Archive | September 2015

Breaks My Heart Every Time

There’s a new resident at my mom’s care home. I’ll call her Jenny. The first couple of times I met her, she seemed so together – introduced herself, remembered on my next visit that I was Dorothy’s daughter and she’d met me before, asking my mom how it went at the doctor when we returned from an appointment – that I almost wondered why she needs to be in board and care. She walks with a walker, but (like my mom) seems to get around really well with it. I was happy that my mom would have someone at the house to chat with besides the caregivers, who are really kind and engaged but too busy to just sit and visit with her.

Then one time when I brought Mom home from an appointment, Jenny said to me “I know you! You live next door to Bert, don’t you?” I shook my head. No, sorry, you’re thinking of someone else. “But I know I’ve seen you there,” she insisted. “I know you!” I told her again, you’re thinking of someone else. I don’t know Bert. Mom spoke up then, saying, “This is my daughter. You’ve met her before.”

Jenny may get confused about who I am, but she always seems happy to see me when I come in. Whoever she thinks I am, I’m glad that person is someone she likes.

This afternoon when I brought Mom home from church, Jenny met us just inside the door. “Will you do me a favor?” she asked me. I was busy helping Mom, who had taken off her sunglasses and was asking for her regular glasses from her purse, so I didn’t respond. Jenny was saying something about someone she hadn’t seen in a long time. Maria, the head caregiver, held up a pill bottle and started talking to me about one of Mom’s medications that needs to be reordered.

Jenny was still talking to me, looking intently at me from a few yards away, but I hadn’t heard a word she’d said. She started to cry, loudly, like a small child. I looked helplessly from one caregiver to the other, hoping one of them would do something, but they were paying Jenny no mind. “I’m sorry to be a crybaby,” she was saying, sniffling. I felt horrible.

I kissed my mom goodbye, told Maria that I would request a refill of that medication, and headed for the door. Jenny was between me and the door. She stopped sniffling and looked at me with hopeful eyes. “Will you drive me to the party?” she asked me. “It’s not far from here, just over on Van Nuys.”

I put my hand on her shoulder and said, as gently as I could, “I’m so sorry that I can’t.”

Jenny began to cry again, almost wailing, “But I haven’t seen them for so long!” I patted her shoulder helplessly and then moved toward the door.

As the door was closing behind me, I was relieved to hear Maria saying “What’s the matter, Jenny?”

If my mom was crying like that, it would break my heart. But she’s my mom and maybe there would be something I could do to make it better. I never know how to respond when it’s another resident. And it breaks my heart just the same.

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What’s new on the medical front

After 24 hours in the hospital for observation and follow-up visits with a geriatrician, her cardiologist and (finally today) her neurologist, here’s the latest. The hospital cardiologist ruled out the need for a pacemaker. After reviewing the results of the heart monitor overnight, he concluded that her heart rhythm is not slow, just irregular. Both he and her regular cardiologist wanted to blame a medication called Sinemet that she takes to help with her gait and balance, because one of the side effects of Sinemet is a drop in blood pressure. That’s what they think caused her to faint in church that day – either a sudden drop in blood pressure or something called a vasovagal syncope, caused by straining on the toilet. Apparently that’s a common cause of fainting in the elderly. (File that under: Things I never wanted to know about getting old.)

She was discharged with no changes to her medication. At the cardiology follow-up, he suggested asking the neurologist about reducing the Sinemet dosage. But he didn’t seem particularly concerned about a single fainting episode and said it was fine for us to wait until the September appointment with the neurologist to review that.

The neurology appointment got postponed by two weeks because the Medicare Advantage HMO failed to authorize it in time (don’t even get me started on that), but we finally saw Dr. O today. She was impressed by Mom’s energy level, how well she’s walking (no shuffling, easily navigating corners with her walker) and the lack of tremors. Her one concern was that Mom’s blood pressure was high (170/60), in spite of all those blood pressure medications she’s on.

Dr. O didn’t give her one of the standard memory tests this time; instead, she just made conversation, asking her what she does all day. Mom replied that she lives in an elderly care home with some very nice people. Dr. O asked if there are activities, do they watch a lot of movies? Mom: “I entertain myself by doing puzzles and reading, mostly. There aren’t a lot of activities, but sometimes we all sit around the table and play… something.” She looked at me hopefully, expecting me to fill in the missing detail, but I’ve never been there when they were playing a game at the table. I asked if they still do exercises in the morning, and Mom said yes and demonstrated the type of seated exercises they do. Dr. O seemed satisfied with that, though I know she’d be happier if Mom didn’t spend 98% of her day sitting.

When asked how she’s been feeling, Mom replied that she’s doing great. I told Dr. O about the fainting episode and resulting hospital visit. When I raised the question about the Sinemet, Dr. O shook her head and told me that with Mom’s BP as high as it is, she doesn’t think it’s having a significant BP-reducing effect — certainly not enough to warrant removing a medication that has made such a positive difference in her mobility and energy level.

Dr. O is ordering a carotid artery ultrasound to check for narrowing or partial obstruction of the carotid arteries. This was not a comfortable thing for me to hear, since a blockage of the carotid often leads to heart attack or stroke, but I’m glad she’s getting tested for it. According to WebMD, one of the first indications is often a TIA, which I am pretty damn sure is what happened to her when she ended up in the hospital three years ago and we started down this road together. You’d think they’d have done this carotid artery ultrasound back then, but nothing about the slipshod medical care she got back in that small mountain town surprises me anymore. It’s getting checked out now and that’s what matters. For all my frustrations with the administrative aspects of her medical group, I am truly grateful for the great team of doctors she has now.

Next week, it’s the kidney specialist.