Tuesday, March 20, 2007
Health Review: 3/20/07
Blood Pressure:
Since 9/06 her BP has become a little harder to control: Her diastolic was wandering more frequently into the 80s and her systolic was regular hitting the 140s and 150s. I increased her dosage of lisinopril 10 mg from 2 per day to 3, adding an extra at bedtime from mid December on. Since then, her diastolic is usually between 65 and 75 and her systolic rarely goes above the 150s, usually coming in between 120 and 145. I think keeping her on this dosage is a good idea.
Blood Sugar:
Blood Glucose control since 9/06 has been excellent. Even through the holidays, I found very few occasions to increase her 10 mg glipizide 2 per day to three.
Urinary Issues:
No change. Macrodantin continues to keep her UTI free.
Hydration:
No change.
Energy Level:
She's beginning to come out of winter hibernation. Although slow this winter, she was no slower than usual for winter and was fairly active during the holidays. I detect no changes from her usual pattern.
Skin & Circulation:
No changes.
Appetite & Diet:
Once again, during winter, reverted to her hibernation pattern of skipping lunch but having hearty breakfasts and dinners. This is beginning to change and light lunches are being added as it gets warmer and she moves more.
Dementia:
Remains unchanged.
Will & Spirit:
Remain strong and high, respectively.
Medication & Supplements:
Remain the same, except for the above noted change in her lisinopril dosage.
CHF:
Furosemide administered very few times since 9/06. I can’t remember the last time she experienced extremity/abdominal edema and I used it.
COPD:
Remains unchanged. Continues to use 3/lpm concentrated oxygen when she sleeps and tanked 2/lpm continuous oxygen when moving around outside.
Bowel Movements:
Continues to eliminate every 24-72 hrs; usually every 48 hrs. Fecal consistency, volume and ease of elimination remain good to excellent. Rare use of Phillip’s Milk of Magnesia as a laxative.
ISSUES FOR APPOINTMENT ON MARCH 22, 2007, AT 1400 P.M.:
Since 9/06 her BP has become a little harder to control: Her diastolic was wandering more frequently into the 80s and her systolic was regular hitting the 140s and 150s. I increased her dosage of lisinopril 10 mg from 2 per day to 3, adding an extra at bedtime from mid December on. Since then, her diastolic is usually between 65 and 75 and her systolic rarely goes above the 150s, usually coming in between 120 and 145. I think keeping her on this dosage is a good idea.
Blood Sugar:
Blood Glucose control since 9/06 has been excellent. Even through the holidays, I found very few occasions to increase her 10 mg glipizide 2 per day to three.
Urinary Issues:
No change. Macrodantin continues to keep her UTI free.
Hydration:
No change.
Energy Level:
She's beginning to come out of winter hibernation. Although slow this winter, she was no slower than usual for winter and was fairly active during the holidays. I detect no changes from her usual pattern.
Skin & Circulation:
No changes.
Appetite & Diet:
Once again, during winter, reverted to her hibernation pattern of skipping lunch but having hearty breakfasts and dinners. This is beginning to change and light lunches are being added as it gets warmer and she moves more.
Dementia:
Remains unchanged.
Will & Spirit:
Remain strong and high, respectively.
Medication & Supplements:
Remain the same, except for the above noted change in her lisinopril dosage.
CHF:
Furosemide administered very few times since 9/06. I can’t remember the last time she experienced extremity/abdominal edema and I used it.
COPD:
Remains unchanged. Continues to use 3/lpm concentrated oxygen when she sleeps and tanked 2/lpm continuous oxygen when moving around outside.
Bowel Movements:
Continues to eliminate every 24-72 hrs; usually every 48 hrs. Fecal consistency, volume and ease of elimination remain good to excellent. Rare use of Phillip’s Milk of Magnesia as a laxative.
ISSUES FOR APPOINTMENT ON MARCH 22, 2007, AT 1400 P.M.:
- We have some Rx’s to renew and one, the lisinopril to change, but, otherwise, everything seems to be going well. No outstanding issues to address.
- You’ll notice that between 9/06 and 2/07 I did not take her in for blood work. Her preference was not to go and I didn’t fight her, since she’s been doing fine. In fact, the blood work results for 2/07 and this month show that she remains stable since 9/06.
- You’ll also notice that blood glucose numbers are spotty and blood pressure numbers are very spotty. Frankly, Dr. Coury, I was beginning to suspect that I was becoming so statistic happy that the statistics were using me instead of me using the statistics. I decided to see if I could live without statistics, except for somewhat frequent blood glucose numbers and occasional blood pressure measuring, and trust my instincts about how my mother was doing. The result? Mom and I both relaxed more than ever around each other. My mother was thrilled that I wasn’t following her around with a lancet or a cuff and wasn’t insisting that she get stuck every month. I’ll certainly continue the monthly blood draws, now that it’s warming up and she’s begun to move more, and, of course, I’ll keep up blood glucose and blood pressure monitoring a little more assiduously than this winter; especially if she appears to be having health problems. But, now I know, sometimes, monitoring can be an annoyance, rather than a help.
I will bring blood glucose charts with me and a short review of her BP since 9/06, during the times when I took it. Things have gone so smoothly, though, that I don’t see any need to burden you with every little detail along with this report. - We look forward to seeing you and your excellent staff on March 22nd at 2:00 p.m. Only good things to report, Doctor. I’m sure Mom’s going to make 90 this August, and then, we’ll set our sites on the next “Big One”, just for fun.
- Please feel free to schedule any blood tests or other tests as you wish. If you want to order some scans or ultra sounds just for maintenance purposes, there is are imaging labs, up here, that can handle those. If not, well, that’s fine, too. Mom’s cruising.
Everything is falling nicely into place...
...in regard to Mom's upcoming doctor's appointment on Thursday. Today I'm taking her to my barber to have her hair cut. She's finally decided that she's willing to try having it cut in order to enhance scalp health. The trump card? She remembered, surprisingly, something one of her former hair salon stylists said some years ago: "It's just hair. I don't know why people get so excited about it. If you don't like it, it always grows back." I suspect, in fact, that despite my mother having only about half the amount of hair I do (and, believe me, I've got much less than what would normally be considered a full head of hair), her hair grows faster than mine.
At any rate, what I've talked her into is this: Having the back cut in a short-but-not-too-short shag, in order to overlap enough to cover her scalp but be short enough so that it'll show shape but not have to be treated with styling gel to keep it looking good. It seems that there is almost no styling gel on the market, anymore, that doesn't irritate my mother's scalp. That will take care of half of her head. The top part and the front sides will be somewhat longer and nicely shaped so that I can curl her hair, tease it and style it, maybe even be able to use some of her favorite glittery and pearly clips in it, but not have to enforce it with irritating gels in order to get it to look good. While I was prowling my barber's collection of styling products this morning, though, while awaiting my own hair trimming, I noticed a styling product that contains no alcohol, plastic resins or PVP film formers. I'm going to give this a try. As well, my barber gave me a sample of a conditioner that can be left in the hair after washing to protect the scalp. If this stuff works, I'll publish the names of the products.
My barber also cautioned me against using the typical products for the control of scalp irritation on Mom. I've been using Dermarest and Scalpicin, after having unsuccessfully trying a Tea Tree preparation. She was adamant that the above two products in particular, and products such as Head & Shoulders and Tegrin don't work on scalps such as my mother's. She also cautioned me against washing her hair as often as I do currently. "No more than two times a week," she said. "You can rinse it and rub some of the build-up out, but don't wash it a lot."
One of the quirky benefits of visiting this particular barber is that she has a huge sense of humor. She provides, directly in front of her patrons when they're in the chair, continually changing poster boards pasted full of sayings ranging from the gently funny to the wildly ironic...sort of like a collection of car stickers, only better. Some time ago she made T-shirts with her favorites and sells them at her shops. Today, while awaiting my turn in the chair, I took to reading one of the shirts she had hung on the wall for display. I was reminded that, during my mother's daily bathing, she reads whatever is on the T-Shirt I happen to be wearing and this usually elicits a wide variety of gentle, funny, conversation, a great introduction into her day. I realized that one of these shirts would be the perfect bath uniform for me. The T-shirts are so loaded with sayings, front and back, that by the time she's read all of them, she will have forgotten her first readings and we'll be back where we started. So, I bought one. I'll be introducing my new bathing uniform when I awaken her in a few minutes. Should be fun.
When I entered the shop, this morning, unbeknownst to me, my barber was working on a very bitter, cautious woman. The shop is small and close, one chair, one barber, which encourages cross conversation. Never having met the patron in the chair, I announced when I walked in, "Let me tell you what I love Prescott. This morning I stopped by the Mail Box (a commercial mail facility) to post a small package. The proprietor was walking across the street from the bank with a load of cash for his cash register in hand. I can't think of anyplace else, right off, where someone would consider doing this."
My announcement was only barely acknowledged. It appeared that I had interrupted the patron being served in mid-thought; but she continued, without a hitch what turned out to be a tirade against the injustices taking place in her trailer court. Here and there, when my barber was able to get a word in edge-wise, she'd sympathetically offer, "You've got to keep after them [name of patron]; you can't give up."
After the patron left and I was settling myself into the chair, my barber winced in apology for the previous conversation. First, she told me that she was surprised that the patron didn't light into me immediately after my anecdote.
"That's okay," I said. "She makes the rest of us look good."
My barber chuckled then told me, "She's very bitter. She's a former nun and got angry with with God and left. Now, she doesn't have a good word to say about anyone or anything." It seems that the woman is also perpetually frightened and defensive. The barber told me that this woman, who is probably somewhere in her 70's but could be in her early 80's, who knows, it's hard to tell, when one gets to the upper registers, carries a complete arsenal of weapons in her pockets and purse and sports a full bullet sash across her chest.
I was astonished. "You're kidding! Here, in Prescott!" It's a good thing, I thought, that she's here instead of in a larger community. If she were in Phoenix she'd probably be wearing a full suit of armor everywhere.
My barber and I contrasted this patron's attitude with my mother's, who remains highly optimistic about both life and people. Amazing what different paths people travel through life.
I thought about what might happen if and when this woman ever reaches a point where she needs others to help care for her. I can't even imagine what it might be like to provide care and support for an Ancient Someone who felt as though she had to keep herself perpetually armed against every moment of her life. My guess is that her natural suspicion would be a huge factor in guaranteeing that she never received predictable, proper care. Now, I'm curious. What does happen to people who are this angry, bitter, suspicious and protective as they enter their Ancient Years?
Time to awaken the Mom.
Later.
At any rate, what I've talked her into is this: Having the back cut in a short-but-not-too-short shag, in order to overlap enough to cover her scalp but be short enough so that it'll show shape but not have to be treated with styling gel to keep it looking good. It seems that there is almost no styling gel on the market, anymore, that doesn't irritate my mother's scalp. That will take care of half of her head. The top part and the front sides will be somewhat longer and nicely shaped so that I can curl her hair, tease it and style it, maybe even be able to use some of her favorite glittery and pearly clips in it, but not have to enforce it with irritating gels in order to get it to look good. While I was prowling my barber's collection of styling products this morning, though, while awaiting my own hair trimming, I noticed a styling product that contains no alcohol, plastic resins or PVP film formers. I'm going to give this a try. As well, my barber gave me a sample of a conditioner that can be left in the hair after washing to protect the scalp. If this stuff works, I'll publish the names of the products.
My barber also cautioned me against using the typical products for the control of scalp irritation on Mom. I've been using Dermarest and Scalpicin, after having unsuccessfully trying a Tea Tree preparation. She was adamant that the above two products in particular, and products such as Head & Shoulders and Tegrin don't work on scalps such as my mother's. She also cautioned me against washing her hair as often as I do currently. "No more than two times a week," she said. "You can rinse it and rub some of the build-up out, but don't wash it a lot."
One of the quirky benefits of visiting this particular barber is that she has a huge sense of humor. She provides, directly in front of her patrons when they're in the chair, continually changing poster boards pasted full of sayings ranging from the gently funny to the wildly ironic...sort of like a collection of car stickers, only better. Some time ago she made T-shirts with her favorites and sells them at her shops. Today, while awaiting my turn in the chair, I took to reading one of the shirts she had hung on the wall for display. I was reminded that, during my mother's daily bathing, she reads whatever is on the T-Shirt I happen to be wearing and this usually elicits a wide variety of gentle, funny, conversation, a great introduction into her day. I realized that one of these shirts would be the perfect bath uniform for me. The T-shirts are so loaded with sayings, front and back, that by the time she's read all of them, she will have forgotten her first readings and we'll be back where we started. So, I bought one. I'll be introducing my new bathing uniform when I awaken her in a few minutes. Should be fun.
When I entered the shop, this morning, unbeknownst to me, my barber was working on a very bitter, cautious woman. The shop is small and close, one chair, one barber, which encourages cross conversation. Never having met the patron in the chair, I announced when I walked in, "Let me tell you what I love Prescott. This morning I stopped by the Mail Box (a commercial mail facility) to post a small package. The proprietor was walking across the street from the bank with a load of cash for his cash register in hand. I can't think of anyplace else, right off, where someone would consider doing this."
My announcement was only barely acknowledged. It appeared that I had interrupted the patron being served in mid-thought; but she continued, without a hitch what turned out to be a tirade against the injustices taking place in her trailer court. Here and there, when my barber was able to get a word in edge-wise, she'd sympathetically offer, "You've got to keep after them [name of patron]; you can't give up."
After the patron left and I was settling myself into the chair, my barber winced in apology for the previous conversation. First, she told me that she was surprised that the patron didn't light into me immediately after my anecdote.
"That's okay," I said. "She makes the rest of us look good."
My barber chuckled then told me, "She's very bitter. She's a former nun and got angry with with God and left. Now, she doesn't have a good word to say about anyone or anything." It seems that the woman is also perpetually frightened and defensive. The barber told me that this woman, who is probably somewhere in her 70's but could be in her early 80's, who knows, it's hard to tell, when one gets to the upper registers, carries a complete arsenal of weapons in her pockets and purse and sports a full bullet sash across her chest.
I was astonished. "You're kidding! Here, in Prescott!" It's a good thing, I thought, that she's here instead of in a larger community. If she were in Phoenix she'd probably be wearing a full suit of armor everywhere.
My barber and I contrasted this patron's attitude with my mother's, who remains highly optimistic about both life and people. Amazing what different paths people travel through life.
I thought about what might happen if and when this woman ever reaches a point where she needs others to help care for her. I can't even imagine what it might be like to provide care and support for an Ancient Someone who felt as though she had to keep herself perpetually armed against every moment of her life. My guess is that her natural suspicion would be a huge factor in guaranteeing that she never received predictable, proper care. Now, I'm curious. What does happen to people who are this angry, bitter, suspicious and protective as they enter their Ancient Years?
Time to awaken the Mom.
Later.
Monday, March 19, 2007
Blood Test Results are up...
...for 3/17/07. Although she's dropped a few hundredths of a point here and there, she's holding her own, well within her range. Her CO2 is back within the normal range, so, chances are, that elevation last month was due to the test, which often happens.
I will be doing a health review this month, probably sometime this evening, the results of which I'll publish here. As you know, I haven't been keeping track of her Blood Glucose and Blood Pressure over at The Dailies, which has been a relief, frankly. I have been downloading her glucose readings from her monitor, though, and will probably enter just the bare facts, m'am, but don't expect those too soon. I expect, at some point, I'll get back to that and do a little back dating, at least of her glucose numbers and 20 BPs, but there is nothing unusual to note over there. It's been good for me to get away from doing that. Aside from the fact that not keeping quite as close a watch on her stats has been good for me (they are no longer using me, I am using them), it seems that the constant use of "devices of torture" on her has made absolutely no difference in her overall profile.
I'm looking forward to her appointment. I expect everything to continue as it has for the last 2.5 years. If there are any changes in her medical routine, I imagine they'll have to do with her BP, but that will most likely be a simple change of her Rx for one 10mg lisinopril twice a day to the routine I've been following for some months, now, one 10mg lisinopril three times a day. Otherwise, I expect her PCP to nod, note that she's doing fine, and we'll be outta there within less than half an hour.
Most of the prep for our trip is done. Mom's moving a little bit more than most of the winter and, of course, the drop in elevation usually registers almost immediately, so I expect her to be trotting into the office like an old race horse.
I still have some post catching up to do, but only half as much as before, I think. I'm hoping to finish that off this week.
I will be back...
...later.
I will be doing a health review this month, probably sometime this evening, the results of which I'll publish here. As you know, I haven't been keeping track of her Blood Glucose and Blood Pressure over at The Dailies, which has been a relief, frankly. I have been downloading her glucose readings from her monitor, though, and will probably enter just the bare facts, m'am, but don't expect those too soon. I expect, at some point, I'll get back to that and do a little back dating, at least of her glucose numbers and 20 BPs, but there is nothing unusual to note over there. It's been good for me to get away from doing that. Aside from the fact that not keeping quite as close a watch on her stats has been good for me (they are no longer using me, I am using them), it seems that the constant use of "devices of torture" on her has made absolutely no difference in her overall profile.
I'm looking forward to her appointment. I expect everything to continue as it has for the last 2.5 years. If there are any changes in her medical routine, I imagine they'll have to do with her BP, but that will most likely be a simple change of her Rx for one 10mg lisinopril twice a day to the routine I've been following for some months, now, one 10mg lisinopril three times a day. Otherwise, I expect her PCP to nod, note that she's doing fine, and we'll be outta there within less than half an hour.
Most of the prep for our trip is done. Mom's moving a little bit more than most of the winter and, of course, the drop in elevation usually registers almost immediately, so I expect her to be trotting into the office like an old race horse.
I still have some post catching up to do, but only half as much as before, I think. I'm hoping to finish that off this week.
I will be back...
...later.
Sunday, March 18, 2007
Luxurious day, yesterday.
When I entered Mom's bedroom at 1000 to awaken her for her blood draw, she was raised on her right elbow and rubbing the sleep out of her eyes.
"I didn't sleep very well last night," she announced, even though she looked bright eyed to me. "I kept waking up."
"Were your dreams unsually vivid?" I asked.
"No, I don't remember dreaming."
"Aha!" I announced. "I'll bet you were remembering that I'd be getting you up earlier than usual today."
"Why in the world were you planning to do that!?!"
Not quite the dissolution of my theory, expressed in the immediately previous post. If her subconscious remembers the reason, that doesn't necessarily mean that an oblique trigger is going to shoot it into her conscious mind. "It's blood draw day, today."
"Oh," she acknowledged, unenthusiastically. "That's right."
"And Blood Draw Breakfast Day."
"Oh! That's Right!" Huge grin. "Sweet Rolls! That must be the reason!"
I grinned back, gleefully satisfied that at least one of my memory tricks works.
Although I'm far from a sun worshipper, I like spring, here (yes, despite the calendar it's already spring and, yes, I know, it's due to global warming). The sun has already retreated halfway out of our living room, which means I don't have to close the upper window blinds in order to see my computer screen. Don't have to wear sunglasses to read the Sunday newspaper. The sweltering not-even-spring-yet temperatures, this year, in the Phoenix metroplex (Tempe registered 100° yesterday) translated to 86 in downtown Prescott and the low 70's up here; sensuous breeze; all windows and doors open well into the evening; brilliant blue sky. As we were maneuvering Mom into the car she noted, "What a beautiful day! You just can't beat these Iowa summers!"
I didn't bother to correct her. Iowa or Prescott, Arizona, it's true that, where ever we were, yesterday, the weather couldn't be beat.
Mom moved well and easily during the blood draw portion of our morning. We arrived at 1119 and were outta there by 1130. Saturday, it appears, is a great day to have blood drawn.
She wasn't interested in a nap until 1430, then arose around 1600 and remained up of her own accord until midnight. Her back bothered her a bit, which is typical of a day in which she walkers, especially if I haven't been able to get her moving for awhile, but she refused analgesics and her nap took care of the ache. For dinner I made the best tomato biscuit pie I've yet pulled out of the oven. She asked for a second "sliver" of a slice. "I don't really need it," she admitted, "but it just tastes so good!"
Additionally, I had occasion, yesterday afternoon, to review This Isn't Your Mother's Caregiving. I was nudged to take special note of the bullet that mentions that, typically, when one is caring for a demented Ancient One, gratitude from the care recipient, either during caregiving or once it's done, isn't one of the hallmarks of this type nurturing. When I wrote that, I wasn't postulating, I was writing from experience. Yesterday morning, though, during Mom's bathing, lost in our own thoughts while I was scrubbing, rubbing and lubricating her back, Mom said, "I'll bet there's no one in this city that has better care taken of them than me."
I laughed. "I'd bet on that one, too."
When she turned to face me, just before we began dressing her lower body, she continued, "Thank you. You don't know what this means to me."
I was astonished. "You're right," I said, "I usually don't. I guess I do now, though."
You just never know about demented awareness. Sometimes, despite all appearances to the contrary, it'll snap to and embrace you at the most unexpected moments.
Off to replenish supplies.
Later.
"I didn't sleep very well last night," she announced, even though she looked bright eyed to me. "I kept waking up."
"Were your dreams unsually vivid?" I asked.
"No, I don't remember dreaming."
"Aha!" I announced. "I'll bet you were remembering that I'd be getting you up earlier than usual today."
"Why in the world were you planning to do that!?!"
Not quite the dissolution of my theory, expressed in the immediately previous post. If her subconscious remembers the reason, that doesn't necessarily mean that an oblique trigger is going to shoot it into her conscious mind. "It's blood draw day, today."
"Oh," she acknowledged, unenthusiastically. "That's right."
"And Blood Draw Breakfast Day."
"Oh! That's Right!" Huge grin. "Sweet Rolls! That must be the reason!"
I grinned back, gleefully satisfied that at least one of my memory tricks works.
Although I'm far from a sun worshipper, I like spring, here (yes, despite the calendar it's already spring and, yes, I know, it's due to global warming). The sun has already retreated halfway out of our living room, which means I don't have to close the upper window blinds in order to see my computer screen. Don't have to wear sunglasses to read the Sunday newspaper. The sweltering not-even-spring-yet temperatures, this year, in the Phoenix metroplex (Tempe registered 100° yesterday) translated to 86 in downtown Prescott and the low 70's up here; sensuous breeze; all windows and doors open well into the evening; brilliant blue sky. As we were maneuvering Mom into the car she noted, "What a beautiful day! You just can't beat these Iowa summers!"
I didn't bother to correct her. Iowa or Prescott, Arizona, it's true that, where ever we were, yesterday, the weather couldn't be beat.
Mom moved well and easily during the blood draw portion of our morning. We arrived at 1119 and were outta there by 1130. Saturday, it appears, is a great day to have blood drawn.
She wasn't interested in a nap until 1430, then arose around 1600 and remained up of her own accord until midnight. Her back bothered her a bit, which is typical of a day in which she walkers, especially if I haven't been able to get her moving for awhile, but she refused analgesics and her nap took care of the ache. For dinner I made the best tomato biscuit pie I've yet pulled out of the oven. She asked for a second "sliver" of a slice. "I don't really need it," she admitted, "but it just tastes so good!"
Additionally, I had occasion, yesterday afternoon, to review This Isn't Your Mother's Caregiving. I was nudged to take special note of the bullet that mentions that, typically, when one is caring for a demented Ancient One, gratitude from the care recipient, either during caregiving or once it's done, isn't one of the hallmarks of this type nurturing. When I wrote that, I wasn't postulating, I was writing from experience. Yesterday morning, though, during Mom's bathing, lost in our own thoughts while I was scrubbing, rubbing and lubricating her back, Mom said, "I'll bet there's no one in this city that has better care taken of them than me."
I laughed. "I'd bet on that one, too."
When she turned to face me, just before we began dressing her lower body, she continued, "Thank you. You don't know what this means to me."
I was astonished. "You're right," I said, "I usually don't. I guess I do now, though."
You just never know about demented awareness. Sometimes, despite all appearances to the contrary, it'll snap to and embrace you at the most unexpected moments.
Off to replenish supplies.
Later.
