Friday, August 26, 2011

I'm So Dizzy... My Head is Spinning...

It almost never fails.  Timothy comes for a visit, and Mam-ma Polly has a "spell!"  So I should not have been surprised when my phone rang Sunday evening... "I tell you what," Mam-ma began... "I've got to go to the doctor.  I'm can't take much more of this being dizzy."  Mam-ma's dizziness had first been reported to me on Thursday, when the nurse arrived for work that morning to find Mam-ma sitting on the porch, overheated and wearing a thick sweater fastened tightly up to her chin.  The nurse made her go inside.  She also discovered that Mam-ma had not taken her night-time "sleep aid" because, as she told me later... "I don't want to get hooked on drugs."

I asked Mam-ma if she had spoken to her nurse, and she said she had.  I told her I would speak with the nurse, also... at least by Monday morning.  She then asked, "Have you got the baby?"  "Yes," I answered... "but I will still talk with your nurse."  We hung up, and I phoned the nurse at the ALF.  It occurred to me that when I first moved Mam-ma to Southridge, I took all of her meds from home... and there was a scrip for Meclizine, which is prescribed for vertigo.  When I spoke with Peggy, the weekend nurse, she said that all vital signs were good.  I asked about the Meclezine, and she said, "You are right!  She does have some... I will give her one."

So Monday morning, Timothy and I went to check on Mam-ma.  She was dressed, but lying down on her bed, covered with an afghan.  She said she was still dizzy.  I spoke with the daytime nurse, Lola, and made sure that she was aware of the dizziness problem persisting... and she said she would keep Mam-ma on the Meclizine - and let her doctor know what was going on.  I thought all was well.

So we had chalked up her dizziness to the heat and lack of sleep. All vital signs were good. I visited her on Friday, and she seemed fine. I returned on Saturday, and she was still well. When she called Sunday night, her first words were, "I bet you don't have time to talk to me." "Why would you think that?" I replied. She couldn't say. But she told me she needed to see a doctor for her dizziness. I reminded her that we no longer see a doctor - the doctor comes to see her now... every month. If there is a problem in between times, we need to report it to the nurse, who will talk with the doctor.

Tuesday afternoon, the phone rang... Lola.  She said Mam-ma was still dizzy, and that she was not able to put her thoughts together well.  She said, "It's worse than yesterday.  I've spoken with her doctor, and he either wants her taken to our local ER... or transported to the hospital where he is in Jacksonville (some 50 miles away), so that he can do a total work-up on her.  Now, while I am having this conversation, Timothy has picked up the extra phone in our bedroom and is talking to Lola... "Un-huh...oooohhh... yeah, yeah, yeah..." mimicking me and my responses to Lola!  I got him off the phone and told Lola that I thought we would opt for the ER, but I would talk with my husband and get back with her shortly.

My husband said he would watch Timothy while I went to the ALF to check on things.  When I arrived, Mam-ma was confused and dizzy, and we all agreed she needed to be transported to the ER.  An ambulance came almost immediately, and off we went.  I was not comfortable driving her there... and I knew that if we walked in, there was every possibility she would be made to sit up and wait in the waiting area for who knows how long.  This way, she was wheeled immediately to a room.

Immediately an IV port was inserted, and Mam-ma was hooked to the machine to monitor her vitals.  Her blood pressure was 114/69 - a very low reading for her.  I was doubly glad we came and that I had her transported by ambulance.  I handed my print-out to the nurses that contained all of Mam-ma's data - insurance/Social Security numbers, medications and dosages, prior surgeries and medical history, contact info for emergencies, allergies, and more.  They were all extremely impressed!

The ALF doctor had suspected an inner ear problem, but Mam-ma's ears were clear.  The ER doc suspected a lingering UTI, since she was treated for one a month or so ago, and he said sometimes they can be hard to obliterate - and cause all sorts of troubles, including dizziness.  An EKG, chest X-ray, CT-scan, and lab work were ordered to rule out stroke, heart attack, renal failure, and a thyroid problem.  All came back as "normal."  The urinalysis was clear - no infection.  Kidney function was slightly diminished, but the doctor said, "I'll take it for 98 years old.  In fact, I'd take her labs any day of the week!"

The diagnosis was just unexplained dizziness... treatment was to continue Meclizine for a few days, stay off her feet and use a wheelchair to get around... and hope it subsided.  Someone from the ALF came and got her and drove her back to the ALF.  I followed, and we got her settled in bed.
James, the maintenance guy, had come to see Mam-ma as the ambulance personnel arrived, and he had promised her that "we'll get those cherries planted when you get back."  I didn't know what that was all about.  But later Tuesday night, my mother and her husband dropped in to check on Mam-ma, and she let it slip that she has been sent "to the house" several times lately for getting overheated.  In fact, Tuesday morning, she had asked James to lower the hanging flower baskets on the front porch so she could remove dead leaves, and she got dizzy and fell.  She told me this in the ER... but she had not told her nurse or the aides that she fell.  Luckily, she was not hurt.

She told my mom that while cousins visited recently, they purchased fresh cherries at the store, and Mam-ma saved the pits and dried them to plant.  She said James told her he would dig a hole and help her plant them... and that "we'll never see them," meaning she won't live enough to see a tree grow from those cherry seeds!  Lola, the nurse, told me later that Mam-ma told James that she needed to dig the hole herself!  I told Lola that I had experience with Mam-ma and hole digging - and I had wrestled a shovel from her once, and she cursed at me!  Lola was stunned.  I told her, "I'm just warning you... she can be a stinker!"

Anyway, I talked to James, and he assured me that he would take good care of Mam-ma and make sure she was "happy, but that she doesn't get hurt."  Because he is a man, and Mam-ma adores him, he might have a shot at making that happen!  While Mom and her husband visited Mam-ma, an aide came in with clean laundry and put it away in the drawers.  Another aide came in to retrieve Mam-ma's dinner dishes... and Mam-ma had already been up and returned them to the kitchen!  So much for staying off her feet and in a wheelchair!

The bottom line is, we are pretty certain that Mam-ma is overheating, despite her protests that she is not.  She claims she is cold and doesn't sweat.  The nurse has tried to explain to her that just because you don't feel hot and sweaty doesn't mean you are not overheating.  She was also told in the ER that she needed to drink more fluids throughout the day... something she does not do.

When I got back home, Timothy had slept 2.5 hours, so his Uncle Greg had really had a fairly easy time of it, thank goodness.  I had alerted my mom and my sister, and both were on standby, should I need them.  But all worked out well in that regard.

I have cautioned Lola that my grandmother is stubborn and fiesty... and she doesn't listen.  She will probably get overheated again... and that's just the way it is.  My sister took Timothy to visit on Thursday, and she was already out of the wheelchair and using her walker again.  My sister said the wheelchair was parked in the hallway outside Mam-ma's door... as if she were done with it!  She pushed Timothy up the hallway in her walker... actually quite a distance.  So I assume she is feeling better and the Mecclizine has worked.

The other concern I had at the ER was what might be done for - and to - my grandmother.  I could see she was not "right," but based on my experience with her, I felt this still was not all that serious.  And I questioned the doctor about all of the tests... were they really necessary?  What would they do should a problem be found?  After all, she is almost 99, a DNR (Do Not Recuscitate) patient, and she does not want any heroic measures taken to prolong her life.  The doctor agreed... no surgeries, nothing invasive.  But he said, "If it is a stroke or her thyroid, we might adjust her medications.  If it is a UTI or a heart attack, we would give appropriate medications to treat the problem."

I felt better knowing that we were on the same wave-length, and my point is that you must speak up.  You must advocate for your loved one and say, "Hey... no heroics here.  No unnecessary poking and prodding and making him/her uncomfortable.  We're not here to run a tab to Kingdom Come - even if Medicare and other insurances will cover it."  After all, my grandmother and I had just had "the conversation" on Saturday about the last days of her life and how she does not want to be a burden - or put through the wringer.

So for now, the "crisis" of the moment is averted.  Timothy comes again to stay with us for a few days on Sunday, so who knows what will happen.  One thing is for certain... it will never be dull!


Mark said...

Glad they didn't find anything major going on, but not glad because sometimes it's better when you know for sure and they can just do whatever needs to be done. Sadly, healthcare is not as simple as auto maintenance (which is not so simple anymore, either!). I've decided that, although the statistics are against me, I'm using Mam-ma as my longevity role model.

Debbie Robus said...

I agree, Mark! However, I am fairly sure we DO know what was wrong with her, since she let it slip to my mom that she had gotten overheated several times - many more than the two of which we had become aware in recent days. Apparently she does not understand that you can be overheated and feel chilled - and not sweat. And she has never been one to drink enough water throughout the day. So we are pretty sure she dehydrated.

As for the longevity role model, you are on target! We've been having a Facebook discussion about our school custodian, Pop Garrett, who lived to be 108. At that rate, Mam-ma has at least 9 more years! By that time, Timmy will be in Little League, and I will probably need a rubber room!