Tuesday, August 10, 2004
Mom is doing very well...
...at her job of physical rehabilitation at the SNF. Her schedule is Occupational (upper body) Therapy in the morning and Ambulation (lower body) Therapy in the afternoon. This afternoon there was a slight glitch. After lunch while I was in the bathroom she decided to lay down for a nap. When I returned she was sprawled on the bed, having gotten herself out of her wheel chair and into bed on her own.
"Mom," I said, "I'll bet you'll just get settled down and they'll come collect you for your afternoon therapy sessions."
"I'll rest until then."
"Okay, but I'll bet you won't want to get up when they come and, you know, you have to, it's your job."
"I will."
Less than a half hour later her afternoon therapist arrived. Mom hadn't slipped into sleep yet, but she was obviously comfortably headed there. I told the therapist that I'd warned her about therapy and that she couldn't get out of it with a nap.
The therapist worked on her for a few minutes with me in the room helping. My mother didn't budge. Didn't even open her eyes. So I slipped around the door out of the room. Still, I heard the therapist having difficulty. So, I came back in, wrapped my arms around my mother's shoulders and gently "whupped" her up while the therapist moved her legs into position over the edge of the bed. I broke my rule a little that I wasn't going to interfere between therapists and my mother but I figured I was making up for yet another broken rule, that I would exit the room immediately when therapists entered. Today I didn't and the therapist, Mom and I all paid for it by Mom thinking she could get away with sleeping through a scheduled session because I was there and her memory of me, alas, is that I often give in to her when she's hard to get going.
She finally trotted off with the therapist, with me, once again, telling this therapist (one to whom I hadn't talked), "Don't ever take 'no' for an answer from my mother. She can always move a little bit."
The therapist reported that she had a long and successful session. Her strength increases daily, thank the gods. I told the therapist that, now that my mother is "into" the routine, when I'm there on Thursday I'm going to attend her therapy sessions so I can learn her exercises and we can continue them at home. The therapist encouraged me to do this.
Later, when we were alone in the room I said, "See, Mom? Moving gives you [universal] energy. You thought you needed a nap and now, here you are, properly moved, and you have no interest in laying down (she didn't)."
She glared at me. "I suppose you're right."
"I'm going to remember this when we get home, Mom, and remind you of it every day."
"I'm sure you will," she said, continuing her comic glare.
"I think we should do more scheduling of our days to include activities, movement, you know, the stuff that keeps you up."
"What about scheduling naps?"
"Of course we'll do that if you decide you need a nap. I know you get tired. But I think you'll be tiring less often now."
"We'll see," she said.
We will.
More good news. No more metformin. Several of the physicians who've consulted on my mother and to whom I've spoken don't like metformin for their elderly patients (wonderful, I say). I've been given new guidelines for her blood sugar; glipizide only and don't worry unless she goes above 200. I won't have much problem with this. I've also been told to administer the glipizide about half way through the meal instead of a half hour before, which I understand and had often wondered about. I'll experiment a little with this and see which way gives me the best results. As well, I've been given new parameters for Hemoglobin A1c: "in the range of 7" which I am interpreting to mean 7.0 - 7.9. These are not ranges that one wants to heed if one's Ancient One has been a diabetic for a long time. Mom has been diabetic only since 1999, when she was 82.
The last of the good news is this: It has now been a little over two weeks since Mom has had a cigarette. As a result her breathing treatments have been cut to nothing, she is not on oxygen 24/7, when she is she is normally dialed to 1/lpm to .5/lpm which brings her in at Blood Oxygen 97 at rest. Today during her afternoon therapy she performed without oxygen and her Blood Oxygen came in, during the session, at 93/94, which is what one could expect from a normal breather (somewhat higher in an athlete). My guess is that she will probably continue to need oxygen up here but at much lower levels and much less often, assuming that we commence a non-smoking life-style when she arrives home. I'm going to give it all I've got. She is no longer thinking about cigarettes at the SNF, has dropped quite a few of her paraphernalial habits connected with smoking and I'm hoping that we will be successful in this. It amazes me how quickly her aerobic ability is returning after just two weeks. As the nurse who checked her into the SNF said when I told her what was going on with Mom's smoking and how her oxygen is being cut wa-a-ay back, "It's never too late to quit smoking." For awhile I think the challenge will be to keep Mom busy enough so that she doesn't think about smoking here at home. And, of course, I simply won't have cigarettes around. Keeping her busy will be important because one of my previous challenges when I was attempting to modify her smoking habit was that she'd "take to bed" when she couldn't smoke. I think it will be easier this time but I'm not expecting miracles. I expect some pitched battles about smoking on the horizon. I also expect that, after much repetition, it will finally sink in that she feels better and can maneuver better when she's not smoking. Being motivated to stay up, of course, isn't necessarily a plus in her case as she loves to sleep. But if I can keep her busy I think we'll have this licked.
There are many good reasons for her to not take up smoking again when she returns home, not the least of which is that her heart is still checking out very good, no signs of congestive heart failure; just the opposite, in fact. Being able to wean her off oxygen, while it may go more slowly up here (I may keep her on it at night and put her on a 1/lpm dose when she's moving around for awhile) will also be a good thing. It will allow her much more mobility. I'm going to stop using cigarettes as medicine when I want to raise her blood pressure or stimulate bowel movements. We'll figure out other ways to do those things.
Two people at the facility commented on my aggressive support of my mother's therapy today. One, the Education Coordinator, congratulated me on knowing when to leave the room in order to allow my mother the stage upon which to perform for others. The other, a CNA I see all over the place at the facility, also congratulated my efforts and added, "So many people let their loved ones lie around thinking they're doing them a favor then wonder why it is their loved one has to stay longer than planned."
Remind me to talk about the very interesting discussion the Facility Administrator and I had about the recent glut of commercials on TV, sponsored by Adult Protective Services, regarding abuse of the elderly.
I fed myself coffee, feeling a surge of energy right after I returned from the Valley, and intended to input some of the few tests I have left but I'm beginning to fade despite the caffeine so I think I'll do that tomorrow. Tonight, I just want to sit here and feel good about what is happening for my mother. Old dogs. New tricks. Longer, more active lives. It all works out, doesn't it?!?
Later.
"Mom," I said, "I'll bet you'll just get settled down and they'll come collect you for your afternoon therapy sessions."
"I'll rest until then."
"Okay, but I'll bet you won't want to get up when they come and, you know, you have to, it's your job."
"I will."
Less than a half hour later her afternoon therapist arrived. Mom hadn't slipped into sleep yet, but she was obviously comfortably headed there. I told the therapist that I'd warned her about therapy and that she couldn't get out of it with a nap.
The therapist worked on her for a few minutes with me in the room helping. My mother didn't budge. Didn't even open her eyes. So I slipped around the door out of the room. Still, I heard the therapist having difficulty. So, I came back in, wrapped my arms around my mother's shoulders and gently "whupped" her up while the therapist moved her legs into position over the edge of the bed. I broke my rule a little that I wasn't going to interfere between therapists and my mother but I figured I was making up for yet another broken rule, that I would exit the room immediately when therapists entered. Today I didn't and the therapist, Mom and I all paid for it by Mom thinking she could get away with sleeping through a scheduled session because I was there and her memory of me, alas, is that I often give in to her when she's hard to get going.
She finally trotted off with the therapist, with me, once again, telling this therapist (one to whom I hadn't talked), "Don't ever take 'no' for an answer from my mother. She can always move a little bit."
The therapist reported that she had a long and successful session. Her strength increases daily, thank the gods. I told the therapist that, now that my mother is "into" the routine, when I'm there on Thursday I'm going to attend her therapy sessions so I can learn her exercises and we can continue them at home. The therapist encouraged me to do this.
Later, when we were alone in the room I said, "See, Mom? Moving gives you [universal] energy. You thought you needed a nap and now, here you are, properly moved, and you have no interest in laying down (she didn't)."
She glared at me. "I suppose you're right."
"I'm going to remember this when we get home, Mom, and remind you of it every day."
"I'm sure you will," she said, continuing her comic glare.
"I think we should do more scheduling of our days to include activities, movement, you know, the stuff that keeps you up."
"What about scheduling naps?"
"Of course we'll do that if you decide you need a nap. I know you get tired. But I think you'll be tiring less often now."
"We'll see," she said.
We will.
More good news. No more metformin. Several of the physicians who've consulted on my mother and to whom I've spoken don't like metformin for their elderly patients (wonderful, I say). I've been given new guidelines for her blood sugar; glipizide only and don't worry unless she goes above 200. I won't have much problem with this. I've also been told to administer the glipizide about half way through the meal instead of a half hour before, which I understand and had often wondered about. I'll experiment a little with this and see which way gives me the best results. As well, I've been given new parameters for Hemoglobin A1c: "in the range of 7" which I am interpreting to mean 7.0 - 7.9. These are not ranges that one wants to heed if one's Ancient One has been a diabetic for a long time. Mom has been diabetic only since 1999, when she was 82.
The last of the good news is this: It has now been a little over two weeks since Mom has had a cigarette. As a result her breathing treatments have been cut to nothing, she is not on oxygen 24/7, when she is she is normally dialed to 1/lpm to .5/lpm which brings her in at Blood Oxygen 97 at rest. Today during her afternoon therapy she performed without oxygen and her Blood Oxygen came in, during the session, at 93/94, which is what one could expect from a normal breather (somewhat higher in an athlete). My guess is that she will probably continue to need oxygen up here but at much lower levels and much less often, assuming that we commence a non-smoking life-style when she arrives home. I'm going to give it all I've got. She is no longer thinking about cigarettes at the SNF, has dropped quite a few of her paraphernalial habits connected with smoking and I'm hoping that we will be successful in this. It amazes me how quickly her aerobic ability is returning after just two weeks. As the nurse who checked her into the SNF said when I told her what was going on with Mom's smoking and how her oxygen is being cut wa-a-ay back, "It's never too late to quit smoking." For awhile I think the challenge will be to keep Mom busy enough so that she doesn't think about smoking here at home. And, of course, I simply won't have cigarettes around. Keeping her busy will be important because one of my previous challenges when I was attempting to modify her smoking habit was that she'd "take to bed" when she couldn't smoke. I think it will be easier this time but I'm not expecting miracles. I expect some pitched battles about smoking on the horizon. I also expect that, after much repetition, it will finally sink in that she feels better and can maneuver better when she's not smoking. Being motivated to stay up, of course, isn't necessarily a plus in her case as she loves to sleep. But if I can keep her busy I think we'll have this licked.
There are many good reasons for her to not take up smoking again when she returns home, not the least of which is that her heart is still checking out very good, no signs of congestive heart failure; just the opposite, in fact. Being able to wean her off oxygen, while it may go more slowly up here (I may keep her on it at night and put her on a 1/lpm dose when she's moving around for awhile) will also be a good thing. It will allow her much more mobility. I'm going to stop using cigarettes as medicine when I want to raise her blood pressure or stimulate bowel movements. We'll figure out other ways to do those things.
Two people at the facility commented on my aggressive support of my mother's therapy today. One, the Education Coordinator, congratulated me on knowing when to leave the room in order to allow my mother the stage upon which to perform for others. The other, a CNA I see all over the place at the facility, also congratulated my efforts and added, "So many people let their loved ones lie around thinking they're doing them a favor then wonder why it is their loved one has to stay longer than planned."
Remind me to talk about the very interesting discussion the Facility Administrator and I had about the recent glut of commercials on TV, sponsored by Adult Protective Services, regarding abuse of the elderly.
I fed myself coffee, feeling a surge of energy right after I returned from the Valley, and intended to input some of the few tests I have left but I'm beginning to fade despite the caffeine so I think I'll do that tomorrow. Tonight, I just want to sit here and feel good about what is happening for my mother. Old dogs. New tricks. Longer, more active lives. It all works out, doesn't it?!?
Later.
