Margaret was seen by her normal Specialist Physician on Monday and, no, he hasn't bunked of with his girlfriend. He said that her kidneys were still bad but stable and the arm should heal in 6 to 8 weeks and that she will have to stay in hospital until it does. He is worried by the continuous fluid build up in Margaret's legs and lungs and the subsequent load it places on her heart.
Margaret is still utterly confused but is actually quite happy. She has no concept of me living at home while she is hospital and last night rang the nurses to find out why I hadn't come home for dinner. I actually visited her at 5.00 pm as usual to help her eat her dinner. While there I showed her a set of photographs of our our great nephew's wedding taken by my brother. I set up a sideshow using her laptop computer and she loved looking at everybody and making up tales about them. I have now transfered them to her Electronic Photo-frame so she can watch them along with the other personal photos in it's memory.
Wednesday, June 30, 2010
Monday, June 28, 2010
What A Difference A Day Makes
On Saturday night Margaret was barely conscious when I left her. The nurses called in the Physician who doubled her drip rate as she was severely dehydrated. When I visited her at 9.30 am on Sunday she was up sitting in a chair having just been showered and dressed in a clean gown. She was still on her drip but was talking on to our daughter Helen on the phone. The conversation was a bit weird and when she hung up she began talking to me in much the same way. i think she was remembering things from her past and somehow or other relating then to her present condition. She was talking about her sister, V. in the present tense while actually V had died just on a year ago. She told me about her imagined visitors yesterday which included another person who had died earlier this year. More amusing she said that her normal Physician was not visiting her because he had run off with his girl friend. We did have a Doctor depart suddenly for this reason 11 years ago but Dr. H is happily married with two small children and I am assured he will in today following his weekend off.
The weekend Physician dropped in to see Margaret and said that he had been worried the night before but was pleased to see Margaret bright and cheerful. He asked if she was normally as confused and I had to tell him that, while she had occasional confusion, this continuous stream of confused thoughts was new. He has continued with the higher drip rate but has had to increase her Frusimide as she was a bit gurgley. He said that she in on a fine balance at present. Too much Frusimide and she has kidney failure too little and she has congestive heart failure.
Margaret ate a good lunch with my help and was put back in bed to rest for the afternoon. She still requires two people to help her while out of bed and even then is very wobbly.
After lunch I went home for a break, to feed Louis and put my feet up before Louis' walk.
Back at the hospital Margaret was still on a high and prattling away about imagined events for the day but she decided that she didn't like me. I stayed to help her with her dinner but when I left to go home to have mine she got upset.
Helen phoned her later and had a forty minute strange conversation during which Margaret told her that I had put two chairs together and hidden under a sheet before taking my dinner home with me!! I wonder what today will bring.
The weekend Physician dropped in to see Margaret and said that he had been worried the night before but was pleased to see Margaret bright and cheerful. He asked if she was normally as confused and I had to tell him that, while she had occasional confusion, this continuous stream of confused thoughts was new. He has continued with the higher drip rate but has had to increase her Frusimide as she was a bit gurgley. He said that she in on a fine balance at present. Too much Frusimide and she has kidney failure too little and she has congestive heart failure.
Margaret ate a good lunch with my help and was put back in bed to rest for the afternoon. She still requires two people to help her while out of bed and even then is very wobbly.
After lunch I went home for a break, to feed Louis and put my feet up before Louis' walk.
Back at the hospital Margaret was still on a high and prattling away about imagined events for the day but she decided that she didn't like me. I stayed to help her with her dinner but when I left to go home to have mine she got upset.
Helen phoned her later and had a forty minute strange conversation during which Margaret told her that I had put two chairs together and hidden under a sheet before taking my dinner home with me!! I wonder what today will bring.
Sunday, June 27, 2010
Margaret Has A Quiet Day
The title says it all. Margaret spent most of Saturday asleep. When she woke up she was quite incoherent except from between 11.45 am and 12.30 pm when she actualy woke up and allowed me to feed her some lunch. This was the first food she has eaten since Tuesday.
I visited her at 10,00 am and stayed till 1.00 pm. The nurses did not get her out to bed for a shower but cleaned her up in bed. She barely stirred during the whole procedure. The weekend specialist physician examined her just before lunch. He said that by withholding her Frusimide her kidney function had stabilised but there were now signs of fluid accumulating in her lungs so he would have to re-instate them. She is on a drip all the time.
I visited from 4.30 pm to 6.30 pm but she didn't really wake up. I tried to get to have some dinner but she wouldn't or couldn't open her eyes. She didn't event notice me kiss good night when I left.
Later in the evening Helen phoned me to say that she had spoken to the RN in charge of Margaret who said that Margaret was now severly dehydrated and her drip flow rate had been doubled.
Margaret is not in pain and normally sleeping peacefully. I don't think that she has urinated in the last couple of days. If not she is in a very poor renal shape.
They told Helen that Margaret will be moved to an area where she can be monitored more closely but not to the High Dependency Unit. Really they are just providing palliative care which is all that Margaret wants.
I shall visit in about an hour.
I visited her at 10,00 am and stayed till 1.00 pm. The nurses did not get her out to bed for a shower but cleaned her up in bed. She barely stirred during the whole procedure. The weekend specialist physician examined her just before lunch. He said that by withholding her Frusimide her kidney function had stabilised but there were now signs of fluid accumulating in her lungs so he would have to re-instate them. She is on a drip all the time.
I visited from 4.30 pm to 6.30 pm but she didn't really wake up. I tried to get to have some dinner but she wouldn't or couldn't open her eyes. She didn't event notice me kiss good night when I left.
Later in the evening Helen phoned me to say that she had spoken to the RN in charge of Margaret who said that Margaret was now severly dehydrated and her drip flow rate had been doubled.
Margaret is not in pain and normally sleeping peacefully. I don't think that she has urinated in the last couple of days. If not she is in a very poor renal shape.
They told Helen that Margaret will be moved to an area where she can be monitored more closely but not to the High Dependency Unit. Really they are just providing palliative care which is all that Margaret wants.
I shall visit in about an hour.
Saturday, June 26, 2010
Margaret Has Been Transferred to Noosa Hospital
I checked out of the hotel early yesterday morning and drove straight home to offload our luggage. I phoned Nambour Hospital to check when Margaret was being transferred to Noosa and as it wasn't to be until the afternoon drove back to Nambour to visit her.
When I arrived she was in a terrible condition. Apparently she had given them problems overnight including demanding wine with her dinner. The silly nurse asked if she was an alcoholic. I told her that Margaret has had a couple of glasses of wine with her dinner for many years and I asked Margaret where she was and she replied. "On Holiday!". She just wanted, what I had last night, a drink with her dinner which by the way she didn't eat anyway. She had been heavily sedated so was really confused.
Overnight she had been given three units of blood to counter the loss caused by the break and had been on a saline drip to ease the load on her kidneys. After I arrived she kept trying to get out of bed and she had to have the rails up. She had also removed her sling and cuff and her arm was just dangling. I sat with her from 9.00am until 2.00pm and she was rambling most of the time. She had no idea where she was or what was happening. At least the nurses began to realise that she was just really sick and confused. The Geriatician said that he was worried that her renal function had got worse but had decided to not to to another blood test. She was put on another drip prior to her transfer to Noosa at 2.00pm. She still hadn't eaten and was just sipping water occasionally.
When Margaret was taken down to await her ambulance transfer I drove back to Noosa and picked up Louis from kennels, took him home, gave him some water and a big bone and left him. i went to the hospital to find that Margaret had arrived just minutes before. I was able to complete her admission paperwork and get to her room just as they were setting up her drip.
I sat with her from 3.30 pm until 7.15pm and was concerned that she did not have her bed-rails up and when when she tried to get out of bed to go to the loo put them up myself and called the nurse. It took two nurses, with me manoeuvring the drip, to get her to the loo and back into bed. She is really weak and later she was drifting in and out of consciousness. She kept telling me that she could not do it but didn't know what she could not do. She also cried out in pain on several occasions but did not really regain consciousness.
At 6.00pm I asked when she was going be seen by a doctor and when she was goint\g to have any painkillers. Her specialist had gone home before she had arrived! At my request they gave her some panadol and called the duty physician to write up her medications otherwise she would have received no medication or other treatment until some time today. I left at 7.15 pm to get something to eat as I had not eaten sing 7.00 am.
Helen phoned me at 7.45 pm to say that she had phoned the hospital and the physician had made sure Margaret had had all her medications and had given her a sedative to enable her to sleep. She still hasn't eaten.
Obviously I shall get to the hospital early today to try and catch her doctor.
When I arrived she was in a terrible condition. Apparently she had given them problems overnight including demanding wine with her dinner. The silly nurse asked if she was an alcoholic. I told her that Margaret has had a couple of glasses of wine with her dinner for many years and I asked Margaret where she was and she replied. "On Holiday!". She just wanted, what I had last night, a drink with her dinner which by the way she didn't eat anyway. She had been heavily sedated so was really confused.
Overnight she had been given three units of blood to counter the loss caused by the break and had been on a saline drip to ease the load on her kidneys. After I arrived she kept trying to get out of bed and she had to have the rails up. She had also removed her sling and cuff and her arm was just dangling. I sat with her from 9.00am until 2.00pm and she was rambling most of the time. She had no idea where she was or what was happening. At least the nurses began to realise that she was just really sick and confused. The Geriatician said that he was worried that her renal function had got worse but had decided to not to to another blood test. She was put on another drip prior to her transfer to Noosa at 2.00pm. She still hadn't eaten and was just sipping water occasionally.
When Margaret was taken down to await her ambulance transfer I drove back to Noosa and picked up Louis from kennels, took him home, gave him some water and a big bone and left him. i went to the hospital to find that Margaret had arrived just minutes before. I was able to complete her admission paperwork and get to her room just as they were setting up her drip.
I sat with her from 3.30 pm until 7.15pm and was concerned that she did not have her bed-rails up and when when she tried to get out of bed to go to the loo put them up myself and called the nurse. It took two nurses, with me manoeuvring the drip, to get her to the loo and back into bed. She is really weak and later she was drifting in and out of consciousness. She kept telling me that she could not do it but didn't know what she could not do. She also cried out in pain on several occasions but did not really regain consciousness.
At 6.00pm I asked when she was going be seen by a doctor and when she was goint\g to have any painkillers. Her specialist had gone home before she had arrived! At my request they gave her some panadol and called the duty physician to write up her medications otherwise she would have received no medication or other treatment until some time today. I left at 7.15 pm to get something to eat as I had not eaten sing 7.00 am.
Helen phoned me at 7.45 pm to say that she had phoned the hospital and the physician had made sure Margaret had had all her medications and had given her a sedative to enable her to sleep. She still hasn't eaten.
Obviously I shall get to the hospital early today to try and catch her doctor.
Thursday, June 24, 2010
There is some improvement.
This morning I found Margaret in a much better shape. I thing the steroids have given her more energy. The arm doesn't appear to be causing too much pain unless she tries to use it. While I was there the Physiotherapists took her for a little walk and confirmed their original decision that she would not be able to come home until the arm was strong enough to support her using her wheely walker. This is a minimum of 6 weeks and possibly up to 12. A good thing is that Margaret is going to be transferred to Noosa Hospital for the recovery period and this will probably be tomorrow.
One problem they have encountered is that Margaret had chest pains last night and they have assumed that it was a precursor to a heart attack and she has been put on a drip and oxygen. Her haemoglobin has dropped and they are giving her three units of blood as I type. The good news is that her Creatinine is back down to 220 and eGFR back up to 18 which lifts her out of End Stage Kidney failure.
I spent from 10.00 am until 3.00 pm and it was noticeable that she is still in a very confused state and is still not eating very much but even so I think that she is happier than yesterday. She got unhappy when she was sat in a chair for too long and was trying to get herself back to bed. I had to gently restrain her. She is too weak to put up much resistance so just sat and sulked until they finally put her back in bed.
I check out of here to morrow and will visit Margaret on the way home and then when she gets to Noosa Hospital. I shall be picking Louis up a 3.00 pm so will have somebody to talk to tomorrow night.
One problem they have encountered is that Margaret had chest pains last night and they have assumed that it was a precursor to a heart attack and she has been put on a drip and oxygen. Her haemoglobin has dropped and they are giving her three units of blood as I type. The good news is that her Creatinine is back down to 220 and eGFR back up to 18 which lifts her out of End Stage Kidney failure.
I spent from 10.00 am until 3.00 pm and it was noticeable that she is still in a very confused state and is still not eating very much but even so I think that she is happier than yesterday. She got unhappy when she was sat in a chair for too long and was trying to get herself back to bed. I had to gently restrain her. She is too weak to put up much resistance so just sat and sulked until they finally put her back in bed.
I check out of here to morrow and will visit Margaret on the way home and then when she gets to Noosa Hospital. I shall be picking Louis up a 3.00 pm so will have somebody to talk to tomorrow night.
Wednesday, June 23, 2010
Things get Worse
When I visited Margaret yesterday afternoon she was a lot more comfortable and her pain control was working providing she didn't try and use her left arm. I stayed for an hour or so before coming back to the resort for a rest before dinner. Even so I was tucked up in bed and asleep by just after 9.00 pm.
This morning I got to the hospital just before official visiting at 11.00 am and Margaret was in a very lethargic and confused state. She wanted to get out of bed to go to the loo and I called a passing nurse to help her. I was told that she requires two people to assist her onto a special toilet chair to be wheeled to the loo and helped back in the same way. Margaret had other ideas I heard her get off the chair and try and get out of the loo and back to bed. I rang for her nurse why I tried to get Margaret to stay still. She was actually using her broken arm to support herself.
I asked if she had had all her medications and the nurse said yes so I asked if they included her steroids (prednisone) and I was told no as these had not been written up. I asked to see her doctor who, by luck, was on the ward. A mistake had been made and Margaret had gone over 48 hours without steroids which are vital to keeping her functioning properly after the demise of her adrenal glands a few years ago. She was given them immediately and she slowly she became more alert.
That was the good news, the doctor said that her blood tests had shown that her kidney function had dropped significantly and the Creatine Level was over 300 and eGFR 13. Normally dialysis would carried out but, as I have said before, not in Margaret's case. They have stopped most of her non-essential medications, even Frusimide. Her legs are already swollen and they have put on TED stockings to assist drainage. As excess fluid affects her heart she is in a precarious position between total Kidney failure and congestive heart failure.
I stayed with Margaret from 11.00 am to 3.00 pm. She is not in too much pain but hasn't eaten anything today and they are trying to get her to drink more water. She was visited by another specialist in geriatrics and she will probably be transferred to medical ward in the next couple of days. He confirmed that if all goes well Margaret is looking at between 6 and 12 weeks before she can return home and even this will be subject to a safety review.
At least I am getting some rest at the hotel which will prepare me for the next few months.
This morning I got to the hospital just before official visiting at 11.00 am and Margaret was in a very lethargic and confused state. She wanted to get out of bed to go to the loo and I called a passing nurse to help her. I was told that she requires two people to assist her onto a special toilet chair to be wheeled to the loo and helped back in the same way. Margaret had other ideas I heard her get off the chair and try and get out of the loo and back to bed. I rang for her nurse why I tried to get Margaret to stay still. She was actually using her broken arm to support herself.
I asked if she had had all her medications and the nurse said yes so I asked if they included her steroids (prednisone) and I was told no as these had not been written up. I asked to see her doctor who, by luck, was on the ward. A mistake had been made and Margaret had gone over 48 hours without steroids which are vital to keeping her functioning properly after the demise of her adrenal glands a few years ago. She was given them immediately and she slowly she became more alert.
That was the good news, the doctor said that her blood tests had shown that her kidney function had dropped significantly and the Creatine Level was over 300 and eGFR 13. Normally dialysis would carried out but, as I have said before, not in Margaret's case. They have stopped most of her non-essential medications, even Frusimide. Her legs are already swollen and they have put on TED stockings to assist drainage. As excess fluid affects her heart she is in a precarious position between total Kidney failure and congestive heart failure.
I stayed with Margaret from 11.00 am to 3.00 pm. She is not in too much pain but hasn't eaten anything today and they are trying to get her to drink more water. She was visited by another specialist in geriatrics and she will probably be transferred to medical ward in the next couple of days. He confirmed that if all goes well Margaret is looking at between 6 and 12 weeks before she can return home and even this will be subject to a safety review.
At least I am getting some rest at the hotel which will prepare me for the next few months.
Tuesday, June 22, 2010
Margaret's Holiday is Over
After my post last night I went to bed about 9.30 pm and Margaret was well settled down. At 11.15 pm Margaret woke up and got out of bed to go to the loo. She got out of the wrong side and had to stagger around the bed to reach her wheely walker but didn't make it. She fell heavily on her left shoulder and was in a great deal of pain and had laboured breathing. I phoned for an ambulance and contacted reception. The night manager came to assist and left a porter to direct the paramedics to our unit.
They arrived within twenty minutes and after checking Margaret out gave her morphine for the pain and took us both to Nambour Hospital. Here they took blood tests and X-Rayed her shoulder and chest. The X-Rays showed a clean fracture of the humerus at the shoulder. She was kept in overnight and I went back to hotel and got three hours sleep before breakfast.
I phoned the hospital at 9.00 am to find that she was in an orthopaedic ward and had been examined by a specialist who said surgery was not required and she could go home with her arm in a cuff and sling. I packed some clothes and went to pick her up only to find another doctor examining her. He was a geriatric specialist called in by the physiotherapists who had said that, due to her lack of independent mobility and poor health, it was unsafe for her to come back to the hotel or even to go home.
The doctor was very concerned with her renal and cardiac conditions. Her kidney function has dropped to 18 ml/Lt, the lowest since last year, there was fluid build up in the lungs and her heart was irregular. he told me that she could not come home until she could use her wheely walker which could be several weeks if not months. When the fracture settles down and is not as painful she will have and Aged Care Assessment Officer assess her condition. In the doctor's opinion her dementia is now quite severe and with her poor physical condition she is now "High Care" and should be in a Nursing Home from now. I shall reassess my position later but as I said at the start of this blog if she can be made safe at home I will continue to care for her.
I am going to stay at the hotel until Friday as originally planned as this will make it easier to visit Margaret and I can also get a good rest.
Margaret is in a great deal of pain as any movement of the arm affects the fracture but with only the ball joint above it, it is not possible to splint. I am going to have rest before going back to see her later this afternoon.
They arrived within twenty minutes and after checking Margaret out gave her morphine for the pain and took us both to Nambour Hospital. Here they took blood tests and X-Rayed her shoulder and chest. The X-Rays showed a clean fracture of the humerus at the shoulder. She was kept in overnight and I went back to hotel and got three hours sleep before breakfast.
I phoned the hospital at 9.00 am to find that she was in an orthopaedic ward and had been examined by a specialist who said surgery was not required and she could go home with her arm in a cuff and sling. I packed some clothes and went to pick her up only to find another doctor examining her. He was a geriatric specialist called in by the physiotherapists who had said that, due to her lack of independent mobility and poor health, it was unsafe for her to come back to the hotel or even to go home.
The doctor was very concerned with her renal and cardiac conditions. Her kidney function has dropped to 18 ml/Lt, the lowest since last year, there was fluid build up in the lungs and her heart was irregular. he told me that she could not come home until she could use her wheely walker which could be several weeks if not months. When the fracture settles down and is not as painful she will have and Aged Care Assessment Officer assess her condition. In the doctor's opinion her dementia is now quite severe and with her poor physical condition she is now "High Care" and should be in a Nursing Home from now. I shall reassess my position later but as I said at the start of this blog if she can be made safe at home I will continue to care for her.
I am going to stay at the hotel until Friday as originally planned as this will make it easier to visit Margaret and I can also get a good rest.
Margaret is in a great deal of pain as any movement of the arm affects the fracture but with only the ball joint above it, it is not possible to splint. I am going to have rest before going back to see her later this afternoon.
Monday, June 21, 2010
We are on holiday??
We made it and are at the Novatel Twin Waters Resort. I put Louis in kennels yesterday afternoon (Saturday) but Margaret was still looking for him in the evening. We had a leisurely morning and left home at 11.30 am after I had packed. We stopped at Coolum for a light lunch and checked in just before 2.00 pm. After a quick tour of the reception area and a cup of tea/coffee I put Margaret to bed for a rest while I got my computer logged into emails etc.
The suite is great with a separate lounge/dining/kitchen area away from the bedroom/en-suite area. The only problem is that the couches in the lounge are too low and soft and Margaret got stranded when she sat on one. I had to drag the coffee table close to her so she could get up using it as a firm support. She forgot later and got stuck again!! The loo in the en-suite is also a problem as there are no rails to help her get up so i have to maneuverer her wheely-walker into the loo so she can use it as a support. This means that I can expect to have rescue her during the night. Note that this is the same suite which we had last August when Margaret had no problems. I hadn't realized how weak she has got since then.
We went to dinner at 6.30 pm and had an Indian/Asian buffet with a bottle of Chardonnay. Wwe were back in the room at 8.30 pm and Margaret wanted to go to bed. I got her into bed and tried to give her her tablets (nine) but she wouldn't sit up to drink some water. Instead the vomited the whole lot down the front of her nightie and on her bedding. I cleaned her up and, after identifying her painkillers and sleeping tablets in the debris gave her some more (four) but she will have to do without the others tonight.
A great start to a holiday!!
The suite is great with a separate lounge/dining/kitchen area away from the bedroom/en-suite area. The only problem is that the couches in the lounge are too low and soft and Margaret got stranded when she sat on one. I had to drag the coffee table close to her so she could get up using it as a firm support. She forgot later and got stuck again!! The loo in the en-suite is also a problem as there are no rails to help her get up so i have to maneuverer her wheely-walker into the loo so she can use it as a support. This means that I can expect to have rescue her during the night. Note that this is the same suite which we had last August when Margaret had no problems. I hadn't realized how weak she has got since then.
We went to dinner at 6.30 pm and had an Indian/Asian buffet with a bottle of Chardonnay. Wwe were back in the room at 8.30 pm and Margaret wanted to go to bed. I got her into bed and tried to give her her tablets (nine) but she wouldn't sit up to drink some water. Instead the vomited the whole lot down the front of her nightie and on her bedding. I cleaned her up and, after identifying her painkillers and sleeping tablets in the debris gave her some more (four) but she will have to do without the others tonight.
A great start to a holiday!!
Sunday, June 20, 2010
Things are Improving
The Blue Care carer who came to look after Margaret last Wednesday afternoon was new, which gave me some concern as Margaret does not like new carers. I should not have worried because S was a lovely lady who took to Louis immediately and soon had Margaret on side. While I was enjoying my computer club meeting she and Margaret became friends and discussed S's personal life. She had just moved from South Australia, our old State , and remarried. Margaret fell in love with her new wedding ring.
Margaret slept reasonably well on Wednesday night and I got a reasonable nights rest, which I really needed. Thursday was scheduled as a busy day, shopping early followed by a visit to Margaret's GP at 10.30 am then lunch out and a Pharmaceutical In House review later in the afternoon. It got even busier. A, the GP, was concerned with Margaret's increased swelling around her feet and the fluid built up in her chest and reinstated the higher dose of Frusimide. He was also concerned with her sore knee and sent us off to get X-rays and an Ultrasound Scan to see what was going on. He sent us to a new Radiology Centre in Noosaville where he said we would get prompt treatment. Their earliest available appointment was Monday, that is the day we go away. A quick phone call to the GP's surgery resulted in them making an appointment with local hospital's x-ray department who could fit Margaret in at 2.00 pm which just gave us time for lunch.
The X- rays were normal but the Radiologist conducting the Ultra Sound Scan pointed out that there appeared to be an infection in the knee extending from the site of a bite or wound caused by recent falls. The results would be sent to A that evening.
The Pharmaceutical In House Review is a Commonwealth Government initiative where patients and carers dealing with a large number of medications each day are reviewed to see how they are coping and if there are any possible changes which can be recommended to the patient's GP. The reviewer, a very experienced Pharmacist, does not actually change anything but gives advice of medication control. Our reviewer, G, was very good. Margaret takes about seventeen different drugs and between thirty and forty tablets a day. G first checked my control system which passed muster. I use a seven day drug dispenser and had a typed list covering all the medications and when they are administered which I update following any changes by the GP. I fill the dispenser up each Saturday morning, check if prescriptions need to be filled and note those which must be renewed at the next visit to the GP. It takes about an hour. Each day I hand Margaret her tablets in a medicine cup and check that she takes them which is sometimes a fight. Next the reviewer checks each medication in turn and checks any possible conflict between them. The gave rise to several recommendations to her GP and a couple of good pieces of advice on ways to reduce the actual number of tablets Margaret has to take. All in all a good review and I look forward to the GP's response.
Margaret was very tired as she had been on the go from 10.00 am until 5.00 pm but I could not get her to rest and consequently she had a bad night a which also kept me awake. I counted 6 occasions when she woke me between 12.00 midnight and 4.00 am.
On Friday morning I phoned the GP's surgery at 8.00 am but the receptionist said that he hadn't got the X-ray and Ultrasound results yet so I made an appointment for Saturday morning. I had to get a couple of things which I had forgotten on Thursday while shopping and while I was out the GP phoned to talk with me and Margaret actually managed to answer the phone on the second go but left the Answering Machine on by accident so I could hear what was said. Basically I was to phone back but Margaret was getting dressed as she was sure that we were to go in the the surgery. I phone A back and he confirmed that there was a deep infection in the knee which would be very painful hence Margaret's demands for pain killers. He had already given her a course of antibiotics which hadn't worked so wanted to try an older more powerful antibiotic. I was to pick up the prescription and fill it immediately. Margaret should take them for twenty four hours and see him as arranged on Saturday morning,
Following the advice from the pharmacist on Thursday I had been administering paracetamol to Margaret on a two tablets, four time a day basis rather that on demand. This resulted in much better pain control. This was approved byt the Blue Care RN who came later in the day. Apparently studies have shown that paracetamol is more efficient with severe pain used this way but exceeding eight tablets a day can injure the liver. Margaret was much more comfortable and we had a quiet night apart from having to give her Lomatil following a bout of diarrhoea during the night.
On Saturday we saw her GP who told us that Margaret had deep seated infection in the knee. I was probably a boil which had not come to a head and was resistant to the antibiotics which he had tried previously. The one she is presently taking are very effective but can have side effects. As Margaret had taken several tablets over twenty four hours and was showing no side effects she is to continue taking them over a ten day period. He wished us a happy holiday break and we will see him again when we come back to consider results of the Pharmaceutical Review and check the knee.
The rest of Saturday went well. The knee looks like it is responding to treatment and Margaret was feeling more comfortable. She went to bed and off to sleep without any problems. A about 2.15 am she got up to go to the loo when she stumbled against the door frame and tore the skin on her right forearm. She woke me and i was able to ease the skin back and put on a dressing. It is a small tear, about 25 mm across and the flap was easily eased back. I have a comprehensive first aid kit stocked using the Blue care RN's advice.. The dressing I used can stay in place for up to seven days and providing there is no infection the tear should heal OK.. We were back in bed by 3.30 am. This morning the arm is comfortable and I suppose infections will be prevented by the antibiotics she is taking for the knee.
Today we take Louis to kennels and pack for our break.
I will update how we are going later in the week.
Margaret slept reasonably well on Wednesday night and I got a reasonable nights rest, which I really needed. Thursday was scheduled as a busy day, shopping early followed by a visit to Margaret's GP at 10.30 am then lunch out and a Pharmaceutical In House review later in the afternoon. It got even busier. A, the GP, was concerned with Margaret's increased swelling around her feet and the fluid built up in her chest and reinstated the higher dose of Frusimide. He was also concerned with her sore knee and sent us off to get X-rays and an Ultrasound Scan to see what was going on. He sent us to a new Radiology Centre in Noosaville where he said we would get prompt treatment. Their earliest available appointment was Monday, that is the day we go away. A quick phone call to the GP's surgery resulted in them making an appointment with local hospital's x-ray department who could fit Margaret in at 2.00 pm which just gave us time for lunch.
The X- rays were normal but the Radiologist conducting the Ultra Sound Scan pointed out that there appeared to be an infection in the knee extending from the site of a bite or wound caused by recent falls. The results would be sent to A that evening.
The Pharmaceutical In House Review is a Commonwealth Government initiative where patients and carers dealing with a large number of medications each day are reviewed to see how they are coping and if there are any possible changes which can be recommended to the patient's GP. The reviewer, a very experienced Pharmacist, does not actually change anything but gives advice of medication control. Our reviewer, G, was very good. Margaret takes about seventeen different drugs and between thirty and forty tablets a day. G first checked my control system which passed muster. I use a seven day drug dispenser and had a typed list covering all the medications and when they are administered which I update following any changes by the GP. I fill the dispenser up each Saturday morning, check if prescriptions need to be filled and note those which must be renewed at the next visit to the GP. It takes about an hour. Each day I hand Margaret her tablets in a medicine cup and check that she takes them which is sometimes a fight. Next the reviewer checks each medication in turn and checks any possible conflict between them. The gave rise to several recommendations to her GP and a couple of good pieces of advice on ways to reduce the actual number of tablets Margaret has to take. All in all a good review and I look forward to the GP's response.
Margaret was very tired as she had been on the go from 10.00 am until 5.00 pm but I could not get her to rest and consequently she had a bad night a which also kept me awake. I counted 6 occasions when she woke me between 12.00 midnight and 4.00 am.
On Friday morning I phoned the GP's surgery at 8.00 am but the receptionist said that he hadn't got the X-ray and Ultrasound results yet so I made an appointment for Saturday morning. I had to get a couple of things which I had forgotten on Thursday while shopping and while I was out the GP phoned to talk with me and Margaret actually managed to answer the phone on the second go but left the Answering Machine on by accident so I could hear what was said. Basically I was to phone back but Margaret was getting dressed as she was sure that we were to go in the the surgery. I phone A back and he confirmed that there was a deep infection in the knee which would be very painful hence Margaret's demands for pain killers. He had already given her a course of antibiotics which hadn't worked so wanted to try an older more powerful antibiotic. I was to pick up the prescription and fill it immediately. Margaret should take them for twenty four hours and see him as arranged on Saturday morning,
Following the advice from the pharmacist on Thursday I had been administering paracetamol to Margaret on a two tablets, four time a day basis rather that on demand. This resulted in much better pain control. This was approved byt the Blue Care RN who came later in the day. Apparently studies have shown that paracetamol is more efficient with severe pain used this way but exceeding eight tablets a day can injure the liver. Margaret was much more comfortable and we had a quiet night apart from having to give her Lomatil following a bout of diarrhoea during the night.
On Saturday we saw her GP who told us that Margaret had deep seated infection in the knee. I was probably a boil which had not come to a head and was resistant to the antibiotics which he had tried previously. The one she is presently taking are very effective but can have side effects. As Margaret had taken several tablets over twenty four hours and was showing no side effects she is to continue taking them over a ten day period. He wished us a happy holiday break and we will see him again when we come back to consider results of the Pharmaceutical Review and check the knee.
The rest of Saturday went well. The knee looks like it is responding to treatment and Margaret was feeling more comfortable. She went to bed and off to sleep without any problems. A about 2.15 am she got up to go to the loo when she stumbled against the door frame and tore the skin on her right forearm. She woke me and i was able to ease the skin back and put on a dressing. It is a small tear, about 25 mm across and the flap was easily eased back. I have a comprehensive first aid kit stocked using the Blue care RN's advice.. The dressing I used can stay in place for up to seven days and providing there is no infection the tear should heal OK.. We were back in bed by 3.30 am. This morning the arm is comfortable and I suppose infections will be prevented by the antibiotics she is taking for the knee.
Today we take Louis to kennels and pack for our break.
I will update how we are going later in the week.
Wednesday, June 16, 2010
I Really Don't Like Being a Carer
The title reflects what I feel today. This post is a day later than normal because I was to tired to sit down and concentrate. I'll go back to my last post which was last Tuesday and we were waiting for the the Blue Care RN to check up on Margaret and give her a shower.
The first thing that the RN noted was that Margaret was less "with it" than normal. She was also peeing almost continuously which could mean that her mineral levels, especially Phosphorus and Sodium could have dropped which can cause confusion and dementia. Margaret's latest blood test showed that these were normal and not the cause of her problems. Anyway I made a decision to reduce Margaret's Frusimide from 200mg a day to 120 mg a day which meant that she took two 40 mg tablets less each day.
Margaret wasn't up to going out for lunch so she spent most of her time in bed and grumbled about her sore knee which actually doesn't appear to have anything wrong with it. I believe that there is something there giving her problems so I will check it with her GP this Thursday (tomorrow). She has got more confused as the week went on. I had bought a plant for Margaret and put it in a large pot in such a place that she could see it while lying down in her bed. The trouble is that she can't remember its name and asks me several times a day, sometimes with only minutes between her queries. The plant is an Hibiscus with pretty red flowers.
The Friday Blue Care RN noted that Margaret showed signs of Cyanosis around her lips and also thought that she could have blood oxygenation problems and said that I should keep a watch on her.
Over the weekend we have had a lot of activity in our little street, only five houses in a cul-de-sac. Our neighbour's daughter has spent her whole life dealing with a major deformity which stunted her growth and subjected her to numerous medical problems. Now in her early twenties her kidneys had failed completely. After a short stay in hospital she had come home to die. On Saturday the Blue Care nurses were with her most of the day and her family came to visit. She died on Monday afternoon. This has upset Margaret and while she knows that C is dead and at rest she still thinks that she is suffering. Luckily for C she died at home with her loving family. Her mother has been her full time carer for all C's life.
Since then Margaret has become very difficult to care for. She has started refusing to take her morning tablets and screaming at me when I try to persuade her to take them. As these tablets include her steroids which are vital to keep her going because of her Adrenal Gland Failure and tablets to combat possible strokes and heart failure it is essential that she takes them.
Margaret is spending more and more time in bed but on Monday night I had a major problem getting her to go to bed and it took forty five minutes to get her to take her bedtime tablets and settle at about 10.45pm I went to bed a little later but at 12.30 am she came an woke me demanding paracetamol tablets for pain. I am under instruction to limit her to eight per day and only two in any four hours so I had to say no. This set of a tirade of abuse and screaming at me. She continued through out the night even after I gave her some at 2.00 am nearly an hour early. I think that I got less the an hour and a half sleep and was even too tired to get up and give Louis his morning walk.
Yesterday the Blue Care RN again commented on Margaret's condition and noticed that, following the reduction in Frusimide, her feet were beginning to swell and the was getting fluid built up in her chest. She may have to go back to the higher dose even though she is still peeing almost continously.
Last night Margaret refused to go to bed so I left her tablets for her to take and went to bed, exhausted, at 10.00 pm. Margaret took all her tablets including two paracetamol bur half an hout later woke me up asking for them. She wouldn't believe me that she had had them and spent the rest of the night watching TV in her room with the volume up high and calling out to me that she couldn't sleep. At about 3.00 am I gave her more painkillers but when I got up at 5.00 am to shower then take Louis out she began screaming at me again. I had actually managed to sleep for a few hours between interruptions one of which was when she wheeled into my room and yelled, "It's alright for you, you can sleep!".
Now she is settled and quite calm. This afternoon I go to my Computer Club meeting and hand her over to a carer from Blue Care for four hours.
Tomorrow we see her GP and next Monday we go away for s few days .
The first thing that the RN noted was that Margaret was less "with it" than normal. She was also peeing almost continuously which could mean that her mineral levels, especially Phosphorus and Sodium could have dropped which can cause confusion and dementia. Margaret's latest blood test showed that these were normal and not the cause of her problems. Anyway I made a decision to reduce Margaret's Frusimide from 200mg a day to 120 mg a day which meant that she took two 40 mg tablets less each day.
Margaret wasn't up to going out for lunch so she spent most of her time in bed and grumbled about her sore knee which actually doesn't appear to have anything wrong with it. I believe that there is something there giving her problems so I will check it with her GP this Thursday (tomorrow). She has got more confused as the week went on. I had bought a plant for Margaret and put it in a large pot in such a place that she could see it while lying down in her bed. The trouble is that she can't remember its name and asks me several times a day, sometimes with only minutes between her queries. The plant is an Hibiscus with pretty red flowers.
The Friday Blue Care RN noted that Margaret showed signs of Cyanosis around her lips and also thought that she could have blood oxygenation problems and said that I should keep a watch on her.
Over the weekend we have had a lot of activity in our little street, only five houses in a cul-de-sac. Our neighbour's daughter has spent her whole life dealing with a major deformity which stunted her growth and subjected her to numerous medical problems. Now in her early twenties her kidneys had failed completely. After a short stay in hospital she had come home to die. On Saturday the Blue Care nurses were with her most of the day and her family came to visit. She died on Monday afternoon. This has upset Margaret and while she knows that C is dead and at rest she still thinks that she is suffering. Luckily for C she died at home with her loving family. Her mother has been her full time carer for all C's life.
Since then Margaret has become very difficult to care for. She has started refusing to take her morning tablets and screaming at me when I try to persuade her to take them. As these tablets include her steroids which are vital to keep her going because of her Adrenal Gland Failure and tablets to combat possible strokes and heart failure it is essential that she takes them.
Margaret is spending more and more time in bed but on Monday night I had a major problem getting her to go to bed and it took forty five minutes to get her to take her bedtime tablets and settle at about 10.45pm I went to bed a little later but at 12.30 am she came an woke me demanding paracetamol tablets for pain. I am under instruction to limit her to eight per day and only two in any four hours so I had to say no. This set of a tirade of abuse and screaming at me. She continued through out the night even after I gave her some at 2.00 am nearly an hour early. I think that I got less the an hour and a half sleep and was even too tired to get up and give Louis his morning walk.
Yesterday the Blue Care RN again commented on Margaret's condition and noticed that, following the reduction in Frusimide, her feet were beginning to swell and the was getting fluid built up in her chest. She may have to go back to the higher dose even though she is still peeing almost continously.
Last night Margaret refused to go to bed so I left her tablets for her to take and went to bed, exhausted, at 10.00 pm. Margaret took all her tablets including two paracetamol bur half an hout later woke me up asking for them. She wouldn't believe me that she had had them and spent the rest of the night watching TV in her room with the volume up high and calling out to me that she couldn't sleep. At about 3.00 am I gave her more painkillers but when I got up at 5.00 am to shower then take Louis out she began screaming at me again. I had actually managed to sleep for a few hours between interruptions one of which was when she wheeled into my room and yelled, "It's alright for you, you can sleep!".
Now she is settled and quite calm. This afternoon I go to my Computer Club meeting and hand her over to a carer from Blue Care for four hours.
Tomorrow we see her GP and next Monday we go away for s few days .
Tuesday, June 8, 2010
Not Much to Report
As the title says there is not much to report this week as things have been quite uneventful. Margaret got the results of her blood tests from her GP on Friday. They were quite stable with her eGFR holding at 28 ml/min and her Creatinine 157 umol/L. These would cause concern for a normal person but for Margaret with chronic kidney failure they are not too bad. The big surprise was her Cholesterol which was 5.6 mmol/L which is very good for her so her new medicines are working in this area. However her Triglycerides are 6.5 mmol/L which puts her in a high risk area for heart attacks.
While at the GP's we discussed whether Margaret could stand a short break away from home and it was agreed that she could. She can't travel too far and needed to rest during the day not to get too run down. We have decided to go away for four nights from the 21 June to the Novatel Twin Waters Resort where we stayed last August. I have booked a similar suite to last time which means that we have a separate living area so I can sit and read or play with my laptop while Margaret rests. We will take short excursions from about 10.00 am to 3.00 pm and have lunch out. We will have breakfast and dinner at the resort. We are under strict instructions to get in touch with the GP in the event of Margaret's health deteriorating. At the resort is only 40 km from home this is not a problem.
One little thing which shows Margaret's increased dementia, which is probably caused by the high Creatinine levels, is her problems in remembering the name of her new Teddy Bear. When my sister Sue visited she gave Margaret the new Teddy Bear. It was special because you could pop it in the microwave oven for a few seconds and it would come out warm and smelling of lavender plus what ever i had cooked last! Margaret has called HER Lavender but keeps forgetting her name. She knows that she smells so it often gets called Stinky! At least three times a day she asks me her real name. I just sing, very badly, "Lavender Blue, Dilly, Lavender Green So she remembers it. Occasionally just saying, "Blue and Green" works but it is gone a few minutes later.
While at the GP's we discussed whether Margaret could stand a short break away from home and it was agreed that she could. She can't travel too far and needed to rest during the day not to get too run down. We have decided to go away for four nights from the 21 June to the Novatel Twin Waters Resort where we stayed last August. I have booked a similar suite to last time which means that we have a separate living area so I can sit and read or play with my laptop while Margaret rests. We will take short excursions from about 10.00 am to 3.00 pm and have lunch out. We will have breakfast and dinner at the resort. We are under strict instructions to get in touch with the GP in the event of Margaret's health deteriorating. At the resort is only 40 km from home this is not a problem.
One little thing which shows Margaret's increased dementia, which is probably caused by the high Creatinine levels, is her problems in remembering the name of her new Teddy Bear. When my sister Sue visited she gave Margaret the new Teddy Bear. It was special because you could pop it in the microwave oven for a few seconds and it would come out warm and smelling of lavender plus what ever i had cooked last! Margaret has called HER Lavender but keeps forgetting her name. She knows that she smells so it often gets called Stinky! At least three times a day she asks me her real name. I just sing, very badly, "Lavender Blue, Dilly, Lavender Green So she remembers it. Occasionally just saying, "Blue and Green" works but it is gone a few minutes later.
Stinky Lavender
Tuesday, June 1, 2010
A Winter's Tale
Sorry I couldn't resist the title as today is officially the first day of winter in Australia and it is a bright cold morning.
This week has been a fairly quiet week with no major dramas although there have been a couple of worrying moments. Last Wednesday Margaret saw a small tablet just under her bed and got down on the floor, picked it up and took it!. I think that it may have been Lofoxenal which is to stop diarrhoea and in itself wouldn't do to much harm but Margaret was now stuck and couldn't get up again. She called me but in spite of all our joint efforts she didn't have the strength to get up. We literally had a cup of tea/coffee while we thought the situation over. She wasn't hurt and it seemed a bit much to call an ambulance for assistance. Our helpful neighbour, S, was out and we were on our own. In the end I got a low plastic step which we used to use to get in and out of our caravan. Margaret managed to roll onto her knees then wiggle her bottom over the step and sit down. Now, with help, she could bring each leg to the front. We tried to get her up again and again she failed. The step was too low. I left her sitting there finishing her tea while I went to the garage for more inspiration. Here I found four pieces of wood about 100mm/4inches square an 50cm/2 foot long. Back in the bedroom Margaret supported herself against the bed and I lifted each side of the step in turn and inserted two pieces of wood either side until she was high enough off the floor to get herself up. Apart from a few dimples on her bottom from the step she was OK but it had taken over half an hour to rescue her.
This week has been a fairly quiet week with no major dramas although there have been a couple of worrying moments. Last Wednesday Margaret saw a small tablet just under her bed and got down on the floor, picked it up and took it!. I think that it may have been Lofoxenal which is to stop diarrhoea and in itself wouldn't do to much harm but Margaret was now stuck and couldn't get up again. She called me but in spite of all our joint efforts she didn't have the strength to get up. We literally had a cup of tea/coffee while we thought the situation over. She wasn't hurt and it seemed a bit much to call an ambulance for assistance. Our helpful neighbour, S, was out and we were on our own. In the end I got a low plastic step which we used to use to get in and out of our caravan. Margaret managed to roll onto her knees then wiggle her bottom over the step and sit down. Now, with help, she could bring each leg to the front. We tried to get her up again and again she failed. The step was too low. I left her sitting there finishing her tea while I went to the garage for more inspiration. Here I found four pieces of wood about 100mm/4inches square an 50cm/2 foot long. Back in the bedroom Margaret supported herself against the bed and I lifted each side of the step in turn and inserted two pieces of wood either side until she was high enough off the floor to get herself up. Apart from a few dimples on her bottom from the step she was OK but it had taken over half an hour to rescue her.
The rescue system back in the garage.
The next instance was similar. On Friday we were waiting for the Blue Care carer to come and help Margaret shower while I caught up with some emails in our study. Margaret wheeled herself in to join me and sat down on the foam sofa which doubles as a temporary bed. Unfortunately this is quite low and again Margaret couldn't get up. Now this was a much more difficult problems as there is no hard surface to provide us with support. I was about to try plan B using an office chair when the Blue Care RN drove into the drive and with her help we got Margaret up.
The RN gave Margaret a lecture about sitting anywhere where her bottom is lower than her knees as she just isn't strong enough to get up from a semi squat position.
One nice thing to happen is that Margaret made contact with an old friend after about fifteen years. She was sitting at dinner early last week when she asked me to get a photo of her friend and his lovely wife with their four young sons from the bookshelf to look at. They live in the USA and the last we heard of him was that he was carving out a successful career as voice over artist and coach in Hollywood. Next morning, on impulse, I looked him up on the web and he has a website. This once I will use his full name, Patrick Fraley. He gave a contact email address so I dropped him a short note telling that Margaret would love to her from him. We received a lovely email back within a couple of hours. Patrick's life has also been hard recently because his oldest son died last year at 24 years and his wife has had a kidney transplant. In spite of this he sent us a lovely photo of his family taken just before his son's death and reminisced with Margaret about his time in South Australia. In 1974 he was a young drama MFA from Cornell and he came to Adelaide to set up Drama Workshops at Theatre 62. Margaret was one of his first students and they have been friends ever since. We shall now keep in touch by emails.
Most of the last week Margaret has been feeling quite low but we did get out for lunch Thursday. Apart from that she has been resting. She had a blood test sample taken yesterday and will get the results on Thursday.
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