Medical Question - Trouble Walking, Turning and Standing
My mom is 74 years old and taking no medications. (Yes, I know. Female, old and mother - I've hit the trifecta to hate away).
She has trouble walking - she claims she can't get her feet to move sometimes. She is unable to turn - pivot or move. She also has trouble getting out of chairs (even the lift kind).
We've been to the doctor and he either can't or won't tell her why she sometimes has to stand for a few minutes and think about moving her feet before she can start walking. My aunt, who is her age, has no trouble at all walking and still bowls every week.
She also will stumble backwards and not be able to stop herself. She falls a lot and I'm concerned for her.
Can anyone give me any leads as to what would cause this sort of problem? I'm hoping someone here has dealt with something similar and can give me some insight as to what might cause this.
She takes physical therapy which helps but we'd like to know what's going on.
What's going on? She's 74 years old.
Sounds a bit like Parkinson's, yet she is older than most cases onset.
Find another doctor, preferably one who specializes in geriatric medicine.
Partner's mother - 78 - has had a condition called stenosis which effects her ability to walk, even sit for long periods of time. She has had some injections into the spine but the effects do not seem to last more than a week. Physician keeps pushing surgery but she has some other health issues and is afraid to take the chance.
Could be something for you to look into for your mother.
When you say "we've been to the doctor" do you mean that you've taken her yourself and sat with her during the consultation/examination? Or does someone else take her? (I assume she doesn't go by herself). Do you take her and she goes into the consultation by herself? Some older people either can't or are unwilling to relay what's said during an appt. In the former case, they may forget or not have the cognitive abilities to understand what the doctor has said. In the latter case, sometimes they don't like to hear what's being said and they engage in a form of denial.
I've been through this with both of my elderly parents. When I lived in another state, I would get partial, fuzzy, or incomprehensible explanations/descriptions of their medical appts. By that point my father had developed Parkinsons, and it took a couple of visits home to figure out exactly what was happening.
With them it was a combination of declining cognitive abilities (by that point my mother had pre-morbid Alzheimers symptoms), secretiveness, and a paranoia that the doctor was misleading them and trying to make money from them, even though Medicare and their supplemental insurance covered everything.
After my father passed away, I moved to take care of my mother. She would claim everything was fine, but it was clear she was developing serious symptoms of dementia. I'd take her to the doctor and he'd ask the usual questions and she'd smile and nod and say everything was fine. But it clearly wasn't. If I hadn't been there to describe her behavior and symptoms, the diagnosis wouldn't have come for another couple of years when her confusion would have become more apparent during a 20 min. consultation.
And yes, it does sound like Parkinsons. Does she shuffle her feet a lot and not move much? There are medications that can help. You should go into the consultation with your mom or get her to sign a release of information so that you may talk to the doctor directly if you haven't already. If s/he's not forthcoming with information, then find another one.
My father had this. It wasn't Parkinson's. It was damaged knees and legs.
Thanks, r4. I'll look into that.
Yes, r5, I go into the consultation room with her and listen to what the doctor says and ask questions. His response is, basically, "she's just old" which is bullshit. My aunt is her age and still drives, bowls, travels and generally gets around like she did in her 50's.
Mom says she's not in pain but sometimes it feels like ants are crawling around on her legs. (The doctor didn't address this issue, either, when we brought it up). It sounds like a nerve issue to me but medical stuff is totally foreign to me.
Frankly, I don't care for this guy but since she lives in a small town, he's about the only doctor available (and he's YOUNG so you'd think he'd know what's going on). And she refuses to change doctors. You know how they are when they get older - NO CHANGES!!!
What was damaged, r6? Was it nerve damage or from an old injury?
Sometimes you can have bilateral strokes which can equally affect movement on both sides. Did the onset of this problem seem spontaneous or progressive?
Sorry you're going thur this OP. It's hard taking care of an elderly parent, especialy when doctors aren't doing their job.
I've found that doctors are very willing to take a serious, or 2nd look at a problem once they know that you have no problem taking your medical needs somewhere else. I don't know if it's the the thought of losing the $$ or if they are worried about their reputation with other doctors but it works.
How far are you from a larger town or city OP?
About 40 minutes, r10. But my mom refuses to change doctors. I've discussed it with her. The older they get, the more stubborn and married to their routines they become.
Even the most minor change (going to the store on a different day) has her clutching her pearls in hysteria.
(I don't understand it and I hope I never get so rigid.)
Are you sure she isn't on any medications? This can be a side affect of taking anti-cholesterol drugs for many years.
Another possibility is neuropathy. Very common in older people.
I would try to get a referral to a neurologist. This is outside the scope of what a GP can diagnose.
If progressice, that would not be typical of strokes, unless there were several small strokes. That scenario would be extremely uncommon for bilaterals.
With Parkinson's you would likely see hand tremors, etc in concert with slow movement.
Spinal Stenosis is definitely worth investigating.
Does she have any underlying conditions, or medications in the past, that would cause neuropathy?
[quote]But my mom refuses to change doctors. I've discussed it with her. The older they get, the more stubborn and married to their routines they become.
Just make an appointment, then tell she she's going, that you've arranged all of the details, that you won't be happy until she has the benefit of a second opinion -- as a courtesy to you, not as a replacement of her old doctor.
Sometimes you have to do, not ask.
What R15 said.
Falling backwards is a specific, telling symptom associated with such things as progressive supranuclear palsy. It's serious and needs to be looked at NOW. It's not just an age thing and it's not a Parkinson's thing, usually.
Most 74 year olds are fine. Sounds like Parkinson's to me, op.
Take her to a neurologist but still sounds like Parkinson's, even with out the shaking or broad movements.
It sounds like a neurological problem to me.
See a neurologist.
Is there a gerontological nurse practitioner or gerontology MD in your area? Gerontological NPs are the schizz. They do fantastic physical examinations of patients. They leave a full hour for the first consult with a patient and really care about their elderly patients. It's rare to hear one say, "Meh, she's old." if a person has a condition related to ageing, the NP will explain it in detail and talk about possible treatments.
I agree with R21. I've also seen some gerontologists who have the same level of concern for their elderly patients, but with them it's hit and miss finding a good one.
Perhaps a form of dystonia?
There are many forms and manifestations of this neuro-muscular disease.
A friend's mother who has developed problems with balance has to pause when she stands to get herself balanced before she can walk. She has to do the same thing when she turns. The worst is when she needs to move backward, especially when it's quickly to avoid stepping on her always underfoot dog, and I think it's only a matter of time until she falls.
Thanks for your responses. Yes, I think that's what I'll have to do - just make an appointment and take her to a new doctor, NP or neurologist if I can find one.
That's exactly what my mom does, r25. EXACTLY. And your friend's mom WILL fall over the dog. Or over a rug or something.
Thanks for the links, too, I'll take a look at them and see if I can find a neurologist in the area we can go to. Not sure if Medicare will cover it since I doubt her doctor would refer her.
Does it make me sound like a bad person to say I don't want this to happen to me? My dad had Parkinsons and dementia. It was horrible. I do NOT look forward to old age. Seems like hell.
Hate to say it, OP, but ALS has some strange initial manifestations.
OP, don't give the PCP any choice. Tell him you want your mother evaluated by a specialist, don't ask him.
First of all OP, good on you for looking after your Mom. I'm in a somewhat similar situation.
First of all, if you fear your Mom falling get one of those "I've fallen and can't get up" gizmos. I got Life Alert for my mother.
Second, I also recommend someone trained in geriatric medicine. Hooked my mother up with a geriatric doctor and it's made a world of difference. I believe they are trained to actually listen to their patients and not just prescribe something.
A good doctor will be able to evaluate your Mom and then refer her to a neurologist who is familiar with older patients.
Good luck to you and your Mom and keep us posted.
OP, tell your mother's physician that you would like a referral to a neurologist. If he makes the referral, she'll likely be less resistant. If this were spinal or joint-related, there would be significant pain, or numbness and tingling associated with her movement. What you describe is the messages not getting from the brain to the extremity. The neurologist will take a history, examine her and possibly want MRI scans, including of her brain.
[quote] She also will stumble backwards and not be able to stop herself. She falls a lot and I'm concerned for her.
Your mother is Courtney Love?
74 is not really THAT old. I know plenty of 74 year olds who are perfectly healthy.
You really need a new doctor and insist that her doctor refer you to a neurologist.
Please! You tell THEM, don't let them push you around.
R31, She sounds like Liza to me.
OP, you need to take your mother to the nearest city that has sophisticated medical facilities and services, whether that is the nearest university town with a medical school and associated medical services or a larger city close to wherever you are.
OP, it was an injury from falling down the stairs when younger. He was also on cholesterol meds which affected his muscles.
Yes, r29 - she has a Life Alert. More for MY peace of mind than hers.
LOL at r31/33. Not Courtney or Liza. HA.
We do have some great University medical facilities within an hour drive. I'll look into that - thanks for the suggestion. BTW - I called her and let her know what I had found on some of the earlier links and suggestions you all had posted. She told me to thank you for the help.
That really concerns me, r35. I've taken some really hard falls in my day (horseback riding, roller blading, skiing). Shit. I'm doomed.
She's old. Put her down. You'd do it if that was your beloved cat.
Agreed, r32. But in addition to telling them, you need to double and triple check with the info you're given. For example. My mother was supposed to get an MRI for her back pain. After a couple of days didn't hear from the MRI people. They never received the authorization from the doctors office.
My mother had a hip replacement 4 weeks ago at Eisenhower in Rancho Mirage. When we checked in for surgery an elderly volunteer grabbed me by the wrist and said "OK son come this way and we'll prep you for surgery."
My experience with the medical system is that no one is communicating. Her experience in the rehab facility was, uh, different. She's home now and had a good surgeon but the therapy facility was torture.
Ask questions. Ask questions. Ask questions. And really don't be afraid to be a a pain in the ass with questions.
very good advice, R38
You are very right about the lack of communication in medical facilities and services, and the mix-ups and mistakes. And sins of omission.
OP, COQ10 is a supplement that can do wonders. I don't know if it can help her pain, but it can help her energy level.
She's not really in any pain, r40. That's just it. She says nothing hurts, it just feels "weak" and her muscles "shake" if she walks around too much.
But I'll suggest the supplement. She's actually been pretty good about taking her vitamin supplements daily and doing her exercises.
Is she eating enough protein and vegetables, but especially protein like fish, legumes, pork chops, tuna, salmon, etc.
Many elderly try to exist on cinnamon toast or similar and become weak.
Our bodies convert COQ10 into its active form, ubiquinol. As people age, that conversion process becomes more difficult.
OP's mother needs to be taking ubiquinol, not COQ10.
I've been told that's true for anyone over 40 or recovering from trauma. A co-worker who had a series of devastating strokes in her mid-30s was told to take ubiquinol instead of COQ10 by a knowledgeable doctor.
Whatever happened to Courtney Love? You never hear about her anymore. Or did she die and I missed it? That happens.
What causes a balance disorder?
A balance disorder may be caused by viral or bacterial infections in the ear, a head injury, or blood circulation disorders that affect the inner ear or brain. Many people experience problems with their sense of balance as they get older. Balance problems and dizziness also can result from taking certain medications.
In addition, problems in the visual and skeletal systems and the nervous and circulatory systems can be the source of some posture and balance problems. A circulatory system disorder, such as low blood pressure, can lead to a feeling of dizziness when we suddenly stand up. Problems in the skeletal or visual systems, such as arthritis or eye muscle imbalance, also may cause balance problems. However, many balance disorders can begin all of a sudden and with no obvious cause.
[quote] Initial diagnosis may be done by the family doctor who takes a history of the appearance of symptoms, observes the patient's gait and cognitive skills, and rules out other causes of these symptoms. The first clues may be the order in which the symptoms appeared, and the way in which the patient answers the doctor's questions.
[quote]The next step should be a referral to a neurologist for further testing, including further cognitive tests and possibly an MRI and CT scan. Normal Pressure Hydrocephalus may be diagnosed based on what the scans reveal. It must be noted that other neurological conditions may cause the enlargement of the ventricles, so tests may be inconclusive.
Does your mother have a pace maker? This could pose problems for an MRI if so. My dad was suffering a bunch of heart & diabetes problems when this option popped up. It would have required taking him off the pacemaker as well as taking him off most of his drugs in order to check for this.
Wishing you well OP and I agree that getting older is scary. My dad is about to turn 70. I recently relocated to be closer to my parents and while they are very healthy, things are going to probably just happen. You seem smart and caring and your family is lucky to have you. Keep us posted, great advice on this thread.
No body has mentioned thyroid, but thyroid levels often drop in the elderly... my father had trouble standing up from a chair or moving as his had fallen so low.... he was constantly cold, had gained weight, yet his doctor never bothered to do a thyroid panel until I called and asked what his levels were.....
Call around and see if the medical centers in your town have established an inhouse senior health care center... it is a growing business and most large hospital systems are doing them, all the doctors in them work with nothing but elderly and appointments are geared toward older people and their need for more time to describe the symptoms. It is appalling how dismissive regular doctors can be of the elderly, directing all the questions to the son or daughter as they do not want to wait for the elderly person to think and form the answer.
[quote]It is appalling how dismissive regular doctors can be of the elderly, directing all the questions to the son or daughter as they do not want to wait for the elderly person to think and form the answer.
R49, OP's mother's GP is being dismissive when he waves off her problems by saying she's just old. I was offended for her when I read that. What level of care could he be giving her with an attitude like that?
My elderly mom had difficulty turning and was shuffling as she walked. We had every test under the sun run on her. At first we thought it was Parkinson's, but finally she was diagnosed with Hydrocephalus--a build-up of fluid on the brain which interfers with the brains ability with some basic motor functions. She had a shunt inserted to control the fluid build up. The surgery has a 10 to 50% chance of improving the symptoms. See the link below or just Google Hydrocephalus. Took us nearly seven months to figure it out.
I cared for my partner who had Parkinson's before he died of it, sounds a lot like it.
Thank you all for the excellent leads.
We don't think it's Parkinson's. I know the doctor did check for that since my dad also had it.
Can I pick up ubiquinol at a drugstore? Or is it something I need a prescription for?
She does eat a pretty balanced diet although I think it's meat heavy. She has lost a lot of weight in the past 2 years and it's mostly muscle mass. That concerns me - maybe I will ask to get her thyroid checked or see if she's had it done recently. She has another doctor's appointment later this month so I'm going to be taking your suggestions with me when we go to the doctor.
She does have osteoperosis which may have something to do with it. One of the links upthread said a compression of the spinal cord from osteoperosis could cause some of her symptoms.
I probably should be thankful she's not in pain. I think it frustrates her that she can't get her body to work.
OP, you can buy ubiquinol at vitamin and health food stores. I'm not sure about drugstores because I don't shop for vitamins there.
Hitting the sauce HARD on the sly.
Look for vodka bottles, OP!
Could be some vertigo signs there. The problem turning and falling back.
My mother was diagnosed with NPH after she started having trouble walking, remembering, and controlling her bladder. The surgery helped. In any event, go to a good neurologist. Do some research to find somebody talented. Are you near a teaching hospital? The best specialists will be found there or, at least, affiliated with one. If you're not, it may be worth a trip to a city with a great medical school. Your mother's at an age where she can still live many productive years, so don't let her down.
OP, it sounds to me like your mom isn't getting the "messages" from her brain to her legs, to execute movement. It could be a stroke. It could also be inner ear disorder affecting her balance. or a dozen other things. When my mother turned 88, she became incontinent and started wearing Depends. As a result, she developed chronic urinary tract infections.
One minute she was fine, normal. She'd take a nap, and when she awoke she'd be talking gibberish and nonsense. Acted all muddled and confused. I thought she had a stroke. When I took her to the doctor, they put her on antibiotics and in 48 hours she was normal again. It was mystifying.
I found out urinary tract infections are very common with elderly people whether or not they're incontinent. Eventually they put her on a prophylactic course of antibiotics. She was 92 when she passed away.
Yes, get her to a specialist and start weaning her away from the doctor who thinks it's "just old age;" 74 is definitely not old.
Unless she has had some permanent damage from a stroke, or she is diagnosed with some degenerative condition, she should get mobile, and she will be able to do it with some PT. But she definitely needs a new Doc. Kudos to you for being there for her.
Your life on the runway is OVER!
OP should come back and tell us how her Mom is.
Apologies, r60. My uncle (mom's older brother and her only surviving sibling) passed away last week so we attended the funeral.
Mom's doing ok. Mentally she's still fine - which I'm very thankful for. She's using her walker more and more and the bruises she got from her last fall have completely healed.
We've been discussing her symptoms and the links you've so kindly posted. She is amazed that there is so much information available now.
She's willing to try pretty much anything - I'll buy her some ubiquinol the next time I'm near a nutrition store. She's also increased her protein intake by drinking protein shakes. I told her she also needs to eat normally with the shake.
I think I might have her use some canned goods as weight (hold in her hands) when she does her leg exercises. Just for some increased resistance. She has a band but is afraid to use it around her ankles.
Holistic medicine won't cure what is obviously Parkinson's, or worse.
Turn to the left!
Now turn to the right!
Definitely circulation problem if those are her only symptoms: either PAD or, more probably, heart. You need to see a cardiologist. She may need a pacemaker.
Pacemaker procedure is now routine with very little invasiveness.
These exercises from NIH's senior health division are recommended for helping with balance.
She won't go for surgery, r64. She's afraid she's too frail. I don't think she is but it's not me under the knife.
Thanks for the link, r66. She was just telling me about her leg exercises - she's afraid she's not improving so I'll have her try some of these.
pivot step walk walk walk that connects with point turn....
Pacemaker surgery is nothing R67. They put it all in through an artery in the neck and there is no cracking of ribs or opening the chest.
my father in law has similar simptions - falls a lot too was diagnosed with Inclusion Body Myositis
Why do people say things stupid things such as "Go to a good neurologist." No, I had in mind trying to find a horrible, alcoholic, bottom of his or her class former vet to take my mother to. I sure as hell don't want to find a good one.
I think the poster meant "see an appropriate neurologist." There are neurologists who make a specialty out of different problems: I've seen over 20 neurologists who are solely headache doctors. Right now, I'm making plans to see a very famous one--in neuro circles--who publishes exclusively on a particular type of rare headache.
So I think the advice is, "See a neuro whose main interest in gerontological issues."