more than one thing can be in play.
All sorts of issues many be at play here. It may take a while to figure out.
Is some medical problem (lack of O2 from TIAs?) causing panic & anxiety? Heart issues can cause panicky feeling I think?
There are folk that sit themselves on the floor comfortably "I fell!" to gain attention. Fairly rare though.
Watch & wait for more clues I suppose. Report anything new to her medical team, but you know her best so trust your gut.
My dad was diagnosed with Conversion Disorder about 6 years ago. His episodes were scary and he ended up in the ED several times, often by ambulance. His symptoms were leg paralysis (literally could not stand or move legs), blindness, jaws clenched and chin jutted out, seizure type movements, he cried out that he was dying…..very scary scene. We didn’t know what to think. My dad is a heart patient. He had quadruple bypass 20 yrs ago. So, full cardio tests were done with cardiologist to rule out heart problem. Also, all kinds of tests tests were done by neurologist, ENT, Primary, etc. His BP stayed normal during the episodes! So after physical causes were ruled out, he was referred to psychiatrist, who diagnosed him with Conversion Disorder. He went on Depression/Anxiety meds and they did help. He takes daily meds, with something for episodes too. His episodes are more subdued now because we know how to handle them, but they still occur. After an episode, he’ll sleep and be weak for days.
I have met the psychiatrist and my dad several times and asked what causes it, She says no one knows. Sometimes children get it, adults, seniors….some are anxious, some aren’t……I believe my mother’s Somatic illnesses finally got to him and made him get sick, but…….who knows for sure.
I will say that a good psychiatrist would be helpful distinguishing between Somatic Illness in general or Conversion Disorder. Either way, you have my sympathy. These conditions are tough on the patient and particularly tough on their family caregivers. Try to get help and keep your mental health. Take care.
If you are talking about psychosomatic symptoms or conversion disorder, you AREN'T talking about someone who is "just deciding" to quit walking.
My mother, an anxious person her whole life, became debilitated by overwhelming anxiety about all sorts of odd things (weather in distant places, ants in her kitchen, the frequency of her bowel movements).
My brother declared that she was having a "pity party" and needed to stop it.
A new doctor (a geriatrics specialist) referred her to a geriatric psychiatrist who insisted on a complete cognitive workup. We thought she was crazy, because mom was " sharp as a tack".
Imagjne our shock when we discovered after formal testing and neuro diagnostics that 1. Mom had had a previously undiagnosed stroke (and yes, they ALWAYS did CT scans in the ER) and 2. She had the reasoning
ability of a 6 year old.
I think getting your mom a consult with a geripsych is the most useful thing you can do. It sounds as though there may be long standing, untreated mental illness clouding the picture.
The kind of workup you get in an ER is not exhaustive.
Yes, anxiety is making this lady's symptoms worse. She has fibromyalgia. She has been increasingly unreasonable and labile for the last several weeks. Many of us with experience with dementia have suggested that there is cognitive decline in play, only to be told that no, there is no dementia.
Finally, if a psychosomatic disorder is suspected, the person who should be doing the diagnostic workup is a psychiatrist.
Were you able to get some sleep after your ER adventure?
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