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Caregiver’s Toolbox Ep. 42 “Understanding Sepsis”

Speaker 1:

Welcome to The Caregiver’s Toolbox, Tools for Everyday Caregiving. We provide education and information on senior care topics. Here’s your host, Ryan McEniff.

Ryan McEniff:

Hello everybody and welcome to another overdue episode of the Caregiver’s Toolbox. My name is Ryan McEniff, I’m here with Janet. We are back together doing another episode, it has been way too long. Today we’re talking about something very timely. We are talking about sepsis, which has been brought up in the news because of our past President, George H.W. Bush, got it and was hospitalized with it after his untimely death of his wife, and so we thought this would be a goo time to talk about it because it’s not something that everybody knows about. People don’t talk about it much but it causes a lot of chaos and a lot of people can pass away from it. Janet, you’re my clinical person, you’re amazing at all this stuff. We’ve always been you’re clinical, I am the business side of things. What is sepsis?

Janet:

Well, sepsis, it’s also called septicemia. Some people generally refer to it as a form of blood poisoning. It’s one of those things that it affects a large population and yet only a third of Americans have ever even heard of it or know what it is. It’s due to an infection that usually when you get an infection your body fights it off. You get a fever and that’s your body fighting it off. What sepsis is, is when your body goes into hyper-drive to try and kill an infection and it ends up turning on your body and it ends up damaging healthy stuff and oftentimes it can be fatal.

Ryan McEniff:

Obviously, it was close… He was in critical condition at one point in time with this so it certainly is an example of how quickly it seems to come on and the damage that it can do.

Janet:

Yeah, and it’s one of those things that even for doctors can sometimes be a little bit difficult to pick up because the initial symptoms mimic a lot of other symptoms so it can be a little tough. The elderly are really susceptible to it because they probably already have some underlying medical conditions so their immune system isn’t that great to begin with. People that are diabetics, they tend to have wounds that don’t heal in a timely way and especially people that have to use catheters, IVs, feeding tubes, anything that allows …

Ryan McEniff:

Is foreign, yeah.

Janet:

… Germs to come internal to the body. You think of former President Bush, he covers all categories. The man has Parkinson’s. The man is elderly. The man’s immune system was very low, just as part of the mourning process of having lost his wife. What happens is your body just all of a sudden turns on itself to try and get rid of this germs and it can cause organ failure, organ damage, cognitive disabilities, and in some cases it can move very quickly once you get it. It’s one of those things where about 50% of people that contract it do poorly or fail or, at the very least, end up re-hospitalized within three months.

Ryan McEniff:

Yeah, and I was going to mention just because you get over the initial diagnosis and you recuperate, that doesn’t mean that there aren’t lasting effects and ongoing complications that can come with this.

Janet:

Yes, and cognitive abilities are one of the things that can come up. I was looking at some statistics and I was even looking for the papers to see what people had to say about sepsis as a result of President Bush and 40% of sepsis patients are re-hospitalized within three months and these initial hospitalizations, that costs our healthcare system $5.5 billion, and that’s only the first time in the hospital.

Ryan McEniff:

Yeah.

Janet:

That doesn’t count re-hospitalizations, nursing homes, BNAs coming, private home care or families that cut back on their jobs to support caregivers, and some of this damage can be permanent, lasting, people needing organ transplants, forms of dementia. One study that I was just reading up the other day said there’s, on average, 20,000 new dementia cases in the elderly annually because of sepsis. A lot of people when they hear dementia they think Alzheimer’s but this is something that has nothing to do with Alzheimer’s, this is an infection and it results in permanent dementia.

Ryan McEniff:

Yeah, and obviously 5.6 billion a year isn’t pocket change. Like you said, that doesn’t even include whatever re-hospitalizations come with it because people leave the hospital just because they might not for the same exact ailment, if they’re so weak that they fall or they’re so weak that they come back for another disease that because their immune system is so low and they’re fighting, it just becomes a vicious cycle of going in and out of the hospital and, as we’ve said in other podcasts, in general, one of the worst places to take elderly people is the emergency room in the hospital because there’s a bunch of sick people there. Everybody’s sick in there and it can be easy to come out just as sick, if not sicker, than when you went in. That’s not a knock on the hospital system, they’re doing a great job, but it’s just the nature of the beast.

             So many times we’ve seen patients, we’ve seen clients, and we’ve heard about where people go into the hospital and people have an idea that mom will get better, everything will be okay and they’ll come home feeling great. They come home weighing less, less body mass or muscle mass, they’re dehydrated, just because being in a different facility than being home causes stresses as well as being sick and trying to cope and get over with what they’re doing. There are plenty of different things that can occur once somebody’s in the home that maybe you weren’t expecting that is going to be that collateral damage from this disease and from this infection … Excuse me, not disease, this infection.

Janet:

Yep, and bacteria we know, it’s like we joke around and talk about daycares being little Petri dishes …

Ryan McEniff:

Yeah.

Janet:

… And every kid shares it. The same thing can happen to adult daycare centers, any place that there is a congregation of germy people.

Ryan McEniff:

Absolutely.

Janet:

As a result, the last thing you want to do is have to take mom and dad to the hospital or even doctor’s appointments during flu season or things of that nature and it’s really, really important to watch. Oftentimes, this can come around as a result of pneumonia, which is very, very common in the elderly so you have to watch that. That’s why … To your point, the hydration and making sure they’re getting enough fluids, which is probably the number one problem with elderly people because they’re concerned about getting to the bathroom so they don’t drink, and we’ve talked about UTIs. UTIs can become …

Ryan McEniff:

A nightmare real quick.

Janet:

Septic very, very easily and people just don’t have the health and the energy to fight it off. I mean, you think President Bush had the best of care around the clock with his Parkinson’s and yet this is the situation he found himself in.

Ryan McEniff:

Absolutely, so it’s not … Just because you have the means to be able to pay for it doesn’t mean that it’s not going to happen for you.

Janet:

Yeah.

Ryan McEniff:

Well, something I was looking at here. I mean, there’s a nice little acronym for sepsis and The Sepsis Alliance offers the following acronym to help the public easily remember the telltale signs of sepsis. S is shivering due to a fever over 101, E is extreme pain or general discomfort. That’s a little vague but we’ll work with it. P is pale or discolored skin, that should be easy to see. The next S in sepsis is for sleepiness, confusion or changes in consciousness, and then the I is I feel like I might die or similar remarks from a patient. That kind of goes back to the extreme pain or general discomfort. Then the final S is shortness of breath.

             Kind of going back to what you said as I’m sure that I don’t know The Sepsis Alliance that well, I’m sure they’re all good people over there trying to do their part, but there’s a lot vague descriptions or symptoms in that acronym, right? You’re dealing with extreme pain, general discomfort, shivering due to a fever, so maybe you think somebody just has the cold or the flu. It just proves your point where you’re talking about that it’s not exactly the easiest to pinpoint and say, “Oh, this is that right there, I know exactly what this is,” because it’s a lot of vague, general symptoms that accumulates at one time.

Janet:

Right, and in some cases, depending upon what the other underlying medical conditions are, if someone suffers from shortness of breath …

Ryan McEniff:

Yeah …

Janet:

That’s their baseline so I think what they’re trying to get to with acronyms like this is, if these things are not part of the norm or, as the clinical people call it, the baseline for that person. At the same time, if an elderly person has underlying medical conditions and they develop a fever or have a cold you got to watch them that much closer because you and I can maybe be out a day if it’s a really bad cold and we bounce back. This can quickly go downhill for an elderly person so it’s really what is their norm and of these things, as far as shivering, the aging process thins your skin and you go to an assisted living, you go to a nursing home and people have got their ski jackets on in July and you go into their room and you could grow orchids in there because they keep the heat so high.

Ryan McEniff:

Absolutely.

Janet:

There’s what is normal but then there’s this is more so.

Ryan McEniff:

Absolutely.

Janet:

That’s when you have to watch it most.

Ryan McEniff:

Because everybody’s baseline is different and so you’re going to have to, just like you said, take that into consideration. If somebody’s always wanting it to be warm, that doesn’t necessarily mean that they have a disease, that might just be what their baseline is. That’s interesting. It’s so …

Janet:

And stress low is your immune system.

Ryan McEniff:

Yeah.

Janet:

I mean, George Bush, who knew his wife since he was 17 or something, that was a tremendous loss to him. Other family members, when they lose a spouse, their immune system is very vulnerable. Or certain holiday seasons, especially if someone has some kind of dementia because there’s memories, and it wears you down. You know how you’re tired after a major event. Well, if you got a low immune system you’re a little more fragile,

Ryan McEniff:

It completely makes sense and I’m sure there are plenty of people out there that just thought he was sick or just saw … They chop it up to just, “Oh, his was immune system, a bug got in, a bug.” Well, this bug is a serious issue and it causes a lot of damage throughout the country on a yearly basis when it comes to hospitalizations, re-hospitalizations, and obviously people’s health.

Janet:

Yep.

Ryan McEniff:

Then people like us get calls where it’s like, “Hey, we need private home care,” because somebody needs to be there around the clock to make sure they get better for the three or four days, the week, the two weeks, whatever it is until they get back on the mend.

Janet:

When they come home doesn’t mean they’re better.

Ryan McEniff:

Unfortunately, that’s the case. Well, excellent. Well, thank you, Janet, and thank you all for listening to The Caregiver’s Toolbox, Tools for Everyday Caregiving. We will see you on the next go round. Thank you.

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