DEAR DR. GOTT: I have a friend whose wife is a 58-year-old Caucasian. She doesn’t smoke or drink alcoholic beverages. She has two daughters. Both her pregnancies were without problems. She is seldom ill. She walks three miles at a brisk pace three to four times each week and isn’t overweight. She is not a complainer or one who visits doctors without cause. She is very conscientious about eating a healthy diet. Most of their vegetables are grown in their home garden. Her only health issue has been a fairly high blood pressure. Around 155/95. She has been taking blood pressure control medicine for about three years with little effect.
Shortly after New Years she was hospitalized for about 10 weeks after she became sick with vomiting and chronic diarrhea. She was treated at a local hospital and then sent to a larger facility for further testing. She has undergone extensive testing at both hospitals but no diagnosis has been made. Although her symptoms have abated quite a bit, she now is experiencing mental problems. She has severe mental loss which started when she was in the hospital She doesn’t recognize many of her life-long friends. She can’t remember how many grandchildren she has or their gender.
She recently was tested by a neurologist and was told she didn’t have any kind of neurological problems. She has undergone every kind of test imaginable. The doctors have now told her husband that she should be seen by a psychiatrist.
I wonder if you may have any comments or suggestions with regard to her condition? Thank you very much for any consideration you may have regarding her illness.
DEAR READER: We certainly cannot fault her impeccable lifestyle from a dietary standpoint or fitness angle. And, because she has been on blood pressure medication for three years and you don’t indicate any modification of the strength, brand or frequency, I wouldn’t lean toward that being an issue either.
I must question what caused the 10-week period of hospitalization following the bout with vomiting and diarrhea. Did she have a severe allergic reaction to a food additive? And, what was she given while in hospital in terms of medication? Could one drug have had a devastating cross effect against another? What was she placed on for control of her symptoms? Was her bowel punctured during a colonoscopy? Did she have any dyes injected into her body as part of the testing? Some medications, to include those for anxiety that are meant to reduce stress can literally kick some folks right in the seat of the pants. Was she given something to calm her that had an unexpected adverse reaction, or was she simply over-medicated? Something happened somewhere and a thorough investigation might shed some light on this devastating outcome.
Then too, some people – even those who appear extremely together in every sense of the word – have been known to literally fall apart at the seams when hospitalized or placed in a nursing home. They no longer have the control they once did. Daily patterns have been compromised. Strangers, no matter how kind, mingle everywhere. Needles draw blood and specialists never seen before ask personal questions. And, the patient does the only thing he or she can by shutting down, entering a world that “outsiders” cannot penetrate. At 58, a rather young age, my guess is your friend isn’t suffering from Alzheimer’s or one of the many forms of dementia. She may have simply shut herself off from the rest of the world and it might take an appreciable amount of time to bring her back.
My recommendation is to have the family behave as they normally would. As long as she is able to function in her home, she should be allowed to get back to the day-to-day routine she previously appeared comfortable with. She should sleep in her own bed, watch her favorite television programs, walk around the block, and prepare meals if she is capable. Her grandchildren should be allowed to visit, as long as they and the rest of the family members understand and accept the complexity of the situation. In other words, her lifestyle should be close to what it was previously.
Something is going on. Although uncommon, some forms of dementia can present in people her age. If a psychiatric disorder is a possibility, consultation may help. Perhaps she needs a top notch diagnostic center such as the Cleveland Clinic or the Mayo Clinic.