Age: 94.0
Sex: M
Vaccine: COVID19, FLU3, COVID19, FLU3, COVID19, FLU3, COVID19, FLU3
Symptoms: Renal impairment, Somnolence, Tongue dry, Toxic encephalopathy, Ultrasound kidney normal
Clinical narrative: My father was 94 years old when he received both his covid and flu shots on 10/6/24. He began having new health issues soon thereafter. He went to the ER on 10/10/24, and he was in and out of the ER, hospital, and inpatient rehab for four weeks. My family and I finally got him back home on 11/5/24. A week later on 11/11/24, he was in the ER again. The next day my family decided to put him on hospice at home He passed away at home on 11/25/24. I was his primary caregiver. Please see my detailed description below about what happened. PLEASE NOTE: I strongly feel that people of advanced age like my Dad should only receive one vaccination at a time, and that this should also be the case for people with dementia/Alzheimer's. If a vulnerable person has just completed a round of antibiotics, perhaps a specified period of time--longer than just a couple of days--should be allowed to pass before a person receives a vaccination. I urge the government to consider modifying its vaccination recommendations accordingly. My father received his annual flu and covid shots during the same pharmacy visit on Sunday, October 6, 2024. He had received both shots at the same time the previous year without a single side effect. However, in October 2024 he was a year older, and his dementia had presumably progressed some since the fall of 2023. Prior to receiving covid and flu shots on 10/6/2024, Dad had been taking a 2-week round of antibiotics to treat an H-pylori infection. From Friday, 9/20/2024 through Thursday, 10/3/24, Dad was taking the following antibiotics and other related medications at the direction of his pharmacy care doctor's office: amoxicillin; levofloxacin; omeprazole; and probiotics. At my sister's suggestion, I purchased Culturelle Ultimate Strength Probiotic to help ensure that at 94 years old, my Dad's body would be able to handle his ingestion of antibiotics multiple times a day for two weeks. Fortunately, he tolerated the regimen very well. On 9/30/24 I contacted Dad's primary care doctor's office to ask when it would be okay for Dad to receive his covid and flu shots. I was told that once his antibiotic regimen had been completed, I could take him on or after the following day. Dad completed his antibiotic regimen on Thursday, 10/3/24. I figured I'd wait a couple of days before introducing additional drugs, i.e. the vaccines, into his body, and so took him to get his covid and flu vaccines at 3:00 p.m. on Sunday, 10/6/24. That night, I noticed something a bit unusual. I generally served Dad supper sometime between 7:30 p.m. and 8:15 p.m., per his preference. He would sometimes say he wasn't hungry, and I would then encourage him to eat something in order to stay strong. I would suggest he just eat what he could. On the vast majority of these occasions, he would then eat at least part of his supper. When I tried to serve him supper the night of October 6, though, he said emphatically, I'm sick of eating! He had said this recently before on 10/4, but tonight he seemed to be more agitated about it. He quickly calmed down and went on to eat the food I had brought him. His level of agitation had been fleeting but noteworthy, as it as a new development. I had occasionally seem him that agitated before, but never over supper. The previous year on 10/19/23, my Dad had unfortunately fallen and broken his wrist. Since then, my siblings and I had cared for Dad 24/7. I lived with him and cared for him the vast majority of the time. I helped him with a variety of his ADLs, or Activities of Daily Living. This included walking with him to and from the bathroom. As we walked, I held the back of his belt with my left hand, and gave him my right hand to hold. This was a technique we had learned from visiting occupational therapist, who had come to the house in 2023 to help us after Dad's fall. Since Dad's fall I had also assisted Dad in the bathroom, cleaning him, changing his disposable brief as needed, etc. It was not unusual for use to get up during the overnight hours so he could use the toilet. However, during the first overnight following his 10/6/24 vaccinations, I noticed during our visit to the bathroom that he had not held all his urine until he sat on the commode. This happened again during our bathroom visit early in the morning of 10/7/24. This continued to occur intermittently thereafter. It was another new development since his vaccinations on 10/6. Additionally, he had an episode of diarrhea just before 4 p.m. on 10/7. Later that day I decided to have him start taking the Culturelle Ultimate Strength Probiotic again, hoping that might help his gastrointestinal system. I re-started him on this daily probiotic just before 6:30 p.m. on 10/7. Usually when we left the bathroom, Dad and I would typically take a walk around the house. This was a way to incorporate exercise into his daily routine. When leaving the bathroom in the early evening of 10/7, he was not up to walking our usual route, so we walked a shorter route. I also noticed he had napped much of the day on 10/7. This was not entirely unusual, as he previously had sometimes had days when he would nap quite a bit. But I made a note of it in Dad's health log. In the early afternoon of 10/7, I asked Dad how he was feeling, and he said very good. I took his temperature, and he did not have a fever. Around 4:45 a.m. on 10/8/24, Dad needed to use the toilet. On our way back to his recliner chair, where he liked to sleep, we used our usual walking technique. As I held the back of his belt and his right hand while I walked with him, I noticed he seemed to momentarily lose his balance a couple of times. This was quite unusual. I asked him how he felt and he said fine. As he was a Type 2 diabetic, I checked his blood sugar with his Freestyle Libre 14-day system. The first reading was 91. A short time later it was a bit higher. At 5:06 a.m., it was 101. He didn't seem to have low blood sugar. Dad and I went back to sleep and got up around 7:30/7:45 a.m. so he could use the bathroom. I was noticing on our trips to and from the bathroom since the day before that he seemed more hunched over when he walked and when he stood at the bathroom sink to wash his hands. After we returned to his recliner, I asked him if he felt okay, and he said yes. I offered him coffee and sugar-free cookies, which he normally had early in the morning as his start-of-the-day snack. He would typically enjoy them as he watched the program on TV. But this time, he declined and went back to sleep. I had checked his blood sugar at 7:33 a.m. and 7:49 a.m. and got readings of 128 and 123 respectively. At 8:22 a.m. on 10/8 I called Dad's primary care doctor's office to report that Dad had not been himself. I explained the recent changes I had observed in him. At 8:56 a.m., the doctor's office called me back and said Dad's primary care doctor wanted to see him at 10 a.m. that morning. I woke Dad up around 9 a.m. and explained Dr. wanted to see him and why. I offered him coffee and cookies before leaving, and he declined. I'm not a cookie guy, he said. This was completely out of character. I always made sure we were well-stocked with his favorite sugar-free cookies, which he normally ate daily. Fortunately on 10/8 he was willing to drink some high-protein drink instead before we went to see Dr. As we left the house to go to his appointment, he was able to walk with me out the front door, across the porch, and down the front porch stairs. As he tried to get into the car, I noticed he was having a harder time than usual with that, but he was able to do it When we arrived at the doctor, I walked over to the building entrance area and got a wheelchair for Dad, which I normally did. Dad was able to get out of the car and into the wheelchair okay, but as I wheeled him in to the building, I noticed he was slouched over a bit to one side. When we saw Dr., she examined him and we discussed his recent symptoms. She said his recent fatigue, premature urination, diarrhea, etc. could all be side effects from his having received the flu and covid vaccines. She recommended I monitor Dad another 48 hours, and if there was no improvement, I should collect a urine sample from him and get it to the lab for analysis. She would have a urinalysis and culture test done to see if Dad had a urinary tract infection. She asked if I had seen blood in his urine, and I told her no. Because Dad was in remission from bladder cancer, I often looked in the toilet after he peed to see if I could spot any blood, and I never did. After returning home from seeing Dr., I prepared for Dad his usual eggs and sausage for breakfast. By the time I served them to him with coffee, it was late morning. Normally he would consume all of it, and sometimes have a cookie or two afterward. But this morning he only ate about half of the eggs and sausages and drank only half a cup of coffee. Also, he needed me to place a pillow behind his back to help support him while he was sitting up to eat, something he had not previously needed. Around 12:30 or so on 10/8, I suggested Dad go to the bathroom, as he hadn't used the toilet in several hours. He agreed, and as he stood and held the grab bar on the wall by the toilet, I pulled down his Depends-like brief. As I did so, liquid stool came out of him. I also discovered his brief contained a significant amount of mostly liquid stool. This was his second episode of diarrhea since his 10/6 covid and flu vaccinations. Around 3:45 p.m. on 10/8, I checked Dad's blood pressure, blood sugar, and oxygen level. All were fine. A couple of hours later on our way out of the bathroom, he walked quite slowly and was pretty hunched over, but we made it back to his recliner. Afterward he ate half a sandwich with coffee. I normally gave him half a sandwich for lunch because he had said repeatedly that a whole sandwich was too much. I normally gave him a full cup of coffee with it. But this time I brought him half a cup of coffee to start with. As he tried to drink it, quite a bit of his coffee ended up on his sweatshirt, which was not normal. I could see he was gradually getting weaker. On 10/9, around 12:30 a.m., Dad needed to use the toilet so we went to the bathroom. On our way back to his recliner, he had to work very hard to walk the approximately 20-foot distance in between. I was worried his legs might give out, but thankfully, he made it. Around 10 a.m. that day when he needed to use the bathroom, he initially had trouble standing up from his recliner chair, so he sat back down. After a few moments he tried again and managed to stand. But he again had difficulty walking to and from the bathroom. When we finally got back to his chair, he was unable to center himself on the chair because he was unable to comfortably walk to the center. As had been happening recently, he ended up sitting toward the right side of the chair, i.e., the side nearest the bathroom. That day, 10/9, I decided to better do two things: contact the local Council for Aging for a loaner wheelchair; and contact Dad's primary care doctor to see if I should get a urine sample in now rather than wait a full 48 hours. Dr. was out of the office that day. After waiting a while to hear back from the covering doctor, I decided on my own to just get a urine sample to the lab. With the help of my sister, we got hold of a loaner wheelchair, and also got a urine sample to the lab in the early afternoon of 10/9. Later that afternoon I spoke with Dr.'s nurse about Dad's increasing weakness. She said it could be due to the vaccines or a possible UTI; she would let Dr. know and see what Dr. wanted to do when she returned to the office the following morning. In the meantime, Dad and I tried to use the wheelchair to get him to and from the bathroom, with mixed results. It took more effort than usual for us to get him into the wheelchair. Getting him out of the wheelchair was even harder, as he had too much difficulty standing up from it. I also noticed during this process that initially he had a little trouble following my commands. I spoke with him about the option of placing the commode with its bucket close to his recliner, but he preferred using the commode over the toilet. At one point on 10/9, I checked Dad's blood pressure, heart rate, blood sugar level and oxygen level, and all were okay. Around 5 a.m. on Thursday, 10/10/24, Dad wanted to go to the bathroom. As much as he tried to stand up from his recliner chair, he wasn't quite able to stand up all the way. Even though he couldn't stand up, I somehow managed to help him urinate into a urinal. As soon as Dr.'s office opened, I called for help. Soon thereafter I spoke with one of Dr.'s nurses. She said Dad's urine culture results were still pending, and the doctor did not want to put Dad on more antibiotics prematurely. The nurse said something else might be going on with Dad, and recommended he go to the hospital for a full evaluation. I hated to call 911 because Dad's two previous trips to the hospital over the last year had been very stressful for him. Before his advanced age and dementia, he had by nature been an easygoing person with a high threshold of pain even when he was away from home. But later in life, going to the ER and/or the hospital were significantly more difficult for him. Unfortunately, on the morning of 10/10/24, I didn't have a choice. I called 911 and Dad was transported to the ER, where blood and urine samples were collected. His blood resulted low in potassium and high in calcium. His urinalysis resulted high in white blood cells, etc., so a UTI was suspected. He was given IV antibiotics and potassium fluids while in the ER. From the ER he was admitted to the hospital, where he received IV potassium fluids for several days. To my knowledge, Dad had not previously had a potassium deficiency, so this was something new for him. The calcium supplements previously prescribed by his PCP were discontinued. When a culture resulted from Dad's urine sample that I had collected at home on 10/9, the culture showed only 10,000-50,000 mixed gram positive organisms. Antibiotic were discontinued. NP was the hospitalist who coordinated Dad's care for his first five days in the hospital. When I spoke with her on 10/11/24, Dad's first full day in the hospital, she said she did not think Dad had a UTI. She said the combination of flu and covid vaccines Dad had recently received could be affecting him. She had seen other cases of people receiving 2024 covid and flu vaccines together and then experiencing more significant symptoms than they had in the past. She said generally vaccine side effects can affect someone for about 48 hours. But for someone of Dad's age at 94 years old, side effects could last longer. Additionally in Dad's case, the reduction in his food and drink intake in recent days could be contributing to his health problems. She said his Alzheimer's Disease could also be playing a role, as it can cause physical as well as cognitive decline. In her written report about Dad on 10/11/24, NP stated, Suspect patient has sudden onset of weakness is related to the combination COVID and flu vaccine in advanced elderly patient. Her 10/11 report also stated, Urine cultures unremarkable. Discontinue antibiotics, and, No evidence of UTI. A copy of her 10/11/24 is enclosed as Attachment A. My family and I noticed while visiting Dad on 10/12/24 that his speech was not normal, as he was having some difficulty clearly articulating his words. He spent much of that day trying to get out of his bed, as he wanted desperately to go home. He pleaded with me to help him leave and go home. I tried to explain it was not yet safe for him to leave, and that people at the hospital were trying to help him get stronger so he could leave. I said we wanted to get him home as soon as he was strong enough for me to safely take care of him. At one point on 10/12, two of the hospital staff used a hoya lift to transfer Dad from his bed to a recliner chair that had been placed right next to his bed. After he was seated in the chair, he allowed the nurse to feed him a bit of lunch. Suddenly she had to leave to tend to another patient. After she left, Dad said he wanted to get out of his chair and walk to another chair. I told him that wouldn't be safe for him to try to do, as he was not yet strong enough to walk. This didn't seem to register with him cognitively, as he continued to be very focused on getting out of his recliner chair. Two staff then used the hoya lift to return him to bed. He then repeatedly tried to escape from his bed. I felt so badly for him. He probably didn't understand what was happening, and I know at least some of the time he did not know where he was. He just knew he wasn't home, and that's where he wanted to be. I was told by hospital staff multiple times that hospital patients with dementia can experience what's called hospital delirium, which can add to their confusion. The nurse gave Dad a low dose of Ativan to help alleviate his agitation. It seemed to work for a while but then wear off. The night of 10/12/24, Dad was given a low dose of Seroquel to ameliorate his agitation. At some point on 10/12/24, Dad was started on IV magnesium fluids, and he was still receiving IV potassium fluids. Also on 10/12, Dad was taken for an MRI scan, as NP wanted to see what it could tell us about his brain. On 10/13/24, Dad was minimally responsive to hospital staff or family visitors. It seemed the Seroquel given to him the night before was taking a very long time to wear off. NP came to see Dad, and she let me know his 10/12 brain MRI showed severe microvascular disease and amyloid deposits, which cause dementia. But there was no evidence of a stroke, major hemorrhage, or tumor. For much of Monday, 10/14/24, Dad was still drowsy and mostly sleeping. When NP stopped in to his room, she indicated to make that she was dubious his current condition was a result of Seroquel medication he had taken two nights before. She said it was possible he would come out of his current state, but she didn't know if he would. This was a particularly scary time for my family and me. NP said the MRI showed Dad had advanced dementia. She said amyloid angiopathy was a progressive disease and was contributing significantly to Dad's advanced dementia. Severe microvascular disease was also contributing to it, she said. She told me she ordered thiamine be given to Dad intravenously to see if that would help him. It is very noteworthy that Dad was seen around 8 a.m. on the morning of 10/14 by Neurohospitalist. In his related report, Dr. described Dad's condition upon the doctor's examination as follows: He was currently sleepy, wakes with repeated stimulation and acknowledges examiner but unable to provide any meaningful history. He states he feels 'lousy.' He denies any focal weakness but feels generally weak. In his report, Dr. indicated he had reviewed Dad's 10/12/24 MRI results. He went on to say the following about Dad. On examination he was encephalopathic without focality. His presentation appears most consistent with a toxic metabolic encephalopathy, possibly related to vaccination, in the background of poor cognitive reserve and failure to thrive...Ensure glucose and other electrolytes are stable. Consider course of empiric thiamine... A copy of Dr.'s report is enclosed as Attachment B. From Dad's medical records, it appears Dad was stated on IV thiamine at 9:34 a.m. on 10/14/24 (see enclosed copy of IV thiamine administration record, enclosed as Attachment C). Also on 10/14/24, Dad was re-started on IV antibiotics, specifically, ceftriaxone. A urine sample had been collected on 10/13, and the ensuing urinalysis showed bacteria with WBCs in clumps, according to NP's 10/14 report regarding Dad. She also noted, Prognosis remained guarded. A copy of her 10/14/24 report is enclosed as Attachment D. According to Dad's medical records, ceftriaxone was re-started at 3:27 p.m. on 10/14. (A copy of the related section of Dad's hospital Medication Administration record is enclosed as Attachment E.) Before antibiotics were re-started for a possible UTI on 10/14/24, a wonderful development occurred. At approximately 2:20 p.m. that day, my brother went to my father's bedside and began talking to him, even though Dad's eyes were closed. Within moments, Dad opened his eyes and started chatting with him! Soon thereafter, I went to Dad's bedside and joined them in conversation! My brother and I were elated that Dad had finally come to, and also that he was articulating his words better than he had been on Saturday, 10/12. Dad told us some of his stories, and even did a little laughing and singing. He seemed content and comfortable. A nurse and assistant came to check his brief, etc., and were happy to see him awake and alert. After they left, brother and I talked with Dad a bit more. Then brother asked him if he was tired, and he indicated he was. So we let him rest. Later when a couple of other visitors came to see him, he woke up and spoke with them briefly. When brother went to say goodnight to him, Dad woke up and they chatted a bit. When I saw him open his eyes on his own several times, I went over to speak with him, and he spoke with me briefly before falling back to sleep. But this afternoon and evening, he was opening his eyes more, was more communicative, and was not agitated. This was all major progress for Dad. Dad continued to receive thiamine and antibiotics daily for the remainder of his hospital stay, i.e., for three more day (10/15 through 10/17/24). A culture resulting from Dad's 10/13 urine sample was negative. However, it was thought this may have been a false negative due to Dad's recent receipt of antibiotics. When I arrived at Dad's hospital room around 11 a.m. on 10/15/24, he was sitting in his chair bright and alert, and he was working with a Physical Therapist and Occupational Therapist. With their assistance and the aid of a rolling walker, he had been able to stand up from his bed and walk a few feet to his chair. Given his condition less than 24 hours prior, this was a major development for him. Soon thereafter he was working with a Speech Therapist. After her evaluation of Dad's swallowing ability, she decided he should be on a diet of pureed foods and nectar-thickened liquids. Apparently, Dad had unfortunately developed some dysphagia during his recent episode of somnolence. When NP came to see Dad on 10/15, she said perhaps his recent long-term somnolence on 10/13-10/14 had in fact been due to receiving Ativan during the day on 10/12 and then Seroquel on the night of 10/12, and now the effects of those medications had worn off. She said the antibiotics and thiamine Dad had been receiving since 10/14 might also be helping him. She noted in her 10/15 report that Dad had had some degree of encephalopathy, and that, Encephalopathy has improved on 10/15/2024. (A copy of her 10/15/24 report is enclosed as Attachment F). Dad continued receiving potassium supplementation on 10/15, this time by mouth. Around 7:15 pm on 10/15, Dad was able to engage in a FaceTime call with my sister. He only saw/spoke with her for a few minutes, but it made them both very happy. She told me afterward that he sounded like his usual self. I also thought his speech had progressed back to baseline. Dad was doing well when I arrived at his hospital room on Wednesday, 10/16/24. Soon lunch arrived and he ate a little pureed food and all of a Magic Cup, which is a fortified ice cream-type food. He also drank some thickened coffee. I was told he had eaten a little breakfast and drunk most of his Mighty Shake that morning. While visiting with him on 10/16, I gave him multiple teaspoons full of thickened water. I spoke with NP, Dad's new hospitalist coordinating his care. She said she wanted to keep Dad in the hospital one more night, and if all went well, discharge him to a skilled nursing/rehab facility the following day. Around 4:45 p.m., I learned Dad's blood sample taken earlier that day showed his potassium level was finally back to normal. Unfortunately, no physical, occupational or speech therapist was able to see him on 10/16. While I was visiting with Dad on 10/16, he expressed to me that he wanted to go home. I told him it wasn't safe yet for him to come home with only me there to help him. But, I said, he could go home when he was stronger. I said he would probably leave the hospital tomorrow and go to a place where physical therapy would help him get stronger, and I would be with him there every day to help him. He then said he wanted to go home, but he couldn't, and he thought he would never go home. I told him that wasn't the case, but he didn't seem to believe me. When supper came, he refused to eat or drink; he said he would eat when he got home. I said I wanted to get him home, but it's going to take some time so he can get stronger first. I told him eating would help him get stronger, to no avail. Trying to reason with a loved one who has Alzheimer's and vascular dementia isn't always successful. So that night I decided to say goodnight to Dad earlier than usual in order to give him some space. I assured him I would come see him the next day. On my way out of his room, I spoke with a nurse about the situation, and she said a nurse or aide would try in a little while to get him to eat something. When I called the nurses' station from home later that evening, I learned that did not have any better luck trying to get Dad to eat some supper. The next morning, 10/17/24, I called the nurses' station to see how Dad was doing. Dad's nurse said he had eaten about 25 percent of his breakfast. She said he was confused about where he was, and when she told him he was in the hospital, he asked if I knew he was there. She told him yes, and he then told her he felt a lot better knowing that I knew he was there, she said. She confirmed the plan was still to discharge Dad to a rehab sometime that day. I told her I wanted to be present for his discharge. When I arrived in Dad's hospital room in the early afternoon, he was in better spirits than he had been the night before, but he still wanted to go home. I broke my heart that I couldn't take him home yet. By 2 p.m., a medical transport team had arrived. Dad was discharged from the hospital and taken to the rehab, located nearby. I followed in my car and met him there. After my brother got out of work, he stopped by the rehab to visit with Dad as well. Later, after my brother said goodnight and left the rehab, Dad talked with me again about wanting to go home. He didn't want me to leave him at the rehab and was extremely upset about the prospect of me going home that night without him. I tried to explain to him that he needed to meet with a lady at the rehab the next day, a lady who would assess how strong he was and whether he was strong enough to go home. He wanted to talk to my brother to see if he would get him out of there. I got my brother on the phone, and he basically told Dad the same thing I had said. He encouraged Dad to get some rest tonight and we'll see how strong he is tomorrow, and we'll go from there. He told Dad we were just looking out for him. Dad seemed to calm down after he spoke to my brother, but he did ask me how long his stay at the rehab would last. I suggested he get some rest tonight and we'll see how tomorrow goes. After he finally went to sleep, I went home to eat and get some sleep so that I could be ready the next day to look out for him. Unfortunately, Dad hadn't eaten much on 10/17/24, I wanted to get him home as soon as possible, not only because he wanted desperately to go home, but because being home might help improve his appetite and willingness to eat. Over the next three weeks, Dad continued to be given a daily thiamine supplement. He worked with PT, OT and Speech Therapy staff at the rehab and made significant progress. His swallowing improved enough that he could safely eat ground meat, and also drink plan water between meals. He gained enough body strength to et up and walk many feet using a walker; a therapist was always with him using a gait belt and/or wheelchair to help him if he lost his balance or grew too tired to continue. One day he was able to go to the toilet with the aid of his walker and one staff person. This was all exciting for my family and me. But unfortunately Dad also had setbacks during his three weeks at rehab. He still was not eating enough. And on two occasions, he went to the Emergency Room. Both ER visits were prompted by the condition I had found him in when I arrived at the rehab for may daily visit with him. On both 10/16/24 and 11/4/24, he was extremely lethargic upon my arrival at the rehab and barely responded to me when I spoke to him. During his 10/16/24 ER visit, he was given IV fluids. After a while, he opened his eyes and was more alert. He spoke briefly, but much more normally, with my brother and me. It seemed to my brother and me that the fluids were helping Dad. A nurse at rehab had suspected he was experiencing dehydration. However, the ER nurse initially said his blood work did not show dehydration. However, after that nurse and her colleague changed Dad's disposable brief, I asked her what they had found. She said the used brief contained a small amount of feces but no urine even though Dad was been receiving IV fluids. She looked at his blood work results again, and after we discussed his kidney function history, she realized his current kidney function was below normal. She said perhaps he had come into the ER with borderline dehydration and needed fluids after all. Dad's blood work in the ER that day showed his potassium level was fine. Dad woke up a second time in the ER, at which time he again spoke with my brother and me, and he also sang and hummed. When we asked how he was feeling, he said good. A urine sample was collected and analyzed, and his ER nurse suspected he had a UTI. She said his urine was cloudy, and high in WBC, RBC, mucus, leukocytes and protein. When the nurse returned a little later, she said they were in fact going to treat Dad for a UTI, and she started him on antibiotics. Dad also underwent a scan to see if he had a kidney stone. The scan was negative for kidney and ureter stones, but the image of one kidney and ureter was not normal compared with a PET scan Dad had undergone for his oncologist a couple of years before. Dad was admitted to the hospital. When I visited Dad the following afternoon, I could see he was continuing to do better. That evening while I was still with Dad, I learned from the hospitalist and an in-house urologist that they did not think Dad had a UTI after all. His culture result from the urine sample taken in the ER the day before was negative. However, the CT scan of Dad's pelvic area taken on 10/26 showed his left ureter was swollen. I was told Dad's regular urologist would be contacted with a request to come to the hospital to see Dad and review his case. Dr., and before him Dr., had been monitoring Dad's bladder with regular cystoscopies because of Dad's history of bladder cancer. The following morning, 10/28/24, a urology PA went to the hospital to see Dad instead. PA called me afterward, as did Dad's hospitalist. Dad's blood work was not showing normal kidney function and normal creatinine level. Their recommendation was for Dad to undergo another scan I two weeks to see if his ureter swelling had gone down. They explained multiple possible causes for the swelling. If the ureter swelling did not resolve on its own, we could discuss potential next steps. They felt Dad could be discharged from the hospital that day, 10/28, and seen thereafter on an outpatient basis. It is noteworthy that in PA's report on Dad, he stated that Dad "was hospitalized he