Mom & Me Three Archive

    This is the third time I've had "extended release" problems with medication prescriptions; the second time the problem involved being told by a doctor Mom would be getting an "extended release" version of a medication that doesn't exist. Each of the three episodes has involved a different doctor.
    This time Mom's doctor told me he would be prescribing an "extended release" 10 mg tablet of lisinopril for Mom to take once a day. When I called the pharmacy to ask some questions about the prescription and referred to it as "the extended release version" the pharmacist flatly told me that there is no such thing, yet, for lisinopril.
    "Really. Interesting. That's the second time in a couple of years I've had a pharmacist tell me that information I got from a doctor about a medication was wrong."
    Short silence. "Well, I don't know what to say. All I can tell you is that lisinopril does not come in an extended release form, generic or by brand."
    See, the thing is, I think doctors know, for instance when a particular medication is not available in an extended release form. I think doctors are still in the habit of lying to their patients and patient advocates in order to promote a type of placebo/self-hypnotic effect in a particular direction within the patient. The problem is, now that people are doing more medical research on their own behalf and much more information is being made available for laypeople to do this, doctors are now going to have to deal with the effect of patients' reactions to medications and procedures when the patient knows the doctor has been lying to them.
    Guys, it's time to come out of your god-closets and step up to the medical plate. Your patients and their advocates are waiting for you...
    ...later.

...just before he left the examining room, for taking such "good, close care" of my mother! I've been meaning to mention this over the last few days as I remember it at odd moments.
    My reaction? I was flabbergasted. I said, "You're welcome," of course, and mumbled something else about how it was nothing, it is my mother, after all.
    Wow. I cannot express how good it feels to have her doctor, her PCP, too, thank me. Most doctors would prefer that I not be anywhere near my Mom when they're seeing her so they can have at her and make their decisions in the absence of her mind and anyone else's but theirs.
    I just picked up the 10 mg/1 per day prescription for lisinopril. Over the last few days I've been giving her 10 mg as two 5 mg doses twice a day to prepare her body. I think, at first, I'll try administering the dose at night, either at dinner or bedtime, that I haven't decided.
    It's a mellow day, today, which is fine with me. I don't know why but I woke up a little irritated and decided I needed a down day. Mom's sleeping off something, I'm not sure what. It isn't me. I was pretty good at putting off my irritation when I was around her.

    I think I covered everything!
    Later.

Mom's Blood Pressure:

    First of all, I've completed the project to which I referred earlier: An averaging of her blood pressures per month and per period for as long as I've been taking them. I've posted the results here at Mom's Daily Tests & Meds.
    I got the idea from something her PCP said when we discussed her blood pressure and I talked about how I'd been upping her dose of lisinopril based on the BP's I'd been taking two to four times a day. He was overwhelmed with the numbers. We both acknowledged that she appears to need a bit more lisinopril to keep her blood pressure in order.
    At this point I asked if my concern for her BP was "out of hand".
    "Yes it is," he said, "and let me tell you why." It seems that the value of BP readings are most valuable when taken on an average. "Don't compare apples and oranges; look at all breakfast readings, all lunch readings over a period of time."
    So, I decided to average her BPs over all the months for which I have at least three readings for each meal per day, per month. You can definitely see the tighter control with lisinopril obvious in the steadily declining averages.
    The PCP also told me that doubling the dose of lisinopril usually accounts for only a few points of a drop per indicator. Thus, he wrote Mom an Rx for 10 mg lisinopril/day once a day. "If, on a particular day, you think she needs it, you can also administer another 10 mg at dinner." He also explained that most of his patients who are being treated for fairly high BP are on 10 mg/twice per day, so Mom is well within not-overmedicated range. He is happy with her averages across the board, though.
    I asked him about how often I should check her BP.
    He surprised me: "No more than a couple of times a week. Then take them for all periods and wait a couple of days, unless you see something unusual over that day."
    I'll try, hard, to do this.
    I need to get that prescription filled today. Yesterday I made sure she got 10 mg lisinopril in all (two 2.5 mg tablets in the morning, two at night, since they are not extended release).

Shots:

    Yeah, I was blown away that the pharmacy up here has flu, pneumonia and tetanus shots and her doctor's office did not. She won't be able to get a pneumonia shot at the pharmacy. Under Medicare they only give the pneumonia shot every six years. So, Mom can get that one in April at her doctor's office in 2006.
    Hmmm. I just called the pharmacy about shots. It seems that the shortage that affected my mother's PCP's office is not affecting the pharmacy. Although there were times in the last week when the shot table was free for long periods of time and there was not a run on flu shots it seems that "the shortage" (this is the first I'd heard of it) is dictating that the pharmacy does not have its inoculation tables up this week and is hoping to do one more run 11/5 from noon to 1800. But call, she cautioned.
    As for the Rx for lisinopril so soon after the last one, she explained that since Mom is on TriCare the Rx may override the last as a new Rx, in which case I'll have extra if she needs more than 10 mg on a particular day, and I can experiment with anywhere from 2.5 - 10 mg if this should happen. I'm always looking for a way to use the least amount of medicine possible.

Ears:

    The nurse did indeed perform "ear lavage" on my mother's right ear (the problem ear), four times in a row until Mom acknowledged that, yes, her ear was developing some tenderness.
    The nurse also invited me to peer into Mom's ears. She used the left as the control ear, since it was clear. I could clearly see the plug of wax in her right. It was much tinier than I expected.
    "It doesn't take much to block one's hearing," was the nurse's response to my amazement.
    Although full removal was unsuccessful at the office the plug was apparently loosened enough so that her hearing was restored yesterday morning and remained so all day. I'm assuming the plug drained out.
    The nurse suggested that if it didn't drain out we could come back in "a couple of weeks". I explained to her that I'll use Debrox again before we take another trip down and up the mountain so soon.

    Let me check my previous lists to see if there's anything else I can fill in off the top of my head.

Bowels on the Run:

Is explained in the only post for November 1, 2005, at Mom's Daily Tests & Meds.

Dem Old Bones

Mom is simply no longer comfortable in a car if she has to fold and unfold herself as she enters and exits. No more low to the ground cars. Even with the aid of my "hootchie kootch" stretch that I do immediately after getting out of a car and through a modified version of which I direct my mother once she's straightened out up exiting a car. Of our cars, the truck is more comfortable than the sedan except that the design of the seat, itself, is uncomfortable for her: It throws her back and makes is hard for her to sit on her but rather than her spine. It's weird.
    So, I don't know, I think about this every year or so, maybe we'll look into purchasing a "new" (new little used cars are a possibility, too, especially if the warranty travels) car, trading in our two cars on one. We'll see

    The Air Up Here vs The Air Down There

    The city smell was much stronger on this trip, even though the air was tinged with blue. Mom didn't notice it but she used more oxygen than I was expecting. Through most of the appointment she was on oxygen and didn't mind it. I noticed her mouth breathing more than last time. Although during lunch, right after we hit The Valley, she did fine while sitting without oxygen. She could have used it every time she moved, though, but the walker was a tight fit for the bathroom. She used it on the way in and out, though, although not on continuous. She breathed fairly well through her nose on pulse, which sometimes doesn't happen up here.

Cigarettes and MCF's

    As it turned out she only had about 6. She, of course, didn't smoke while she napped, no one made a big deal of it and cigarettes were cleared from the table several times during the evening for appetizers, the meal, the giving of gifts, dessert. You know how it is when it's your birthday.
    I slapped continuous flow 2/lpm oxygen on her for the trip up after the cigarettes. She was an animated companion. She did want a cigarette when we'd finally settled at home and the door was no longer due to be open for unloading. I lied and said she only had one left in the pack and she could have that. I figured it would relax and daze her enough to get her to bed, which it did, around midnight I think.

Manicure Kit

    No one carries the type of manicure kit I have in mind anymore. So, I'm going to look for it on the web. We did, however, replace her collection of manicure tools that have broken or rusted beyond repair.

"Family" Discussion

    I am glad and we are lucky that Mom and I are so comfortable with MCF&Family that we plan like family. MCF's family owns a cabin in the southwestern mountains around Pagosa Springs, Colorado. Cabin Elevation: Around 9200'. Anyway, she had her photos from a recent visit and passed them around the table. The place reminded Mom a lot of Spearfish Canyon, SD; more than reminded her. When it was suggested that maybe Mom could tolerate that altitude for a few days, I noticed her gently phasing into Spearfish Canyon, at a somewhat lower elevation, and announcing that of course she could, she'd been "there" many times. Anyway, both MCF and I think that in a warm season, late spring, summer, if she's up to it in a little less than a year (you never know), we might be able to do this. Mom became very excited, phasing all over the place, wondering if we "might run into any of the folks" while we're "there".

Miscellaneous Stuff:

    Mom's excitement about Christmas was more than evident. She volunteered some of our plans without confusion. On the trip back she suggested that we plan "a shopping trip to the Valley". I'm in favor of this, even though it will mean another down-and-up day. I'm thinking maybe I can plan one on one of MCF's off days in the middle of the week, we'll throw in the wheelchair this time for Mom's and our convenience and hit the Chandler Mall and maybe a few other places.
    Once during the trip while we were in Ulta she demanded, "Where's my purse?!?". She's ready to shop.

    Yesterday was a lost day, a recovery day. Today might be, too, since we don't have to go for shots today; can't, in fact, until Saturday, now. She may or may not want to go to Barnes & Noble with me. I have a birthday gift certificate for that store burning a whole in my pocket. As well, I have several small home improvement projects planned for the house and have my information from MCBIL about which electric drill and bit set to buy. Maybe I'll do that today, too, if it looks like it's going to be a slow, sleepy day for Mom.
    My primary plan is to deliver nutritious meals to her today, cut waaaay back on the sugar and monitor her hydration.
    My secondary plan is to drink lots of coffee.
    Oh. If you click on the link above regarding Spearfish Canyon and scroll down the page about two third of the way, you'll see two paragraphs headed, respectively: Savoy and Roughlock Falls. In the one about Savory you will read mention of Latchstring Inn, which my maternal grandparents owned and ran for a couple of decades. Roughlock Falls is "about a mile up" from Latchstring Inn. We would frequently hike "up there" and spend a few hours during the day in the summer when we visited. The canyon, by the way, is enchanting in the winter. Used to be hard to get into and out of but my understanding is that the roads have been rebuilt and that problem is fairly well solved. Apparently there are places in the Canyon, now, where one can jet ski. Makes me shudder.
    Later.

    ...I'll stat later. With two Starbucks gift cards under my belt I've got enough time before the rental place opens to gas and get an eggnog latte. I'm a day behind.
    Oh, and the dogs. I want to mention about the dogs.
    Later.

1. Mom smoking at MCFs
2. The "family" discussion of MCF's family's cabin in Colorado and a discussion about the possibility of both Mom and me visiting next year (you never know)
3. Thanksgiving plans refined
4. flu and pneumonia shots
5. old bones
6. The Air Up Here vs The Air Down There
7. stats for yesterday
8. explanation of project
9. the disposition of Mom's ears

    In the meantime, I have a car to gas and deliver.
    Later.
    Hmmm...maybe I'll do stats now, get that out of the way, and return...
    ...later.

...as she retired.
    Her last words to me, delivered with her head tilted in her characteristic "I'm overjoyed" pose, were, "We certainly did! I thoroughly enjoyed it!"
    After days like today and images like the last she offered me before sleep crept between us, I have to say, it's hard to believe that one day this woman will be dead. I see why she has such a hard time believing in her mortality. I have a hard time believing in it!
    She so exuded vitality that her doctor did a double take when he entered the office, made to greet her first, as he always does, for which I am eternally grateful, it is she, after all, who is the patient, and spied her sitting on the edge of the examining table, swinging her short legs so they knocked against the side of her perch, channeling an 11 year old boy about to slip away from the adults and manifest the mischief on his mind. He was charmed like a bird off a tree. I'll bet he questioned her mortality, too, asking himself, "Is she even human? She's probably one of those immortal creatures in Cocoon who have never died!" Although in the movie one does die.
    I noticed today that her PCP is just coming into the lap in which he will hit his stride as a physician and a healer. He's much more comfortable with his patients, any tag-along advocates and himself with his patients. He has a very quirky, ingenuous, likable character, aside from his A.I. brain. I noticed he is running a "family practice", as well. I'm actually pleased about this. He is good enough and interested enough in doctoring that he might be one of those physicians who follows patients from various states of adulthood into Ancienthood.
    The upshot of our appointment is that he doesn't think it's necessary to see her for another five months. Perhaps she's hit an octagenarian plateau that we haven't known about because so few "normal" people have ever before antcipated one's late 80s or lived through them.
    I've designed a project as a result of one aspect of the appointment: her Blood Pressure. I'll be performing it shortly to inform myself about her blood pressure profile. I'll explain later.
    In fact I'll be further elaborating and explaining lots about yesterday later.
    Oh. Mustn't forget "Bowel's on the Run"; not in the usual sense.
    When I mentioned to her PCP that she seems to be hitting the blossoming I'd been expecting at the advent of summer he responded, "We'll take it any time we can get it."
    I am so curious, now, to find out how she will eventually die. I can't even imagine, anymore.
    No Rx for an oximeter. We forgot to discuss it. But, I'm not worried. She ran for about half the day without oxygen.
    I need to start the next round of drying and hit the sack. I have a car to fill and return in the morning. I'm not even going to edit this post for anything.
    More...
    ...later.

1. We are keeping the cane.
2. Mom will, indeed, have her ears cleaning professionally tomorrow unless they drain completely between now and 1400 tomorrow.
3. I haven't forgotten about my intention to write about things caregiver's aren't supposed to say to their visitors. I just haven't had the time, although the list continues to expand in my head. Expect that sometime within the next week or so.
4. I have yet to get back to finishing the cataloguing for the index. Let's hope some time opens up for that, as well.

    Again, later. Really.

...everything ahead of time for today so that I could have most of a day to myself, somehow I managed to space the fact that tomorrow is a travel day and there's lots to do to prepare for that, including:

• Doing The Full Meal Deal on Mom's hair;
• Coaxing her body into moving its bowels (which hasn't yet happened);
• Setting aside all our traveling supplies so they can be easily and quickly stowed in the car we're renting;
• Choosing Mom's outfits (a couple of changes, just in case) ahead of time, packing the alternates, laying out the initial set;
• Making sure all bills due at the beginning of November are paid so I'm not worrying about that;
• Compiling a short "study" of my week long experiment on Mom with lisinopril to present to the doctor for discussion about whether to up her dosage permanently;
• Seeing to it that her blood sugar record is up to date as of today (her PCP always asks);
• Making eggnog bread, a loaf of which I'll be presenting to MCF and her family because she, knowing how much I love eggnog, is the one who told me about eggnog quick breads;
• Compile and a list of things to do gather and do tomorrow for the trip.

    In addition, Mom's excitement about the trip tomorrow continues. She is not, I should mention, at all excited about the doctor's appointment. She's asked me once today if, since it's "merely routine" we could cancel it and spend the entire day at MCF's. I didn't think she was going to go down for a nap but spending an hour under the hair dryer relaxed her into a nap mood so I can take some deep breaths, now.
    As well, although the birthday meal I planned is in the Preparation-Lite category, still it requires some preparation. And, of course, there are all the daily chores to do as their optimum times approach.
    I'm in a good mood, though, and feel like The Proper Birthday Girl so the day is advancing well.
    I probably won't post again until Wednesday except for the rest of today's stats. So, here I go an my birthday way...
    Later.

...for the url to the excellent template prescription letter for an oxymeter/oximeter. I've already created a filled in copy of it, printed it and have it ready for our doctor's appointment tomorrow. Being conservative as he is it's possible that he will not think it is "time" for me to have such a device, but I noticed on the Nonin site that I can buy the same handy-dandy instrument off prescription as either a pilot's or a hiker's aid. When I searched out costs I discovered that a Nonin discontinued pilot's aid, which has been replaced by a newer model, is selling for $100 less than the portable medical model which appears to be exactly the same type. I'm going to try for an Rx first, in case Medicare/Tricare will subsidize some, if not all, the cost. If that doesn't work we'll purchase the discontinued pilot's aid outright.
    As an aside, for those of you who are interested, the template is a very succinct, complete document which, with only slight modifications, can handily be used as an Rx letter for any of a number of medical assistance devices. As well, it is part of a site, EFFORTS (Emphysema Foundation For Our Right to Survive which looks as though it is extremely complete and thus very helpful for those with pulmonary problems. It's a keeper.
    Mom decided not to accompany me on my two errand trips, yesterday, but that's all right. I'm encouraging her to rest up for Tuesday. Her usual physical profile is that, after several days of movement a couple of days of rest acts on her like a weightlifter doing a couple of days of strenuous workouts. My guess is that tomorrow, in The Valley, she will be in tip-top shape. As well, the lower altitude will enhance her ability to breathe and her energy level. She'll probably be unstoppable. She's remembering the trip, very much looking forward to it and has even remembered that at MCS's home, where we'll be spending the afternoon and evening, there is a toy dachsund with whom she's fallen in love. She can't wait to see him again. I expect that the visit to MCS's home will involve some cigarette smoking so somewhere along the way I'll pick up a pack of cigarettes for her so she doesn't smoke MCS out of hers.
    I hear her blowing her nose. Time to start her day.
    Later.