Tuesday, October 7, 2008

Keep a Close Eye on Things

Last week was not a good one for my grandmother. After a trip to the doctor on Monday for more sample steroid inhalers for her cough and the admonition to continue her nasal spray for the fluid on her eustachian tube, she started a routine of roller-coaster blood pressure. One day it would be 150/80, and the next day it would be 90/70-something. By Thursday when we went to the hairdresser's, she was very week and wobbly, and her BP was about 115/70-something. For probably the last three months, my grandmother's weekly grocery list has changed dramatically. One week, I might buy a cabbage and salt pork - the next, household items and a loaf of bread and some butter. I know she has food in her freezer, so I have not questioned too much - other than, "don't you need milk or eggs?" Almost every week, I buy a package of Chips Ahoy chewy chocolate chip cookies - and at least every two weeks a 6-pack of 20-ounce Cokes and a bag of Hershey's kisses. She tells me that she is trying to keep her energy level up, and those things taste good to her - a woman who almost NEVER ate a store-bought sweet and maybe drank a Coke a month. Now she has a glass of Coke every morning instead of a cup of coffee.

At nearly 96 years of age, I figure whatever my grandmother chooses to eat is HER choice! She has always cooked meals that no other single person I know would cook for just one - chicken, vegetables, mashed potatoes, cornbread - so I wasn't worried. However, lately she has not felt like cooking as much - and we won't even talk about what ensued when Meals on Wheels was mentioned. She does NOT like their menu - and she feels she can't afford it, although I have assured her she can... and even if she only drinks the milk each day, it's worth that. I used to buy her a half-gallon of whole milk AND buttermilk each week - now her milk ruins before she can drink it all.

So, it came as little surprise to me last Saturday morning when her blood sugar was 309! The Home Health nurse reported to my grandmother's doctor (as she is required to do for such a high reading), and he promptly ordered a prescription over the telephone for pills to lower the blood sugar. I felt quite certain that wasn't really necessary, so I told the nurse I was not going to pick up the prescription - that I figured the number was due to Mam-ma's poor diet. Once I explained to the nurse how Mam-ma was eating, she understood fully. I asked Mam-ma to lay off the sweets Saturday and eat a decent diet, and Sunday the blood sugar was 121. Monday it was 110!

Monday morning, the doctor's nurse called at 8:15 and said, "Don't pick up that prescription just yet." I told her I had no intention of picking it up - that Mam-ma doesn't need it, and I told her why - and she talked to the doctor, and now they are going to check Mam-ma's blood sugar 2 times a day for a week and see how it is. She will not be happy, and I don't blame her, but thankfully it is just a finger prick and not full-blown bloodwork.

Bottom line: You have to know the whole story - you have to have the whole picture. It frustrates me to no end that a doctor prescribes a pill over the phone - on the weekend, no less - without having someone's records in front of them, much less all of the facts. With the enormous case load doctors have these days, there is no way they can possibly recall everything about an individual patient from memory and prescribe properly from their living room chair or kitchen table. I would never want to deny my grandmother treatment or in any way interfere with her health and well-being, but at this point, I feel like she and I know more about how she is doing than anyone else. So my suggestion to anyone who is caring for a senior - or someone of ANY age, for that matter - is to consider the WHOLE picture... make sure what you are being told makes sense in the scheme of EVERYTHING.

Be a good detective, ask LOTS of questions, and take a step back and look at all factors before accepting a diagnosis and/or prescription. My grandmother did NOT need a pill to lower her blood sugar - she needed a good plate of meat and potatoes (which she ate!) and an egg or two. The day before her high reading she had capped off the night with a bowl of potato soup and a slice of lemon cheesecake! Thankfully, when the nurse mentioned a pill to her, she had the mental faculties to tell her, "I want you to talk to Debbie first." Your loved one may not be able to do that, so you will have to be ready to step in yourself and handle these situations. Be your loved one's advocate - stand up for yourself - and especially for THEM!


On another note... for several weeks ago my grandmother has been hinting she might need to go to the hospital. The word "hospital" has been dropped several times, in the context of how well "those girls" (meaning the nurses) cared for her. Last weekend, I reminded her that a trip to the hospital would most likely result in a follow-up visit to the nursing home - if only for rehab. This had NOT occurred to her, and she did NOT like it! She agreed that we do not want this to happen and must do all we can to avoid it. Having to return to the nursing home is one of my grandmother's biggest fears. I told her we do NOT want to go to the hospital - and we certainly do not want to go to the ER. She agreed and said, "I know it is an inconvenience, but if I have to go to the ER, I would rather go to Searcy (30 miles away)." I swallowed hard and said, "I'm sorry, but you do not have a doctor in Searcy except for your cardiologist, and if it isn't related to your heart, he can't and won't treat you. So that is just not an option." I followed up by adding that we have no intentions of going to ANY emergency room, so we were not even going to discuss this. She agreed.

I've quit saying that I've heard it all. There are more wacky comments and ideas to follow... I just know it!

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