Saturday, July 17, 2004
My careful attack on Mom's blood sugar meds...
...has gone to hell since Thursday's introduction of Cipro XL. Today is her last dose and I'm hoping I'll be able to continue working to control her blood sugar on fewer meds after tomorrow. I did my typical research and found warnings all over the place that type 2 diabetics on oral medication "may experience changes in blood sugar" when taking antibiotics, steriodal preparations and some other things. The most common change reported is low blood sugar, but my mother's etiology is that when she takes powerful antibiotics her blood sugar rises, and this is what it's been doing. Yesterday I gave in and administered metformin to counteract her high notes.
The Cipro seems to be doing the job very quickly. I'm pleased about this. She is having pronounced swings between high and low energy which affected our plans, yesterday. At one point she was adamant about accompanying me to the grocery. By the time we did her hair (the full meal deal) and dressed her, her energy had bottomed out. She didn't want to take a nap, which surprised me, but she didn't want to go to the store either. I decided not to badger her. I can tell, from her blood pressure readings, that her body is vigorously fighting her urinary tract infection. She elected to watch The Lion King while I shopped. I expected to find her laid out on the couch when I returned but she was up and glued to the set.
Throughout the day she'd consider napping then a quarter to a half hour later she'd decide she wasn't tired. Finally, around 1800 she headed in for a nap before dinner, telling me she was "bushed" and to be sure and awaken her at 2000, as she didn't expect she'd be able to abort the nap on her own. About an hour after retiring she was back in the living room under her own steam wanting to help me pick through raspberries for a sauce I'm making today.
Regarding how she contracted E. coli: I've given this some thought. My best guess is that it's from the mini-accidents she was having for a couple of weeks after beginning the mega-iron regimen. The maxi-accidents are easy to detect and clean up immediately, but she had two episodes of expelling small turds that neither she nor I detected until she went to the bathroom to urinate and I checked her underwear before changing it out, as I always do. After two of those happened I initiated a regimen (which she didn't appreciate, although she went along with it) of checking her underwear every hour or so to make sure nothing went undetected. As well, although I am meticulous when I clean her, paying minute attention to her uro-genital-anal area, whether it be when we're bathing her or cleaning up after an accident, it's entirely possible that I missed a spec here and there which could have traveled into her urinary tract. Her wiping habits after a non-accidental bowel movement are not a problem and she is an energetic, thorough hand washer, but, you know, when accidents are occur sometimes all these precautions are not enough, especially on someone with an old immune system.
Although it was a bit difficult to collect stats on Friday, I've got a back-up to record over on Mom's Daily Tests and Meds to which I intend to apply myself sometime today.
In the way of commentary, our experience with the urgent care nurses and doctor was not any different than our usual experiences. Although I specifically asked for complete information from both the doctor and nurse on the Cipro she was prescribed, the only information I was offered was that she should take it "with food". Once I got home and did a little research I discovered that it works best two hours before or after a meal, fluid intake is a priority, I could expect her blood sugar to go crazy and her blood sugar meds would probably not work as well as normal.
One highlight of our visit, though, for which I was grateful is that I was able to discuss with this physician my recent discovery that almost all type 2 diabetic medications and many blood pressure medications, especially those which are diuretic, are derivatives of sulfa. When my mother was in the Navy sulfa drugs were tested on her and she was determined to be allergic. The physician we had was an older man who had also been in the military during the Korean police action and had much experience with sulfa, then and now. He told me that although sulfa preparations are quite a bit different now than they were then, "cross reactions" do occur, in the sense that those who were allergic to the older sulfa drugs can have a variety of reactions to current sulfa based medications, sometimes noticeable but often undetectable unless "special tests" are done. Over all, he said, this doesn't necessarily mean that the drugs aren't effective, but it could mean that "other bodily functions could be affected". I find this interesting in light of my mother's acupuncturist's discovery, when I asked her to check Mom out for reactions to metformin, that Mom's body was reacting to it as though it was an "allergen". I've decided, when I start acupuncture treatments on Mom again, which should be within a week or so, to give the acupuncturist a list of all Mom's medications, whether I've discovered that they are sulfa-based or not, and have her diagnose Mom for reactions and treat her, if necessary, to dispel those reactions. In addition I think I'll also have her do an overall sulfa diagnose-treat regimen. I'm hoping this will help Mom's body use the medications more effectively when they are necessary without running the risk of triggering what is now her recurrent iron deficiency anemia.
I'm doing some backdraft thought regarding my inability to understand that Mom's low energy level and apparent and sudden onslaught of weakness, beginning a couple of week's ago, was due to the development of a particularly virulent infection. I even recall mentioning here or perhaps to MCS at one point a few more than a few days ago that her urine appeared to be a bit cloudy one morning. My reaction, though, was to increase her garlic consumption and, hmmm, something else, I can't remember right now. When you're dealing with an Ancient One the learning curve never ends. My lesson this time involves realizing that although sometimes it is legitimate to attribute her lethargy to over sleeping and lack of movement it would be wise if this is not my first assumption. It's hard to tell with the old but I need to be more observant and less assumptive when it comes to her energy levels.
I found it necessary to apologize to her for my insistence on trying to up her energy level by insisting that she awaken earlier, "whupping" her out of bed when she was dragging and firmly guiding her toward movement. My initiative in trying to change her lethargy index over the last few weeks has actually taken hold in her memory and over the last few days she's been wary about her own interpretations of her dynamically convolutive energy swings. This has caused her some confusion in regards to whether or not she should nap or retire for the night. When I realized this I immediately explained to her, several times yesterday, every time she tried to use my almost two week's full of advice in order to keep herself from feeling lethargic, that I was in error this time making and stating the assumption that her low energy level was due to over sleep and lack of movement (and, I remember cautionarily adding, self-perpetuating if these cycles weren't broken). I told her I was very, very sorry that I let her down and that I was in the process of learning my lessons about what to consider when her energy level drops and stays low for a period of days. I told her that my first assumptions and advice were not incorrect across the board but in this case I was definitely out of line and should have been much more careful in my analysis. Luckily, my blinders did no harm this time but they did delay treatment of a critical infection and this is something I have to keep in mind now. It's definitely not easy being green.
As a reminder to myself, I want to more fully discuss my surrender; it's a complicated issue and I don't want people to think that I am advocating surrender in all cases, at all times, across the board for all caregivers whether the care is being taken of children, the infirm or the elderly. In fact, one of my all time favorite pop songs is Corey Hart's Never Surrender from the 80's, I think. I've found in this experience with my mother, though, that my personal surrender to her, which is probably better stated by saying that it is a process of constantly reminding myself to attempt to walk in her shoes with every step she takes, is of great benefit to me in helping me to be aware of not only how to treat her, but when to give in to her, when not to give in to her and how to conduct myself with her when I need her to give in to a treatment, regimen or request in which she is clearly not interested. One of my primary strategies is to always give her all the background from which I'm working, whether she remembers it or not, repeat this information as often as necessary and respect the fact that, although her short term memory is a sieve, her in-the-moment ability to understand and analyze is not. As well, her long term memory and her ability to rummage through her cerebral storage, which contains decades of data, is reliable and quick on the draw.
An update:
...later.
The Cipro seems to be doing the job very quickly. I'm pleased about this. She is having pronounced swings between high and low energy which affected our plans, yesterday. At one point she was adamant about accompanying me to the grocery. By the time we did her hair (the full meal deal) and dressed her, her energy had bottomed out. She didn't want to take a nap, which surprised me, but she didn't want to go to the store either. I decided not to badger her. I can tell, from her blood pressure readings, that her body is vigorously fighting her urinary tract infection. She elected to watch The Lion King while I shopped. I expected to find her laid out on the couch when I returned but she was up and glued to the set.
Throughout the day she'd consider napping then a quarter to a half hour later she'd decide she wasn't tired. Finally, around 1800 she headed in for a nap before dinner, telling me she was "bushed" and to be sure and awaken her at 2000, as she didn't expect she'd be able to abort the nap on her own. About an hour after retiring she was back in the living room under her own steam wanting to help me pick through raspberries for a sauce I'm making today.
Regarding how she contracted E. coli: I've given this some thought. My best guess is that it's from the mini-accidents she was having for a couple of weeks after beginning the mega-iron regimen. The maxi-accidents are easy to detect and clean up immediately, but she had two episodes of expelling small turds that neither she nor I detected until she went to the bathroom to urinate and I checked her underwear before changing it out, as I always do. After two of those happened I initiated a regimen (which she didn't appreciate, although she went along with it) of checking her underwear every hour or so to make sure nothing went undetected. As well, although I am meticulous when I clean her, paying minute attention to her uro-genital-anal area, whether it be when we're bathing her or cleaning up after an accident, it's entirely possible that I missed a spec here and there which could have traveled into her urinary tract. Her wiping habits after a non-accidental bowel movement are not a problem and she is an energetic, thorough hand washer, but, you know, when accidents are occur sometimes all these precautions are not enough, especially on someone with an old immune system.
Although it was a bit difficult to collect stats on Friday, I've got a back-up to record over on Mom's Daily Tests and Meds to which I intend to apply myself sometime today.
In the way of commentary, our experience with the urgent care nurses and doctor was not any different than our usual experiences. Although I specifically asked for complete information from both the doctor and nurse on the Cipro she was prescribed, the only information I was offered was that she should take it "with food". Once I got home and did a little research I discovered that it works best two hours before or after a meal, fluid intake is a priority, I could expect her blood sugar to go crazy and her blood sugar meds would probably not work as well as normal.
One highlight of our visit, though, for which I was grateful is that I was able to discuss with this physician my recent discovery that almost all type 2 diabetic medications and many blood pressure medications, especially those which are diuretic, are derivatives of sulfa. When my mother was in the Navy sulfa drugs were tested on her and she was determined to be allergic. The physician we had was an older man who had also been in the military during the Korean police action and had much experience with sulfa, then and now. He told me that although sulfa preparations are quite a bit different now than they were then, "cross reactions" do occur, in the sense that those who were allergic to the older sulfa drugs can have a variety of reactions to current sulfa based medications, sometimes noticeable but often undetectable unless "special tests" are done. Over all, he said, this doesn't necessarily mean that the drugs aren't effective, but it could mean that "other bodily functions could be affected". I find this interesting in light of my mother's acupuncturist's discovery, when I asked her to check Mom out for reactions to metformin, that Mom's body was reacting to it as though it was an "allergen". I've decided, when I start acupuncture treatments on Mom again, which should be within a week or so, to give the acupuncturist a list of all Mom's medications, whether I've discovered that they are sulfa-based or not, and have her diagnose Mom for reactions and treat her, if necessary, to dispel those reactions. In addition I think I'll also have her do an overall sulfa diagnose-treat regimen. I'm hoping this will help Mom's body use the medications more effectively when they are necessary without running the risk of triggering what is now her recurrent iron deficiency anemia.
I'm doing some backdraft thought regarding my inability to understand that Mom's low energy level and apparent and sudden onslaught of weakness, beginning a couple of week's ago, was due to the development of a particularly virulent infection. I even recall mentioning here or perhaps to MCS at one point a few more than a few days ago that her urine appeared to be a bit cloudy one morning. My reaction, though, was to increase her garlic consumption and, hmmm, something else, I can't remember right now. When you're dealing with an Ancient One the learning curve never ends. My lesson this time involves realizing that although sometimes it is legitimate to attribute her lethargy to over sleeping and lack of movement it would be wise if this is not my first assumption. It's hard to tell with the old but I need to be more observant and less assumptive when it comes to her energy levels.
I found it necessary to apologize to her for my insistence on trying to up her energy level by insisting that she awaken earlier, "whupping" her out of bed when she was dragging and firmly guiding her toward movement. My initiative in trying to change her lethargy index over the last few weeks has actually taken hold in her memory and over the last few days she's been wary about her own interpretations of her dynamically convolutive energy swings. This has caused her some confusion in regards to whether or not she should nap or retire for the night. When I realized this I immediately explained to her, several times yesterday, every time she tried to use my almost two week's full of advice in order to keep herself from feeling lethargic, that I was in error this time making and stating the assumption that her low energy level was due to over sleep and lack of movement (and, I remember cautionarily adding, self-perpetuating if these cycles weren't broken). I told her I was very, very sorry that I let her down and that I was in the process of learning my lessons about what to consider when her energy level drops and stays low for a period of days. I told her that my first assumptions and advice were not incorrect across the board but in this case I was definitely out of line and should have been much more careful in my analysis. Luckily, my blinders did no harm this time but they did delay treatment of a critical infection and this is something I have to keep in mind now. It's definitely not easy being green.
As a reminder to myself, I want to more fully discuss my surrender; it's a complicated issue and I don't want people to think that I am advocating surrender in all cases, at all times, across the board for all caregivers whether the care is being taken of children, the infirm or the elderly. In fact, one of my all time favorite pop songs is Corey Hart's Never Surrender from the 80's, I think. I've found in this experience with my mother, though, that my personal surrender to her, which is probably better stated by saying that it is a process of constantly reminding myself to attempt to walk in her shoes with every step she takes, is of great benefit to me in helping me to be aware of not only how to treat her, but when to give in to her, when not to give in to her and how to conduct myself with her when I need her to give in to a treatment, regimen or request in which she is clearly not interested. One of my primary strategies is to always give her all the background from which I'm working, whether she remembers it or not, repeat this information as often as necessary and respect the fact that, although her short term memory is a sieve, her in-the-moment ability to understand and analyze is not. As well, her long term memory and her ability to rummage through her cerebral storage, which contains decades of data, is reliable and quick on the draw.
An update:
- I was wrong about Hidden Valley Ranch dressing. The original buttermilk recipe, which is what we use (although I mix it differently than the package directions), does not contain sweeteners and is essentially the same as the 1996 mixture.
...later.
