Skin infection

I’ve had a couple of good visits with Mom since the difficult day with Bino. Later that week, a nurse called me about completing an annual assessment. I could do it over the phone or in person. I opted to do it in person so I could also have a visit with Mom the same day. The assessment took just a few minutes. It was a series of questions gauging how important a number of things are to Mom. For example, how important is it for her to keep up on current affairs? Not at all. How important is it for her to have a pet? Not at all, I had just learned. How important is it for her to select her own clothes? Not very important. It’s a state-mandated assessment, I assume for all nursing home residents. Not too applicable to nursing home residents with advanced dementia.

After the assessment, I found Mom’s roommate and her daughter in the program area. I caught up with the daughter, who I hadn’t seen for awhile. Her mom is still with us, and she still visits her twice a day every day to help feed her. Across the room, another daughter from support group was giving her mom a manicure and pedicure. Her mom is still pretty with it. An activities staffer went and got my mom from a distant chair and encouraged her to come over to me. So then the six of us sat together and chatted. I tried not to leave Mom out of the conversation too much. I think she can still be sensitive to that, and she certainly was earlier in her illness.

A few days later, I got a call from a nurse that Mom had been diagnosed with cellulitis, a skin infection. The nurse practitioner had been in that day and noticed a red, warm area on Mom’s leg and determined that it was cellulitis. So Mom was going to start taking antibiotics. I asked if Mom seemed to be bothered by the sore spot on her leg. The nurse said no, Mom was just carrying on as usual. When I mentioned this in support group a day or so later, the doctor who runs group asked how advanced the infection had gotten before it was discovered. I wasn’t sure and said I didn’t know. I know urinary tract infections can cause changes in behavior in dementia patients, but until the doctor asked questions about this skin infection, I hadn’t given thought to the potential for Mom’s behavior to be affected by her infection. I looked up cellulitis online, and it can be accompanied by fever, chills and joint pain in addition to soreness at the site of the infection. But apparently if she had any additional symptoms, they weren’t affecting her enough for her behavior to change.

I visited Mom this afternoon, the first time I’ve seen her since that diagnosis. She was sitting in the lobby when I arrived, bopping her head to the oldies music playing on the stereo. I pulled up a chair and sat down. The receptionist said she had just tried to give Mom a piece of candy, and Mom had taken one bite and then set it aside. Mom started talking to me about food, so I wondered if she was regretting passing on the candy. I got a can of root beer out of the vending machine. I took a couple of sips and gave Mom the can, and she took a big drink. “Ah, that’s good,” she said. She talked off and on, and at one point she rattled off a series of large numbers. I said, “Wow.” And we both started to laugh – she had a big belly laugh. I’m so glad she can still have a good laugh. I looked at her leg, and the site of the infection was easy to see. It was a big circle about three inches across on her left calf, with a raised purple lesion in the middle. No broken skin. The skin was tighter in that region, and raised. I touched the outer areas of the circle, and it was warm. I asked Mom if it hurt. She didn’t seem affected by my touch.

An aide came into the lobby and sat on the arm of Mom’s chair and whispered in her ear: “Do you want to go to the bathroom?” Mom said, “I’m tired.” The aide said, “I know. And you told me your feet hurt.” She coaxed Mom out of the chair. “Are you coming?” Mom asked me. The aide said I would sit there and wait for her to come back. And I did. Another resident came and sat in Mom’s chair while she was gone. I said hello to him. When Mom returned, I dragged my chair away from him over to another chair so I could sit with Mom. He didn’t seem to notice.

Mom finished up the root beer. She needed a reminder each time she picked up the can of how to hold it so the hole faced her as she lifted it to her mouth. I touched the bottom of her socked foot and I could feel a raised area where she has a severe callus. I asked if it hurt. She didn’t answer, but she pulled her foot away. I asked her a few times if she wanted to take a walk. She didn’t really seem to understand. But she seemed happy to remain sitting. I wonder if her feet hurt all the time. At one point, she said, “Where’s the boy?” I assumed she meant Mr. R. But it’s hard to know for sure. On weekends, visiting is discouraged after 3 p.m. because there is no receptionist after that time. So as 3 o’clock neared, I told Mom I had to go to the grocery store. Which was true. I reached down to hug her and she puckered up, and I gave her a kiss.

2 comments so far

  1. Megan on

    I could relate to your wondering about your mom’s feet hurting possibly all the time.

    That’s one of the many hard things with dementia – never knowing where it hurts exactly, or how that hurt might manifest in behavior changes or avoiding certain activities.

  2. momsbrain on

    Meg: So true. Mom used to be generally achy all the time in her hips. I wonder about the pain signals in her brain, and if they are affected. The doctor who runs support group often says patients who scream a lot are probably in pain. Mom’s behavior is generally good, so I assume if she is feeling pain, it is not agony for her.

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