Tag Archive | aging

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.

Perspective

After a doctor’s appointment last week, Mom and I stopped at a CVS drugstore to pick up a few things. When she’s not feeling tired, she enjoys getting out and doing things – even if it’s just browsing a drugstore for ten minutes.

As I got out of the car, a middle-aged woman approached me, asking if I could spare any change. I brushed her off, saying “Not now but maybe when we come out.” She continued talking to me, explaining that she hates asking for money but she and her husband are both out of work and currently living in her mother-in-law’s garage – and when she saw me lifting the walker out of my trunk, she eagerly offered to help. “I’ve got it,” I said, “but thank you.” The woman explained that she wants to work and would be happy to do anything – wash windows, clean houses, walk dogs, yard work.

I wasn’t sure how Mom would react to her, having spent most of her life in smaller communities where this sort of situation is uncommon. I can still vividly recall her reaction to an older woman sitting in a motorized wheelchair by the side of a freeway off ramp a few months ago. “Why would they just leave her there?” she burst out. “That’s a terrible place to leave someone!” I quickly explained that I thought the woman had probably chosen to sit there to ask for money, though glancing in the rearview mirror I didn’t see her holding a sign… and she wasn’t close enough to the road to take money being handed from a car window without getting out of the chair…

Anyway, we went in to the drugstore and I picked up the few things we needed and let Mom buy a bottle of Tums that she didn’t need because they were on sale. We picked out some cookies for her to take home, too, since we’re still trying to keep her from losing any more weight. I rang up our purchases with my debit card and got $10 cash back.

As we left the store, I discreetly passed the ten to the woman who had asked for help. She glanced at the bill in her hand and burst out “Oh, thank you so much! I could hug you!” – adding quickly “But I won’t. I know most people don’t want to be touched by strangers.”

“You can hug me,” Mom said immediately, turning with a smile.

I nodded and smiled my assent. “She’s a hugger.”

The woman hugged my mom gingerly around the shoulders, as if she might break. And she kept smiling and waving to us as we pulled out of the parking lot.

I drove away thinking how very fortunate Mom and I both are, despite the increased burdens of her care costs over the last year. I’ve been frustrated lately with all the costs for my own health care and Mom’s medications and incidentals (Ensure, incontinence products, haircuts, etc.) that just keep adding to my credit card debt because there’s not sufficient monthly income to cover it all. But I have a job and I have credit cards, and neither of us needs to go without. And Mom’s monthly income is enough to cover her base level of care at a wonderful home, where she is happy and engaged. And that, to me, is priceless.

Girls of All Ages Have Drama

I read a great article (Mean Girls in the Retirement Home)  recently, and it got me thinking…

I didn’t witness out-and-out bullying at the two assisted living communities where my mom lived, but I definitely saw that there was a pecking order, with those who were still mentally sharp shunning those who were cognitively compromised. I used to worry about Mom being mistreated as her dementia advanced. So, first off, I’m thankful that we got her out of that dynamic and that she now lives in a homelike environment too small for cliques.

But I had noticed the last couple of times I visited that they’d moved the chairs in the TV room, separating Mom from her chatterbox friend Georgia… and that Miss Chatterbox (or, as Mom calls her, Miss Know-It-All) seemed quiet and sullen. The article got me to wondering if there had been some kind of Mean Girl drama. So when I took Mom to get her nails done yesterday, I asked her about it.

“Well,” she said. “I heard her talking about me and I didn’t like the way she described me, and I told her so.” The offending piece of description was something like “she does her own thing and doesn’t care about anybody else,” and Mom said “If that’s what she thinks of me, I don’t see how I can be friends with her.”

No one who knew my mom pre-dementia would ever describe her as someone who doesn’t care about others. She’s always been one of the kindest, most giving, most nurturing people I have ever known. So I can understand how being described in that way would sting. But I can also understand why Georgia, who appears to constantly need someone to listen to her and validate her, might be hurt if Mom started tuning her out so that she could focus on her crossword puzzles. Aside from the staff, my mom is the only person there capable of making intelligent conversation… so I suspect Georgia might be sorry she’s burned that bridge.

We never do outgrow the drama, do we? LOL Well, hopefully it will soon be water under the bridge.

So Thankful!

After doing the grocery shopping for Thanksgiving dinner, I stopped by the care home to see Mom for a few minutes. I gave back her watch, which I’ve had for over a month now because I kept forgetting to take it in to get the battery replaced, and she was very happy to have it back. Holding her hand, I noticed how long her fingernails are and that there was dirt under a couple of them. As I was leaving, I mentioned this to the head caregiver, who said she will clip and file Mom’s nails tomorrow.

After kissing Mom goodbye and telling her I’ll see her tomorrow for church, I went out the front door… and I literally skipped to my car, like a little kid.

Can I tell you how awesome it is to leave Mom’s place feeling like SKIPPING?! I nearly always left her last place feeling like crying.

Thursday she had a follow-up with the kidney specialist, and the owner of the care home brought her to the appointment. I met them at the doctor’s office, and it was so encouraging to see Mom smiling and joking with the owner and the caregiver who had accompanied them. The doctor ordered some more labs, and the caregivers volunteered to take her down the street to the lab to get it done right then, so that I could go back to work. When we said goodbye, I hugged and kissed Mom and told her I would see her Sunday. She was perfectly happy to go with the caregivers, who she always refers to as “my friends” because she can’t remember their names. She may not know their names, but they have become her family. And they are fast becoming my family as well.

As Thanksgiving approaches, I am thankful for many things. I am thankful that Mom is healthy enough and strong enough to climb the stairs into my apartment building to share the holiday with me. I am thankful she lives in a home that is truly a HOME, not an institutional setting. I am thankful for family — both the family we were born into and the family we have found, or who found us.

Relief

Yesterday was my first day back at work after moving my mom. I called her in the afternoon to see how she was doing. I asked if she was having a good day. “Oh yes!” she replied. “I mean, we’re just sitting around watching TV, but it’s with a group of friends.”

I stopped by after dinner to visit. She was watching TV with the group and showed me that she had received a card from a friend and a letter from her cousin in Michigan. I told her that I was having her newspapers forwarded, so she should have some new papers to read soon too.

“I’m going to be here for a while, aren’t I?” she asked.

“Yes,” I said. “But you like it here, right?”

“Yes, I do.” After a thoughtful pause, she added, “It’s better than living alone, actually.”

This is exactly what I’d hoped for, that she would prefer the company of a group home to being alone in her room all day. Before I left, we talked a little more about the nice home she lives in now. “What makes this place special,” she said, “is their attitude. It’s a very caring place.” I couldn’t agree more.

I feel such a profound sense of relief, knowing that she is not only safe but also happy in her new home. The weight of worry that has been grinding me down for months has been lifted, and I feel so lighthearted I could almost fly.

Losing My Cool

Despite my best intentions about being the “voice of calm” for my mom right now, I lost my cool yesterday. I arrived to take her to a doctor’s appointment, found her room warm and stuffy (the portable AC not working properly), and couldn’t figure out how to get her switched from the oxygen generator to the portable oxygen tank. And I melted down, right there in front of her. I panicked. I raised my voice. I was the exact opposite of calm.

I rang her call button and got a caregiver to come help me with the oxygen, and then I pulled it together. But navigating a wheelchair and a portable oxygen tank on a little wheeled stand is a skill that will take me some time to master, and the whole trip to the doctor was difficult and stressful. After my little freakout, I held it together – but I wasn’t the calm, soothing presence that I always try to be (and usually am) with her.

We stopped at Foster’s Freeze on the way home from the doctor and I bribed her to eat with a caramel milkshake, which I think was the first food she’s taken more than two or three bites of all week. (At this point, I don’t even care about healthy food. I just want her to eat something. Anything.)

I’m worried that she’s still so weak and her oxygen levels are still so low. I’m afraid that when we get a new blood culture done next week it’s going to tell us there’s still infection. But there’s nothing I can do about it right now except keep a close eye on her. As a result of this worry, when the home care agency told me that the home health nurse who evaluated her on Tuesday had determined there was “no further need” for nursing care, I lost my cool again and almost shouted at her: Are you freaking kidding me?!

Deep breaths.

A New Diagnosis

Mom finally saw the neurologist today. When I told her about the appointment last night, she asked “What’s the purpose for seeing this new doctor?” I didn’t want to talk about dementia, so I said the first thing that came to mind – that her regular doctor was concerned about her balance issues, as evidenced by the recent falls, and had referred her to a neurologist. I hoped I wouldn’t look like a liar when her falls weren’t the focus of the doctor visit, but I figured she probably wouldn’t remember by then anyway.

It was a long appointment for an office visit, but Mom was a trooper. First the nurse gave her one of those mini memory tests, where they ask basic questions like “what day of the week is it?” and “what year is it?” and “do you know what state you are in?” and then ask you to write a sentence and draw a diagram. She ACED that test in December, getting only one question wrong. I was slightly concerned that if she did too well on it this time, they would dismiss my concerns about her dementia. I needn’t have worried. She flunked this one good and proper. She thought she was in Arizona but couldn’t name the city, had no idea what day of the week or year it was, but was fairly confident that today was sometime in November. For the writing sample, the nurse told her to write a sentence – any sentence you want. I jokingly asked if anyone had ever written “This test is stupid” as their sentence. The nurse chuckled and said no, not that she could recall. When she collected the test paper from my mom, the nurse read her sentence out loud: “This is fun.”

Then a young man whose name tag identified him as Sam, a medical student from USC, came in and asked Mom several of the same questions. This time she answered that the month “must be July” and gave the year as 2018. Interestingly, though, she knew that it was winter – less than a minute after saying that it must be July. Both of those are understandable, I think, considering that this is her first Southern California winter and it was 80 degrees today. But where the hell did 2018 come from? Sam the med student also did some tests of reflexes and muscle strength (“You’re strong!” he told her with a grin), asked me a bunch of questions about her medical history, and had her walk across the exam room and back without her walker, noting her shuffling gait. I liked Sam. He was friendly and kind, listened attentively, and had taken time to read the notes I’d faxed over the day before documenting her symptoms and their progression over the last year.

Finally, Dr. O, the neurologist, came in. She started off with some of the same basic questions. Mom again gave the year as 2018, thought she was in a hospital (not a doctor’s office), but this time she correctly identified the current month as February. Dr. O asked her “What kind of doctor do you think I am? Am I a heart doctor? A foot doctor? Or what kind?” Mom looked thoughtful and answered “I don’t know, but I know I don’t need a heart doctor.” I think I saw Sam the med student smile at that, and it was all I could do not to laugh, considering that we’d just had a five-minute discussion about her heart conditions and medications.

And here’s the irony: her falls and balance issues did turn out to be one of the focuses of the visit. After observing her shuffling walk and the slight tremors of her hands (which is a brand new symptom I’ve only noticed in the last couple of weeks) and hearing about her falls, the doctor’s preliminary diagnosis (pending CT scan) was age-related Parkinsonism. My mom’s younger brother, my uncle Tom, had Parkinson’s Disease. Dominic at her assisted living community also has it. Parkinsonism, Dr. O explained to me, is not the same thing as Parkinson’s Disease but it has some of the same symptoms including gait and balance issues, postural instability and tremors. Memory loss and disorientation can accompany it, but Dr. O said those symptoms usually show up much later than the physical symptoms. Since Mom’s memory issues started at least a couple years before we noticed any of the Parkinsonism symptoms, she suspects there is another neurological disease (she turned away from Mom and mouthed “dementia” to me) at work here. I guess the CT scan will help identify what kind of dementia. The “A” word (Alzheimer’s) was never mentioned.

We left with orders for blood work and a CT scan and two prescriptions – something commonly prescribed for Parkinson’s patients to help the balance issues and Namenda, commonly prescribed to Alzheimer’s patients for memory loss. Dr. O wants to see her again in two months, which seems to me a long time to wait to go over the results of the CT scan and blood work. But I’m hoping, between the new meds and the physical therapy that is supposed to start this week, that we’ll be able to report some improvement in her mobility by then.

As a reward for being such a good sport about the 90-minute doctor visit, I took Mom out to dinner and we shared some warm apple pie a la mode for dessert.