Thursday, March 30, 2006
I just added a paragraph...
...to the Guilt Trip essay, to which the link will directly lead you. It's an omission that's been bothering me ever since I published the essay and have been attempting to unsuccessfully remind myself to add since publication. My self-reminders were finally successful.
Later.
Later.
Surprisingly good day yesterday...
...despite Mom complaining of unusual stiffness and body aches both morning and night. Some of the detail is at The Dailies post for yesterday. Besides what's reported there, Mom was very animated, helped me bake what looks to be some luscious banana bread almost exactly from a Joy of Cooking recipe that does not include any liquid other than bananas (a lot) or eggs. Mom mashed the bananas. Her napping time was shortened, as well, and we spent a lot of time just talking, watching more episodes of Northern Exposure, only one informal exercise session but she did well (she doesn't really realize we're doing exercises when we do these and I leave her in her rocker). It was a great rainy day for both of us.
I continued my research on alternate sources for Niferex-150 after she went to bed. Much to my surprise, one of the links buried a couple of pages back brought up a TriCare Pharmacy listing for Niferex-150 Forte, which, if prescribed for her, we'd be able to get for an astoundingly reduced price. The problem is that it also includes megadoses of Folic Acid and Vitamin B-12, neither of which Mom needs. I decided to fax the doctor today with the following discussion of the possibility of him prescribing this supplement for her:
In my search I also found an article that addresses iron supplementation for people with Chronic Kidney Failure, chiefly those who are on dialysis, published by the National Kidney Foundation. It addresses supplementation by injection, as well as maintaining adequate levels of Erythropoietin. Although interesting, I'm not sure the article applies to Mom. First of all, she's not on dialysis and appears to be quite a ways away from that possibility. Second, there has been, up to 9/02/04, no indication that her erythropoiesis is challenged. Third, everything except her direct anemia indicators run fine to high. It's possible that I'm misunderstanding, from Mom's perspective, some of what the article talks about. And, of course, it wouldn't hurt to run new tests on all those items related in any way to iron deficiency anemia. Third, she rarely reaches a hemoglobin count of 11 or above, but her doctor is satisfied with her range and I can't help but think it's because everything else indicates that her body is doing the best it can and all other indicators suggest that further types of therapy (except for blood transfusions if she runs too low) would not help. I'm not sure that I'm even going to mention the article and its recommendations to her PCP on Tuesday. I'll probably just wait and see what he says about the possibility of prescribing the enhanced Niferex-150.
When I peaked in on her at 1030 her eyes were open but she asked me to let her continue to sleep. As I close this post it is noon. I'll check on her again but if she wants an extra hour or so, I'll let her go. We're experiencing the tail end of one low and the advance feelers of another which promises rain tomorrow, make that Saturday (I'm a day ahead of myself).
Later.
I continued my research on alternate sources for Niferex-150 after she went to bed. Much to my surprise, one of the links buried a couple of pages back brought up a TriCare Pharmacy listing for Niferex-150 Forte, which, if prescribed for her, we'd be able to get for an astoundingly reduced price. The problem is that it also includes megadoses of Folic Acid and Vitamin B-12, neither of which Mom needs. I decided to fax the doctor today with the following discussion of the possibility of him prescribing this supplement for her:
Possible Prescription for Niferex-150 Forte:Later on, before her appointment next week, I'll probably do some research on the long term effects of high levels of folate and B12, if any exist.
Currently my mother is taking two Niferex-150 capsules a day to keep her anemia in relative check. This iron supplement is strictly OTC and not covered by her Medicare/TriCare prescription coverage. We are paying about $80.00 per 100 capsules for this supplement. I've just discovered that Medicare/TriCare does cover Niferex-150 under prescription if it is prescribed as "Niferex-150 Forte". The cost to us would be $27.00 for a 90 day supply (180 capsules).
There is, however, a problem. Each Niferex-150 Forte capsule contains 1 mg Folic Acid and 25 mg Vitamin B12. My mother always runs high on B12 on her blood tests and frequently runs high on Folate. Her last blood tests for these were taken on 9/02/04 (you should have copies of these from your previous office):
Folate: 24 ng/ml which was nominally high for Prescott elevation (reference range 6.0-23.0) and fairly high for Mesa elevation (reference range 3.0-17.0).
B12: 1092 pg/ml which was fairly high for both Prescott elevation (referene range 220-960) and Mesa elevation (192-982). She has, in the past, run as high as 1200 pg/ml.
There are a couple of adjustments I could make in her supplements to alleviate some of the problem:We can afford to continue to buy the OTC Niferex-150 without added Folic Acid and B12. Although it would be nice to be able to save a substantial amount of money by getting this iron supplement by prescription, I'm also leery of the necessity to also raise her B12 and Folic Acid, in the bargain, by the amount required by the prescription iron supplement. In your opinion, would it be best to stay with the non-additive OTC supplement and bite the bullet regarding cost or will she be okay on the prescription supplement with the substantial increase in B12 and Folic Acid? I understand that you may want to run some inclusive iron TIBC, B12, Folate and possibly other tests before deciding.
- I can stop her extra 400 mcg Folic Acid Supplement and see if I can find a multi-vitamin with a lower dose of Folic Acid (her current multi-vitamin contains 400 mcg, so she's getting a total of 800 mcg a day at present). If I can't find an adequate multi-vitamin with a lower dose (or no dose) of Folic Acid, continue her current multi-vitamin and stop her extra Folic Acid supplement, with two Niferex-150 Forte capsules a day she'd be receiving a total of 2400 mcg Folic Acid daily, 200% more than she currently receives.
- I can try to find a multi-vitamin with a lower lower dose of B12 (her current multi-vitamin contains 30 mcg). If I can't find a lower dose in an adequate multi-vitamin and switch her to Niferex-150 Forte, she'd be receiving 167% more B12 than she is now.
In my search I also found an article that addresses iron supplementation for people with Chronic Kidney Failure, chiefly those who are on dialysis, published by the National Kidney Foundation. It addresses supplementation by injection, as well as maintaining adequate levels of Erythropoietin. Although interesting, I'm not sure the article applies to Mom. First of all, she's not on dialysis and appears to be quite a ways away from that possibility. Second, there has been, up to 9/02/04, no indication that her erythropoiesis is challenged. Third, everything except her direct anemia indicators run fine to high. It's possible that I'm misunderstanding, from Mom's perspective, some of what the article talks about. And, of course, it wouldn't hurt to run new tests on all those items related in any way to iron deficiency anemia. Third, she rarely reaches a hemoglobin count of 11 or above, but her doctor is satisfied with her range and I can't help but think it's because everything else indicates that her body is doing the best it can and all other indicators suggest that further types of therapy (except for blood transfusions if she runs too low) would not help. I'm not sure that I'm even going to mention the article and its recommendations to her PCP on Tuesday. I'll probably just wait and see what he says about the possibility of prescribing the enhanced Niferex-150.
When I peaked in on her at 1030 her eyes were open but she asked me to let her continue to sleep. As I close this post it is noon. I'll check on her again but if she wants an extra hour or so, I'll let her go. We're experiencing the tail end of one low and the advance feelers of another which promises rain tomorrow, make that Saturday (I'm a day ahead of myself).
Later.
Wednesday, March 29, 2006
I haven't felt much like writing, lately...
...let alone in here (amazing, huh). I've been gathering resources for some mini-essays on some reminders I posted here to myself over the last few months, doing some baking, enjoying the rain, reading, having a good time with Mom, setting things up for our doctor's visit on April 4th (we'll be meeting friends for dinner before heading back up the mountain in the evening; I've also been calling pharmacies down there close to where we'll be staying to see if I can get a better price on Niferex-150, no luck so far, in fact it looks as though I'm getting about the best off-line price around, despite the fact that I think it's exorbitant).
Thought I'd better check in, though, and let everyone know I'm mellow, at the moment...
...later.
Thought I'd better check in, though, and let everyone know I'm mellow, at the moment...
...later.
Tuesday, March 28, 2006
MCS looked over the Blood Draw results...
...and has this to say:
I faxed the doctor with her Health, BG and BP reviews this morning. In case you're wondering, the reason I don't publish her BG and BP reviews here is because all that information is over at The Dailies, although in a much less compact and handy form.
Later.
Mom looks anemic according to her RBC count and her hemoglobin level. Hypochromasia means that the color of the RBCs is lighter than normal. This can be caused by the fact that each cell has less than the normal amount of hemoglobin in it so it stains lighter. That also indicates anemia. Atypical lymphs are nothing to really worry about unless they are in large numbers. One over the high level is not a lot at all. Unfortunately atypical lymphs can be "made" by techs that are too enthusiastic when they make the slides (we had one tech that pressed so hard to make slides that most of the lymphs looked atypical). They can also be caused by any change in the body-including allergy attacks, transit viruses that really cause no disease, but can affect the body, to just a change in the metabolism of the body. It will be interesting to see if the doctor attaches any significance to this. Personally I wouldn't worry. If Mom had Mono her atypical lymph count would be up around the 60s or 70s and she would have many more lymphs than she has.Out of curiosity, I searched all Mom's test results and, besides this particular draw, she's shown Hypochromasia, usually "2", sometimes "3" on six other occasions, all of which have been accompanied by Hemoglobin in the "9" region. So, I'm not going to worry. So there.
I faxed the doctor with her Health, BG and BP reviews this morning. In case you're wondering, the reason I don't publish her BG and BP reviews here is because all that information is over at The Dailies, although in a much less compact and handy form.
Later.
Health Review: 3/27/06
[To Be Faxed 3/28/06 A.M. to Mom's PCP]
Blood Pressure:
Her pre-dinner BPs look good, including the averages [Average Awakening BP: 137/66; Average Pre-Dinner BP: 120/60]. I’m concerned about her awakening BPs. Although it irritates her to have her BP taken upon awakening (usually anywhere from a 15 minutes to an hour after she awakens), high BP is high BP and I’m wondering if I should increase her before bed dose of lisinopril by 5 or 10 mgs.
Blood Sugar:
Although her Blood Glucose has run, in this period, higher than usual while still remaining in her “good” zone, I’m hoping this will raise her HA1c. You’ll note in the “Extra Meds” portion of the BP chart that lately I’ve given her a second glipizide (10 mg) in the evening, especially when feeding her dessert or a very rich meal.
Urinary Issues:
No change. Macrodantin continues to keep her UTI free.
Hydration:
No change from last month.
Energy Level:
In this period she finally experienced her usual “winter hibernation”, which was late this year: Low energy level, little movement, 14 hours per day of sleep almost every day, occasionally more. A few factors applied: It’s been cold and we’ve had rain and snow; I’ve been having an almost constant cold and although she hasn’t appeared to pick it up, I notice she not only showed some Atypical Lymphocytes on her recent Blood Draw, which she previously never has, but they also ran into the high range. Since everything else in the results looks low normal for her, I’m thinking that her body has been successfully resisting my longstanding cold.
Skin & Circulation:
Two areas, noted below, that I’d like you to check as possibly cancerous, or, at least, of concern. Also, when rubbing down her legs in the evening I’ve noticed an occasional small warm patch on her outer, lower right calf. We just got a new kitten, as well, and she’s been getting a fair number of scratches on her arms and legs which continue to heal well and quickly. Otherwise both continue to be excellent.
Appetite and Diet:
Because she’s been moving so little and sleeping so much, she’s been skipping lunch a lot, lately, or requesting an unusually light lunch. Otherwise, both remain excellent.
Dementia:
Remains unchanged.
Will & Spirit:
Remain strong and high, respectively.
Medications & Supplements:
She’s gotten adult aspirin six times this month (see Extra Meds on BP Report) for various episodes of stiffness or her right knee hurting. I figure both are because she is refusing to move much. I expect this will change within a couple of weeks when the weather rewarms.
CHF:
Furosemide administered 4 times this period due to torso and feet swelling and elevated BP that wouldn’t relent on its own. See BP Report.
COPD:
Her breathing has been very good this period. Other than putting her on concentrated, continuous flow 3/lpm oxygen at night, she hasn’t been mouth breathing much during the day nor has she been moving much so we haven’t used tanked oxygen much.
Bowel Movements:
Continues to eliminate every 24-72 hrs; usually every 48 hrs. Fecal consistency, volume and ease of elimination remain good to excellent overall. Rare use of Phillip’s Milk of Magnesia as a laxative.
ISSUES FOR APPOINTMENT ON APRIL 4TH, 2006 AT 2:00 P.M.:
Blood Pressure:
Her pre-dinner BPs look good, including the averages [Average Awakening BP: 137/66; Average Pre-Dinner BP: 120/60]. I’m concerned about her awakening BPs. Although it irritates her to have her BP taken upon awakening (usually anywhere from a 15 minutes to an hour after she awakens), high BP is high BP and I’m wondering if I should increase her before bed dose of lisinopril by 5 or 10 mgs.
Blood Sugar:
Although her Blood Glucose has run, in this period, higher than usual while still remaining in her “good” zone, I’m hoping this will raise her HA1c. You’ll note in the “Extra Meds” portion of the BP chart that lately I’ve given her a second glipizide (10 mg) in the evening, especially when feeding her dessert or a very rich meal.
Urinary Issues:
No change. Macrodantin continues to keep her UTI free.
Hydration:
No change from last month.
Energy Level:
In this period she finally experienced her usual “winter hibernation”, which was late this year: Low energy level, little movement, 14 hours per day of sleep almost every day, occasionally more. A few factors applied: It’s been cold and we’ve had rain and snow; I’ve been having an almost constant cold and although she hasn’t appeared to pick it up, I notice she not only showed some Atypical Lymphocytes on her recent Blood Draw, which she previously never has, but they also ran into the high range. Since everything else in the results looks low normal for her, I’m thinking that her body has been successfully resisting my longstanding cold.
Skin & Circulation:
Two areas, noted below, that I’d like you to check as possibly cancerous, or, at least, of concern. Also, when rubbing down her legs in the evening I’ve noticed an occasional small warm patch on her outer, lower right calf. We just got a new kitten, as well, and she’s been getting a fair number of scratches on her arms and legs which continue to heal well and quickly. Otherwise both continue to be excellent.
Appetite and Diet:
Because she’s been moving so little and sleeping so much, she’s been skipping lunch a lot, lately, or requesting an unusually light lunch. Otherwise, both remain excellent.
Dementia:
Remains unchanged.
Will & Spirit:
Remain strong and high, respectively.
Medications & Supplements:
She’s gotten adult aspirin six times this month (see Extra Meds on BP Report) for various episodes of stiffness or her right knee hurting. I figure both are because she is refusing to move much. I expect this will change within a couple of weeks when the weather rewarms.
CHF:
Furosemide administered 4 times this period due to torso and feet swelling and elevated BP that wouldn’t relent on its own. See BP Report.
COPD:
Her breathing has been very good this period. Other than putting her on concentrated, continuous flow 3/lpm oxygen at night, she hasn’t been mouth breathing much during the day nor has she been moving much so we haven’t used tanked oxygen much.
Bowel Movements:
Continues to eliminate every 24-72 hrs; usually every 48 hrs. Fecal consistency, volume and ease of elimination remain good to excellent overall. Rare use of Phillip’s Milk of Magnesia as a laxative.
ISSUES FOR APPOINTMENT ON APRIL 4TH, 2006 AT 2:00 P.M.:
- Two skin areas to be examined for possible excision: One a mole at the base of her throat which she’s had forever but has, within the last period, become coarser than usual and a very small dry patch on her left upper forearm that she’s also had for awhile but has begun to increase in the last period.
- She hasn’t yet had a flu shot. Prescott never refreshed it’s flu serum supply after it ran out this winter. It may be too late in the season, but I thought I’d mention it in case it’s not. Also, her last pneumonia shot was in 2000. I’m wondering if it’s time for another.
- Should I worry about her high BPs on awakening and raise her before bed dose of lisinopril, or not worry?
- You’ll probably want to take blood for another HA1c, and any other tests you deem significant.
- Any other routine tests, blood or imaging, that you want to prescribe?
Monday, March 27, 2006
Blood Draw Results are up...
...for 3/24/06. Pretty standard, except for an "Atypical Lymphocytes" reading. She normally has none, but this time she's got a reading 1 point above normal range (a range which has never before been represented). Could be an opportunistic viral infection. There are other possibilities, including one that bingos exactly: Anemia due to Chronic Disease, specifically Chronic Renal Failure. Could be mononucleosis. Her PCP may or may not address this, considering that everything else is fairly well within her normal range, although her Lymphocytes are lower than usual, but not out of range for her. I was hoping for a higher hemoglobin and RBC, but now I understand why she's been so tired, lately. We're, apparently, experiencing a low cycle at the moment. So, basically, she's holding her own, a little shakily at present but hanging in there. This time this lab included the BUN/Creat Ratio, which is nice, and a Hypochromasia reading, as well, which is normal. There is more written about Hypochromasia in pets than in people on the web. Although I can't be sure, I wonder if this addition was ticked off by some of the other readings, most particularly the Atypical Lymphocytes, since any kind of a reading has never before appeared on her tests. At any rate, the fact that the color of her RBCs is normal calms me, a bit.
I'm running a little behind schedule. Better awaken the Mom.
Later.
I'm running a little behind schedule. Better awaken the Mom.
Later.
I'm surprised it's been so long since I last reported, here.
No problems. We've just been doing our thing. I've been reporting regularly in The Dailies. You know this if you've been keeping up with things over there.
I'm unusually interested in the results of Mom's blood draw on Friday, mainly because of the couple of recent incidents of using furosemide on her and having to extend the administration beyond one dose. I discuss that a bit over in the post for today at The Dailies. I'm particularly interested in her kidney functions and her electrolytes. I'll be picking those up in the morning and reporting them here immediately. I'll also be spending the day compiling her blood pressure and blood sugar reports and setting up her Health Review, all of which I'll fax to her doctor either tomorrow or Tuesday, depending on how long it takes me to get all that stuff together. The Health Review will include an outline of what I want to discuss at her upcoming appointment next week. As usual, I'll be publishing that here. Oh, yeah. Gotta remember to reserve a car, too.
I've been setting up Northern Exposure for her a lot over the last few days, which is nice because I enjoy that program, too, although somehow I've managed to keep myself incredibly busy and have yet to watch an entire show.
I also decided to start a "Caregiver History" of our family, as much as I know of it. When I finish it will be published in the Essays section. I decided to do this because it occurred to me that if I catalogue what I remember of caregiving within our family as far back as I'm aware, including what I know of caregiving that went on within extended family, towards both elders and youngers, it might give me a foundation for understanding how it is my born-into family has arrived where it has, at present, in regard to Mom and how we surrepitiously designed her current caregiving situation. I'll let you know when I finish and publish it. This is an aspect of caregiving I don't think anyone's ever addressed: The caregiving history within families and how it relates to "present" caregiving arrangements, for anyone within the family. Something tells me it is important to take this into consideration when studying Ancient One and Infirm caregiving...just a hunch, on my part. Somewhere "back there" in these journals I know I've written a little about caregiving of elders in my mother's family and what I perceived her generational attitude to be toward elder care, as well as what I understood about her parents' generation's attitudes. Now it's time for me to record everything I remember and see what sense I can make of it. So far, nothing spectacular has occurred to me but I've just begun. Expect this one to take awhile, although not as long as the TOC! Somehow, it seems to me that if we know where we've been and what our legacies are in regards to caregiving, it will be easier for us to see where we are and make more conscious, practical, informed decisions about where we're going. I mean, as a nation, family to family, we have all these ideals but we're far from successful at launching them, despite the few and spectacular efforts that are being tried (one of which I mean to address within the next few days). I think part of this lack of success is because we are both unaware and afraid of our family caregiving histories.
One more thing I want to mention regarding "no one" in my family reading my journals. In my superlative snit I was not only unfair to MCS but to MFS, as well, who, for a long time, kept up very regularly with the journals. Since she's gone dark I have no way of knowing whether she continues to read them, or even if she still has a computer. If she is, her computer is hiding any kind of indication that she might be following along. But, anyway, I know it was unfair of me to declare that none of my sisters was doing any reading here, when, in fact, only one of my sisters was completely ignoring these journals.and I apologize for this. I have to watch myself when I'm angry. I have a tendency to condemn the entire world when only one country has disappointed me; and, as well, drag out peripheral disappointments and throw them in with the actual disappointment without identifying them as separate and acknowledging that, within the context of a particular seige of anger, certain disappointments don't belong. Now that I'm aware of this, I'll watch for it.
To bed. It's going to be a long day, tomorrow. Although, the rain will bless its length and I know I'll feel in peak condition.
Later.
I'm unusually interested in the results of Mom's blood draw on Friday, mainly because of the couple of recent incidents of using furosemide on her and having to extend the administration beyond one dose. I discuss that a bit over in the post for today at The Dailies. I'm particularly interested in her kidney functions and her electrolytes. I'll be picking those up in the morning and reporting them here immediately. I'll also be spending the day compiling her blood pressure and blood sugar reports and setting up her Health Review, all of which I'll fax to her doctor either tomorrow or Tuesday, depending on how long it takes me to get all that stuff together. The Health Review will include an outline of what I want to discuss at her upcoming appointment next week. As usual, I'll be publishing that here. Oh, yeah. Gotta remember to reserve a car, too.
I've been setting up Northern Exposure for her a lot over the last few days, which is nice because I enjoy that program, too, although somehow I've managed to keep myself incredibly busy and have yet to watch an entire show.
I also decided to start a "Caregiver History" of our family, as much as I know of it. When I finish it will be published in the Essays section. I decided to do this because it occurred to me that if I catalogue what I remember of caregiving within our family as far back as I'm aware, including what I know of caregiving that went on within extended family, towards both elders and youngers, it might give me a foundation for understanding how it is my born-into family has arrived where it has, at present, in regard to Mom and how we surrepitiously designed her current caregiving situation. I'll let you know when I finish and publish it. This is an aspect of caregiving I don't think anyone's ever addressed: The caregiving history within families and how it relates to "present" caregiving arrangements, for anyone within the family. Something tells me it is important to take this into consideration when studying Ancient One and Infirm caregiving...just a hunch, on my part. Somewhere "back there" in these journals I know I've written a little about caregiving of elders in my mother's family and what I perceived her generational attitude to be toward elder care, as well as what I understood about her parents' generation's attitudes. Now it's time for me to record everything I remember and see what sense I can make of it. So far, nothing spectacular has occurred to me but I've just begun. Expect this one to take awhile, although not as long as the TOC! Somehow, it seems to me that if we know where we've been and what our legacies are in regards to caregiving, it will be easier for us to see where we are and make more conscious, practical, informed decisions about where we're going. I mean, as a nation, family to family, we have all these ideals but we're far from successful at launching them, despite the few and spectacular efforts that are being tried (one of which I mean to address within the next few days). I think part of this lack of success is because we are both unaware and afraid of our family caregiving histories.
One more thing I want to mention regarding "no one" in my family reading my journals. In my superlative snit I was not only unfair to MCS but to MFS, as well, who, for a long time, kept up very regularly with the journals. Since she's gone dark I have no way of knowing whether she continues to read them, or even if she still has a computer. If she is, her computer is hiding any kind of indication that she might be following along. But, anyway, I know it was unfair of me to declare that none of my sisters was doing any reading here, when, in fact, only one of my sisters was completely ignoring these journals.and I apologize for this. I have to watch myself when I'm angry. I have a tendency to condemn the entire world when only one country has disappointed me; and, as well, drag out peripheral disappointments and throw them in with the actual disappointment without identifying them as separate and acknowledging that, within the context of a particular seige of anger, certain disappointments don't belong. Now that I'm aware of this, I'll watch for it.
To bed. It's going to be a long day, tomorrow. Although, the rain will bless its length and I know I'll feel in peak condition.
Later.
