The Dreaded U.T.I.
Personally, having suffered multiple times from U.T.I.s (urinary tract infections), I consider myself quite an expert on them. They are extremely painful and require immediate attention. Waiting too long can result in a full body infection and even hospitalization. Hospitalization is absolutely the last experience which I want to impose on Hubby ever again. That in itself will be a chapter not to be missed.
Having a family member with the condition is more complicated when they have Dementia. Sometimes spouses cannot describe their pain, or its location. When Dementia is severe, they might not be able to communicate at all, but may have unusual behavior. Sometimes they do not feel the discomfort, but have the infection just the same. Blood in the urine can be a sign of infection and doctors will ask about that immediately. Bizarre mental activity can be related to an UTI and many times caregivers want to rule out the possibility of such an infection before looking elsewhere for answers. An ignored UTI can become sepsis and patients can actually die as a result.
The number of patients who enter a hospital with an entirely different complaint, who are then put on a catheter, which then results in sepsis which kills them, is shocking. I have seen more than one elderly patient in the hospital with such an infection when the antibiotics could not fight the condition. One of the largest risks when hospitalizing elder patients is that of an UTI. It seems to me that the catheter is used as a matter of routine. With it, diapers need to be changed less often. Urine can be measured easily. Is it only because it is easier for the nursing staff? Is that why lives are being put a risk? Perhaps if the nurses did not measure the urine, but simply weighed the patient daily, it could be a safer option. As I write this, I realize that not all patients can be removed from their beds to be weighed. When Hubby had his first heart attack in Sun Valley Idaho after skiing, he was taken to St. Luke’s hospital in Boise, Idaho. Even almost thirty years ago, that hospital had beds which weighed the patient in the bed! It is time for everyone to benefit from such technology advances.
Our experience went something like this: Hubby complained about some time ago that it hurt him to “pish.” I think that is a sweet word; it reminds me of “fish” and fish are cute little things. Other words that are more graphic for the same process, appeal less to my writer’s sensibilities. Being such a self-proclaimed expert on the UTI in general, I knew that I would need to get a urine sample to the laboratory ASAP. A friend kindly bought me a plastic specimen bottle with a tight cap so I could get a sample the next morning when our health-care provider’s labs would open. I called the family doctor and told him that I had placed Hubby on large doses of cranberry extract (in the form of tablets and a product called “Cys-control” which is mixed with water to make a pleasant drink), and after taking the sample, had given him a pill I had in the house (for my own previous similar infections) called “Sedural” which turns the urine a lovely shade of orange, and helps the spasms to relax and hence relieves the pain. The intense cranberry extract did not obscure the tests which needed to be performed on the specimen. I had some antibiotics in the house and the doctor suggested that one of them might help the infection. The important thing to remember is that antibiotics will give a false reading if they are ingested before the specimen is taken, so one has to hold off using them. Then of course there is another complication which may arise – the possibility that the antibiotic you have been using at the doctor’s suggestion, is not the correct one for the bacteria which will ultimately be found in the culture. Isn’t this a fun subject!? It is hard to wait for lab results to return in a few days-time when someone you love is in pain.
I woke up extra early in the morning to get the sample to the laboratory by 8 am. That is way too early for a spouse who is often up with Hubby in the middle of the night having a fascinating conversation. Five days later, after daily doses of cranberry extract, Sedural and explanations about the very strange color of his urine these days, I was quite stunned to be told that the culture came back negative. My immediate, humble conclusion was that there must be something wrong with the lab. I am an expert after all. Giving my ego a few minutes to heal from its bruising, I picked up the phone to speak to Dr. N. once again. I asked if there could be other explanations for urinary discomfort, and of course there are. So, we “shlepped” (a lovely Yiddish term for dragging someone or something) Hubby in for a physical appointment with Dr. N. and discovered the problem was a bit more complicated and not at all as I presumed.
Often, I ponder the question of whether or not to hospitalize Hubby. He recently suffered Congestive Heart Failure and an apparent Heart Attack. His legs became swollen and there was fluid collected around the heart and lungs. It was suggested that I have him admitted to hospital to have an I.V. inserted in order to administer the diuretic and a catheter to remove the fluid from his body. I declined the offer. We have had multiple experiences with hospitalization for Hubby after dementia set-in. It is not unusual for these specific patients to become psychotic in the hospital environment. Hubby classically pulls out every tube and demands to leave. Not much point in taking him anymore.
Giving Hubby diuretics (prescribed by his doctor of course) to remove the excess fluid in his system, accomplished the same goal as putting him into a hospital. One benefit was quite simply… no catheter… no infection… no risk. I felt quite sure that had I admitted him, he would never have survived hospitalization. Hubby has lost 15 pounds of fluid so far, and even though the left side of his heart appears very low functioning in the ultrasounds, still, his quality of life is good and he is getting excellent care at chez-nous!!
This seemed to be an experience worth sharing, because if it was to happen again, I would do exactly the same tests and would take the same approach. You or I would be right to do so. The risk is just too serious to ignore.