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.
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