HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

Hi Doctor, My Grandpa Is Diagnosed With Alzheimer Since A

Posted on Fri, 1 Nov 2019

Question: Hi doctor, my grandpa is diagnosed with alzheimer since a while now, recently he entered the last stage of alzheimer which he is sleeping most of time, he cannot move right or left in bed anymore and has difficulties in eating too and not talking anymore, just a very few words. About a week ago hes condition got very worse and we moved him to the hospital, (intensive care) they diagnosed him with pneumonia, and hes blood pressure and diabetes were high. He stays there a week and eventually they fixed all the issues and said just take him home, theres nothing more we can do, they gave us the medicine i attached which he is taking now. Now the issue is today hes both hands, face and leg are swelling, i dont know what causes that, the blood pressure and diabetes are in normal range. So what cause that? Also some parts of hes body are blue/red from sleeping all time. Can you please tell me how to deal with that, and what are necessary steps to do, as he is on last stage of alzheimer i ve heard that he can catch pneumonia very easy again. So what necessary steps and which medications i should give him that may help ease things for him. The medicine in my area is very bad so i really need your help please describe me everything you can. Thanks!

Answered by Dr. Ivo Ditah (2 hours later)

Brief Answer:
For how long has he been taking this drug?

Detailed Answer:
Hi and thanks so much for this query.
I checked the image, he seems to be taking the antibiotic Ciprofloxacin...

I am so sorry to hear about what your dad is battling with. Certainly, the prognosis is poor and I must be honest with you. The fact that he is unable to eat appropriately means food particles and oral secretions somehow trickle into the lungs and serve as foci for the start of pneumonia. It would be very difficult to prevent this. It is often the inevitable exit path for most persons with end-stage Alzheimer's dementia.

The attached drug, Ciprofloxacin, is an antibiotic. It is difficult to understand he might be taking this for that long. Generally, he should not take this more than 2weeks. However, this drug is not known to cause swollen legs and feet.

Swollen legs and feet are often related to failing kidneys, liver and heart and also may be due to poor nutrition. If a few blood tests are done, we would be able to establish what the cause is. .But given the fact that he eats very little, this is likely stigma for poor nutritional status. You may want to discuss this with his doctor.

I understand how demanding this can be. I wish your dad well but I also understand he might not be around much longer. Continue to care for him as much as you can and show him much love.

Please bring up the above suggestions with his doctors and let me know what comes out of it.

Feel free to follow up with me if need be.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Ivo Ditah (10 hours later)

Thanks for answering, about the food since hes out from hospital we are using the feeding tube in his mouth and giving him liquids and soup. I guess that solve the poor nitrition right? The antibiotics above he has been taking for 10 days now. We ve done blood tests last monday and all were fine, hes hand was a little swollen in the hospital and forgot to say that he had kidney infection during the time he stayed in hospital. Last monday when they cleared him out the blood tests were getting fine. Until yesterday where hes hand, face and legs looks bigger. hes sleeping all time now sometimes if we talk to him he say some words. Some body skin parts are blue/red from laying all time, we got him medical bed. What else should we do? Should i send you the tests and reports from hospital time?

Follow up: Dr. Ivo Ditah (19 minutes later)

edit: feeding tube in his nose sorry not mouth

Answered by Dr. Ivo Ditah (7 hours later)

Brief Answer:
I'd like to review the results!

Detailed Answer:
Hi and thanks for this follow-up information.

1. Soups and liquids would be grossly imbalanced to ensure proper nutrition. I would be advocating for a PEG tube for feeding. This way, he can receive an appropriate and well-balanced diet.

2. I am concerned about who manipulates the Nasogastric tube at home. I do hope you have skilled medical personnel who can safely use this.

3. Kindly send copies of the hospital records to me for review.

I look forward to hearing from you.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Ivo Ditah (1 hour later)

i have uploaded the last hospital records for review, as i said in my country medicine is very bad, please help with what you can. also please tell me what we should do for the skin, as its bad Blue/red from laying all time, an ointment or something

Follow up: Dr. Ivo Ditah (1 hour later)

Also about who manipulates the nasogastric tube, he has a training nurse with him, she is the one taking care of him. She knows how to use it, she grind vegetables and fruits for him and feed it to him through that tube

Answered by Dr. Ivo Ditah (13 hours later)

Brief Answer:
Apply Zinc oxide, change bed position every two hours

Detailed Answer:
Hi,

The greatest fear is him developing sores from constantly lying on the same position. The care team has to help him change positions every two hours. This will prevent prolonged pressure with consequent ulcers on dependent areas. Also, applying zinc oxide will help keep the area dry and less likely to breakdown. If possible, apply protective pads to bone prominent areas such as heels, sacrum and shoulder blade.

I have reviewed the labs. They are okay and nothing can adequately justify the fluid overload.

On another note. I will not encourage aggressive care at this time. He's simply not having a quality life and I will not advocate for invasive and aggressive interventions that may end up prolonging and inflicting more suffering.

I wish you well.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Ivo Ditah (12 hours later)

Sure i understand. I just wanna make things easier for him, so he doesnt suffer pain. I told her to change his position every 2 hours and will get the zinc oxid. Anything else you want to add?

Answered by Dr. Ivo Ditah (15 hours later)

Brief Answer:
Keep me updated with his progress!

Detailed Answer:
Hi and thanks for following up with me.

Keep me updated with his progress.You ma also report a few of his vital signs to me once in a while. That way, I can keep track of what is going on. Also, feel free to contact me in case of any lingering worries. Above all, I emphasis comfort over aggressive measures judging from all I have gathered from you.

Best wishes.

Note: Get a consultation booked to know more about aging related medical issues. Click here.

Above answer was peer-reviewed by : Dr. Yogesh D