Thursday, July 9, 2009

Mixed Medicines - Mixed Messages

Yesterday afternoon about 4:15, I was scrambling to finish vacuuming our house and get a shower, so that we could go to a funeral visitation for the father of our childhood friends. The phone rang, and it was Mam-ma, and she sounded absolutely horrible. She almost never got out a question... when was the funeral? I told her 11:00 a.m. the next day, and she said, "Well, I am gonna have to go to the doctor. I haven't been able to pee today. And I've took the headache. I've just drunk water all day." I questioned her... could she not go at all? was it a little or a lot? and she said yes, she could go, but it was just a dribble.

Here's how our conversation went after that...

  • Me: Call tomorrow and see if you can get an appointment tomorrow afternoon.
  • Mam-ma: Well, if I can get in tomorrow morning, I'll get Ruby to take me.

  • Me: I would rather that I went with you.
  • Mam-ma: Well I would, too.Me: Are you saying you can't wait until afternoon?
  • Mam-ma: I don't know... my belly is starting to hurt.
    Then she adds... (and remember, this is all very halting and in spurts between heavy breathing and in a whiny, raspy voice!)
    When Shelly (her Home Health aide) was here this mornin', she said, "You're a gonna get a kidney infection." She called the nurse.
  • Me: What did the nurse say? (I never did determine EXACTLY what the nurse said, because she never really explained that.)

  • Mam-ma: My blood pressure was 95.

  • Me: 95-what? Was that the bottom number or the top?

  • Mam-ma: I don't know... just a minute... (she goes to check her notes)... It was 95 over 57. We went on and took my bath, and then she took my blood pressure again, and it came up to 130/66.

    I asked if her feet were swollen, and she said no.

Mam-ma said she had called the clinic and nobody answered. I reminded her that we saw her doctor last Wednesday at the dentist, so apparently they are closed on Wednesdays, and she said, "Yes, but I thought some of the girls would be there." I kept wondering, WHY are you just now calling me about this? I told her that I might have been able to do something, like get her to someone else, if I had known earlier in the day, but now we were pretty much out of options. I told her that I did not really want to take her to the ER unless she absolutely had to go, and she said, "No, I'm not going to the ER." So I told her to call this morning and see what could be done, and we would go from there... that I woul not call her hairdresser until we knew for sure about the clinic.

Then I called my sister, and we discussed it, and she asked if Mam-ma had taken her BP again. I told her not for me... and Suzanne thought she should. So she offered to call her, which I thought was a great idea. Well, things were totally different for Suzanne. Mam-ma answered with a strong clear voice and sounded upbeat. She did say she couldn't pee well, but she admitted to Suzanne that she didn't have an urge to go to the bathroom like you do with a UTI - and that she COULD go... just not very much. I had told Suzanne, Mam-ma's idea of "a lot" and ours is not the same... are we talking a quart or a teaspoon? When she tells me she is vomiting, sometimes it is some miniscule phlegm that I would not even classify as such.

Suzanne asked Mam-ma to take her BP again, and it was 189/89. However, she told Suzanne that she had been out in the yard and filled her birdbath and watered her garden. Suzanne got onto her and told her NOT to go back outside again in this heat and to stay quiet. She said she was going to after she "got done." Suzanne asked, "Get done with what?" Well, supper, she said... after supper she was going to bed. I told Suzanne, "Yes, and she is likely to show up at the visitation with Ruby!" Suzanne laughed... she said while Mam-ma was taking her BP (and she had to take it twice to read it) she was talking (which you aren't supposed to do). Greg asked me, "You two honestly believe a BP reading your 96-year-old grandmother took?" I told him yes and no. What told me the real tale was how strong her voice was to Suzanne. After talking to Suzanne and hearing how Mam-ma was for her, and knowing no Home Health nurses had called me, I determined this was not serious enough to take any action last night.

So this morning at 8:15, a very whiny, breathy Mam-ma called me and said, "Well, they can't see me until 1:30 this afternoon, and then I'm a walk-in work-in, so no telling how long we will be there."

  • Me: Call the hairdresser and cancel your hair appointment.

  • Mam-ma: Well, I'll see if she can take me late in the afternoon.
  • Me: No, cancel it. We have no idea how long we will be, and you are usually Pat's last client. That's not fair to ask her to hang around all afternoon in case you can come late. I know you want your hair to look nice for Saturday and Sunday (she has TWO parties to attend this weekend!), so if Pat can't work you into her Friday, we'll do something else - either do it ourselves or take you somewhere else.

So Mam-ma said okay. I talked to my sister, and she asked if I had asked about the peeing and the BP this a.m., and I told her no... we didn't get that far. And honestly, after how she acted with Suzanne yesterday, I can't trust what she tells me anyway! Suzanne said if her BP is all over the map like that, she probably does need to see a doctor, but we have no clue what all she has done to cause it to go up and down... like watering her birds and garden. And I still maintain that this stems mainly from her seeing her doctor at the dentist's last week. She is bound and determined to go to the clinic. And Greg and I wondered if she was a little jealous/miffed over the funeral visitation. She doesn't like to go to visitations, but at the same time, she knew we were going... and it was at our church and not at the funeral home, so she may have thought we would take her along.

I wish I could say this was the most bizarre trip I'll ever make to Mam-ma's doctor, but I'm afraid to do so!*lol*
The funeral was very nice... but long... Masonic rites at the cemetery. So we rushed to grab a quick bite, and I pulled into Mam-ma's driveway right at 1:30... she was in her garage... her walker was parked by the entryway. She didn't even unfold it... just sorta steered it toward me at the car. As we drove away, she said, "You've just come from the funeral, haven't you." I told her almost - that we had downed a quick bite of lunch, but yes, I had just gotten there.

I asked, "So you called the hairdresser and told her you weren't coming?

  • Mam-ma: NO! I didn't call her. I figured YOU would.

  • Me: No... I told you to call her. We have got to do that right away - she is wondering where you are!

  • Mam-ma: Well, we might be able to go later.
  • Me: NO! Remember, we are not doing that... (I'm dialing Pat).
    I get Pat on the phone, and yes, she is wondering. She says she has a comb-out at 2:00 and now she can go home after that. I asked, would she possibly have something tomorrow, and she hesitantly says it will be 2:30. I ask if she is sure that is okay with her (I know she has to make arrangements for her grandson), and she says it is... and in the background, Mam-ma is saying, "or we could maybe go later today." I turned away from the phone and said, "We are NOT doing that!" So back to Pat... she says we can come tomorrow at 2:15.

We get inside, and it's very slow, so we get in pretty quickly. Mam-ma tells the nurse her spiel and we toddle to the bathroom and she gives a specimen. Then Dr. B. comes in, and the first thing he asks is, "Did you get your teeth fixed?" I'm shaking my head no and telling him, don't ask... that is literally a sore subject. He apologizes, and of course, Mam-ma is now saying, "No I didn't, and I tell you what, I need to have them fixed." So you know what will be next on the list! I told Dr. B. to stick to the body, and he laughed and said, "That's what I get for trying to make small talk!" (Side note...we made three trips in three weeks to have Mam-ma's dentures adjusted to accommodate her eroding jawline, and she still says they don't fit right. She talked earlier in the week of a trip to the dentist again, but somehow that never materialized.)

So Dr. B. starts asking Mam-ma questions. She tells him she can't go to the bathroom. He asks, like, is she able to go at all? Oh, yes, when she takes her Lasix, she goes real good for about an hour after that, and then she can't go any more.

  • Dr. B.: Do you feel like you need to go again?

  • Mam-ma: No.
  • Dr. B.: How often do you go?
  • Mam-ma: Well, after I take my Lasix, several times for about an hour, and then maybe 2 times the rest of the day.
  • Dr. B. (looking totally confused): So what's the problem?
  • Mam-ma: Well, I need to go!
  • Dr. B.: Why? Does it hurt when you go?

  • Mam-ma: No, but it hurts down there (pointing to the lower part of her abdomen.) It's just terrifying!

  • Dr. B.: What's terrifying?

  • Mam-ma: Well, when you go sit on the commode and you can't go.

  • Dr. B.: Do you feel the urge to go?

  • Mam-ma: No, but I just need to go! I've drunk and drunk water and lemonade until I'm so full!

  • Dr. B.: That's obvious - you've diluted your urine!

He went on to say that he thought between the Lasix and the heat of the summer, she might be dehydrated a little. I told him about the BP, and how it came up with a bath, and again when she went outside. She had argued she doesn't go outside.

So I asked, have you been back outside since you watered? Dr. B. said, "That's a good question. I was going to ask what you've been doing." She said, "Well, when you have a garden, you have to keep it watered, and so I had to go out yesterday and water my garden." He asked her about her garden. Her answers were slow - and halting - and confused, and she had a terrible time figuring out what to say and getting it out. Poor Dr. B., he was just sitting there with his arms folded, frowning, trying to figure out what the heck was happening!

I asked if she walked this morning, and she immediately said "NO!" Dr. B. shot back, "Why not?" and she said, "Well, because I didn't feel like it!" He checked her breathing and listened to her heart and belly. He finally wrote a prescription for six Cipro pills and Pyridium for 3 days. He started telling her to take the Pyridium 3 times a day and the Cipro two, and I asked, "Can't I just put that in her pill compartments for breakfast, lunch and dinner?" He said yes. He also drew blood to see if she had depleted her potassium.

Dr. B. is so confused about what the problem is at this point, and I tried to explain to Mam-ma - "He is saying it is normal to pee a lot after you take the Lasix and then not any more. And he's trying to tell you that you don't need to drink that much fluid" and she is saying, "But I need to go!" So Dr. B. asks, "What else is going on? Is there something else bothering you?" She says no. I ask, "Mam-ma, are you feeling bad somewhere else - do you hurt somewhere or something?" She says no, other than now she's "took the headache."

So Dr. B. starts working on the computer, and I mentioned that she now takes Nexium instead of Aciphex, and he said his nurse had changed that in the files. And I added... "And, recently I discovered a bottle of Prosom (a tranquilizer) in her cabinet, and a bottle of Darvocet (narcotic painkiller)!" He asked where that came from, and I said, "You prescribed it - I think in April 2007!" He started looking through his records, and Mam-ma said, "No, you gave me a 90-day supply 90 days ago, and I need a refill!" He whirled around and looked at her and said, "I prescribed that in 2005, and you need to get rid of it!" I asked about the Darvocet, and he said, "It's probably not any good now, either, and I need to write a new scrip." I said, "Wait a minute... why does she even need that?" He answered, "She really doesn't." I told him I could get rid of that, too!

Then I told him, "You know, she takes a lot of extra-strength Tylenol. I buy a lot of that." He asked how much, and Mam-ma started in, "Now I don't take that much of that!" I said, "Mam-ma, I bought you a bottle a few months ago with 100 tablets, and it was buy-one-get-one-free, and just a week or so ago you had me buy another bottle." Dr. B. asked her if she took Tylenol every day, and she said, "No, I don't take it every day... I just take one tablet every night to sleep." He laughed, and then he asked me if it was Tylenol PM. I told him no... just extra-strength Tylenol. Mam-ma was saying, "No it's not, no it's not... it's Equate!" Dr. B. said, "You really don't need that Tylenol - that's what the Ativan is for, but I'm going to allow you - for now - to take ONE Tylenol at night if you want, but NO MORE!" And I brought the Darvocet and Prosom home with me and got rid of it.

Dr. B. asked Mam-ma something - I can't remember, and she said, "I don't care," very blankly, and he asked, "what do you mean you don't care?" and she said, "I just feel so bad that today I just don't care about anything. I just don't care." and she stared blankly across the room, and Dr. B and I just sat and looked at her for about 30 seconds. It was bizarre. So we gave the blood and gathered our things and left - but Mam-ma was so confused she had trouble finding the lab to give her blood... and she had just been down that hallway to give the urine sample. Dr. B. said no infection showed in the urine sample, but just in case there was some, the Cipro would head it off... and the Pyridium would relax the bladder, and he suspected she is having some spasms. That was all he could come up with!

I went to the pharmacy and got the Cipro and Pyridium, and when I got back to her house to put them in her daily medicine compartments - which I filled for 2 weeks on Tuesday when Greg and I went by - her Friday and Saturday night medicines were missing. I asked her about it, and she said she got mixed up and took the wrong day... but everything else was right. So, I replaced that medicine for tomorrow night and Saturday and put in the new meds... and I started her Cipro for supper tonight, because I had talked to my niece Jasmine (who is a CNA at the nursing home), and she told me that she needed to EAT a meal with the Cipro. She also said, "It sounds like she is dehydrated," which is pretty much what Dr. B. said... and Jasmine also said that Mam-ma would have to straighten out that fluid intake on her own, which is true. Anyway I got the medication straightened out - and I handed Mam-ma a Pyridium and told her to take it, and to take another at supper time.

I left and went on to Wal-Mart to buy OUR groceries, and Greg called me. "Mam-ma Polly has called and wants you to call her when you get home." So I turned around and phoned her, and she said, "You shoulda told me to take food with that medicine. I just threw up everything in my stomach!" I told her I really didn't think that she needed to eat with the Pyridium, and it had been so soon that I wondered if something else wasn't going on. "Well no it's not!" she said. "I was talking to Ruby, and I hung up and felt that coming up, and I tried to hurry to the kitchen, but I didn't get there." I asked if there was a mess to clean up and she said she had already done it. Then she said, "All that yellow stuff came up." I pointed out that the pill was brown. "Yeah, I know," she said, "all that reddish brown stuff came up." I told her she didn't have to take any more of those pills, and she said, "But I NEED them! I'm gonna take the next one at supper with food."

She said she was going to eat some chicken stew I had taken her, but I put onions and spices in that, and I told her I felt it was too heavy - to just fix some soup. No telling what she will do! But in talking to Suzanne and Jasmine since, Jasmine says that Pyridium wasn't in her system long enough to make her vomit, so we don't know what happened there, but Suzanne and I have surmised that if she took two extra doses of night-time medication, THAT is what has lowered her BP (and possibly upset her stomach!). At night she takes a Coreg for blood pressure, her Synthroid - a thyroid medication, and her Nexium for acid reflux. So since Tuesday, she's had 2 extra doses of those!

So, she is really mixing up her medicine, which I suspected yesterday when she called. I don't have any clue what to do about it beyond putting the meds in those little boxes. I am soooo glad Suzanne called her yesterday and I didn't take her to the ER. As Jasmine put it today, "So in essence, she didn't need to go to the doctor?" Exactly! And there is no way I can keep her from taking that medicine Dr. B prescribed today, but hopefully 3 days' worth won't hurt her. It's all I can do.

So that was my day. Oh yes, I got to the car with my groceries and noticed milk filling a Wal-Mart bag... guess one of my gallons of milk had burst... so I had to return to the store to exchange that. It was about 93 degrees, and I had a car filled with chicken and milk products, so I had to really hurry. I'm whizzing down the aisle back to the service desk with a fresh jug of milk, and one of my earrings goes flying across the floor. "What else?" I'm thinking, but fearing I shouldn't even wonder! I was soooooooo glad to get home to Greg and the cats and my clean house! And tomorrow is beauty shop and groceries for Mam-ma! The fun continues... I hope things are quieter in your neck of the woods!

1 comment:

Mark said...

Here's hoping it was just those extra doses causing her abdominal pain and headache. I suppose that with older folks, vomiting can be delayed quite a bit.

You are strong and patient. It is interesting how much differently she speaks with you vs. Suzanne.

My mother's father made it to age 93. He was fortunate to have lived in his own house until 92, when he moved from Kansas down to Arkansas to be closer to family. None of my family served as caregiver to any of my grandparents in the capacity that you do for Mam-ma.