Has Advanced Dementia, Hypothyroid And Myoclonus. Prescribed With Levothyroid, Celexa And Aspirin. What Tests Should Be Done?

Posted on Fri, 6 Dec 2013

Question: mom is 88 yo, has advanced dementia,hypthyroid, myoclonus, rectocele, has been holding her breath off and on for the past 2-3 days, started really infrequent, now is more frequent, we have to open her mouth so she can breathe, her dental hygiene is good cause we do it for her, she is able to manage food and water and swallow okay, still has gag reflex, meds are Namenda, Aricept, levothyroid, celexa, aspirin, climara patch vit C, vit, E, vit D-3, multi vitamin, cranberry capsules, and miralax, culturelle, Clear chest x-ray yesterday, labs and ua good. is alert, no cognitive changes, started her on omeprazole last night. ER docs had no answers, however, she didn't hold her breath at all while there. by the way her b/p and pulse normal, what tests should I be requesting to help her, or meds to help her or what? haven't found much info on this condition. thanks. YYYY@YYYY

Answered by Dr. Varanasi Pundarikaksha (2 hours later)

Brief Answer: Liver and renal function test... Detailed Answer: As reported your mom is 88 and with dementia, hypothyroidism ,myoclonus and rectocele with breathing off and on frequently and she is on multiple drugs. At this point, it is better to observe the side effects and adjust the dose and modify the treatment (if needed). You should discuss with her treating doctor before you plan to modify any treatment. As far as test are concerned, I would order liver function test like SGPT & SGOT as well as Serum Creatinine to monitor the liver and kidney functions. I would also examine her lungs and chest to exclude cardiopulmonary causes of apnoeic attacks. Besides whether or not the apnoeic attacks are associated with bradycardia needs to be checked. And if necessary Theophylline may be initiated with the consultation of a Physician to ameliorate the apnoea. I strongly recommend you do any changes or tests after discussing with her treating physician. Hope this helps. Let me know if you need clarifications. Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Varanasi Pundarikaksha (13 hours later)

Thanks for response, I did forget to mention that when she coughs she has pheghm in her throat area, heavy sputum, I ended up taking her to ER last night and got her admitted, it was a difficult task to get her admitted, cause she had no episodes of holding her breath or coughing, finally she did so they admitted upon much urging. her vitals are completely perfect, her labs are perfect, all function good except for when she coughs, it appears painful, so she will stop the cough and hold her breath to try not to cough. when she holds her breath her face turns red and lips purple. we would open her mouth so she could breathe, again they did a chest xray which was clear. what diagnostics should I request from hospitalist? so far am requesting endoscope, and barium swallow eval, However, I don't know that she will be able to follow instructions for barium swallow.

Answered by Dr. Varanasi Pundarikaksha (33 hours later)

Brief Answer: Mucolytics and bronchodilator.. Detailed Answer: As the chest x-ray and all other organ functions are clear, I don't think there is any serious concerns. But as she holds her breath because of pain, I may suggest a course of antibiotics as per the report of sputum culture and sensitivity and also mucolytics with bronchodilators and see if that improves her condition. You can consider consulting a chest physician for detailed examination and supervision to circumvent the situation. Regards

Above answer was peer-reviewed by : Dr. Prasad