Clutching throat, "it's hot it hurts"

CatsWithHandsAreTrouble

Mom keep clutching throat and crying it's hot, it hurts. She's had 8oz of ice cold water but is in tears. "Hysterical."

Happened once before but not sure how we resolved it.

Any ideas? It's an hour after her bedtime. Might have uti

CatsWithHandsAreTrouble

Well not sure what happened still, but I got her seated on her bed and she went through about five tissues blowing her nose and crying and still saying it hurt. I put on her usual bedtime show and somehow got her to laugh. That seemed to help change things around.

I got her settled down in bed and got a washcloth and ran it under cold tap to dampen it slightly. I put it on her head and she said she really liked that and she settled down some more.

Just redampened the cloth and she seems as her usual self.

Thanks for stopping by :)

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BassetHoundAnn

This might be out in left-field but she might have an infected salivary gland. Those can come from dental decay, viruses, not getting enough liquids. They hurt like hell at the top of the throat. The solution is to have her suck on something like a Popsicle or a lemon slice or lemon drops, to get the salivary glands working. Just a thought for something to try.

CatsWithHandsAreTrouble

Thank you Bassethound, that's very insightful. She's definitely not gotten a lot of liquids lately. Not sure how fast the onset of an infected salivary gland is though.

Thank you, too, Hoping4Endurance. It is definitely tricky trying to figure out what is hurting. She was telling me all sorts of things but beyond that it hurt and that she's hot, the words were very jumbled.

M1

I wonder about acid reflux possibly? Esophageal spasm? Is she on any meds for those things? So hard to tell.

CatsWithHandsAreTrouble

M1 she is on pantoprazole for gastritis. Around the 22nd of March, her PCP changed the dosage from one a day to one every other day. Not sure what the reasoning was. I think she's been on it since October 2022 or there abouts. I think we were concerned about acid reflux before the gastritis. Maybe we should revisit that?

Marta

Yes, cats. Definitely revisit the acid reflux. It’s very suspicious that her symptoms popped up after the dose of pantoprazole was reduced. This med is one of the PPI meds. Providers are pressured by insurance companies to reduce the dose in a proactive manner, due to cost. But when the patient has breakthrough symptoms, which sounds like what your Mom may be experiencing, the provider can revert to the original dosage at which the patient had no symptoms, and use the evidence of breakthrough symptoms to justify the dosage change to the insurance company.

the fact that she has symptoms one hour after bedtime fits perfectly with this scenario, as gravity comes into play when lying down, allowing acid to reflux upward. A simple phone call to her PCP office should be sufficient to get that dosage increase.

Best to you. You are such an attentive caregiver.

Marta

M1

there you go, definitely call on this. It does fit.

Pantoprazole is generic and therefore cost is not a factor in decreasing the dose I don't think. There is some data that proton pump inhibitors taken long-term can contribute to dementia, but once it's present the horse has left the barn. This has always been a concern for us; my partner has always had terrible reflux related to her severe scoliosis. Unfortunately, there was no choice but for lifelong use of proton pump inhibitors. But I do wonder if it has been a contributing factor to her dementia. Her life without them would have been miserable in other ways though. Damned if you do and damned if you don't.

You can also raise the head of her bed or prop her up on a wedge pillow, that may help, too. And not everyone knows this, but chocolate and peppermint can exacerbate reflux a lot. Should be avoided in the evenings, for sure.

CatsWithHandsAreTrouble

It was happening after her bedtime, yes, but she hadn't gotten to bed until after. Dinner was later than usual and dad kept giving her things to eat (one of which was a chocolate ice cream cookie) and she had a difficult time taking her evening medication which added on to how late bedtime was. The symptoms were more or less ten minutes after she got her pills, roughly half an hour after she stopped eating. She had been upright the whole time.

These past few weeks she's also been experiencing increased and heightened anxiety which would normally resolve in one day but it's almost been nonstop this week. She had gotten her memantine dosage reduced at the same time as the PPI because the doctor thought "it has no benefits for her in this stage."

I'm trying to recall the first time she had an episode like this to see what the similarities are. I do not think she was on the PPI then.

She's also on a waiver/assistance program that covers the cost of her medication so if it's about reducing costs, it might be solely on the doctors end and not mom's insurance. I'm not sure though. These are definitely things to think about

CatsWithHandsAreTrouble

Okay, She is down for bed now. She clutched at her throat twice today, once around 4:30pm after having jello made with orange juice, and once around 7:40pm while I was taking her to the toilet for last visit.

I've got her in bed and propped up on pillows at roughly 20°. That's how she usually is. She's coughed a few times...

Do y'all know if acid reflux is constant? If she had it yesterday, would she have it again today or does it vary with what you ate?

M1

If it's flaring up it can be pretty persistent. The acid in the orange juice could irritate. If you have enough you might want to go ahead and dose the pantoprazole daily until you make the phone call. You may be able to get it over the conter too (like Prilosec/omeprazole), but the mg dosage may be lower than the prescription strength

CatsWithHandsAreTrouble

Thank you M1, always appreciate how thorough you are.

We might have enough to go to the previous prescription (once daily) because the script hadn't been updated. It was at first twice daily for a week and then once daily, or at least that's what the pill bottle says.

CatsWithHandsAreTrouble

I talked with my older sister about the pantoprazole dosage. She looked up that it might be "rebound reflux" happening and I saw some sources state that it could take 8 to over 20 weeks for it to stop.

She thinks the doctor cut back the dosage to reduce the number of pills mom takes and that the gastritis had been resolved.

But honestly, if reducing the dosage would cause mom to have discomfort that she cannot articulate and causes long-lasting distraught for her, I'm not sure if that would be the right path. Especially since dementia is a one-way street.

CatsWithHandsAreTrouble

Just an update:

Mom hasn't had the throat episode since Saturday but my younger sister said she was doing it Friday night. Older sister took mom in to get a urine sample done; waiting on the culture results but supposedly they were still able to get results from something that confirmed she had an infection.

SDianeL

Make sure that she's not aspirating. That is dangerous. I would speak to her doctor. Does she have a visiting nurse?

CatsWithHandsAreTrouble

SDianeL what would she be aspirating? Her spit? I think it's a little too early for that to be happening just yet but I am trying to be on the lookout for that.

What would you suggest to say to the doctor? It'll be a game of telephone though, my older sister is mom's health proxy. And which doctor should this be brought up to?

What do you mean by visiting nurse? Is this something we should have?

Sorry for all the questions, I just don't know what you mean.