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PD symptoms or Infection
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An_250062 posted:
How lucky am I to find Dr. Stacy on WebMD?!? My mother was a patient of yours up until 3 yrs ago when we moved to the West Coast and I brought her with me. About that time she developed her first UTI which you diagnosed via email. Her only symptoms were confusion, hallucinations, and very sudden and sporadic slurred speech and loss of movement. She has had frequent UTI's ever since and the urologists seem to be at a loss. I understand these are common in PD patients. Each time she gets one my first clues are the hallucinations and confusion. For the past 6 mos they have been constant. She tests positive for UTI, receives oral antibiotics and then about a week after the treatment finishes we're back to square one. I have suggested to both the PCP and the urologist that perhaps she has never been cured of the infection and needs a stronger injection or IV antibiotic. One told me they would not hospitalize for UTI and another told me I'd have to take her to the ER to get her admitted. Well I tried that on two occasions but since the dipstick tested negative at the time (probably due to the recent completion of oral antiobiotics) they would not admit her. I think both of these doctors as well as several caregivers believe this is just end-of-life PD. I've also been told that even though her cultures grow positive for E-coli bacteria anyone's urine would do so after the allotted time so maybe she doesn't even have an infection. ?? After reading several posts online it does sound like this is how the last few days of a PD patient's life can be described. When I read these posts I have to wonder was it really end of life for these patients or were they possibly infected with bacteria that might have made them seem off kilter. I've really struggling with this right now. Everyone is beginning to make me feel like I am the crazy one and that I cannot accept the fact my mother is dying. If it is end of life PD I can accept that and I hope her suffering ends quickly. But I don't know how to be sure whether it is that or the infection. Your advise is greatly appreciated!
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DUKE MEDICINE
Mark A Stacy, MD responded:
Dear An_250062,
Thank you for your kind words. These are extremely difficult issues, but you have every right to make decisions with accurate information. As a physician, my highest priority would be to know the patient's wishes. If your Mother is able to discuss, ask her if she wants to have more aggressive treatment. If, yes, or if you believe she would, pursue admission for IV antibiotics.

These are questions that you may wish to bring to the physicians caring for your mother:

1) If we treat her UTI, will her confusion and hallucinations get better? (Like before)

2) If so, how can we prevent these UTI's in the future? Would a catheter help? Do we need to change her other medications?

I think if those questions are answered, you will be able to develop a plan.

ps: I once had a friend say to me: "Since you are confused, I will use small words." Do not let a medical vocabulary cloud your understanding of a doctor statement!