Mom & Me Three Archive

...remains neither heightened nor lessened. At 0845 this morning, when I checked on her as she was sleeping and awoke her to reattach her oxygen before I headed on an early trip to Costco and to do some faxing, I asked her if her side hurt and she said, while laying on her bed on her left side, groggy with sleep just exited and about to be reentered, that it was "bothering" her "a little". When I returned and she was sitting on the toilet, having just had a bowel movement, she reported that it was "fine". However, as we were bathing her she experienced a few mild twinges while washing her arms and one sharp twinge when she bent over to retrieve a dropped wash cloth. We again discussed the possibility of a cracked rib. I consider this more of a possibility than I did yesterday but still not a certainty. She experiences no discomfort when standing, walking or getting into and out of her rocker (which is set pretty low to the ground). She did have a little discomfort getting off the toilet (which has an extension on it and is set about 5 inches higher than her rocker). She also experienced a sharp twinge once when sneezing while sitting on the toilet, but sneezed a couple of times later in her rocker before receiving acetaminophen and experienced discomfort. Once the acetaminophen kicked in she was pain free. Overall, when she does experience pain, she reports it is "less than yesterday".
    I'm not sure whether the PCP will recommend x-rays on Tuesday. I expect it will depend on how much pain she's still experiencing. I will, of course, question her assiduously before we go and while we're traveling. She has a marked tendency to minimize the reporting of pain, discomfort or any type of dis-ease symptoms when she is in a medical office but is much less shy with me and, anyway, I know how to interpret her disavowals of discomfort when she is experiencing some. At any rate, if x-rays are recommended that's not a problem. The imaging office is just a couple of blocks down a parallel street and is an efficiently run center; rarely is there much of a wait.
    She continues to have no pain when breathing nor difficulty breathing. Since last night I've been monitoring her temperature arterially on the forehead in case internal infection develops from a severe bruising or possible puncturing of an organ. She does not appear any paler than normal, though, no unusual lethargy or resistance to movement. If she did crack a rib it's probably a slight fracture, leaving the rib intact.
    As a precaution I'm continuing the moratorium on therapy exercises and exercise walkering, much to her delight. I think by the time Tuesday rolls around I'll have a better idea of whether this injury will require any more treatment than I'm already administering. I consider the fact that she was up early and moving around to close windows and doors to cut down on the breeze through the house a good sign.
    Her resilience never fails to amaze me. This morning, after the twinge during sneezing, I said to her, "Damn, it's hell to get old, isn't it?"
    "Oh," she said, smiling, and in contrast to what she sometimes says when she's fine but "feeling old", "you get used to it. It's better than the alternative."
    Considering that I think she still resists believing in her mortality, I wonder what she considers to be "the alternative"! I probably should have asked.

    As for me, I got a very good, restful sleep last night, finally. The Little Girl was sleeping with me this morning, which is a good sign. She hasn't slept with me for awhile and I know it's because I've been too restless in sleep for her to put up with. I'm feeling better about the work involved in our trip to the doctor but still not quite up to the possibility of visiting friends, especially if our visit to the doctor involves getting x-rays.

    I think the cramp is a bit more than a cramp. It's been bothering her more than either of us expected since yesterday. I think it may be a minor internal bruise from her pole trick at the mall when she decided to sit on her walker against my advice. No bruising on the outside, though, and I can't feel any obvious swelling. When I palpate the area it's 50/50 whether I'm going to set of a twinge. It might be a cracked lower rib but she is having no pain when breathing and the only pain she seems to experience is when she leans over acutely, which usually happens when she stands up on her own. So I've been helping her rise and sit. She's perfectly fine walking, lying down, etc. I decided, though, to give her extra strength acetaminophen (dosages catalogued at the Tests & Meds site for today). It seems to be making a difference. I've been asking her to distraction, under every condition possible, if her right side hurts and it seems to only be bothering her when the acetaminophen wears off, and then only slightly. A couple of times when I've asked she's looked at me as though I was nuts and said, "Why should my right side hurt?!?", so I think we're all right. Since this has been going on for a couple of days, possibly since the mall trip, if she is bleeding internally from an injury her stats from her draw this morning may very well indicate this, assuming, of course, that the bleeding is fairly significant.
    The draw and cup peeing went without a hitch. I got caught up in a phone call with MCS so we got a later start than I had planned. The day is unrolling on what would be a normal schedule for Mom.
    Not sure whether I'll have much more to report later besides Dinner Stats. I've got an early date with a fax machine tomorrow and then an essentials trip to Costco before we head down to the Valley on Tuesday. I thought I'd get both in before Mom awoke and I should be able to accomplish this.
    Truth is, I'm not really looking forward to the trip this time. It isn't the heat. Even though we live up here exclusively now, I'm so familiar with summer in the Phoenix metroplex that I don't have a problem with it. Neither does Mom. I don't know, it just seems like so much work and I seem to be feeling the need to slack off. Normally we make the trip a big production, plan on visiting friends there, etc., but I'm not up for all the extra work of keeping my eye on Mom while wanting to pay close attention to my friends. And the added driving, the inevitable smoking throughout the evening that will end up giving me a couple of insufferable nights afterward when I have to again explain the whole story about why Mom no longer smokes and include the truth about her smoking for one evening once in a while, and listening to her insist that she has decided she wants to smoke, again, then, me having to tell her that I won't allow it because her health is so much better now and it's easier for me to take care of her without the frequent health collapses that were definitely precipitated by her smoking...ohhhh...I don't want to get into it. I feel pretty bad about disappointing our friends. But, aside from being fairly mellow, right now, I'm also tired and I don't want any more excuses for having to do more work than necessary.
    So, well, whatever. Later.

...the following list of concerns for discussion to Mom's PCP. Although it is similar to the previous list, I'm including the refinement here for, hmmm...well...in case someone reading this can use it as a template:

ATTN: Wondrous FNP - Name of Medical Corporation
FAX: Their Fax Number
FROM: Me, by name, daughter, caretaker, DPOA, MPOA HCPOA
RE: Mom, by name - Patient
SS#
Upcoming Appt. 6/21/05 @ 1:00 p.m.

To expedite our appointment I compiled the following list of issues I’d like to cover during that time:

1. Renewal and/or new writings of the following prescriptions through at least November: (I’ll be bringing the bottles with me):
• Glipizide ER 10 mg twice per day Qty 120 - no change;
• Protonix 40 mg once per day Qty 90 - probably no change (see #2 below);
• Lisinopril 2.5 mg twice per day Qty 100 (should probably be changed to 3 per day; see #3, below);
• Levaquin: Currently written for 250 mg once per day for 10 days Qty 14, to be filled as needed, written for four refills; as it turned out, 500 mg once per day for 7 days, which was possible considering how the prescription was written, works much better so, if possible, I’d like to change this Rx to the following: Levaquin 500 mg once per day for 7 days Qty 7, as needed, for four refills;
• Continued okay for monthly CBC, BMP and urinalysis, drawn here in Prescott, with results faxed to you and picked up at the lab by me;
• Addition of an order to the Rx immediately above for an inclusion of Hemoglobin A1c, CMP (instead of BMP), Lipid Profile, an Iron & TIBC and Ferritin tests during her November draw (see item #8 below);
• A prescription for very short term, specific Out Patient therapy to help her learn how to use her walker better (see item #9 below);
• Continued approval of diabetic testing supplies through Liberty Medical as needed.
2. Currently my mother is taking 81 mg aspirin once per day in the morning. Considering her slight mini-stroke history should she be on a higher dose of aspirin? If so, will her Protonix Rx help head off possible stomach problems at the pass?
3. I’m thinking that, in order to ameliorate her high systolic blood pressures in the morning her Lisinopril Rx should be rewritten for three 2.5 mg pills per day, one in the morning and two at night. Considering that her diastolic is always very low I’m reluctant to push the dose any higher at this time.
4. I agree, from your description at our appt. on 1/24/05, that she suffers from Chronic Renal Failure. I’d like a very clear explanation of exactly what the indicators are for this diagnosis so that I remain well informed and have a better fix on where she is in the process, since I’m not sure we’re that close, yet, to her diabetes “going on vacation”, but her long standing, prodigious sleep habits continue to concern me.
5. The advisability of a routine re-ultrasound of her torso as a marker for her minor mitral valve leakage and any arterial abnormalities. Since she seems to be doing fine within her limits I thought this could be scheduled for November, when, if all continues well, we’ll be scheduling her next regular appointment.
6. Anything new on the bladder control front, short of surgery, that we might try on her; this isn’t an urgent concern...just thought I’d check.
7. Any OTC supplements we should add or subtract from her daily regimen?
8. Discuss my concern about her iron supplementation: I’m aware that it can play havoc with colonic elimination, although we haven't had this problem, and that metals are metabolized by the liver at what can be an expense to this organ's healthy functioning; despite the high level of antioxidants with which I supplement her (including those in food) would a CMP, a Hemoglobin A1c, and a few miscellaneous iron readings be a good idea for her monthly blood/urine draw in November?
9. We are having the usual trouble with her renewed walker usage. She refuses to believe or follow my recommendations for walking technique that would relieve her of back aches from usage. We have reinstituted her therapy exercises (I’ll provide you with a copy at our appointment) to promote upper and lower body strength and flexibility but I can see that her back aches are mostly related to her technique and she won’t listen to her daughter, of course. Would it be possible to obtain an Rx for very short term corrective therapy for this problem? I think I know a therapist here who might be willing to do this. I hope to have contacted her to confirm this by the time of my mother’s appointment next Tuesday.

Attached is an updated list of her med/supplement regimen although I think there are only two changes: 2 Cholest-Off/day and one cup De-tox tea per day (I’ll bring in the ingredients). I’ll bring in her BP & BG readings for the last month, including 3 per day for the last week (no changes since previous readings); her blood/urine draw will take place tomorrow. You (and I) should have all results by the end of the business day Monday.
I look forward to our appointment. If there’s anything else you want me to bring (besides my mother and the stuff listed above), please feel free to contact me at:
Me
PHONE: Our phone number
Email: My email address

    I just noticed that I misnumbered the items on the original faxed list. Since I'm allowing HTML to number them here, they'll come out correctly.
    When I called this morning to get a 7 pill extension for Mom's lisinopril through the day after her appointment when we'll be able to have the new prescription filled I discovered that our Wondrous FNP will be out, that day, and a new doctor to the clinic will be seeing my mother. Should be fun, as those of you who read this fairly regularly know that I always have an interesting time with new medical personnel who aren't used to me, especially new doctors.
    Something curious happened, as well. As you may remember, we've had this appointment for almost a month. When I originally made the appointment I was aware that we'd be running out of Mom's lisinopril a few days before her appointment and let the clinic know that I'd be calling for a short extension of the exhausted Rx. This wasn't a problem, the person to whom I spoke either remembered what I was talking about or read it in Mom's file (part of which is computerized) and told me there'd be no problem with that, just have the pharmacy fax the request and the office would fax an okay back. When I picked up the prescription, to my surprise, whomever had faxed the okay back (which, as it turns out, was for 14 pills instead of 7) also alerted the pharmacist to tell me that "the doctor requests that [my mother] call the office to make an appointment". Whoops! Somebody fouled! I'm hoping it was simply office mishmash getting in the way of efficiency and not an indication of what we can expect from the new doctor.
    At any rate, I'll be faxing, tomorrow, the regular blood draw review, which is much abbreviated from last month's. I'll also publish that here. As well, at the bottom of the review, I'm going to include the names and addresses of four of the web sites I keep on my mother, the ones in which a medical professional might be interested (then again, might not be, since most of the information on these web sites that would be of interest to medical professionals exists in her record, courtesy, in large part, of me).
    I also published the updated medication and supplement review over at the Tests and Meds site; the one I faxed to the PCP today. Good idea to keep up on that stuff here.
    So, no moving today. Although Mom was up a lot she complained of her knee bothering her, shuffled quite a bit more than usual, and complained, as well, of an occasional cramp in her right side. I figured I'd better let her relax. This evening we decided to watch movies. I wasn't able to get two that we both really wanted to see, In Good Company and Beyond the Sea but got four others. Of those, we tried to watch Aviator but neither of us found it very interesting and both found the portrayal of Katherine Hepburn, to which we'd both been looking forward, laughable. Hepburn may have had an exaggerated persona, but it was her. The portrayal we decided, was, unfortunately, simply exaggerated Hepburn. So, we stopped that movie early on and went on to Kinsey. Before I started it I told Mom what it was about. I don't know if she was ever aware of Kinsey's research. She expressed some doubts about whether she'd be able to "stay with it", considering the subject matter, but she became much more involved in it than I expected. She didn't last 'till the end, but she cut out so close to the end that, as she said, she "knew where it was going", and went to bed.
    Other than the blood draw after Mom awakens and bathes, I'm not sure what's happening tomorrow. It'll depend on her body's recovery from so much movement this week. I need to make a trip to Costco. I'm not sure why, but for some reason it seems we've gone through an awful lot of paper underwear this week. Could have something to do with all the exercising and walkering, which may have caused more than the usual amount of pressure on her bladder, thus more leakage.
    The oxygen concentrator was changed out today and both Mom and I noticed that this model is significantly quieter than the last, so when this one comes up for it's 9 month back-to-the-shop check-up I'm going to request the same model. It's lighter, too, so I can move it into the living room easily for Mom's naps on those really hot days. We don't have many, but when we have them the combined heat from the outside and the concentrator makes it hard for her to nap comfortably.
    Day by day, this week, I've been trying to find some time to get my hair cut before going down to the Valley next week. I found a barber who only takes walk-ins and whose work I like but, each day, when I plan to be one of her customers, something comes up and I have to put it off. Maybe I'll just remain disheveled, or, maybe, once again, I'll butcher my hair myself.
    Yet, again, an early morning for me tomorrow.
    Later.

...rather, I guess, very early this morning, reviewing the minimally high, mostly low point of our day, Mom's walkering session, which you can read about at the previous link. What an episode. My reaction affected the entire rest of our day, which I cover at the link above. Not one of my finest moments, but at least some issues were settled.
    I just awoke about a half hour ago so if Mom decides to sleep in I'll let her. We will have an exercise session today. And, I'll be compiling and faxing a list of items I'd like to review with Mom's PCP on Tuesday, next week. The list is exactly as it appears below in a recently previous post.
    I need coffee.
    Later.

...exercise session was late and long. You can read about it at the link. It was satisfying, though, although her systolic pushed itself up tonight, which I reported on over at the Tests & Meds site. I can't help but wonder if her high systolic was an indication of her annoyance that, once again, I'm not letting up on her.
    Over the last few days much of our conversation has centered around how good it is for her to be increasing her movement. She isn't completely convinced, bless her sedentary heart. She is, though, anxious to believe me, so I think her cooperation will continue through the warm months, at least.
    This evening while we were preparing her for bed she expressed, once again, her disgust for the walker. I decided to level with her. "Mom," I said, "I'll tell you, I doubt that you'll be getting around without it, now. Maybe you'll get to the place where walking without it is not dangerous for you, but I'd be really surprised."
    "Well, I plan to surprise you, then."
    "I hope you do, Mom. But in the meantime consider the miracle of this simple little machine. For all my smarts, it never would have occurred to me that putting a light weight frontal stand on smooth, sensitive wheels would allow people so much stability. It's like the invention of the paper clip. It's such a simple little idea, but so practical and so productive! As far as I'm concerned, I'm just thrilled that someone thought of it. It's so much more practical and allows so much more accessibilty to the world than a cane."
    "Well," she conceded, "when you put it that way, maybe it's not so bad. I still hate it, though."
    "I think what you hate is your need for mechanical help. And, look on the bright side. As long as you hate it, you may very well surprise me, someday!"
    "Oh, I intend to!"
    That's my mom! Gotta love her!
    Oh, as a note to myself, I took her blood glucose about a half hour after I'd administered her dose of Cholest-Off. Her blood sugar was in normal range, so that wasn't a factor in her slightly higher than normal blood glucose this morning.
    So, to bed. Busy day tomorrow.
    Later.

...=>Moving =>Mom today, including a full report on our walkering, yesterday, in case you're interested. Today will be an exercise session day, with an additional exercise which is explained in the report on our walkering. She is not reporting any back aches today. I'm hoping I've figured out a way to head those off at the pass in the future.
    I had a short fit of annoyance yesterday evening as we were heading Mom for bed. I've probably mentioned having these before but, in the interest of the catalogue nature of this journal, I want to cover it. As usual, when Mom decided it was time for her to retire, sometime close to midnight (which is extraordinary...lately she's been going to bed between 2100 and 2230), I gathered myself from the floor and responded to her as usual: "Okay, I'll head back and turn on lights, everything's (meaning her PJ's being in the bathroom and towels and washcloths out) ready, I'll meet you in the bathroom. Be sure and pull your pants and underwear down all the way so you don't sit and pee on them."
    Her typical response followed, "You don't need to do anything, I can just go to bed."
    Upon which I responded, also as usual, "Yes, I do. I need to wash and salve your thigh creases, change your underwear, make sure you brush your teeth, turn on your bedroom (meaning turning on the oxygen concentrator, the humidifier and her bed lamp) and tuck you in."
    She usually takes all this in stride with only a slight look of disdain. Last night, though, her face turned comical and she proceeded to make fun of all the "unnecessary" preparations I go through to get her to bed.
    I guess I must have been feeling touchy last night because I didn't take this in good humor. Once she settled in the bathroom I exploded into a lecture: "Look, Mom, nothing I do for you is 'unnecessary'. It isn't funny or comical, either. I'm tired of being the butt of 'Taking Care of the Ancient One' jokes. I don't have the time to do unnecessary stuff for you. Everything I do for you at night is very necessary. Everything. I know that our continued humor and jokes about all this stuff, changing your underwear, washing your thigh creases, making sure you've got the oxygen cannula on, helps preserve your dignity, but sometimes my dignity suffers as a result of preserving yours. Not tonight. Let me explain this to you in no uncertain terms. If I didn't prepare the bathroom for you, a lot of what is very important wouldn't get done. If I didn't go ahead of you to turn on lights you wouldn't turn them on and you might stumble and fall. If I didn't wash your thigh creases and apply the anti-itch cream you'd scratch yourself silly at night and we'd have a skin problem to deal with. If I didn't make sure you changed out your underwear you'd have further skin problems all over your body, and, in the morning, you'd be floating in your own urine. If I didn't turn on the humidifier, you wouldn't and your nose would be bleeding in the morning. If I didn't make sure you brushed your teeth, you wouldn't. If I didn't make sure you put on your oxygen cannula, you wouldn't and you'd be exhausted in the morning. I know why it's a good idea to keep up the humor surrounding all these operations that could very well cause you to lose your sense of dignity about yourself but, I repeat, I need some respect, too! I am not silly, I am not stupid, I am not unnecessary to your life! At this point, if I wasn't here doing all these things you consider stupid and silly, you wouldn't be here either, and, I guarantee, no one in a nursing home would be doing many of these 'stupid, silly things' that keep you in good health and top condition. They'd just shrug their shoulders, chalk dry, broken skin, dirty underwear, dehydration and bad hygiene up to lack of money, lack of time and advanced old age and you'd probably be in your grave, gotten their through some opportunistic infection that I go to a lot of trouble, on a daily basis, to prevent. We've already experienced that in one of the 'better' nursing homes. I'm trying to see to it that we don't ever experience this again! What I do isn't silly, or funny, or unnecessary. Am I making myself clear?"
    I did, apparently. My mother is never cowed and she wasn't last night but she sobered up quite a bit and thanked me for what I do. That's what I needed.
    Was I wrong in 'taking it out on' my mother? I don't think so. Although she definitely has a fey streak identified as dementia and probably won't remember my lecture, neither will she forget, for awhile, anyway, that I took a stand when I realized it was necessary and asserted my need for respect and my personal pride in what I do for her. Lots of caregivers take care of people who are no longer at a stage where they can understand their caregiver's need for respect and personal pride. At that stage, though, the care recipient is also no longer able to make fun of their caregiver in order to assert their own need for a strong hold on their personal dignity.
    It's a delicate balance, asserting oneself as a caregiver worthy of respect while allowing the care recipient to assert herself, as well, as a person of dignity. Maintaining a balance that works for both sometimes involves letting the scales swing, a little. It's not a one sided operation. My mother is still capable of forthright stands on her own behalf. She was probably making a lopsided attempt, through humor, last night, to do this and, usually, I'm strong enough in my balance to allow it to tip her way. Sometimes, though, I'm not, the balance tips a bit too far and I need to apply a push to the swing. It happens. I think, if it's managed well, everyone gets a much needed chance to blow off some steam and no one suffers.

    Something I've been meaning to mention. I think of it every time Mom and I drive someplace and handicapped parking spaces are unavailable. Yesterday we were lucky. Despite the fact that all the handicapped spaces were filled at Costco we happened upon a space that was just as close and since it was bordered by a basket retrieving area it allowed us enough space to get my mother out and situated with her walker without any fuss. In the meantime, both going and coming, we watched a couple of perfectly able-bodied people swagger from the store to their cars in handicapped spaces, alone, without equipment or disability. I know there are a few of us who don't abuse this right. I don't even park in a handicapped space if my mother is in the car but intends to remain in the car while I visit a particular destination. At New Frontiers, where we managed to get the last space available, the handicapped space next to us was taken by an overwhelming, appropriately placarded SUV out of which poured 5 more than able-bodied teenagers. Right behind us was a van, also with a handicapped placard, which housed a driver carting an obviously disabled person. These people didn't get a handicapped spot. As we were exiting our car I noticed the driver, who had squeezed into a 'normal' space, struggling to get his disabled person out of the car and onto the sidewalk.
    ATTENTION PEOPLE: Here in the state of Arizona (as I imagine is true in most states that distribute handicapped parking permission placards), regardless of the fact that a handicapped parking placard and/or license plate allows access to what are usually considered to be the best parking spaces, IT IS ILLEGAL TO USE THESE SPACES IF YOU, AS THE DRIVER, ARE NOT HANDICAPPED AND YOUR HANDICAPPED PERSON IS NOT WITH YOU! Not only is it illegal, it is selfish, thoughtless and mean. Don't tell me that sometimes it's hard to tell exactly why someone would need to use a handicapped parking space. Believe me, I went through the process of procuring one and I can tell you, the people for whom these placards are intended are easily identifiable. If you have one of these tokens, the granting institutions clearly state they are not for the convenience of the able-bodied. IF YOU DON'T NEED IT, DON'T USE IT! IF YOU DO USE IT WHEN YOU DON'T NEED IT YOU ARE SPITTING AT THE FOOT OF THOSE WHO DO NEED IT, AND, IF THOSE WHO NEED IT ARE LUCKY, YOU'LL BE CITED FOR MISUSE OF THESE TOKENS!
    There, I've said my piece. Or, is it 'peace'?!?, no, not in this instance, definitely not 'peace'! I certainly do not wish peace to those who abuse this privilege!
    Later.

...Stat Ketchup is once again being served over at the Tests & Meds color. The link will take you to the review following all the ketchup.
    I can't lingualize, really, why I haven't been updating here lately. During most of this silent period, I've been feeling very good. Perhaps I'm working up to yet another epiphany but haven't yet experienced the moment of "piff".

    I've had my days, of course, some of them dismal, some of them agitated.
    There have been some triumphant days. Day before yesterday I surprised my mother with an enforced visit to the grocery store. She's been slumping back, lately, into mimicking her winter hibernation and it's been alternately scaring and annoying me, but she has remained harder to move than a planted mule. The element of surprise, though, got her up and going and she performed well with the walker and enjoyed herself on the short trip. For the rest of the day she was unusually alert. Although she took in a nap (rather like others take in a movie) she was down for only an hour; it was late in the day. When she arose she reported that she hadn't actually slept, she'd been laying "there" thinking.
    "What were you thinking about?" I asked.
    She was on the toilet in the bathroom, her routine stop after a nap so we can change her paper underwear and check her for leaks. "I was thinking about the family, you know, my family. How I'm the only one left."
    I was shocked. We've lately had several episodes where she's talked about calling all these people and I've had to remind her, repeatedly, of their deaths. We hadn't, however, talked about any of them in a couple of days. I was flabbergasted that she was remembering their deaths on her own, thus, that she was firmly placed in the present. Her eyes looked a little wet. She's having problems with allergies, as is usual during this time of year, so I couldn't be sure and asked, "Are you crying?" Just voicing the question caused me to tear up.
    "No!" Her statement was more than adamant. "No! I'm not crying!" She's not a crier by nature.
    I knew she was. "Well, I am," I said, struggling to keep from bursting into sobs.
    "It's just such a shame."
    "I know. I'm so sorry it turned out that way for you."
    "Well, sometimes that happens."
    "Yeah. You can always pride yourself on figuring that maybe the best of the lot is carrying on the family reputation."
    She brightened and snickered. "That's a good way of looking at it."
    I reminded her of the two direct relatives who are still alive, one older and one younger, and some in-laws who survive, all older.
    "Yes, I know," she said, "I just never thought it would be this way."
    "Well," I said, as I've been lately wondering and asking her a lot if she's thinking of dying soon because of her unusually slow kick back from winter this year, "that's no reason for you to kick the bucket any time soon."
    She composed herself quickly. "Oh, I know that. I'm not interested in doing that. No, it's just sad that the rest of them are gone."
    Yesterday was a scary day, though. I awoke her around 1000, as I'd promised her I would the night before (she went to bed about 2200) but she nodded off a couple of times on the toilet while we were bathing her. This is the first time she's done that and I freaked. I'd taken a rather high blood pressure for her earlier and took it again, but neither the high one, which was taken just as she steadied herself in an upright position on the bed, nor the drop afterwards registered as unusual, considering her recent BP trends so I had to figure that she was neither mini-stroking nor crashing. She insisted on going back to bed, though, begged me to let her sleep as long as she wanted and, sure enough, she didn't arise until around 1400. From that point on she had a normal day.
    I decided it's time to take a different tack. I'm prodding her to move, again. She's taking it only fairly well. We've had a few exercise sessions since 5/27, but took a long break because I just couldn't get her going. Today I launched into one of my, "It's time to move, again, Mom" lectures. This time I added a new closer: "Look," I said. "You can sleep yourself into your grave or you can act yourself into your grave. Either way, I don't think you're going to lengthen or shorten your life at this point. All I can tell you is, I've decided that I prefer that you move, get out, come with me. I know going on errands with me sounds boring to you but, you know, Mom, life is lived during the errands, during the maintenance, during the normal, everyday 'stuff and things' that you never seem to want to do with me anymore. You had a good time at the grocery the other day, walkered a lot further than either of us expected and not only did it not tire you, you were much more alert than I've seen you in a long time. So I'm going to start in on you again. I know you can be stubborn, but I can be even more stubborn than you. I've got Dad's genes inside my jeans, and you know how stubborn he could be. You scared the shit out of me yesterday when I thought you were mini-stroking or crashing on the toilet. You weren't. You've just gotten in the habit of spending too much time not moving around. Well, that's going to stop. I figure, at this point, letting you sleep the rest of your life away is just as likely to stroke you out of it as pestering you to move. And I think I know you well enough to guess that you'd rather go with your boots on and your butt in the saddle. So, I'm going to start hoisting you up there, again."
    I got a wide-eyed but not negative response.
    She had, though, again, forgotten who was dead. She decided, about 1900 this evening, to call "the folks", which means her parents, to see how they are. When I reminded her of their deaths she decided she wants to go by the property that used to be their home here in Prescott and find their plots in the cemetery just north of Yavapai County Medical Center, here, so we may do that tomorrow, on our way back from a short errand. She's never wanted to do this before, has, in fact, specifically forsaken the suggested opportunity to do these things. So, I don't know, maybe this means something.

    Which reminds me, I want to report in here an amalgam of our several discussions about how I handle her time phasing and why. No tonight, but soon, now that I'm feeling like reporting, again.

    PCP appointment in Mesa on June 21st at 1300. List of things (which will probably expand as I think of more) I want to ask:

1. Should she be taking a higher dose of aspirin;
2. Upping her lisinopril to 5 mg twice a day but doing it with 2.5 mg tablets, in case more movement ameliorates her rising blood pressure;
3. Getting the specific lowdown on what qualifies her as suffering from Chronic Renal Failure...not that I doubt this diagnosis, I just want to be well informed;
4. Getting a better fix on about where she is in the process, since I'm not sure we're that close to her diabetes "going on vacation", but her continued prodigious sleep habits concern me;
5. Checking on the advisability of a new ultrasound of her belly for records purposes;
6. Would a Complete Metabolic Panel, a Hemoglobin A1c, and a few miscellaneous iron readings be a good idea at this time, to see how her enzymes and a few other things are doing;
7. Anything new on the bladder control front that we might try on her;
8. Renew Rx's;
9. Check to see if the FNP is aware of any promising new supplementation we might try;
10. Discuss my concern about her iron supplementation: I am aware that it can play havoc with colonic elimination, although we haven't yet had this problem; I am also aware that metals are metabolized by the liver at what can often be expense to this organ's healthy functioning; despite the high level of antioxidants with which I supplement her (including those found in food) is it time to check her liver enzymes (which would be included in a CMP) and do an Iron & TIBC and Ferritin panels to see if all remains well with her on this front?

    I'll probably be adding to this list during later posts. I plan to fax a list of stuff I want to review with the FNP before the end of the week to give her some time to prepare. She was extremely generous with her time in January and, out of respect for this, I want to make sure that I do all I can to maximize effort in a minimal amount of time.
    Damn, I'm suddenly very tired. Think I'll hit the hay. Expect somewhat more somewhat sooner than...
    ...later.