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Unwelcome friends brought home from the hospital (long)
Old 02-05-2016, 02:02 PM   #1
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Unwelcome friends brought home from the hospital (long)

My mother who is 82 and lives with DH and I, had a 5-day stay in the hospital for a GI bleed (completely resolved) in early December 2015. I stayed with her during the 5 days and slept in a chair (recliner-type) beside her during the night.

It appears she brought home a case of the scabies with her and she has been going through hell. She started with a rash on her buttock and then it spread to all the other locations that have skin on skin contact and are warm and moist (armpits, under the breasts, bellybutton, crotch, etc.).

We went to the dermatologist and saw the nurse practioner who looked at her rashy armpit (only) and diagnosed it as either a bacterial or fungal rash due to not enough showers (mom takes 2-3 per week). Apparently, it is not unusual for older folks to get skin infections as they get older and cut back on showers because they can be hard work. The nurse was advised mom had been in the hospital for 5 days about 6 weeks prior.

Mom was directed to take daily showers and apply fungal powder in the morning and antibiotic cream in the evening. After a week of this there was no improvement and mom was about to go crazy with the insane itch that was waking her up at night.

We went back to the derm and the nurse practitioner diagnosed scabies (no skin scraping taken) based on the rash (looked only at the armpit again) and the insanity producing itch. She prescribed the Premetherin cream which is applied all over and left on for 8+ hours and then washed off. The nurse also prescribed an antihistamine that stopped the itching but mom felt some throat swelling after about 3 days of taking them so she stopped. Just taking generic Benadryl now.

The day before mom went to the derm for the second time, she had a regularly scheduled primary care visit. The nurse looked at her terrible rash and didn't know what it could be but the doc decided to take a skin biopsy. That was sent out on 1/27 and no results are in yet.

Mom's itch started to ratchet up again on Wednesday which was 5 days after she applied the Premetherin cream. The derm nurse had put refill on the Premetherin prescription but had said during the office visit that one application would be sufficient. We got the second tube, made a phonecall to the derm, and were given the go ahead to make another application. Today I slathered her up again from neck to toes and am throwing all her clothing and bedding into a long, hot wash and hot dry.

Has anyone been through this? Any tips or tricks? I've also read on the web about a pill that can be prescribed but apparently the cream is more effective so that is what is typically prescribed. I spoke to one of the derm office nurses today and she said they don't typically prescribe the pill. Mom is going back to the derm Tuesday (2-9). I will bring up the pill with the nurse practitioner. If there aren't any wicked side affects, why not add to the arsenal?

I called the hospital after the scabies diagnosis was made to ask if they had had any issues. None, they said. Once we get the biopsy back or a confirmatory skin scraping (technically, I still have no proof of scabies), I will go to the health department and make a report. DH and I have had no symptoms but, of course, every itch is suspect. I feel so bad for my mom and I just want her to be well! I thank my lucky stars that I RE'd (it's almost been 5 years now) and I'm able to give my mom the care and attention she needs.
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Old 02-05-2016, 04:16 PM   #2
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Skin conditions can be the worst. I wish you mom well and hope she finds relief soon. I'm sure it's comforting to know you're there with her.
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Old 02-05-2016, 04:36 PM   #3
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My fear is that her compromised skin could turn into something more dangerous than just the itchies. We have to really jump on improving the condition of the skin when we go to see the derm on Tuesay. I made mom cut her fingernails because she was doing some damage with her long nails.
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Old 02-05-2016, 04:55 PM   #4
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Sorry to hear about your mom. What has helped us with weird rashes our regular doctors never really diagnosed or were able to cure has been yogurt with active cultures, an anti-Candida type diet with only cooked foods and reduce allergens / mold / scents / dust in the environment as much as possible. For us working from the inside helped when the topical creams applied directly to the skin were ineffective.
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Old 02-05-2016, 05:41 PM   #5
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Why would you think scabies? Not something I would think of in association of a hospital stay. Hope your mom is better soon.
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Old 02-05-2016, 05:57 PM   #6
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A lady in my quilt group came home from the hospital with bedbugs! She said it cost $$$ to be rid of them.


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Old 02-05-2016, 06:43 PM   #7
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My DF got scabies in assisted living. No fun, took forever to get a correct diagnosis. Apparently he wasn't the only resident that contracted them. Sincerely hope mom's doing better, pretty miserable time.
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Old 02-05-2016, 07:19 PM   #8
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Why would you think scabies? Not something I would think of in association of a hospital stay. Hope your mom is better soon.
The most powerful indicator of scabies (other than a pro giving that diagnosis) is the nature of the itch. It's an itch that can't really be calmed and makes the victim go a little insane. I could see the nurse practitioner's face light up when we described the itch as making my mother CRAZY! Being worse at night and waking the victim when they are all warm and comfy asleep in bed is also another indicator.

The timing is also right for a first time sufferer of scabies. Apparently, it takes weeks for the body to begin to react to the little buggers. A person who gets scabies for a second time reacts much quicker.

Of course everything on the interwebs isn't true, but hospitals and nursing homes are listed as places where it is possible to get scabies (see comment in this thread about someone getting it in a nursing home). I don't totally understand the mode of transmission with respect to nursing homes and hospitals. Typically, it is transmitted during sex where certain parts of the body the varmints like to inhabit are in close contact.

When I talked to the hospital, there response was that 'no cases had been reported to the health department.' Was that a weasel-worded response and it was known patients had come down with scabies but those cases had not been reported? For example, even after my call the hospital could still say that no cases had been reported to the health department.

The next time she comes home from the hospital, I'm going to ask the derm for a Premetherin prescription and we are going to do a prophylactic application. $30 for a tube (with insurance) is cheap insurance!

Another point is that the hospital is the only place she has spent any time out of the house. The next longest place she sat was a couple of hours in the dentist's chair to get a crown but that was in early November so I think the timing is wrong. Maybe I need to check the health department to see what has been reported.
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Old 02-05-2016, 07:21 PM   #9
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A lady in my quilt group came home from the hospital with bedbugs! She said it cost $$$ to be rid of them.


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That was the first thing I checked for but thank goodness it was not bedbugs. I think scabies is easier to deal with with respect to cleaning things.
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Old 02-05-2016, 07:27 PM   #10
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My DF got scabies in assisted living. No fun, took forever to get a correct diagnosis. Apparently he wasn't the only resident that contracted them. Sincerely hope mom's doing better, pretty miserable time.
I would advise anyone who is or has been in a group living situation and ends up itching to immediately get and apply Premetherin. It requires a prescription but apparently it's pretty innocuous stuff.

To be honest, I'm very upset with the derm nurse practitioner for not doing a skin scraping on my mom the first time she was in the office. Especially after we told her mom had been in the hospital for 5 days. That extra week was hell on mom and also let the little buggers multiply for another week.
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Old 02-06-2016, 09:59 AM   #11
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I think the dermatologist himself should takeover her case. Another problem in hospitals is staph, as my daughter is having some problems with it reoccurring in spots on her back.
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Old 02-06-2016, 10:52 AM   #12
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Skin scraping is not always necessary and it is not always successful. You have to actually find one if the mites in the burrow, and the inflammation is not just where the might is currently located. Few doctors still have microscopes in their offices anymore, which may be why no skin scraping is done.

I've had scabies twice. Picked it up from patients. And I've diagnosed itand treated it many times. The 5% permethrin needs to be applied twice, one week apart, since the eggs will hatch. It also takes some time for the inflammation to resolve.

Be patient. I think the idea of scabies might be making you feel a bit creepy about the whole thing.




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Old 02-06-2016, 10:54 AM   #13
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And scabies is not a reportable disease. It's itchy. Not life threatening. Still hospital infection control should be checking into it.


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Old 02-06-2016, 01:11 PM   #14
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And scabies is not a reportable disease. It's itchy. Not life threatening. Still hospital infection control should be checking into it.


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Interesting why the nurse from the floor made the comment about no cases being reported to the health department. On my first call, the nurse transferred me to Infection Control but I ended up in another department. When I called back (I had the card from the nurse that was in charge when my mother was discharged so I could get directly to the floor she stayed on after she left the ICU), the nurse kept me on hold while she called Infection Control. The nurse said Infection Control said "No cases had been reported to the health department." I thought it was an odd comment. I will go there in person I guess and talk face to face with infection control.

I liked the hospital and I thought my mother received excellent care while she was there. It's really unfortunate this had to happen. Seems like the hospital would be interested about mom's current issue so they could root cause what went wrong.
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Old 02-06-2016, 01:35 PM   #15
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Skin scraping is not always necessary and it is not always successful. You have to actually find one if the mites in the burrow, and the inflammation is not just where the might is currently located. Few doctors still have microscopes in their offices anymore, which may be why no skin scraping is done.

I've had scabies twice. Picked it up from patients. And I've diagnosed itand treated it many times. The 5% permethrin needs to be applied twice, one week apart, since the eggs will hatch. It also takes some time for the inflammation to resolve.

Be patient. I think the idea of scabies might be making you feel a bit creepy about the whole thing.

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Luckily, the idea of scabies is not creeping me out. I can't imagine this happening around someone who has a bug phobia but I must admit that every little itch gets a look see!

The broken down condition of her skin is what concerns me but I have read much on the interwebs that warned me it will take time to heal. I want to put mittens on her when she sleeps so she can't scratch and end up causing an infection. I'm probably worrying too much about what bad could happen but she's my mommy!

It's interesting to hear that a patient gave it to you. I guess that explains how she could easily catch it in the hospital. I read both that it's easy and difficult to transmit so I don't know what to think.
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Mom diagnosed with Lichen Planus
Old 02-09-2016, 10:17 PM   #16
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Mom diagnosed with Lichen Planus

Today was a follow up appointment with the derm nurse practioner. She took a look at mom's skin (after 2 treatments of scabies cream with virtually no improvement or itch relief) and said, "I think she is suffering from Lichen Planus." Huh?

Nurse asked if the biopsy from PCP had results yet. Called PCP's office from derm exam room since it had been 13 days. PCP's office said that there were results (not scabies) but that mom was supposed to be following up with them for the results. Basically, PCP's office did not want to release the results until my mother returned to their office for a follow-up visit. We have already felt some "milking the system" issues with this office but this was an amazing response. I told them we were at the derm's office and they could speak directly with the nurse practioner to relay the results (which the derm nurse had already nailed). I was put on hold, disconnected, called back, put on extended hold, and then finally they gave the results to the derm nurse. The derm nurse also said with a wink in her eye, "And remember your must follow up with your PCP!"

The nurse practioner asked why the PCP had done a skin biopsy in the first place since it was not a normal action taken by a PCP. Mom's PCP is an experienced physcian (i.e. older woman) who correctly thought it was a good idea to do a biopsy immediately. Today, the derm nurse PA suggested doing one to verify her diagnosis but we would have been lead-time away from an answer. That's when we reminded her about the PCP biopsy.

The bottom line is mom does not have scabies. She has an auto-immune skin condition called Lichen Planus. It can be brought on by stress and/or medications. Mom's GI bleed was very, very scary for her (enormous amounts of blood) and the ICU doctor (who happened to be a pulmonologist) changed her breathing medication regimen (to the good) when she was in the ICU.

I haven't read up on it yet but the derm nurse said it's an event and not a permanent condition. She said in 10 years of practice she has seen 5 or 6 cases so it seems to be relatively rare.

Anyone have any experience with Lichen Planus?
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Old 02-09-2016, 10:26 PM   #17
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Wow - what a story!!
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Old 02-09-2016, 10:29 PM   #18
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It's good to hear that there is a diagnosis for the problem your Mom is dealing with. My concern now would be what can be done to make her more comfortable and control the itching.
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Old 02-10-2016, 06:18 AM   #19
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It's good to hear that there is a diagnosis for the problem your Mom is dealing with. My concern now would be what can be done to make her more comfortable and control the itching.
A big jar of steroid cream and generic Benadryl seems to be the plan for now to reduce the itch. We like to use Aloe Vera to help heal the skin, too.

I was reading the pamphlet we were given. Didn't like the part about increased risk of oral cancer if it appears in the mouth. She does have some white spot 'rash' on the inside of her cheeks so we'll have to keep an eye out. Smoking and drinking raise the risk. Luckily, she is not smoking anymore but she does like her glass of wine with dinner. We thought (as did her pulmonologist) the white bumps were thrush-related but the mouth rinse didn't seem to be fixing it. Now we know why.
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Old 02-10-2016, 06:26 AM   #20
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Wow - what a story!!
I just thank my lucky stars I have the flexibility to stay beside her through all of this because I RE'd almost 5 years ago at 52. Sometimes I get a little stressed out by the gyrations of the market and wonder if I should go back to work for a couple of years but then I remember I'm doing the most important (and rewarding) 'job' there is right now.
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