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Just a question: Why would you want to treat a UTI in a person with late stage dementia? I know this question may sound cruel but in a case like this treating a UTI with antibiotics may just be prolonging the inevitable. In the elderly many of them do not have the pain associated with UTIs like younger people do and the mental changes can be helped with meds other than antibiotics. These people with end stage dementia are terminal, they are going to die, what difference does it make what the cause is. Shouldn't we be more interested in keeping them comfortable rather than prolonging their lives with the use of antibiotics?
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What? I never heard of such a thing. My Doctor said treat until the antibiotics do not work any longer on them, for pneumonia also. Everytime my Moms urine is very strong smelling I give her antibiotics for a week, then stop. I shouldnt be? If this were the case, people would be making sure they got a uti or pneumonia wouldnt they???!!!!!! Trying to understand?
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Sherry1anne, Again, so sorry for your loss, hope you are hanging in there :0(
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Reverseroles: I guess the way to sort of explain my previous entry here is like this. If a terminally ill pts heart stopped (cardiovascular failure) you might choose not to do cardiac compressions to try and save them. If a terminally ill person quit breathing (respiratory failure) you might choose not to give them artificial respirations and put them on a ventilator to try and save them. If a terminally ill person developed a infection that the body could not fight (immune system failure) you might choose not to give them antibiotics to try and save them.
Most people don't have a hard time deciding not to do chest compressions or artificial respirations and ventilator care for a terminally ill person. But, antibiotic therapy is another thing. We've become so accustomed to the use of antibiotics that we just sort of take them for granted. We forget that these are very powerful medicines that can save and prolong lives. And, the question is, is that always appropriate?
My Mom has a POLST form and my brother and I had no difficulty deciding no CPR. It is also marked no antibiotic therapy. My brother and I had a much, much harder time deciding on this and there are times when we question if we did the right thing. Mom has late stage dementia (terminally ill) and her future does not look bright. We have chosen not to prolong Moms' life using any means, but to do whatever we and modern medicine can do to keep her comfortable during the end stage of this horrible disease.
I hope this explains better what my thought is. It is a tough, tough decision.
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Noyjoy3, thank you for writing. I got a DNR for my mother and she signed for no artficial means of support or feeding tubes years ago when she had her mind.(What is a POLST?) My Mom also has late stage dementia, hasnt walked ot talked for 5 years. I need to puree her foods and do everything for her. She can however laugh, and thats all that makes my day. I can ask for a kiss and get one, she is happy. But, she never would want to live like this, she sits and stares most of the day, laughs, then stares again. It takes me 3 hours to get breakfast in her and 2 hours for supper, 1 hour for lifting her on the toilet to bathe her, etc.
I had asked my doctor is she got pneumonia if we would treat it, as I read hospice doesnt always. and he said yes, you treat until the antibiotics dont work. I dont know if I could "not" treat a uti or pneumonia? I do agree with you, why live like this? But on the other hand, why would everyone be careful about bathing, feeding, etc, if they wanted their parent to die. Do you know what I mean? this is so complicated. My moms on bp meds and antidepressant. I am so on the verge of throwing in the towel with no life here. She moved in 8 years ago and I have had hardly a life since. I am married with kids, grandkids, and cannot enjoy my life as I would like to. I would like to hear more, and from others to, is this something to really consider, hummm, it seems like a crime to not treat a medical condition. Thanks again, please write again. Is your mother in your home? Whats her condition?
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Reversroles: A POLST form is Physicians Orders for Life - Sustaining Treatment.
It is called other things in other states but the principle is the same. It is as important to have as an Advanced Directive, in many ways more important. The doctor, working with the pt(if able) or the pts representatives fills out a form addressing what care the pt is to recieve. It addresses: CPR; Medical Interventions, do you want comfort measures only or full treatment; Antibiotic use,
Medically Assisted Nutrition. Once signed by the doctor it becomes a physicians order and is to be honored by all medical personnel. It can be changed by the pt (if able) or the pts rep. This is the form you would want to give the EMTs if you had to call them for your Mom.
Regarding doctors: Remember they are humans too and they bring their own values and ethics to their practice. Sometimes their beliefs agree with those of the pts and sometimes they don't. It is not wrong to leave a doctor if the plan of care cannot be agreed upon. The important thing is to make sure it's an educated decision.
I do not want my Mom to die. I am going to do the best I can to keep her from getting sick. But I also realize Mom is 91, she's tired and I know she really wouldn't want to live like this. Deciding not to treat a medical condition in a terminally ill pt is not the same as trying to kill them! I'd encourage you read up on Pallitive and Hospice Care. I know I had to. You are right this is all so complicated. After years of caring for Mom two weeks ago I admitted her to a Memory Care facility. Mom can still walk with a walker, can still eat and talk but she can't really carry on a conversation. Most of the time Mom is not there. She's off in her own world, living in the past waiting for her Mom or one of her brothers(all deceased) to come take her home.
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Nojoy. My.mother does have an advanced directive but its for no artificial means of support such as life support or feeding tubes. I should look again at it. My moms been here 8 years and hasnt walked or talked for 4 or 5 years. She us however now waking up laughing like hell in her bed at 6am lol.i do understsnd what you are saying but what i dont understand is if this were the norm. Ehy epuldnt people not be so upset ober utis, ehy keep them clean etc. Doesn't mske sense in some ways. I just know i couldnt not treat, well i think? My mkm told me 15 years ago not to ket her live if she couldnt take care of herself. Anyone else chiming in here on this subject? Anyone else choosing to not treat with antibiotics?
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Omg sorry bout the typos, on my small cell.what i meant was why would people be so concerned with keeping a person overly clean , healthy and protected for getting a uti or a cold if this could ultimately end their suffering from disease? A lot of people here, any thoughts, anyone else not using antibiotics ?
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Key word a few posters up...."good" urologist...I get uti's and kidney stones every time i turn around...I am not 50. My first encounter with a urologist...he did a closer examination of my insurance cards than he did of my urine culture, and he made a bigger issue of the fact that I was late to the appointment because of a death in the family than the fact that I had stinky pee and a barely visible stone on a CT scan, but was in extreme pain. Chalked it up to emotions. ! I did the cranberry thing and eventually passed a small stone at home. Scooped it out of the potty and walked it into his office. Made appointment with one of his competitors for follow up. SMH. Meanwhile, had an abdominal CT for some other issues, the original stone was still there, clearly more visible, and i have had five more UTIs. took home test kits to the PCP who did antibiotics. I agree with the mood changes, and increased confusion. One thing that seems to help...long nightgowns as the single item of clothing.....hee! .....estrogen cream.....(keeps things not dried out, according to the gyno) and yes to the more natural soaps and the bidet. There is even a portable one! I got so frustrated with the urologist I made an appointment with the gynecologist who was more than happy to advocate on my behalf, and learned a lot, btw, about women's sexuality through the aging process...yes, even in the 80's, 90's and 100's.....even in care homes. fascinating. But back to the UTI. thing...a GOOD urologist...indispensable.
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