Friday, September 8, 2006
Health Review: 9/8/06
Blood Pressure:
No BP average this period. Seems to be a bit harder to control over the last few weeks, as I’ve been having trouble controlling her Blood Sugar.
Blood Sugar:
Beginning 8/20/06 I’ve had unusual trouble controlling her blood sugar. I began to notice that it was spiking unusually for what appeared to be no reason in the morning and evening. I experimented with cutting out her orange juice in the morning, getting her to move a little more and cutting back refined carbohydrates to almost nothing. Although these keep her out of the 200 range, none of these seems to be ultimately reliable. Getting her to move more does seem to help but I can’t always get her to move enough to help. I’m wondering if a change in medication, either to another type or raising what she’s taking now, might be in order. I understand, though, that glipizide ER doesn’t necessarily yield good results in doses above 10 mg per day and my experience seems to bear that out, even though I give her two 10 mg pills a day, one in the morning and one at dinner. The second one used to help especially if she ate something at dinner that included noodles, rice, bread, something like that. However, neither dose seems to be as effective as previously, anymore.
See “Other Notes” below.
Urinary Issues:
See “Hydration” below.
Hydration:
When I started having trouble controlling her BG (and BP, nominally), I also noticed that she began shedding water like mad. On 9/6/06 she seemed to be displaying what might have been a low sodium incident: General, unusual weakness, especially on right side. I immediately fed her some V-8 juice and within less than an hour she seemed fine, again. Since then I’ve been making sure she gets plenty of sodium and potassium. She’s still flushing more than usual. Trying to make sure she gets neither too little nor too much fluid has been very ticklish, but I’ve been pretty successful.
Energy Level:
No significant change in energy level. Since 8/30/06, though, I’ve been making sure that she sleeps no more than 12 hours at night and no more than a two hour nap, if she’s down that long. I have been getting her out a little more, as I can coax her to move, but this isn’t always successful. She remains strong willed and if my coaxing threatens to become harassment, I drop it.
Skin & Circulaton:
Remain excellent, overall. There are a few “old thing” growths on her right leg and one at the inner corner of her left eyebrow I’d like you to check. The patch on her arm that you looked at in April has remained unchanged. The only one of these that I think looks suspicious is the one at the inner corner of her left eyebrow, but I’ll make sure she is wearing loose pants for her appointment so you can look at the ones on her right lower leg, too.
Appetite & Diet:
Appetite remains good and unchanged. See “Blood Sugar” above for the changes I’ve recently made in her diet.
Dementia:
Her alertness and memory seem to have improved a bit since her Anemia has come under control. Not a lot, but noticeable to me.
Will & Spirit:
Remain very strong and very high, respectively. Despite the problems I perceive we’ve been having, she continues to report that she feels fine, and acts as though she does.
Meds & Supplements:
In a further attempt to control her BG, I’ve added a teaspoon of curry powder to her daily V-8 juice for the last two weeks. This used to work very well. Now, though, her BG is so unpredictable that it isn’t working as well as I’d hoped.
CHF:
She seems to be doing okay with this. 10 mg Furosemide administered once a day over a two day period this time. The humidity has been very high, which tends to cause her to dry hack a bit in order to clear her throat, but this doesn’t seem to be accompanied by unusual fluid retention.
COPD:
No change from last report.
Bowel Movements:
No change from last report. Laxatives administered two days in a row on 9/4/06 and 9/5/06 in order to stimulate a bowel movement, which she had on 9/7/06. I think this constipation, though, may be related to her unusual flushing of water, lately.
OTHER ISSUES TO BE DISCUSSED AT APPOINTMENT:
No BP average this period. Seems to be a bit harder to control over the last few weeks, as I’ve been having trouble controlling her Blood Sugar.
Blood Sugar:
Beginning 8/20/06 I’ve had unusual trouble controlling her blood sugar. I began to notice that it was spiking unusually for what appeared to be no reason in the morning and evening. I experimented with cutting out her orange juice in the morning, getting her to move a little more and cutting back refined carbohydrates to almost nothing. Although these keep her out of the 200 range, none of these seems to be ultimately reliable. Getting her to move more does seem to help but I can’t always get her to move enough to help. I’m wondering if a change in medication, either to another type or raising what she’s taking now, might be in order. I understand, though, that glipizide ER doesn’t necessarily yield good results in doses above 10 mg per day and my experience seems to bear that out, even though I give her two 10 mg pills a day, one in the morning and one at dinner. The second one used to help especially if she ate something at dinner that included noodles, rice, bread, something like that. However, neither dose seems to be as effective as previously, anymore.
See “Other Notes” below.
Urinary Issues:
See “Hydration” below.
Hydration:
When I started having trouble controlling her BG (and BP, nominally), I also noticed that she began shedding water like mad. On 9/6/06 she seemed to be displaying what might have been a low sodium incident: General, unusual weakness, especially on right side. I immediately fed her some V-8 juice and within less than an hour she seemed fine, again. Since then I’ve been making sure she gets plenty of sodium and potassium. She’s still flushing more than usual. Trying to make sure she gets neither too little nor too much fluid has been very ticklish, but I’ve been pretty successful.
Energy Level:
No significant change in energy level. Since 8/30/06, though, I’ve been making sure that she sleeps no more than 12 hours at night and no more than a two hour nap, if she’s down that long. I have been getting her out a little more, as I can coax her to move, but this isn’t always successful. She remains strong willed and if my coaxing threatens to become harassment, I drop it.
Skin & Circulaton:
Remain excellent, overall. There are a few “old thing” growths on her right leg and one at the inner corner of her left eyebrow I’d like you to check. The patch on her arm that you looked at in April has remained unchanged. The only one of these that I think looks suspicious is the one at the inner corner of her left eyebrow, but I’ll make sure she is wearing loose pants for her appointment so you can look at the ones on her right lower leg, too.
Appetite & Diet:
Appetite remains good and unchanged. See “Blood Sugar” above for the changes I’ve recently made in her diet.
Dementia:
Her alertness and memory seem to have improved a bit since her Anemia has come under control. Not a lot, but noticeable to me.
Will & Spirit:
Remain very strong and very high, respectively. Despite the problems I perceive we’ve been having, she continues to report that she feels fine, and acts as though she does.
Meds & Supplements:
In a further attempt to control her BG, I’ve added a teaspoon of curry powder to her daily V-8 juice for the last two weeks. This used to work very well. Now, though, her BG is so unpredictable that it isn’t working as well as I’d hoped.
CHF:
She seems to be doing okay with this. 10 mg Furosemide administered once a day over a two day period this time. The humidity has been very high, which tends to cause her to dry hack a bit in order to clear her throat, but this doesn’t seem to be accompanied by unusual fluid retention.
COPD:
No change from last report.
Bowel Movements:
No change from last report. Laxatives administered two days in a row on 9/4/06 and 9/5/06 in order to stimulate a bowel movement, which she had on 9/7/06. I think this constipation, though, may be related to her unusual flushing of water, lately.
OTHER ISSUES TO BE DISCUSSED AT APPOINTMENT:
- The big issue is the sudden difficultly I’m having controlling her blood sugar. I’m thinking that either an increase or a change in her oral medication might be in order. I understand it is common for Type 2 diabetic oral meds to decrease in effectiveness over time. I’ve had only limited success ameliorating this sudden change through diet, adding exercise, and keeping her up more than usual, but, frankly, her diet was already pretty well controlled, and keeping her moving as much as is needed to lower her blood sugar spikes may not be possible on a long term basis. Certainly, I have trouble with this in the short term.
Over the next few days leading up to her appointment on September 12th at 1400, I’m going to go back to her usual diet, which will include:- Orange Juice in the morning, about 2/3’s cup diluted with about a cup of water;
- The typical amount of carbohydrates during the day, which usually includes 1 oz roasted peanuts with her V-8 juice at lunch and may sometimes include dinners with noodles, or perhaps a hamburger or tuna sandwich.
It’s possible that during this period her blood sugar may shoot up pretty high, but I expect it to remain below 300. At any rate, I don’t think, for just four days, this will hurt her, and I want to make sure what I seem to be observing is in fact happening. Then, you and I will have some hard data we can discuss. During these four days, I will take her blood sugar and blood pressure when she awakens and just before dinner. I will also note the times she’s eating, exactly how much she’s sleeping and how much movement I’m able to coax her into. - I’m wondering if maybe her lisinopril should be increased a little, but I’ll leave this up to you to decide. I’m fine, either way, as I think some of the spikes may have to do with me controlling her routine so severely over the last couple of weeks that she’s gotten irritated with me a lot.
- I’d love to have you draw blood for at least an HA1c. Any other tests you want to order will be fine with me, as well.
- I’ll do as much research as I am able about alternate Type 2 diabetic medications before her appointment. I think we’ve already determined that Glucophage is not a good idea for her. As well, my understanding is that Avendia probably wouldn’t be a good idea, either, for her. However, there are lots of others out there. I’m not convinced that insulin shots are necessary at this time. I don’t think that the problem is that her body has changed all that much, I think, rather, it simply may be that her usual medication may have reached it’s limit of usefulness for her, as, I understand, often happens. At any rate, in all the above I will certainly defer to your expertise and opinion.
- As well, in case it’s necessary, I want you to know that if you want to monitor her more closely with more frequent appointments for awhile, this is not a problem. Since her Anemia has come under such good control, she travels much better than before. It’s still tiring for her, but not nearly as much as it used to be and, as well, she looks forward to trips to The Valley, again. Day trips work out best, as she is very uncomfortable spending the night in unfamiliar territory and, as well her usual routine doesn’t lend itself to overnight visits in hotels, but other than that, I’m sure we can handle more frequent day trips if you feel closer monitoring is necessary, for awhile.
