Mom & Me Three Archive

    This morning I asked MPS if she could look after our mother while I was at traffic school on August 6th. She was happy to do it; even considers that it will help her out. That is a huge load off my shoulders. Although I was prepared to handle leaving my mother alone in the hotel room and checking on her during the break halfway through the class, I was extremely anxious about two problems: That she would be disoriented and, despite me leaving notes all over the room for her not to venture outside, postings about when I'd be back to check on her and back after the class, plenty of her favorite prepared food, her usual entertainment materials and the TV on Animal Planet, and, that, as she has been saying, it would give her a chance to sleep as much as she'd like without me bugging her to awaken, she would venture outside, anyway, and not figure out how to get back in; and, that she would fall and I wouldn't discover her fallen self until a couple of hours afterwards. The gods must surely be with me on this one.
    I'm letting Mom time her own nap today. She's having a minor swelling problem (for which I gave her 20 mg furosemide this morning) and her joints are beginning to revolt against the quick change air pressure we've been having the last few days. Today seems to be the worst. Even my joints are protesting, despite the fact that I love the rain we're finally experiencing.
    She is responding very well to the daily low dose antibiotic Macrodantin. It isn't even darkening her urine (who knows if it's darkening her feces; her feces is always black-just-this-side-of-green from all the iron she takes). She has exhibited none of the side effects. I'm hoping that on the occasion of her next routine doctor's appointment (late October/early November) she will have had 3 months of UTI freedom without body compromise. I continue to feed her pure cranberry juice (diluted with water and sweetened with Splenda®) and yoghurt, in part because one of the side effects of Macrodantin in an increased suseptibility to vaginal infections, since it does not differentiate between "good" and "bad" flora.
    As of August 2nd, which is my mother's 88th birthday, we will also be celebrating one year without any medical emergencies. I'm stoked about this landmark. This will be the first year since the fall of 2002 that I haven't had to trot her into ER at least twice a year and we haven't had to endure specialist appointment after specialist appointment and specialist test after specialist test. As well, everything about her health and well being remains stable or has improved. This year has been the essence of graceful aging for her. I hope my skills and caregiving can keep up with her and she continues to enjoy a graceful Ancienthood right up to her death. Over the last few days I've been reviewing all the caregiving horror stories I've heard over the last several years and can't help but feel humbly grateful to What/Whomever we express gratitude when we're not sure what the genesis of our luck is that Mom and I are not adding to that catalogue.
    I'm beginning to think that the trick to caregiving is to expect everything, embrace everything and trust my instincts about what kind of embrace each event deserves.
    Later.

    The PCP's office called a few hours ago with an overview of my mother's blood work. The nurse covered only a few highlights, I asked about some, but the upshot is, my mother's doing well, better than well.
    Her hemoglobin A1c is 4.6! The preference for diabetics is 6 or lower. This particular PCP likes to see his diabetics come in at 4-6. The nurse said that the doctor feels that 4.6 is running a little low for her and I can allow more sugars. The A1c test is essentially a handy, dandy 3 month review: In other words, it indicates how a person's blood glucose has performed over a 3 month period. Mind you, in my mother's case, the particular 3 month period we're talking about included that decadent Costco chocolate cake, fun with two flats of raspberries, blueberry cobbler, Baskin Robbins French Vanilla ice cream, lemon sorbet and raspberry sherbet. As you know, we didn't have these things every night, nor did we gorge on them. Some of them were consumed when we entertained company. Despite all this, I've been controlling her diet well enough (and, I suppose, we're getting close to Diabetes Vacation Time) that her Hemoglobin A1c was lower than her doctor would like. Hallelujah!
    The other exact number I got was her CBC hemoglobin: 10.2. Both her doctor and I are satisfied with this. I'd love to see another month at 11.3, but she's stable between 10 and 11+, so she's doing fine.
    I asked about her liver enzymes on her CMP and her iron, which, because of her supplements, tends to run high. The nurse probably didn't have the test with her because she couldn't give me numbers but said the doctor did not express concern about either. This is good news as it means my mother's liver is not being ravaged by the iron she's taking; thus, it underscores her good candidate status for daily low dose Macrodantin to prevent her UTIs.
    Copies of all tests are being sent to me. They'll appear here shortly, probably within the next few days.
    We're both still tired from the trip. I thought I'd sleep deeply last night, my first full night of sleep for a couple of days, but I didn't. I tossed and turned and awoke several times. Mom seemed to sleep well through the night but complained of being tired today. She's napping. I think some of it may be in reaction to the antibiotic, as this is one of the temporary side effects mentioned. I've held off on putting her through her exercise regimen but I think we'll try starting that again tomorrow.
    I forgot to mention that her weight at the doctor's office was 144. Typically she comes in at 137. She was shocked, but I wasn't. Her clothes continue to fit her as they did before; they aren't tighter. I think she may be putting on some muscle weight from the exercises, particularly the informal sessions that I usually don't mention over at =>Moving =>Mom. I also saw to it that she was well hydrated for this appointment because I had a hunch either they'd be taking blood or we'd be directed to a very close testing lab to give blood and I expected they'd be wanting a urine sample, too, which, as it turned out, they didn't. It is especially hard to get her to drink when she's traveling but I kept after her, much to her irritation.
    I feel vindicated. Too bad Shiny New Doctor was too shiny and too new to listen to me rather than become defensive with me. Too bad all Shiny New Doctors of his ilk (and, mind you, I have some thoughts, which I'll share one of these days, on which shiny new doctors are most likely to react as he and the one here in Prescott reacted; they don't all react like this) aren't put through some sort of softening course before they are released to Patients. It can do a physician a great deal of good to be educated on two facts:

1. The person who lives in the body knows it better, without the results of medical tests, than anyone else, and
2. if someone has a Medical Advocate who lives with her and manages her health care, you can safely bet on the Advocate knowing the patient's status better than any doctor does.

    Oh well. I've got some stat ketchup to do; not much. I took only one set of stats on Doctor Day and didn't take any yesterday.
    Later.

commented the lab tech at my mother's PCP's office on Tuesday as she signed the release forms necessary for the drawing of blood to be tested.
    He's right, it is. This is something I've noticed before when she signs checks for deposits and all types of forms. I almost always allow her final signature of anything after she's read the document, I've thoroughly explained the contents and we've discussed the implications of her signature. Once in awhile, during bouts of illness and weakness, the pressure of her signature fades to light, but its smoothness of line bespeaks the durability of her determination.
    Just before she signed the release she voiced one of her favorite lines, "I charge for my signature, you know."
    The lab tech laughed. I added, "Mom, you know, if you charge for your signature, shouldn't you also be charging for your blood?"
    She glanced at me, that "at heart I'm a barterer" look in her eye and looked back at the tech expectantly.
    "Too late," he said, slipping the needle out of her vein.
    While we were getting reacquainted with her former PCP, now her reinstated PCP, and he was reviewing prior treatment my mother spoke up several times, understood and responded to questions clearly and with her wry humor and generally made an excellent impression. At one point when the PCP and I were discussing something about how she is doing generally at home, she interrupted me to add detail to some issue over which I'd glossed. I grinned at her and said, as an aside to the doctor, "She remains very feisty."
    "Good," said the doctor, "very good!"
    It is good. Although I may cover the day and the visit in more detail later, here are some highlights:

• Her blood oxygen level, sitting in the office without oxygen, was 94.
• The PCP reviewed all the data about her frequent UTIs with me, agreed with me that scoping and imaging were out of the question and proposed putting her on a low (100 mg) daily dose of Macrodentin (nitrofurantoin macro) to prevent them. I agreed.
• He took blood for a CBC, Iron & TIBC, Ferritin (I think), a CMP and a Hemoglobin A1c (I will be obtaining copies of all results and posting them here, as usual). "I don't think we need to check her cholesterol," he said. She seems to be doing fine and continues to fall into the category of The Elderly w/Occasionally High Readings of Cholesterol Who Are Not Prone to Heart Disease. I agreed.
• He was singularly pleased, maybe even a little surprised, at her "excellent" blood sugar and blood pressure reports. He agreed with the way I've been administering her medication and controlling her diet.
• All medications, supplements and dosages remain the same except for the Rx for Macrodantin.
Her monthly CBC with continue. He agreed with me that the BMP probably only needs to be done at every two draws. He also agreed the the monthly urinalysis can be dropped. He did, as well, write out an as needed prescription for a culture urinalysis if she shows signs of a UTI despite the daily dose of Macrodantin, and, as well, an as need prescription for Levaquin, 500 mg/7 days. Frankly, I'm not expecting to have to use these. Neither is he.
• If all goes well, he doesn't want to see her again until late October/early November, which exactly dovetails with what I consider prudent.
• Although she does well resting without oxygen in the Valley, her oxygen prescription remains unchanged, for the time being, up here. The doctor is confident of my ability to tell when she needs it by her mouth breathing when she's at rest up here, she will continue using it when she sleeps and, of course, when she moves around, with the proviso that as she moves around "more" (which is always a hope of mine), she will probably need it less.

    Overall, the doctor was well prepared and relaxed in his own surroundings. He literally sprawled in his chair once we all realized we could be comfortable with one another. I volunteered information about why Mom was dismissed by the new doctor at her (and this PCP's) former clinic, including the fact that it was my upbraiding of him that "did the trick". He expressed neither surprise nor dismay. He knows me well. Although it wasn't necessary, he mentioned that he knew nothing about our former doctor. He did, however, mention that "90% of my former patients followed me to the clinic" and apologized for the fact that his informational letter to his patients didn't reach us, surmised it was because we had sold our Mesa house just previous to his move and the sending of his letter (I was pleasantly surprised that he'd remembered all this about us), with which I agreed, as we had problems with the forwarding of mail immediately after the sale. I apologized for not following him sooner. He also mentioned, when I praised The Wondrous FNP we'd had in January, that she had left The Other Clinic along with another FNP who was a diabetic specialist and one of our much appreciated medical resources. Luckily, our two favorite nurses joined him at his new clinic. One was on summer hours, since his clinic, like many others in the Valley that cater to an older demographic, suffers from patient downturn in the summer, so we weren't able to connect with her, but I left her a note. Both Mom and I are relieved that she is back in familiar medical hands.
    I am very satisfied with the visit, despite the fact that, I am ashamed to say, I managed to get a ticket for making a California Stop at a red light. I've received only one other ticket in my life, for speeding on a freeway during the 55 mph nationwide limits, almost 30 years ago, so I was not thrilled about the laxity of my driving. I've always considered myself an excellent, more than defensive driver and was appropriately taken to task when I was ticketed. I signed up for Traffic Survival School in order to have the fine lowered and the ticket dismissed. It will occur on August 6th, a Saturday. Unfortunately, there are no classes being offered up here before my court date. We'll be traveling to North Phoenix, just off I-17, for the class. Since the class is 8 hours, Mom will be ensconced in a motel room for that time but I'll have one break to check up on her. We've discussed it and Mom is looking forward to being "left alone to do what [she] wants" for 8 hours in a hotel. I've checked us into the same hotel that is hosting the class. We'll be there the night previous and into the early evening of the night of the class. I've promised her two dinners out, which pleases her. I have some anxiety about her incontinence but we'll come prepared and I'll use my break during the 8 hour class to make sure she's dry and changed and knows I haven't forgotten about her. I've already begun to drill into her that she is not to leave the hotel room for any reason. She is sure she won't. "I expect I'll sleep most of the day, since you won't be there to make me get up, or, I'll watch TV. Make sure it's on Animal Planet," she suggests with an anticipatory gleam in her eye. I expect she's right, and I'm not worried about this.
    Things are going well and Mom's been asleep for 12 hours so it's time to rouse her. Although it seems that I've been able to cover all of what I intended to cover about our Valley visit on Tuesday, I'm sure I'll be back...
    ...later.

...feeling much better today. It rained a little last night. Not much but enough, apparently.

    I have no argument with what I wrote last night. And, today, the furosemide and lisinopril I gave her last night seem to have done the trick. Mom's gotten over a quart of liquid since she arose (late, I let her sleep in since I wanted to make sure the furosemide worked well before I started loading her up with fluid, again, and, besides, that medicine really takes the stuffing out of her). She's in napping, now. I took her BP before she laid down and, of course, it's showing that she's more dehydrated than usual. Her energy level is low. Her feet, which looked fine this morning, appear to be a little pudgy, now. She didn't have it in her to do exercises or even a little walkering practice, I could tell, but she protested the idea, as well, more vociferously than usual, so I knew better than to push her.
    It's a no-win-no-lose situation. Pull the fluid off her and she's dehydrates too fast. Replace fluids as fast as possible and she remains dehydrated yet her feet start swelling, probably because she's not moving much, today. But, she's not into moving much today. God could not get her to move.
    So, I'll be mentioning the fluid retention problem despite her continual dehydration to the doctor on Tuesday. I was thinking, today, maybe she'll be taking furosemide more often, now. Moving seems to help, some, but I can't always get her to move. Elevating her feet actually doesn't help much at all and she doesn't like having her feet elevated, anyway. Maybe we should be using the support socks more. We'll try that, of course.
    We've passed another landmark and I didn't notice.
    Later.