Q: Mom is Declining & Doctors are Stumped
I am hoping this works. I am trying to do as much research and trying to
figure out what is wrong with my mom. She has been on Eskalith or some form of
Lithium for 16 years now. Two years ago she had a drug induced manic episode
leaving her nothing like the mom I used to know. Her memory has been slipping
since. Today is Monday and last week on Tuesday I talked to my mom and it
sounded like she had dementia, she was confused, disoriented, and not making any
sense. She has been on Eskalith, Zyprexa, and Wellbutrin and some other
medications I'm not sure of. Neither my mother or father question the
psychiatrist enough about what medications he gives her or the possible side
effects or toxicity. This upsets me becaus now she has been in the hospital
since Thursday (4 days) because she fell down twice. Obviously that means
something; she has had a fever for all of those days ranging from 101-103. Her
enzymes in her liver are four times the amount they should be, and her white
blood cell count is low. She trembles and is completely in coherent, she has no
idea my father is there. She is strapped to the bed because she keeps trying to
get out of bed. The doctors are "stumped" as they say and are running all kinds
of tests on her and can't figure out what she has. They think she might have a
virus or some infectious disease. To me it seems quite obvious that she has
toxic levels of lithium brought on possibly by her sweating so much when she
went to Australia and NZ a month ago. She started going downhill while she was
there and continued to decline when they got back. I also think there might be
something reacting between the eskalith and the zyprexa. Could you please tell
me anything you can about what might be wrong with my mother. I am getting
nowhere with the doctors, and my father just assumes the doctors are doing the
right thing. Not to say they aren't, but I think there is more to this than
just some infectious disease.
Thank you for your time.
Dear Ms. B' --
This is surely an awful thing to watch, and to feel so unable to "do something"
to have an impact. I'll make some guesses based on what you've written.
First, they probably checked a lithium level a long
time ago and found that it's not a simple matter of too high a level.. It's
such an easy test and so standard a thing to do.
Next: the infectious disease hypothesis is getting such
priority because if it's bacterial and they can't find the source, it could
easily be fatal; but the low white count is puzzling in that context.
Next: what's making those liver enzymes go up? Not
lithium, almost certainly. It's not metabolized by the liver. Could be Zyprexa,
much less likely to be Wellbutrin. A friend of mine says "medicines are guilty
until proven innocent" but it will be tricky trying to control her agitation
without something like Zyprexa, and that is probably holding back the doc-team
you're dealing with. It's really hard to ask staff to just cope with those
symptoms when you think that's what you need to do to figure out a problem;
especially when there's some other potential explanation in the temperature
However, lithium can make people very confused and
disorganized and generally "out of it", so at some point it would be worth
lowering that one too. But brace yourself, things could look quite awful while
each of these medications is considered in turn as the potential culprit.
Your theory about the Australian travel could easily be
part of this: either through dehydration leading to lithium toxicity from which
she's not yet recovered; or simply by inducing a manic phase despite the
medications, as travel of that length is well known to have that risk, and
perhaps her mania just looks different now because either she's older, and has
fewer neurons so can't tolerate that degree of agitation (this theory has to be
considered because of the one other medication on the list, Wellbutrin, to make
sure that someone's considered the possibility of the antidepressant making the
current situation worse).
In general, the number of different organ systems that
are now involved -- brain, obviously; bone marrow (too few white cells); liver;
plus the fever -- means that your mother's situation is potentially quite
serious. If so, then the doctors are in a tough spot: they may need to do
something pretty aggressive to try to address these symptoms, and yet sometimes
the only way to figure it all out is to stop medications, rather than turning
them up or adding new ones. That might account for why it looks like they look
unsure at times of what to do. Here are some general thoughts on
how to talk with
doctors, though it sounds like you may have figured out much of this on your
own. Good luck with the process.
Published June, 2004