Monday, March 31, 2008

Question of the Week - What's Making YOU Crazy?

Do you feel like you are going crazy some days? Do you wonder how you ever got to this point? You are not alone. Last week, I found myself transporting a plastic jug of my grandmother's refrigerated urine to the doctor's office for analysis. I had to wonder... "How did I get here?"

It gets worse... I backed into a parked car in the parking lot. I had gone into the clinic to take the jug of urine. The car was not there when I went in... nor when I came out. I can only assume that as I got into my car, the driver of the one I hit pulled into the slot behind me... and into my "blind spot." Thankfully, no one was injured.

My grandmother's first comment was..."you need to call the hairdresser and tell her we'll be late." I assured her I would when I had finished with the person whose car I hit. Then I looked up and my grandmother was out of the car. I asked, "Mam-ma, where are you going?" Her response: "I was gonna see what you done." Three days earlier she had been in the ER with a blood pressure reading high enough to produce a major stroke, and now she was trying to toddle around a car to look at a busted tail light! I politely asked her to please get back into the car!
On my grandmother's errand day, I try to drive the smaller Jeep my husband usually drives because it is easier for my grandmother to get into than my full-sized SUV. As I drove her to her appointment, she said, "Well, I sure hope you didn't hurt Greg's car!" Gee... thanks for caring!

In retrospect - and in small doses - these comments and actions are funny. But it's a lot like the day some 25 years ago when I read a story to my kindergarten class while the janitor swabbed smelly poop from the boys' bathroom floor, where one of my students had experienced a serious case of diarrhea. As I read the story and the children held their noses and occasionally exclaimed, "Peuweee!" I thought to myself, "I got a Master's Degree for THIS?!" Who knew that I would add transporting cold jugs of urine to my list of answers to the new question, "What are you doing now that you are 'retired'?"

So... what's making YOU crazy these days?!

Wednesday, March 26, 2008

Checking Medications - There is More to the Story!

Be sure and read the comments on the post for "Question of the Week - Are You Checking Your Medications?" Some excellent comments and observations have been noted there, and they tie into what I am about to say.
In the "never-a-dull-moment" category in our family, I received word just as I started into Easter Sunday worship service (9:30 a.m.) that my grandmother was "nauseous and popped out in a sweat." My mother was going to check on her as she went to Sunday School. I called my grandmother, and she said she was okay - lying on her couch - and that my mother had gone to church. So I assumed things couldn't be too bad. I am keyboardist for my church service, so I went ahead to the sanctuary and did my thing, and as soon as the service ended, I drove to my grandmother's house. She was spitting up a little (she calls it vomiting) and had what she calls diarrhea. She was also dizzy.

I got Mam-ma (we say "Mammaw") to the couch and took her blood pressure (BP) and it was 198/90. I gave her time to settle in and took it again and it was still 198/90. I asked her if she felt she was having a relapse from her illness the previous month that hospitalized her, and she said "No." She insisted she was okay and did not need to go to the ER, so I told her I was leaving and she could call if she changed her mind. I really felt she wasn't as bad as in February, and I knew my mom would come along after HER church service and check again.

Before 1:30 p.m. my mom called... "I have your Mam-ma at the ER." Long story short, Mom decided her BP was too high and took her to the ER. We sat there until 7:30 p.m. The nurse put a "needle" in her arm for IVs, but none were ever given. A chest/abdominal x-ray was done (clear as a bell) and an EKG. Her BP stayed high all afternoon and evening - as much as 210/88. The doctor insisted she could not go home with such a high BP. She never got sick... was never given as much as a drop of water. For more than an hour after she returned from X-ray, they "forgot" to connect her back to the monitor. Finally she was given a BP medication about 6:30 p.m. She had missed all of her medications for the day - throwing up the morning meds, and totally missing the noon and evening pills, which included 2 blood pressure medications (and they wondered why her blood pressure was high?!) The ER doctor sent her home with another BP pill and SAID he would give her Phenergan suppositories for nausea, but those were forgotten and someone had to return for them. Thankfully she never took one.

My grandmother spent the night at my mom's so we could monitor her... she was too weak and dizzy to stay alone, but Mom said the next morning, she was up, dressed, packed, and standing at the door to go home before 8:00! The ER doctor had instructed us to call my grandmother's cardiologist, 30 miles away, and discuss what he felt we should do - we had just seen him 6 days prior, and Mam-ma received a clean bill of health and was told to return in 6 months.

Here's where it gets wild... before I could get to the cardiologist by phone, the Home Health nurse came to make her routine check of my grandmother and found her weak and nauseous and called her primary care physician locally, who promptly ordered an antibiotic at the pharmacy and insisted on seeing my grandmother the following day. The Home Health nurse then started reviewing my grandmothers "box" of medications, and she called me saying one of the blood pressure medicines was "missing." I asked her what it was, and she said Lisinopril. I told her Mam-ma doesn't take that. She said, "Well her doctor's list says she does - it was prescribed in June." I puzzled over this for hours... did I forget to have a prescription filled? Did we even see the doctor last June?

Bottom line... in reviewing all of my grandmother's medications, we learned that nobody had an accurate list! When I spoke to the cardiologist's nurse, I learned that he had decreased one of her blood pressure medications, and somehow, I didn't get that information. I went over the list of medications with the nurse, and we got what we felt was an accurate list. Then I confirmed that list with the Home Health nurse. BUT... the cardiologist's nurse said, "Do NOT give your grandmother any more medicine. Do NOT give her the new BP medicine, and do NOT give her that antibiotic." Her opinion was that my grandmother might just have a little stomach "bug" and any more medicine was going to further irritate her stomach. Besides, if she DID have a "bug" - it would be viral, and nothing an antibiotic would help. This nurse knows my grandmother very well, and she said, "I can't figure out why in the world the doctor has called in an antibiotic for her!" So, I didn't pick up the prescriptions. It gets even better - the antibiotic was a "z-pak" for Erythromycin - and my grandmother is allergic to mycin drugs!

So... yesterday we went to see the family physician. I bundled my grandmother warmly and she put on the face mask the Home Health nurse left for her, as we had been told there were no appointments and we were being "worked in" and would have to wait awhile in the waiting area (with all the other sick people - flu is still really circulating in our community). When we got into an exam room I asked the nurse about this mystery BP medication, Lisinopril. It turns out, the doctor prescribed it in June 2006, and my grandmother didn't tolerate it, so they changed it to what she now takes in July 2006, and they never updated THEIR list. There were probably 4 things on their list of medications for my grandmother that she hasn't taken in 2 years! So we got that straightened out, and I told the nurse that my grandmother didn't take the new prescriptions - and WHY - and she made notes of that and also noted that my grandmother was allergic to mycin drugs.

In all, the doctor decided her spikes in blood pressure were due to a "birthday thing" (meaning old age) and since her heart is good and her EKG and echocardiogram from one week prior were actually BETTER, he didn't change anything... but of course, he ordered a 24-hour urine test and wants her back in 2 weeks. She has to collect her urine for a 24 hour period - and keep it cold! - and I will take it to the clinic tomorrow for analysis. Cha-ching! He also told her to start taking a scoop of Miralax daily to try to help with diarrhea. I just hope it doesn't make that worse! We will see!!! My husband's comment was, "So... note to self... you don't know what you are getting when you pull a jug out of an old person's refrigerator!"

The advice from the cardiologist's nurse proved to be correct - stay still and quiet, let the stomach settle, and don't add ANYTHING else to the medications. I did update the little handy-dandy list of info I carry with me, and I am going to post one on my grandmother's refrigerator for medical personnel. AND... I put her medications in the little daily dispensers - morning, noon, and night - so that we can be sure she takes everything and takes it at the right times. She was bringing her prescriptions home from the pharmacy and dumping them in old big bottles that were easier to open, and she said, "I know what's in there!" but we aren't sure she took the right dosages at the right times. When I dispensed the meds into these pill boxes, she said, "Now I don't have any idea what is what!" I told her that *I* did, and that all she had to do was take what was in the box for that particular day and time, and we would be fine. She said she would try that!

So, as DeeBev has so beautifully said in her comments to the first post about this, more medicine is not the answer - for any of us! My grandmother takes 6+ prescriptions per day - 2 blood pressure pills, something for acid reflux, a diuretic, a thyroid pill, a heart medication, plus her "nerve pill" as needed, a daily aspirin, and OTC acetominephen for pain. She also self-medicates with Pepto Bismol, an occasional prescription pain pill, cough syrup, skin creams, stool softeners, and who knows what else that she hasn't told me!

My mother says she now wishes she hadn't taken my grandmother to the ER. We can't turn back the clock. We all do things we wouldn't normally in a panic. But I think my grandmother summed it up pretty well. When the ER doctor came in and began his exam, she said, "What are you going to do to me?" He said, "Well, I'm going to check you over." She said, "No, I mean what are you going to do to me?" He asked, somewhat condescendingly, "You really want to know everything I'm going to do to you?" She replied, "Well... yes! Because if I'm about to die, I want to decide whether or not I want you to do anything!" He stepped back and looked at her, astonished. I told him he had met his match!

My take is, at 95, if my grandmother is able to choose, she should get to. She has a living will. She is not afraid to die. She IS afraid to go back to the nursing home... she was not a happy camper there. The Home Health nurse told me, "You are going to have to toughen up. You are only looking out for your grandmother. Don't let these doctors run over you. If one of them gets mad because you don't take a medication or question something, that's their problem!" I know the clock is ticking with my grandmother. I know that she won't live forever, but as she told her family doctor yesterday, "I've got things I need to be doing, and I need to get better so I can do them!" As long as she is still interested in living, I plan to help her do just that!

Friday, March 21, 2008

Question of the Week - Are You Checking Your Medications?

Okay, so I am a bit paranoid about prescription drugs, but my experience this week reminded me once again WHY I worry so much! In 1997, when my dad was sick with renal failure, his doctor prescribed an iron supplement to boost his blood and give him energy, appetite, and more. For over a month, he took an anti-seizure medication prescribed for a young child instead. The pharmacist inadvertently switched the pills and put the wrong thing in the wrong bottle. Daddy nearly died before the mistake was discovered. So, I have monitored our prescriptions rather closely since then, and I have caught a couple of errors in the process.

This week, my grandmother had phoned in refills for FOUR of her prescriptions. My doctor had phoned in a backup prescription for me for an antibiotic. I knew this drug was expensive - $10 per tablet - and I had requested six tablets. The clerk commented that my prescription was really expensive! Then she began to explain to me that they had filled a prescription for Nexium for my grandmother, because her insurance company had refused to cover a prescription for Aciphex for her acid reflux. I told her, "No, that's not right. I've been down this road before, and I have spoken with her doctor AND the insurance company, and I was told she has a waiver and will be covered for prescriptions for Aciphex for the rest of her life!" The clerk went to check on the computer, and sure enough, there was the approval... the rejection was from December of 2007. With my grandmother's hospital/nursing home stay, she had not needed this refill in awhile.... maybe since December... and I guess nobody bothered to look for updated information on the computer.

While the clerk was straightening out this prescription and refilling it with Aciphex, I glanced at the stub under MY prescription and it said $154+. I knew that couldn't be right. On further inspection, I saw that the pharmacist had given me six 750 mg tablets. I take 250 mg tablets! I pointed this out to the clerk, who showed me the paper where the pharmacist had taken the order. His 2 looked like a 7, and the substitute pharmacist had filled it as such. A double-check on the computer proved that I had always had the 250 mg tablets. Had my husband picked up my medicine for me, he would not have realized the mistake.

I wonder how many seniors would have taken the Nexium and not questioned it. I feel fairly sure my grandmother would have, if she had been told her insurance company would no longer cover Aciphex. How many seniors would have taken the 750 mg tablets, never realizing that they were not the proper dosage... particularly if their Medicair Part D coverage made the price such that they didn't realize the more than double discrepancy? Or what if it was a first-time prescription... they would not know that this was 3 times the dosage they were prescribed!

How many of us are checking our seniors' medications (or our own) to make sure they are the correct medications and dosages? My pharmacy is pretty good to double-check with us on some things, but often, if there is a discrepancy, they simply don't fill the prescription. I always question this, but I have to wonder how long they would wait to mention it. How many seniors would fail to realize they were a prescription short and go without necessary medication? Sometimes we get four or five different medications at one time, so would we miss one and realize we were a pill bottle short? My grandmother is really astute, even at 95, about her medications, and we always take them out and make sure the pharmacy filled the right things. But this cannot be said for all seniors. So who is watching out for them? Are you? If not, it may be time you started.

Monday, March 10, 2008

Question of the Week - Medical Advocates

My husband took his mother to an orthopedist today to see about a pain she has in her knee. It isn't that she couldn't go by herself, but we are learning how important a "medical advocate" is - someone who is able to sit in on an exam and/or consultation and hear what the doctor has to say. For several years now, I have gone with my grandmother to her doctor's appointments. If I am not able to go with her, my mother or sister goes. We find that it is best to have an advocate there to ask questions, make notes (if necessary), and get another set of eyes and ears into the equation for a full understanding of the diagnosis and treatment.

When I go to my family doctor, I usually go alone... but I take a list of questions and things I want to discuss... and I make notes while I am there. Last year I broke my ankle, and my husband went with me to all of my appointments with the orthopedist. I was amazed at how much of what the doctor said had gone right past me... or I could not recall... and I was so thankful that my husband was there to receive the information and internalize it. I realized that if I needed an advocate at age 50, surely older adults could use one, as well.

So the question this week is... how do you handle this issue? Do you go with your seniors to their doctor appointments? Do you communicate with your seniors' doctors and nurses to ensure you fully understand their diagnoses and treatments? Do you think this is important, or do you feel it is being overly protective? Weigh in and share your thoughts and opinions!

Saturday, March 8, 2008

Couldn't Resist Sharing...

This comic strip is so funny. It was sent to me by a friend, and I was unable to locate the author/publisher, so my apologies for not giving due credit. I hope you like it as much as I did!

Thursday, March 6, 2008

Driving - One Woman's Perspective

This was just too good to leave as a comment to the "question of the week." If you have experiences to add, please send them to the "contact" address on the left-hand sidebar. Enjoy!

Do I have experience with the elderly driving?! Father-in-law, mother-in-law, mother. My father-in-law had become a hazard a few years before he died in 1995. He didn't have an accident, but I'm sure it was due to watchful, defensive drivers in the other cars. Fortunately, he had 3 grown children. I never had to say a word. I get slightly nervous when I was a passenger, but figured I would not live forever, anyway. Checking out in a big 'ole Lincoln was not really my style. My father, the Chevrolet dealer, would roll over in his grave if he thought I would succumb to a car wreck in a Ford. But, all was well, no one was hurt and he passed away never knowing what a bad driver he had become.

My mother-in-law drove very little in her later years - past 85. Therefore, when she did, her skills were seriously degraded. Riding with her terrified me! She seemed oblivious to - anyone - at all around her! After 90, she drove at her chosen speed, used the part of the street she wanted and generally terrorized the driving community. But, she too, was fortunate. Her only accidents occurred in her own driveway and carport. Once she was trying to back her car out and somehow managed to get that big Lincoln - sideways - in the carport! Actually, I think that demonstrates some kind of special skill. I certainly couldn't do it! She found herself "stuck" and called her neighbor to come get her car straight. I can't imagine how he managed without driving across her lawn, but nothing seemed the worse for wear except her back bumper being scratched and her pride severely wounded.

She also failed to stop soon enough in her carport and ran in to the steps, I think. Regardless, she had a nasty boo-boo on her front grill. She asked my husband if she should have it fixed. She said, "You know, your daddy wouldn't let a car go with a place like that!" Phil assured her that the ding wasn't that bad. He couldn't see any point in fixing one problem if she was to continue driving. She was taking me somewhere once, and managed to run over her own yard light. Well, she didn't run "over" it, she just ran the side of her car along the pole. Her hearing never deteriorated and she heard the scraping. She stopped quickly and asked me to get out and see what was happening. Well, of course, I couldn't get out! My door was jammed against the light pole. She couldn't figure out my difficulties. I just told her to turn the steering wheel and go slowly. We got out of the driveway with a few mangled flowers and bricks she had used to trim out the base of the light. The strangest part of that story is that I didn't get out and stay at home! Me? No, I just sat in the car and let her drive me across town. But, again, I never had to say a word. (Being the in-law has its advantages!)

My mother - the current problem. She is 89 now and will be 90 on July 4th. She has always lived up to her birthday: she is a firecracker. Her biggest problem is her height. She was short to begin with, but due to osteoporosis, she has shrunk 5 inches to 4'7"! She sits on 2 cushions and apparently can see fine, however, when her car comes down the street, others see no apparent driver. In our small community, everyone knows when they see the silver Buick with no driver, it is my mother. She jokes that according to government standards, she isn't tall enough to sit in the front seat! I ride with her very comfortably on a regular basis. He highway driving is quite efficient and I'm totally comfortable with her. She actually is a better, steadier driver than most people of any age. She keeps her speed reasonable (doesn't poke and only occasionally speeds), watches for other traffic, makes good time and maneuvers our curvy Ozark Mountains highways quite nicely.

But in town? That's a different story. She kinda' "rolls" around town. She steps on the brakes at the appropriate moments. But she seems to never actually step on the gas. She slowly rolls around corners at such a rate that a car which was originally 3 blocks away, has to stop for her. In an effort to not get into the wrong lane, she's run her right rear wheel into a few ditches, but I think that must be better than her making wide turns, crossing the center line. A couple of years ago I had a friend tell me that my mother's driving was hazardous. I was surprised. The friend told me of her being on the wrong side of the street, pulling out in front of people, etc. Of course, that concerned me a great deal. These were problems I had never witnessed. I made a point to watch her for several weeks. I saw none of the things reported to me.

Mother is especially careful because she always says, "No matter what happened, if I have an accident, it will be said that I'm too old to drive! No one will notice anything else." Her car is her independence and she will not give it up without a fight. I assumed either my friend had an "issue" with older drivers or had seen someone else driving badly. The problem? About 3 months ago she tripped and fell, breaking both shoulders. We all thought that would be the end of her driving and many other things. WRONG!! She has had good care and worked very hard on the therapy. So, guess what! Yep, you got it: she's driving again. My husband bravely went with her on her maiden voyage. She had asked someone to "check her out." (She's not stupid, just stubborn.) Phil said she did fine. She has now been driving for several weeks and her care-givers ride with her. The 2 women in question both say she is driving fine. She only has one more week with a care-giver, then she will be on her own again.

Are my fingers crossed? You bet. Am I going to be the one to take her car keys? You bet I'm *not*! I'm still afraid of her. My advice on dealing with the elderly driving? I don't have any. I've just been lucky, I guess. I suggest you try to be the in-law or a coward. It has worked for me!

Monday, March 3, 2008

Question of the Week - How Do You Handle This?

My friend's mother suffered a serious fall in early December 2007. She broke and separated both shoulders, among other injuries. At nearly 90, this little human dynamo has worked very hard to recuperate and fully recover. Her goal has been to drive again, and last week, she did just that! However, her hands are weak from the fall, and surely her reflexes are not what they used to be. But drive she does!

My grandmother relinquished her car four years ago (at age 91), after a 3-month stay in the nursing home to rehab after a fall. She truly does seem better now at 95 than she did four years ago, but certainly not able to drive and cope with traffic and split-second decisions. Last September, she told my mother, "If I had a car again, I could drive myself lots of places and you all wouldn't have to cart me around."

My maternal grandfather fought tooth and nail to continue driving, and we had to sort of "circumvent" him by thinking ahead and making plans to drive him everywhere. On the other hand, my great aunt willingly gave up her car, declaring she was no longer going to drive. It is rarely that easy!

So... the question this week is... how have you handled the issue of your senior's driving?