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When should my mother in law go to the hospital?

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Ulcerative Colitis
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Posted 11/24/2015 4:05 AM (GMT 0)
Hi everyone,

My mother in law has been nauseated and throwing up for several weeks now. The doctor said she's having some bleeding in her colon. She's been on some green antibiotic/anti inflammatory pill for a few months now. She's not able to do anything but get out of bed and go to the bathroom. She's not been able to keep food down. I feel her doctors aren't treating this seriously enough....she's a 65 year old diabetic also. Advice?
Posted 11/24/2015 4:30 AM (GMT 0)
unless she is dehydrated, the ER will not see an "emergency"

it is possible they could do some IV steroids if there is a lot of bleeding. it might also lead to a referral to a different GI.

but for many who do not have an immediate need (e.g., dehydration, anemia, severe pain, uncontrolled bleeding ...) the ER is not so good for chronic conditions.

does she have a diagnosis? have stool tests been done for C-diff?
Posted 11/24/2015 4:36 AM (GMT 0)
How can they tell if she's dehydrated? She's delivering the stool samples tomorrow, although she doesn't know what they're testing for. What is C-diff? I remember her drug is called Pentasa. They took blood, but she doesn't know what they're testing for. I recommended a different doctor also and she seems to think that he just likes to take his time with diagnosis!

Yes, also she has been diagnosed with UC earlier this year. She's had chronic diarrhea for about a decade though.

Post Edited (MILwithUC) : 11/23/2015 9:39:20 PM (GMT-7)

Posted 11/24/2015 5:45 AM (GMT 0)
If she hasn't been able to keep anything down at all than she should go to the hospital especially because she is diabetic and not young. I would recommend seeing a GI who specializes in Ibd and who works with a teaching hospital. Even better if they have an ibd clinic.
It is not worth it to take her to a small hospital that barely knows the difference between ibd and ibs.
It may be worth your while to drive to a good hospitals er
Good luck.
What is your location. Maybe we can recommend somewhere or someone.
Posted 11/24/2015 6:30 AM (GMT 0)
they can tell dehydration by feel of skin, and flatness of veins. if in doubt, they can give harmless saline.

since there is UC diagnosis and if Pentasa is not working (and cannot be increased), then different drugs -other oral or maybe rectal.

then there are immune suppressants, and then biologics.

short courses of sterroids could be used along the way.

if she is taking oral iron - stop asap.

if no c-diff infection, then consider stronger drugs
Posted 11/24/2015 5:02 PM (GMT 0)
She is going 10+ times per day with watery D. I know she does take oral iron.
Her colon doctor is referring her to a GI doctor, and she lives in Corpus Christi, Texas. We're 2 hours south of her. She hasn't been following her diet very well and she doesn't take probiotics, which I recommended. Is there a denial phase with this disease?
She did have a drug switch and they didn't work....made her sick.
I have read some things about Slippery Elm, Aloe Vera, and chamomile. Any other suggestions? She's not a believer in natural cures but I swear by essential oils, which she won't try either.
Thanks for any help on this!
Posted 11/24/2015 8:44 PM (GMT 0)
10+ w/D is not really ER territory by itself - especially if under care of doctor. IF she is not eating, has bad blood sugars, gets pain, and might be dehydrated, the ER could give fluids and maybe pain med. This could be expensive and still not directly treat the UC.

If she is nauseous, I really recommend to stop the iron.

A colon doctor is a GI doctor so that part is confusing.
Posted 11/24/2015 10:51 PM (GMT 0)
Throwing up for so long indicates she needs on endoscopy to see what is showing up there. It could be related to her UC or something else.
Maybe see an ear, nose and throat doctor (ENT) to have this done as soon as possible or maybe they could do it in the ER, don't know if that would be possible.

Dehydration is a real possibility. Holidays make it even harder to see a GI so ER may be called for.
Generally a diabetic diet is not bad for UC, at least from what I've read although some people like me have additional intolerances to some foods that annoy my colon.

Good luck. If she won't stick to her diabetic diet you can't make her.
Posted 11/25/2015 6:27 AM (GMT 0)
IMHO, your MIL needs to be in the hospital based on her N/V, 10+ diarrhea, bleeding and her diabetes. She is clearly not being managed well and given her age, will not have the same physiological reserves as a younger UC patient. Her N/V can indicate inflammation...I have the same symptoms when my flare is advanced.

C-diff is a serious infection in the stool that causes unrelenting diarrhea and requires a specific antibiotic for treatment.

An elevated heart rate, low urine output, dark urine are all indicators of dehydration.

Does she live alone? At minimum, she needs someone with her. Ideally, she need to make an ER visit to an academic hospital as opposed to a community hospital. They can draw labs and get a better picture of what's going on.
Posted 11/29/2015 7:19 PM (GMT 0)
She did go for about 5 hours to the ER, but was not admitted. She was given IV antibiotics and prednisone, and oral prednisone as well as Cipro and some other antibiotic. She did test positive for C-diff, and on her CAT scan her colon was enlarged as well as thickened. I fear she may have toxic megacolon. I recommended the elimination diet for her, but she said it's too restrictive. I'm more concerned about her health than she is, apparently. The surgeon mentioned colon removal if things don't respond with medicine. She's getting referred to a GI doctor, and she was seeing a proctologist.
She was on a liquid diet for 2 days, then had dressing and corn casserole as her first meal :(
I don't have a good feeling about this.
Posted 11/29/2015 7:50 PM (GMT 0)
Sorry to hear about your difficulties.

The thing about diet changes and supplements is that those things really help some people, but others don't respond at all. I've tried all of the diets out there and none of them help me. Supplements help alleviate tertiary problems, like vitamin deficiencies, but they don't help with my symptoms either.

Since you live a few hours away from your mother-in-law, I'd just recommend that you attend appointments when possible, make sure her doctors have an accurate picture of her various conditions, and know that she's been noncompliant with dietary changes up to this point. For instance, if they prescribe rectal meds and you know she won't consistently use them, it's a good idea to speak up. Her willingness to follow a protocol will help her GI determine the course of treatment.
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