Lithium and Trazodone

Chammer

DH is currently on trazodone 50mg at night for sleep.

He has been dealing w a significant infection in his ear and now jaw for the past several months which has created more (understandable) anger and irritation than is his normal daily snarls and growls. Infectious disease doctor yesterday recommended antidepressants which DH refused. ID doctor looked me in the eye and said "lithium 5mg, order it online" (I must have looked like a wounded bunny cause I didn't say anything about DH being the grumpiest man alive)

DH doesn't have a diagnosis of dementia and is an active alcoholic. I have been his "care driver" for this infection (all his medical care actually) as he tells every care provider to call me with any information. I do have medical and durable POA so I am able to act for him.

Lithium orotate is the supplement available to order online without prescription. Dr Google says lithium (specifically lithium carbonate which is the prescription version) and trazodone together can cause serotonin syndrome. Alcohol is also a big no-no but that alcohol won't stop.

Thoughts on whether it is worth it to try the over the counter lithium or just continue to deal with the grumpiest man alive...

M1

I have never ever heard of giving lithium otc supplements and wouldn’t do it. Ask for a referral to a geriatric psychiatrist.

mrahope

And here I thought my DH was the grumpiest man alive <just kidding>! If you are POA, perhaps you can message the doctor with your concerns via an online portal? It worked for me. I would second M1's suggestion about referral to a geriatric psychiatrist, though I can imagine there might be long waiting periods to see one.

harshedbuzz

I also agree with the advice to get DH to a geriatric psychiatrist if at all possible. And be frank about the drinking. Trazodone + alcohol creates an increased fall risk.

Has he been evaluated at all? Perhaps blood tests and some imagine. My dad was an active alcoholic as well. I know that can be a challenge to live with and my mom avoided having him evaluated for almost a decade, in part, because she didn't want to deal with the abuse that would result from throwing him under the bus. Long story, short, one of his dementias was alcohol-related and somewhat treatable. Had he been diagnosed earlier, he might have been able to maintain a sober lifestyle and enjoyed a much better quality of life until his Alzheimer's progressed to later stages.

HB

Iris L.

Alcoholism cause all kinds of medical and neurological issues. I too never heard of otc lithium. Can you be more specific about the persistent ear and jaw infection? Is it parotitis? This needs intravenous medications and possibly surgery. Has he ever withdrawn from alcohol? This is a complex case and needs a specialist.

I just reviewed chronic parotitis. Patients should avoid medication that cause the mouth to be dry, such as antihistamines and including alcohol. He needs to stop drinking to heal this chronic parotitis, if this is what he has. But don't make an alcoholic stop drinking cold-turkey, this can be fatal.

Iris

Chammer

https://alzconnected.org/discussion/67593/frustrating-healthcare-situation

My previous post about DH's ear infection - very long…. It was determined by CT cisternogram in Jan that DH didn't have a CSF leak so surgery to his ear was done late Jan. We paid for the cisternogram otherwise it would have taken 2-3 weeks to get insurance approval and surgery would have been further delayed. His cheek swelling which began in late Dec was just considered "atypical" for ear infection. He was on IV antibiotics for 3 weeks at the time of surgery, off for about 3 weeks then has been back on either IV antobiotics or IV antifungals since beginning of March. Currently on IV micafungin (antifungal-once daily), IV daptomycin (antibiotic-once daily) and max dose of IV meropenum (antibiotics- 3 times daily) due to repeat CT scan in April showing middle ear and mastoidectomy bowl still full of gunk but more alarming, septic arthritis in his TMJ and masticator space infection - new from CT scan in Dec - this is apparently a very rare complication from ear infection and probably was there pre-surgery (can't be from his teeth as he has full dentures for several years)…requires a highly specialized oral surgeon and apparently there is only 1 in our major metropolitan area who treats this. Doc is in a teaching practice at local dental/medical school that unfortunately doesn't take our insurance. We have an appt with this doc May 29 which I had to argue to get because they don't take our insurance. After much back and forth, all parties (including insurance) are in agreement that DH go to university hospital ER to facilitate earlier treatment as any treatment planning is on hold until a determination is made whether his jaw will need surgery. We are planning on going Monday.

I began research back in Sept about seeking diagnosis for DH's cognitive issues. Appointments at that time were 8 months out. I didn't schedule at that time as it required physician referral and I didn't have that. Then his ear issue began and it has been such a difficult and complicated journey that I don't have the patience, strength, or desire to begin a new health care mission. DH has always been wary of the healthcare system and is adamant that he is not depressed and will not take an antidepressant, so I know trying to get him to see any provider who is "psych" will be met with great resistance. My psyche is slashed to smithereens from all the eggshell travel I have done with DH through this and dealing with the bureaucracy of our healthcare/insurance system. And we aren't even done with this yet! DH will need several more weeks of IV therapy whether he has surgery or not …

On a positive note, I spread grass seed in the yard today and I'm sitting on the porch watching several mama and daddy cardinals flit in and out of the sprinkler enjoying a refreshing bird shower!

M1

this would be an extremely difficult infection to deal with without the complications of dementia. Honestly the chances of curing it are low; there might be a possibility of keeping him on suppressive antibiotics (including anti fungals), but it’s going to be a very long slog I’m sure. So sorry. Is there any possibility of giving him medication for his mood/agitation without telling him what it is? Can you bill it as just another antibiotic?

LJCHR

chammer: all that you are dealing with and you ended with such a beautiful positive note about the grass seed and the cardinals-

You are awesome to find that beautiful moment.

Prayers to you for solution to DH mood/agitation.

Iris L.

IMO, I don't see how you could do a dementia workup while the infection is ongoing and he is still imbibing alcohol, both of which impact cognition.

You are seeking help for his grumpiness. Is he receiving any pain relief?

Alcoholics are deficient in nutrients. Nutritional supplements might treat the grumpiness, if due to low B vitamins.

Iris

Chammer

@M1 infectious disease doctor said on Friday that infection won't clear until it is open so I think surgery may be immenent. The plan is to go to University Hospital ER tomorrow morning after home health is here to do PICC line dressing change.

@ljchr how can you watch those adorable birds floof out their feathers and not be amazed?!

@Iris L. he takes several vitamins and supplements as well as his prescription meds His levels when checked have been normal. Hopefully, that continues

Chammer

Quick update: we did go to ER at teaching hospital last Monday and DH was admitted, had surgery for his jaw infection on Weds, continues on all his IV meds and hoping for discharge today after infectious disease doctor visit for home iv therapy plans - they are waiting on final 5 day cultures.

@M1 As you predicted this will be a long course as they are saying this is a skull base osteomyelitis w cultures growing fungus so far. TMJ didn't show osteo but MRI was positive for it in temporal bone.

So far no changes in his cognitive status but I might go crazy if we don't get out of here today! I thought I was sick and tired of doing his IV meds at home until we got here and all I do is sit and stare at the 4 curtain walls - we are in a 6 bed ward in the basement w no windows - thankful for this bed though cause there apparently are bunches waiting on beds in the ER.

At least I get to go home at night!

M1

glad to hear your update—but so sorry, what a difficult situation. I hope he tolerates the (new) home therapy. You're probably looking at at least eight weeks of therapy and I bet longer than that; at some point they may be able to switch him to some sort of suppressive oral therapy (if there is one). fungal infections are so very difficult to treat and the medications that are available can be quite expensive. The good news is that there are more options now than there used to be.

Edited to add: I hope, hope hope that there might be some home health help for you in this too—definitely ask. Maybe help with adl's, showering—anything to make the burden on you a little less.

Chammer

DH does all his ADLs and actually is still working in our business. We have someone available to drive him as needed. His issues are memory issues "light," word finding "light," executive functioning changes "light," personality changes "not light." His anger and irritability have been pretty under control in hospital. I anticipate that will change once we are home and he will be back to his extraordinarily grumpy, angry, mean self. Do they provide HH aides to jolly him up 😂 ?

M1

I'd probably be grumpy too if I were as sick as he is. He probably can't even tell you how bad he feels.

One of our old labs got a fungal infection in her hock (blastomycosis) from swimming in our farm pond too soon after she was spayed. it took a trip to UT Vet School in Knoxville to get her diagnosed, and 6 months of itraconazole twice daily (at $600/month, and that was with a discount from my hospital pharmacy). That's probably the kind of thing your DH is looking at. Most expensive "rescue" dog we ever had…..

Chammer

Ditto on those rescue critters that steal our hearts and a big chunk of our wallet!

DH is still very able to share his physical pain appropriately and his spidey sense when it comes to reading people is incredibly intact. I have to guard any emotions w him as a result!

This illness has caused much pain, discomfort and fear for him. I feel like lots of his current irritation is due to depression - he says he isnt depressed, just can't deal w stupidity so it is everyone around him creating his irritation.

He was discharged from hosp yesterday on a much simpler med regimen 1 IV antibiotics 3 x's per day and oral antifungal once a day ( and his other toutine meds). Hoping this let's him begin to feel more in control of the situation. Right now we are looking at 6 weeks of additional therapy.

I am worried because he needs to keep very tight blood sugar control to heal and to keep it from coming back. It will fall on me to be the blood sugar police - I already sort his meds and either "deliver" them to him to take or ask if he has taken them. Ive also been doing his IV meds. Its ok as long as I am in his good graces… less so when I am not which is about 90% of the time anymore.