Water Infection and Appetite

[Debbie M.]

I wondered if anyone could give me some advice. I care for my 95 year old mother who is generally in reasonable health. She has high bp which is under control with medication, takes medication for depression, has osteoarthritis and osteoporosis and also suffers from a hiatrus hernia and gastric reflux disease for which she take omeprazole. Recently the gastric problem has become worse and the endoscopy showed that she now had severe gastric erosion and the sites of several small but healed ulcers. As a result of this and of feeling constantly nauseous, exceptionally lethargic and of having a permanent 'acid' or 'coppery' taste in her mouth and also being very constipated she is found to have a water infection for which antibiotics have been prescribed (she has just begun the course). The thing that concerns me greatly is her appetite and whether or not it will return, at the moment she is drinking (water and cups of tea) and is pretty well hydrated according to the hospital but she really can't eat anything except perhaps a few spoonfuls of soup, half a mug of Complan or a tiny piece of bread and butter a day. She has lost 18kg in 5 months. She was prescribed Fortisip the high calorie nutritional drinks but they were too rich for her and made her vomit. Otherwise, her heart is OK and her blood test was 'unremarkable', her bowels are OK apart from the constipation which is being treated (although of course she isn't eating anything and only takes very limited exercise). Any help or advice anyone could give me would be much appreciated. In addition to the above my mother is very obstinate and if she doesn't want to do anything she won't!! I try everything but she just won't eat anything at the moment, however tempting and attractive I make it. I work full time but am at home with her every evening and at weekends and she has a carer look in every day. She is marginally more accommodating with her carer but with me it always results in a row and sulks which is no good for either of us! Thanking you in advance. Debbie

[Guest]

Hi Debbie

Have you tried Fortijuce? It is a nutritional supplement rather than the nutritionally complete Fortisip but better than nothing and it is a fruit juice rather than a milkshake-type drink so your mother may tolerate it better. For weight gain Maxijul is often prescribed, this is available either as a flavourless powder which can be added to food or drinks or as a liquid which is available in several flavours. I would suggest that you ask your mother's GP to refer her to a dietitian who can assess her needs and preferences and ensure that she is prescribed supplements which suit her.

[Debbie M.]

Parsifal - thank you so much, just reading your thoughtful reply was enormously helpful. We go to our GP next week to check how the water infection is getting on (hopefully the antibiotics will have worked their magic by then although I appreciate in very elderly people it may take some time) and I will certainly ask him about seeing a dietician, perhaps one who has a particular interest in geriatric dietary matters if that is possible in our area. I will definitely try the fruit juice type supplements - certainly the Fortisip was far too rich for her with her gastric problems and she was so frightened with the vomiting as I think she has only been sick a couple of times in her entire life. Thanky you again for your help. Debbie x

[Sue]

Hi Debbie, My Mum is 96 and can no longer eat anything solid. Amongst other things she often suffers from a distended stomach due to excessive wind and also takes omeprazole. She can't manage things which she finds are too rich and we have had problems finding anything which she can eat. For the last 18 months or so her daily diet has consisted of just 3 bottles of Ensure Plus and about 1 litre of very diluted squash (as she says a normal amount of diluted juice such as you or I would have, burns her throat) with some cranberry juice added. She only has the sweet flavours of Ensure (there are quite a few of them) as she doesn't like the savoury ones at all (actually, she doesn't like anything savoury anymore) and the cranberry every day helps to ward off bladder/kidney infections. Just having a purely liquid diet however was causing her to have severe diarrhoea and as she dosn't have much muscle control any more we were having lots of horrendous "accidents". Giving her just one immodium made her dreadfully constipated and so we got the nutritionist in who suggested one bottle of Ensure Plus could be substituted for one of Ensure Plus with extra fibre and this has done the trick although with a liquid diet she is always going to be prone to having odd bouts of diarrhoea. She was taking a daily low dose of broad spectrum antibiotic because of urinary tract infections but found that these were making her constipated so she only takes them now when she gets an infection. She also gets weighed every 6 months (she can't get onto scales herself as she is wheelchair bound) and since being on Ensure she is only losing about 2lb every 6 months and this wouldn't happen if she could drink 4 Ensure per day but she says she never feels hungry and can't manage any more than 3. There are various types of Ensure she has tried, the juices burnt her throat, the yoghurts were too thick for her to swallow and I think she tried a couple of other things too which were no good. Hope this is of some help for you but I think you should first ask your Mum's doctor or district nurse if she has one to get the nutritionalist to make a visit and discuss your problems. PS my Mum always listens to her care workers, doctor or district nurse and ignores anything I say - perhaps it's a Mother/Daughter carer thing !!!!!!

[Guest]

You may have a community dietitian service in your area which can provide a domiciliary service rather than having to take your mother to the hospital to see a dietitian. If you do use the juice type supplements it might be worth just pouring them into a glass like any other juice drink rather than using them in the normal way with a straw, you have to be a bit devious sometimes I find when someone is rather obstinate . The Maxijule, which has no nutritional value, can be squirreled away in tea or any food.

[Debbie M.]

Sue and Parsifal - thank you so much for taking the time to reply, you have no idea just what a comfort it is to read of other people's experiences and suggestions. I will certainly make enquiries about a dietician making a domicilliary visit as apart from anything else my mother is getting so physically weak now that sitting waiting in hospitals in addition to the journey there is something I would like to avoid if at all possible.

Sue - is your mum's doctor at all worried about the weight she is losing or do they see this as something inevitable or 'natural' at her age? If she isn't suffering from the weight loss and is otherwise OK on the nutritional intake she gets then hopefully they don't put too much pressure on, as I know my mother gets very 'edgy' if she feels any pressure to eat and this makes her nausea and discomfort worse resulting in her frequently turning on me and saying 'how would you like to be force fed?" if I try to make her eat (as much as you can make anyone eat if they refuse to do so). I will certainly, as Parsifal suggests, get a bit more devious in the kitchen and try to disguise things more! It is so reassuring to read of another very elderly mother who has similar problems to my own and who is managing so well - thank you again for your post.

[poppett]

Hi Debbie,

Can`t add any advice except perhaps to dilute the milky based drinks with water.

Have enjoyed reading the posts though.

Take care
Meg

[Debbie M.]

Hi Meg and thank you, I did try diluting the Fortisip drinks but they still came back I'm afraid and now of course the unpleasant experience means she will never try again even though it may not happen for a second time! I will certainly investigate the suggestions that Parsifal and Sue have given me, it is so helpful when you feel you are up against a brick wall and people take the time to reply and to be kind - thank you again for your post. Debbie x

[Sue]

Hi again Debbie - No, Mum's doctor is not worried at all about the small amount of weight Mum is losing, we worked it out that if she continues losing weight at this rate she will be about 135 before she disappears into nothing !!! Seriously though, she is now getting all the nourishment and vitamins etc she needs and in fact looks much better and is healthier than when she was trying to eat food as then she wasn't getting much to stay down and because I was cooking her a fresh dinner every day I didn't realise how much was going in the bin. I'm not suggesting that Ensure is the right thing for your Mum to have - the nutritionalist will be the better judge of that, but although my Mum should have 4 Ensure a day she jut can't manage it and there is no pressure on her to drink more - at our Mums' ages, there shouldn't be any pressure put on them - as long as they are happy and comfortable and are eating and drinking enough to stop them getting ill, that's all that should matter. Mum got pneumonia at Christmas, didn't have any Ensure for a week and was in bed from Jan 1st - March 6th, (she made sure she was well enough to get up on March 7th, her 96th birthday, when she met her great-granddaughter for the very first time) but only lost a couple of pounds in all. It took her til about May to fully recover but she was well and fit enough to attend my daughter's wedding last Sat week with 2 care workers to look after her all day - it made my daughter's wedding to have her Nan there. If I can be of any more help, just let me know. xxxx

[Caring_Mind]

Hello Debbie - it's nice to read a post where there is a lot of advice given! It has also helped me in a roundabout way. My mother isn't eating much now, after having a very good appetite. She gets her own meals (very independent) and when I tell her that in my opinion she isn't really eating very much, I get an earfull about how much she does eat! I have noticed her losing weight quite a lot and now I will see the doctor about her seeing a nutritionalist. She suffers with diabetes, so what and when she eats is quite important. Anyway, not wanting to hijack your thread, I will say that yours is not the only Mum who is stubborn and won't take daughter's word or advice for anything! I have come back from Mum after having a bit of an argy bargy with her today! She then always replies "you don't like me very much do you?" ...and I reply with "no, not today, but I do love you"..........that shuts her up lol.
Wishing you and your mum all the best and (((((hugs)))))) for you both x