LO with Alzheimers / Dementia and trying to treat Osteoarthritis

Dave Cahail

Has anyone had to deal with a LO with Alzheimers / Dementia who is telling everyone that they have pain but based upon physical examination you can't figure out if it is real or perceived based upon how their LO's brain is functioning? 

My 84 year old mother has had some leg swelling and pain over the several weeks. She is morbidly obese and has mid stage Alzheimers / Dementia. The initial diagnosis by the AL MC facility doctor and staff was that it is osteoarthritis based upon their examination and xray of her leg. They had also noticed some lymphodema and were wrapping Mom's leg or having Mom wear compression socks. I have also talked to the staff about applying ice packs to her leg and that does seem to help a bit. The facility doctor has also arranged for light physical therapy and a knee brace. We have also tried to work with the AL MC staff to minimize her snacking to hopefully cause her to lose some weight but don't that doesn't seem to working. These are all treatments that are recommended for osteoarthritis.

Mom was sure that it was a problem with her leg bones so I took her to an orthopedic doctor who did more xrays and informed us that the bones in her leg as well as the knee and hip replacement hardware are all in place and looking fine. Because Mom didn't get the answer she wanted, she thought the doctor didn't know what he was talking about and thought we wasted the day. 

I took Mom to another PCP who examined her leg and told her that Mom that she saw some signs of lymphodema and that compression socks and water pills were appropriate. The doctor didn't think it was gout or cellulitus. This doctor did do some blood work to rule out stroke and and the results came back that Mom was having some issues with blood flow in her capillary veins but nothing major. The doctor recommended we try using gabapentin to help with the pain by treating the nerves in her leg. We have increased the gabapentin three times in the past couple of weeks but it still doesn't seem to be working. The last remaining thing the doctor suggested was an EMG test that checks how the nerves are firing in muscle tissue. This is our last resort. 

Going through this process, it is obvious that my mother is struggling to understand what the doctors are telling her. She just wants a quick fix and I am afraid that doesn't exist. And I am struggling trying to explain to her that there might not be a fix for it and she may just have to live with it. I am afraid she will continue to complain about it as her memory continues to decline and I will have to get in a mode of making something up each time regarding treating it. I am also wondering how much of the pain is in her mind versus actually physical. 

I will continue to work with the AL MC facility staff to try to manage this situation as I can't continue to rack my brain on possible medical solutions or to continue to take her to doctors who just confirm what we have already heard. I am sure there is no easy fix or even a fix for this situation and it is wearing me out. I can schedule her for an EMG test but frankly I don't think it is going to solve this situation and it will cost a lot of money.

If you have gone through something similar, I would be interested in how you handled that situation. 

Stuck in the middle

Lower extremity swelling and pain are normal symptoms of morbid obesity.  If your LO is 84 and morbidly obese, I would be surprised if she did not have osteoarthritis and leg pain.  The treatment is diet and exercise, for weight loss and muscle strengthening and bone growth.  If you find a way to persuade her to follow that regimen, please share it and I will try it with my wife, who is 10 years younger but has the same problems (obesity and knee OA).  

I have post-traumatic OA myself, in several joints.  The foot and knee pain make me want to sit a lot, but I know that doing so will make the condition worse, so I take Aleve and keep moving.  My wife can no longer see that far down the road.  Your LO may not be able to do so either.

mommyandme (m&m)

Prescription strength Lidocaine patches help my mom with pain sometimes.  She doesn’t have the symptoms your LO has but just mentioning.  She’s already on daily Lyrica, Tylenol and Cymbalta.  She’s kind of forgotten about her years of chronic aches and pains (yay! In her head, maybe) 

We just treat other complaints of discomfort as they arise.  If she complains of back, leg, shoulder etc… pain, slap on the lidocaine patch. There’s not any ability for her to really explain what’s going on.

Your situation is very difficult, so sorry.