Friday, May 5, 2017

Three Ring Circus - I mean Clinic

I had Dad into Innovage this morning and talked with their doctor for a long time this evening. I am more and more impressed with their doctor.
Here’s what she said –
Dad’s heart is working at 49% – borderline, but at his age, anything above 50% is considered normal. His valves are a little sticky, but not that bad considering his age and that he recently had a mild heart attack. Heart beats are regular, also unusual considering his recent heart attack. So, all in all, he’s doing very well. He’s supposed to walk more – without fatiguing. Going down to the dining room should be about right. 
Regarding his cognitive/memory scores – they dipped a lot from November to February. Not a surprise. Mostly he’s having those little memory issues like, “what doctor are we seeing today?”

Recap of our morning –
Dad – “Do I look okay without teeth?”
Me – “Yes, Dad”

Dad got his teeth back, after some confusion and not a little frustration mixed with humor. I have to find the humor here.
They have a dentist filling in at Innovage. He usually works in Loveland and is only filling in till they get a new dentist in Denver.
They got out Dad’s dentures, back from the lab, and tried to fit them in Dad’s mouth. Not a good fit at all. Looked closely at the dentures and saw there was a different name on them. So we all assumed the lab had mixed up his teeth with someone else’s. Many calls to the lab…

Dad – “Do I look okay without teeth?”
Me – “You look great, Dad!”

Meanwhile, Dad and I went to therapy – PT checked Dad’s walking. He now has a new, upgraded, heavy duty rollator walker. He walked well and the pulse-ox test afterward showed his oxygen levels were still good. OT came to tell him she would see him at their apartment soon.

Went to clinic. Got Dad’s ears cleaned out. No more wax. He’ll see the audiologist a week from tomorrow (12th). Might provide new hearing aids or new mold for the newer hearing aid.

Dad has an appt with the cardiologist next Tuesday morning. Same cardiologist he saw at Lutheran, so we’ll go to his office on 19th and Ogden.

Back to teeth…
Dad – “Do I look okay without teeth?”
Me – “Dad, you look adorable”

Lab has precautions for the possibility of getting teeth mixed up. In this case, it seems only the names were mixed up. Those WERE his teeth. Didn’t look right to me. Dad’s still got a significant overbite. Seems the folks in the dental office (who have only seen Dad twice) took Dad seriously when he said, his teeth were fine – they fit fine – they were just the way he wanted them… (Dad’s way of saying don’t mess with me). So, they had the teeth adjusted WITH THE OVERBITE. And then kept telling me that’s the way his teeth have always been and that’s the way he said he wanted them.

By this time it was 11:30. I was on the verge of a migraine and I knew I needed to pick up Mattheus from school. I didn’t deal with it. But I told Dr. Kane and she will have the dentist schedule person call me. I am going to ask for new dentures for Dad. Completely new. He can wear the overbite till the new ones come in. He’s just so happy to have his teeth back, he doesn’t care about anything else. He may even balk at getting new ones – means taking impressions. But the dentist showed me how the teeth are getting very worn down on the ones he has.  That plus the overbite fiasco, I’m going to insist on new ones.

Got back to the apartment around noon. Mom was unhappy. I ran out of the apartment. Okay, only because I needed to use the bathroom and Dad had run into theirs. When I came back, I asked Mom what was up. She said she had fallen night before last. Scooted on her butt to their bed. Told several girls what happened, they all said they’d tell the nurse to come down and check on her. No one came. Nurse (LPN) was in for a moment yesterday, didn’t look at her knee, but told her to keep it elevated as much as she can. Maybe that would help. I asked at the desk for someone to come down and look at Mom’s knee. Don’t know if it’s happened yet. I reported this to their doctor and she said she’d send a note to St. E’s asking for Mom to be evaluated after the fall and ask them to report if Mom has continued or worsening pain/swelling, etc. I’ll check in with St. E’s tomorrow and see if someone has actually checked on Mom. I will also check to see if they are walking to meals again. And remind them to CALL ME WHEN EITHER OF THEM HAVE A FALL. Technically, they are supposed to report ALL falls to their doctor, too.

Hoping tomorrow is quiet.

Tuesday, May 2, 2017

Toothy Grins

by Goldie

We’re on to more mundane sorts of issues, now that Dad is recovering from his heart attack. The current complication involves dentures.
The Monday before Easter, both my parents went to the dentist to have their dentures adjusted. They weren’t fitting exactly right. Both of them needed their dentures relined. I don’t know what that involves, but their teeth had to go on to a lab and spend a few days getting this done. Mom and Dad were not thrilled to go home without teeth, but they resigned themselves to it because they wanted to be more comfortable. They got their teeth back on Thursday. The next day, we started Dad’s heart attack adventure.
Within 15 minutes after Dad got home from the hospital, Mom was complaining about her dentures. They (the lab) had obviously done something wrong because her dentures didn’t fit. She needed to go back to the dentist. Even so, she had little faith the dentist would ever get it right. My brother checked with the clinic and was told I would receive a phone call about an appointment. I tried to reassure my brother that it takes a little time to get used to dentures after a reline (I think) and Mom complains each time the dentist does anything with her dentures (I know). It wouldn’t matter how many times they were adjusted, Mom would be complaining by the following afternoon (she does).
The clinic scheduled their dentist visit for April 27, exactly two weeks after they had gotten their teeth back from the lab. The appointment was for both of them, which surprised me as Mom was the only one complaining. I didn’t argue because, well, the thing is, Dad seemed to be developing an overbite. In fact, the overbite was getting worse by the day. Dad didn’t complain, in fact, he said his teeth felt fine and he didn’t need to go in. Mom disagreed. Even with her poor vision, she could see Dad was turning into Bugs Bunny.
In the office, the dentist was confused. How could their dentures not fit so soon after she had adjusted them? A close look at them and the dentist shook her head. She told my dad, “You’ve been using too much Fixodent.” Dad looked at her blankly. The dentist sighed, took a deep breath and yelled, “YOU’VE BEEN USING TOO MUCH FIXODENT!”
“Really?” my Dad replied.
I know how much Fixodent they use. A lot. They keep a tube or two with them all the time. They put more in before meals. The dentist commented about how they must spend $10 per month on it. No, doc. They spend more like $25 per month on their Fix.
It seems Dad’s dentures had such a build-up of dental adhesive, it was pushing the dentures about 3/4 of an inch away from his gums on top. He had not remembered to clean out the old stuff, either, and so it had turned into a cement like substance which was almost impossible to remove. They put Dad’s teeth into the ultrasound cleaner in order to get the gunk off of them. The cement also took off the relining. The teeth would need to go back to the lab, this time to spend an entire week being put right.
Dad was not pleased. “But they feel fine!”
Fortunately, Mom’s dentures were not as bad. She had also been overusing the Fixodent, but not to the same degree. It had thrown off how they fit, which I now know to be the reason she has always complained so soon after they are readjusted. Dentures that fit well do not need any adhesive.
Dad went home without his teeth. We made sure to tell him how cute he looked. He laughed, but didn’t buy it. He won’t venture out of the apartment until he has his teeth back. I will make a trip up there to take out all tubes of Fixodent and Polygrip. Dad’s memory issues combined with habit would mean getting the dentures relined monthly, if we weren’t careful.

Sunday, April 30, 2017

The Tough Guy Back at Home

April 21, 2017
by Goldie

Dad wasn’t the only one who was shocked to find out he had a heart attack. Despite being 92 years old, none of us would have automatically thought, “what about his heart?” This is the first time he’s ever had any heart issues. It wasn’t chest pains that had us packing him off to the emergency room, it was constipation. He was severely constipated and in a great deal of pain because of it. Hospital docs are pretty smart and they tested for the heart enzyme, troponin, and the elevated level showed he had some damage from a very recent heart attack. Seems he has one artery almost completely blocked and, even the exertion of going to the toilet and trying to go was enough to stress his heart.
He didn’t think he needed to go to the hospital. Said the pain would go away in a few minutes.  This had us fooled the day before, but the pain waves were coming back within minutes on the morning we decided he needed to be seen. Jokingly, we told him he now knew what it was like to be in labor. The pain was intense cramping which he felt in his lower abdomen and back, down by his tailbone. What was embarrassing for me was I had been with him the day before and I missed how serious this was. So, backing up a bit, it was Wednesday evening when Mom called and said they were supposed to go to the clinic in the morning and the bus was supposed to pick them up, but she didn’t think Dad should ride the bus. His tailbone was hurting him too much. I reluctantly agreed to drive them to the clinic.
Reluctantly? Yes. They do not like riding on the bus provided by the clinic. Mom still calls before nearly every appointment to see if she can find a way to have me drive them. I balked. I didn’t want them to become dependent on me to drive them all the time, but I agreed to do it this time. The next morning, I panicked. I’m caring for puppies again and I couldn’t just leave them for hours without a sitter. Neither my husband, nor my daughter would be home that day.  Clinic appts mean lots of waiting; it’s usually a full morning. Desperate, I put the tiny three-week-old pups in a large bag, along with a bottle of formula, a pee pad, and a towel to cushion their makeshift bed, and hoped they would stay quiet. I wasn’t sure whether they’d be welcome, but hey, I was only the transportation. I could wait outside.
What happened that morning could have been made into a slapstick comedy. I wanted to be discreet about wee pups. Dad told everyone he saw. We had groups of people stopping to peek at the pups. The dentist insisted on holding one. Tiny pup peed all over her. Official looking woman came over to tell me I couldn’t have pups in the clinic. Dentist said, no problem, she’s just leaving. While I waited outside, various staff persons ventured out with clients who wanted to see the puppies. The dentist came out and offered to sit with them if I needed to go back in. By the time Mom and Dad had both seen the dentist and Dad had seen the audiologist, they were ready to go home. Somewhere in there, I assumed the check-in with the triage nurse happened, but it didn’t. So, yeah, I felt guilty about being distracted and distracting others. Fatigue plus stress does not bode well for decision making. On the other hand, the pups also distracted Dad from his pain.
That evening, both my brothers came into town. On Friday morning, one brother called to say they were taking Dad to the emergency room. As soon as I arrived at the apartment, I saw Dad was in much more distress than he had been the previous day. There was no doubt now. I will say, the staff at the facility missed it, too. They do not have an RN on staff at the moment, and haven’t had one for the last six months. This is at a facility which does not have a skilled nursing unit.
At the hospital we found out just how dangerous it can be for elderly folks to get severely constipated. Dad was dehydrated. The stool was hard and impacted. What to do first? Get heart stabilized, then clean him out, which meant leaving him with his painful cramps. Getting his heart stabilized meant being on blood thinners. Getting the stool cleaned out meant going off the blood thinners because of the risk of excessive bleeding from his rectum. Eventually both were accomplished and Dad was approved to go back home to his assisted living apartment the next day. One of Dad’s arteries is mostly blocked, but other than medication, they won’t do anything about it. He’s 92. No cardiac diet, either. The person in charge of educating us about this came and gave her spiel, but the cardiac doc said, no, let him eat what he wants. That was good because that’s what will happen anyway.
We found out something very interesting. Occasionally, in older people, when there’s a blockage like Dad’s, the heart will find some way of rerouting the blood flow. Doesn’t happen all the time and we can’t count on it, but knowing Dad, if it’s possible, his is that kind of heart.

One Pretty Tough Guy

April 15, 2017
by Goldie

Home from Lutheran Hospital where my dad, Jim Myers, age 92, is still enjoying the hospitality of the cardiac ICU. The paramedic’s name was Jimmy and his nurse in the emergency department was Jim. When Jimmy asked Dad what his pain level was, he said (between grimaces) about one half. One half? Did he mean 5? or .5? Either way, his description didn’t match the look on his face. Jimmy said Dad was one tough guy.
While checking out the problem we brought him in for, they discovered he was having a heart attack. Dad was astounded! About every 10 minutes, he would look at one of us and say, “They said I had a heart attack! I didn’t know I had a heart attack!” I told him he must be a pretty tough guy to have a heart attack and keep going. He was doing much better this evening, propped up in bed, drinking Pepsi, and joking with the nurses. He said he felt fine. When he says he’s peachy keen, I’ll know he’s almost ready to come home.
More later. This caregiver is going to bed.

Friday, January 6, 2017

Almost a Crisis


Years ago, when I was teaching kindergarten, I had an almost crisis. I was so sure it was a real crisis, I went into panic mode. The situation was this: every week we baked bread. When it was ready to be baked, we took it into another room and put it in the shared oven. Each class had it’s assigned day for baking. This particular day, I got distracted and forgot about the bread. After school, I was in a hurry to leave and take our son to his Irish dance lesson. While there, I remembered the bread. It was 4 p.m. and the bread had been in the oven since 11 a.m. This being in the days before cell phones, I was only able to leave a message on a pager via pay phone. I had no way of knowing whether or not the message had been received or whether the oven had caught fire and the entire school was engulfed in flames. After the dance class was over, I drove back to the school and parked in front of the building.
Suddenly, the sound of sirens surrounded me (say that five times fast!) and three emergency vehicles pulled up in back, in front, and alongside of me. I was blocked in by the large fire engine. Now I was SURE I had burned down the school. Funny, though, I didn’t see any smoke or flames. I know that now, but at the time it didn’t really register enough to help me calm down. When they left soon after, I went in and learned there had been a false alarm. The timing of it was magnificent! The payment for my negligence was so wonderfully karmic, I didn’t stress about it afterward. And the bread? The aftercare staff had gotten my message, turned off the oven and took out the bread, which was cooked to hockey puck perfection.
Same sort of thing happened this week.
The last time my dad had his hearing aids checked, we were told he had a lot of wax build up in his ears. Now, I’m the ear cleaning champion of the family. I learned how to correctly irrigate ears a long time ago and have provided my services to my kids, husband, and dad for years. No problem. I went over on Wednesday and got everything set up. The water was just warm enough, just enough peroxide, and a clean bulb syringe. I was going to be gentle, Dad is 92 after all. First two squirts, everything was fine. On the third try, Dad suddenly yelled out in pain. I took everything away and dried his ear as best I good. After a minute or so, Dad said it didn’t hurt anymore and he was fine. I should have known better. He also said he could hear so much better, he didn’t need to wear his hearing aid. Considering he was speaking much louder than he needed to, I should have been very suspicious.
I called that evening and talked with him. He said he was fine, his ear didn’t hurt at all and he could hear much better. Talked with Mom. She said he had taken out his hearing aid because there was some blood on it.
Panic button pressed.
I got back to Dad and asked him about the bleeding. He said it bled a little, but was okay now. I was not to worry. (right)
I didn’t sleep well. Amazing how our brains can be so imaginative at 4 am, isn’t it? Half asleep, I was picturing a perforated ear drum getting infected immediately and going right into his brain and me being accused of neglect or worse and possibly being hauled off by the police and meanwhile Dad is dying of an infected brain because of an infected ear because of a perforated eardrum because I had tried to clean the wax out of his ear and I had probably killed him. And all the while, Dad saying, “It’s okay, I’m fine, and I can hear SO MUCH BETTER” and laughing.
At 6 am, I finally got up, stressed around the house, decided I would call Dad after breakfast. No news is good news and he was obviously okay.
Then the phone rang. It was the nurse at the facility.
“Do you know what is going on with your dad’s left ear?” she exclaimed in a panic more suited to me than to a professional medical person. I admitted my guilt and told her what had happened. By then I had already emailed his doctor and asked if there was anything I should do or be worried about. The nurse went on to say Dad had blood and other stuff coming out of his ear. I said it was probably ear wax. She said, no, it wasn’t wax, it looked like flesh. FLESH?
Okay, now the alarm is going off in my head along with the red lights flashing. I’ve killed my dad. My mind still functioned enough to suggest that the nurse call the doctor’s office because they are more likely to get him in quickly if she calls. She made an appointment for him to be seen for trauma — TRAUMA. I killed my dad and I’m going to be hauled off, I know it. We got a 2 p.m. appointment on the coldest snowiest day of the year so far. Temps in the single digits, schools closed, streets icy. I left my house at noon to go pick him up. Got there and went to the dining room where they were happily eating lunch. Dad didn’t look like he was in distress, in fact he argued with me and said he really didn’t need to go in. He was fine. Right. Got him bundled up, into the heated car, and we slowly made our way across town to the doc’s office.
No perforated eardrum. What he had was “swimmer’s ear”, not something I would have thought of considering the amount of swimming he does not do. The gunk in his ear was ear wax combined with debris and it had hardened and had adhered to the skin in his ear canal. And it was infected. So, when I tried to irrigate it, it loosened like a scab being pried up. That’s what caused the pain. So, in a way, irrigating his ear helped to discover the infection. Dad has some ear drops to help it heal and has to keep it protected while he showers, but he’ll be fine. I went from panic to relief in seconds.
This ended up being something very minor, but it illustrates something we caregivers have to deal with a lot.  A lot of caregivers are having to give medicine through IV ports, deal with issues surrounding ostomy bags, gastric tube feeding, catheters, oxygen, and pressure sores. Even getting Dad in and out of the car can be worrisome. What if I do something wrong and hurt him?
Mom told me Dad still isn’t hearing well, “He can’t hear at all!” She said and went on to say he had taken his hearing aid out. I explained (tried) that Dad’s ear needed to heal and, of course he wouldn’t hear anything without his hearing aid in. I suggested a notebook and pen. Dad can see and read just fine. I also found out something else, which may explain some of the issues he’s had with hearing aids. When the batteries die, he was putting them back in the case where he keeps his hearing aids. When he would run out of new batteries, he’d simply try one of the old ones.
He’s been running on dead batteries for weeks now.

Adding on to this a couple days later.. I did some research and found that hearing aids can cause infections in the ear canal if they are not cleaned well and if the ear is not kept very clean and dry. Now, to go to the hearing clinic with Dad on Tuesday and find out what we are to do.

Thursday, May 19, 2016

Finding what is real

by Goldie

Over the last seven years, my parents have lost a lot in their lives. They’ve had to give up their house, their cars, their neighbors (though not many of the old ones were left), their routines, their mountains of stuff, and their independence. Dad is losing his hearing, Mom is slowly losing her eyesight in one eye. For Dad, the most difficult loss was the ability to go off to the grocery store, the bank, or the hardware store. For Mom, the most difficult loss was her stuff, the clothes, knickknacks, and furniture that overfilled the house for so many years.
They have been sad, angry, depressed, and ultimately, resigned. They reminded me constantly they wanted to go home.
What they have gained is starting to be apparent, too. Dad has the ability to rest now, something he could only do at home when I came over. He looks relaxed instead of tense and on edge all the time. Though they both complain about the food at the facility, Dad doesn’t have to cook anymore.
They’ve gained doctors who understand elder care. Their current doctor with Kaiser has taken Mom almost completely off the benzodiazapenes, substituting a much safer drug for anxiety in its place. Though she complains about her anxiety, she seems happier than she has in decades. She is more aware of the people around her and a little less focused on herself.
They’ve gained a community. There are activities and a shared dining room. The dining room is where they make friends and we are learning that Mom is very good at making friends. Dad says she often stays behind after lunch to chat with the other women. She urges Dad to make friends with the other men, but I don’t think he has the same need to be social at this point. Throughout his life, Dad has always enjoyed people. He loves to joke and tease, and he’s one of the most generous people I’ve ever known. He still loves to joke with the aides and off them a treat from his stash of candy and cookies.
The other day, Mom told me about a woman who had not been living there very long. She had moved in with her sister, but within weeks, her sister had become ill and passed away. Mom felt badly for this woman and said she was trying to sit with her when she could and let her talk.
Wow. I couldn’t have imagined this seven years ago. During these years, I’ve often felt guilty about my part in all they have lost. I’ve had to be the enforcer. No, you can’t take three couches to the apartment. No, I’m not buying cold medicine for you to keep in your apartment. That’s not allowed. Sorry, but no, I’m not taking you to the storage unit to pick up all your stuff.
Now I wonder.. could it be that in giving up all these things that were so important to them, they have found a new freedom? Maybe what we are seeing now is who they really are — without all the stuff (though there’s plenty of stuff still there), without the drugs, without all the familiar routine.
Now when they talk about going home, they mean their apartment.

Care Jam

by Goldie

All the paths converged yesterday, bringing all my caregiving tasks together in one needy and very untidy household.
5:30 am – got up. Emma had had the night shift with the puppies. My “mom” radar had been overactive all night and I finally decided to get up and help with the early morning feeding, already in progress. Puppies have been constipated from the formula so we had tried adding corn syrup and olive oil, then some goat’s milk. Fingers crossed.
6:30 am – Cleaned all the feeding syringes and nipples.
7:00 am – Chris got up. The grandkids are due to arrive at 9:00 or 9:30. It’s our usual Friday.
7:45 am – Another feeding already? Three hours goes by quickly. Rubbing tummies to stimulate them to pee and poop.
8:00 am – Grandkids are here.  Early. Their mom was sick all night, so our son got them all up, fed, dressed, and dropped them off on his way to school. There had been no time to call with the change of plans.
8:00 am – Grandma came out of the puppy room with a loud yip, “HE’S POOPING!”
8:00 am – Our son and grandkids gave me one of those “oh, Grandma” looks.
8:10 am – Son left. Grandkids started fighting. A hard morning for their parents had made them grumpy. Great Grampa (my dad) called and said, “I think Mom would like to get out shopping today”, which meant, “She driving me nuts. Please take her away for awhile.” I gave my excuses to my dad. Then whispered loudly to Chris, “We need a baking project!” He agreed to read a story while I figured out what we were going to do.
8:20 am – Chris was on the couch reading to Opal and Lucien. The oldest, Mattheus, was in with Emma and the puppies. I peeked in to see Mattheus lying on the futon with a puppy curled up next to him. His smile was pure magic.
9:30 am – Kids were fighting again. I told them we were going outside for a walk. Shoes on, we went down to the park near the Senior Center and played on exercise equipment meant for seniors. We ate our snack and I sent a text message to Chris with a grocery list: chocolate, cooking oil, whiskey. He texted back, yep!
11:00 am – We came back home and made the dough for doughnuts. Lucien stirred and told us how he was going to have his own restaurant when he’s older and the sign on it would say BACON. After all this, they played quietly together while I cleaned up and prepared their lunch. Opal said, “I’m three. Now I can have bacon.”
11:30 am – Ate lunch
12:30 pm – The nurse at Mom and Dad’s facility called to ask where Dad’s painkillers were. She had reminded me to bring them and they were all out. I sent Chris.
12:30 pm – Kids resting. Opal was in the puppy room and I was feeding a puppy. She fell asleep while she watched. I finished feeding the pups and washed their feeding stuff. Took an hour.
1:30 pm – Six year olds don’t take naps. Mattheus helped roll out the doughnut dough and cut doughnuts. I don’t have a doughnut cutter, so they came out kind of funny looking. Finished at 2:30 then Mattheus drew pictures in the flour on the table.
3:15 pm – Kids up from rests, ate donuts, and asked Grandpa to read them a story. Emma did the puppy feeding.
3:40 pm – Kids started fighting again. Grandpa gave me a look that said clearly, Do something now before WWIII starts in our living room.
On with the coats and shoes and outside in time to see Mama drive up. She brought us flowers.
5:30 pm – Pot pies for dinner.
6:30 pm – Feed puppies
7:00 pm – Decide not to run errands tonight.
It was snowing. Still is on Saturday evening and it’s not supposed to let up until sometime tomorrow afternoon. Springtime in Colorado.
Despite the extra work, I was grateful for those wee puppies. They were there when one of the kids needed some unconditional licking and loving.
I’m on night duty again tonight.