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!

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