Mom & Me Four Archive

    My "fault", not hers. I'm expecting her to rouse on her own at any minute, hoping for a few more minutes.
    Yes, I picked up an upgrade copy of Microsoft Office Professional with a $75.00 rebate attached. It seems that one can use the upgrade on certain versions of Microsoft Works, one of which I have. I've already installed it, applied online for the rebate and fleeced out the chart making capability. It is not disappointing. I've got other maintenance tasks to which I want to attend this weekend, so I may not get around to importing the numbers and dates and designing a new graph until later.
    I'm itching to work on the TOC this weekend, so I may do some of that. Not sure why. Maybe I'm in a reflective mood.
    Guess I'll go back to the other computer.
    Later.

...I can see that right now, if I'm going to continue working up comparisons of her stats. I tried in three different spreadsheet software systems, Open Office (Windows XP), Microsoft Works (Windows XP) and Appleworks (Mac OSX Tiger), all of which had Auto Chart Functions and only Auto Chart Functions, and none of them was capable of producing the graph I wanted and calculating and inserting assumed data based on the nature of one's parameters (which one is able to set manually). I tried in the three companion database programs, as well. None of them is even close to being as manipulative as Excel. Not that I have been campaigning against Excel. I've just never owned it. I've used it at work(s).
    Long story short, I had to draw up the graph by hand and do calculations separately. I didn't bother to enhance the graphic by superimposing units of liquid measurement and time so that a more accurate smooth time would be insinuated. I had to confine data to what could be read on one landscaped 8.5" x 11" sheet of paper (for faxing). As well, since I had to create the graph in a low level graphic environment (finally decided on Appleworks Draw), save it as PICT, then convert if from PICT to JPG in order to keep distortion at a minimum. There is minor distortion, as it is. You wouldn't notice it, though, if you weren't looking for it.
    So, the announcement is that I just uploaded Mom's Anemia Profile: 7/27/00 - 3/24/06.
    I'm looking at it as I write. Although it's crude it does the trick. I wasn't sure what to expect when I got the idea. I don't think anything would have surprised me and this doesn't. I remember all the peaks, all the canyons and all the intervening plateaus. I just didn't think the up and down dips would be quite as obvious. You have to understand, though, that the "dates" section is not organized in standard months but rather by the dates of her blood draws, which are not completely orderly. Patterns, though, do emerge:

• she spends most of her time in the middle white range, approximately 9.3 - 11.3. Even more specific, a lot of time in the 10s.
• She spends a not inconsiderable amount of time in the 9s.
• If I had represented time more accurately, the jags would smooth out considerably. However, jumps and dips do occur.
• I can very easily correlate certain periods of time with the amount of iron supplementation she was receiving at any one time. In the early years of doctors attempting to diagnose her anemia, when she left a particular anemic state they would advise me to take her off the iron. As well, through much of the valleys I was not using the superior iron I've been using since July of 2004. As it turns out, since July of 2004 she has remained in the white zone, despite the obvious variation.
• I think the reason why I calculated three averages is obvious. Even so, her average has dropped. She never reaches Normal Range any more. She appears to be exiting the time when aggressive iron supplementation "works well". It still works. That's a good sign.

    It's been yet another mellow day, and yet another Saturday in a row begins tomorrow. How nice! I think I'll be doing some maintenance and polishing off some essays and addressing reminders over the weekend, probably tonight, too.
    Anyway, have at the graph. Sorry for it's primitivity. I'm one copy of Excel from doing what I wanted to do. I just couldn't wait.
    Later.

...and Mom slept in again. And I got to some of them. The second, doing a graphic anemia profile on Mom's hemoglobin from 7/00 - 3/06. There are 47 readings in the time frame. I just want to see a picture of the flow of her profile. I thought such a thing would be easy enough to toss off, after data entry, in either Appleworks spreadsheet program or Microsoft Works spreadsheet program. It was beyond me, and I'm not ashamed to say I'm pretty savvy at figuring software things out. So, after several hours of fooling around in both spreadsheet and database programs between two platforms and getting nowhere, I realized the easiest way would be to do it by hand in a drawing program. It's simple and straightforward and I can create it in order to size it down and publish it here.
    As I collected the isolated data I did sneak peaks at her related BMPs, which signal kidney function. Sure enough, when her hemoglobin is high her kidneys are fine; when it's low her kidney's look sensitive but functioning.
    So, that's what I've been doing.
    I'm thinking such a chart would be valuable to her PCP as well as me.
    Yes, her stats are in. Her blood pressure looks very good today. We've been skimping on the fluids, not enough to cause bowel impaction but enough to where both she and I are comfortable. This seems to make a difference.
    I know I'll have to run at least a few minor errands when I awaken later today but I'm going to try to put Costco off until Saturday. Maybe Mom will want to go along. If not, I can get it done between 0930 and 1030 and have some time to cool down before awakening Mom.
    Damn, time for bed.
    Later.

...redesigning and reprinting my business card. I made it into a gif but it looks like shit and I don't won't to fool around anymore trying to ready it for a journal debut. If I ever meet you, you'll probably get one. All it does is advertise my websites under the umbrella The Mom and Me Journals dot Net, the tagline which all of you can read on the first page, the web address, my email address; flip the card over and there is a handy dandy mini-form so I can document where I met the recipient, the date and any "other" pertinent "info". You'd be surprised how many times I've used them. I created them originally just prior to the Sharing Wisdom/Fearless Caregiver Conference and passed out some, not nearly as many as I expected. I needed to change them in order to reflect the more precise identification of my site, and the new email and internet addresses. In case you're wondering, no one's ever found it curious that I have these cards.
    Mom's been up and is now down. I took stats. I probably will again later. She's in good spirits, "just tired."
    I'm a little frenetic. I'm still not "catching up" on my sleep, but I'm pretty productive, even if it is being applied to offhand projects.
    I feel like this is the weekend. I don't know why. So far I've experienced two Saturdays. I think tomorrow is going to be another Saturday.
    Later.

    I honestly don't know when I'm going to get Mom up. I'm watching our local weather, right now. High of 57 today, cloudy, windy, 33 tonight, I'm feeling mellow. Winds west at 10 to 20 miles per hour. That's visible wind.
    Fair skies Saturday through Monday. Maybe I'll just work inside on the web site today, give Mom a rest, some sausage and eggs for breakfast, and home made bread toast, maybe she'll want some marmelade, yes, I will take stats.
    Oh, there's another low extending through most of California. Maybe we'll get some more rain. Maybe I can do some planning regarding gardening.
    Oh. Better put the oxygen out.
    The Monet Rose is doing very nicely! I'm pleased! Almost evokes a desire to nurture from me! Hardy little plant. Bravo!
    Just so you know, another finished essay is possible. So is more cataloguing. So are many things. It's one of those days. We'll see.
    Later.

    I just finished an published an essay that I started in January of 2005, I think, well, it'll say when you go to it. I left the original date and posted a date for today as finally being published. You'll notice a lot of this going on within the next few days. This essay is, and I'll publish the link here, The Myth of the Wisdom of the Ancients, a little brainstorm I had back when and never finished. It's a short little ditty, to the point, lots of examples. Check it out.
    The thing is, I have saved it to the template for this journal twice but the publishing facility has stuck twice, once at 32% and once at 82%. At least, publishing this will kick it into the daily news, so to speak, template. It did successfully publish throughout over at the Essays section.
    So, I'm going to publish this now and see what comes up on the front page links section.
    No, Mom is not up yet. Yes, I'm letting her sleep in, for awhile, until I get worried, anyway. I've got prescriptions to pick up later. Could have done it earlier but didn't. Did some maintenance stuff, including finishing that essay, instead.
    Later. Maybe anon.
    Second publishing attempt.

...at The Dailies, her light went out at 2303, just as I signed off over there.
    She has continued to mention the yesterday's trip all day today. It's very gratifying to know that she really enjoyed herself and looks forward to "more like that". So do I.
    Yes, the revision to her medication schedule is completed, and freshly connected to the appropriate link on the right under Special Posts. This time I didn't obliterate the last med schedule; I copied it, posted it under the appropriate date, yesterday, and changed it as necessary. I wasn't thinking last time and deleted part of her medication history. Too late for that one, but I won't be doing that again.
    I'm tired, too. I'll probably retire soon, as well. I think, at the moment, I'll reread everything I wrote today and see if I have anything to add about yesterday's events. Excuse me.
    Just some cosmetic touches.
    Later.

...I took Modified Over The Counter (which means you have to ask for it and they check your id) cold medicine as speed-lite, yesterday. It helped. I was surprised. It also kept my mood up and since it was a "lite", though steady dose I had no hang-over. It also had ibuprofen in it which nipped any possible aches and pains in the bud. All day long. Very nice. I see why people become addicted to OTC cold medicine.
    So, let's see. Let me check my ticks to myself.

• Appointment happening quickly:
      I think we were at the office for about a half hour. We arrived about 15 minutes early and were called in seemingly seconds later. Her PCP and I were both well organized and in sync. Mom commented later that we both talked at the same time. We did, in a way. We modified and finished each other's sentences in an orderly but probably eclectic way. We both discussed everything and expressed our "feelings" adequately. We prepare well and work together well; we run at each other's speed. This was my response to Mom. I referenced her PCP on this as we left. He laughed and agreed.
      Yeah, we've both come a long way.
• An Insurance Glitch:
      I know I've mentioned this before: Her PCP just happens to have another Ancient One who shares my mother's name, down to the middle initial, approximate birth year and lived in Mesa when we did, just down the street and over. At his previous office they were all aware of this and asked a series of questions to make sure things were filed correctly.
      That woman transferred to her PCP's new practice, too. When the lab tech settled down to take Mom's blood he cited her insurance as "HealthNet", of which I'd never heard. I corrected him. He turned medically snotty. I looked over his shoulder at the documentation in her file. Sure enough, copies of her Medicare and TriCare IDs had been crossed out and a "HealthNet" blurb was attached, although the only identifying marker it held was the name with middle initial.
      I pertly informed the lab tech that I did my mother's business, had been doing this for some years and I would have known, I, in fact, would have been the authorization if such a change had occurred.
      The tech coolly informed me, several times that, "if there is a mistake it will be straightened out."
      I was not satified. At the front desk I questioned the administrative assistant (who is very competent, by the way). She remembered "the second My Mother" dilemma, did some advance research before calling the company accountant up, discovered that both "My Mothers" had migrated and straightened out the problem forthwith.
      The moral is, follow up, follow up, follow up if something seems fishy. Anything. Trust your instincts. What's the worst that can happen? You'll find out too much? I don't think so. And if the people with whom you are dealing are new at dealing with you and put off, push on, push on, push on.
      The Admin Asst made the necessary changes to Mom's file in front of me and confirmed that her computerized billing profile had not been changed. Yet. And, now, won't be.
• Substantial Motel Discount:
      La Quinta Inn, linked in the previous post, was super vigilant and knew a good thing when they saw one in Mom and me. When I was checking out the night clerk noticed that we'd been there for only 8 hours. "It's not even midnight," she said.
      "Yeah, I know," I said, "but this is so much quieter and more convenient than [name of competing but somewhat cheaper motel in a much more harried part of town]. I don't care how much it costs, we'll be doing this, right here, from now on when she has doctor's appointments."
      "Well," said the night clerk, "I'm only going to charge you half."
      It took about 10 minutes for her to "fix it" in the computer and tag my name for future reference. As it turned out, a much more pleasant stay was had at somewhat less than at [cheaper but much noiser and less convenient motel]. And, they gained customer loyalty. Very nice.
• No More Moving:
      That's right, folks. No more moving, unless we're evicted or our house is destroyed.
      Mom had a hard time with this last night. Traveling, even vacationing, stirs her blood, most of the time, anyway. It did this time. But, it is obvious The Phoenix Metro-plex is not healthy for her anymore. Period. I'm satisfied with our arrangements, I'm the one who does the business...
      "True," Mom conceded, which surprised me...
      ...so we're going to do what I find smartest financially and easiest business-wise.
      She used to be a smart business woman on her own behalf. She still carries the manners. She agreed.
      We did have an extended "Who's Dead" session. She and I again mentioned the practicality of designing a brochure that she can keep at her bed with all the information, including short, historic anecdotes and cause-of-death stories. I have been working on this in my mind. When I mentioned it offhand to one of the CSRs at the rental company this morning he, knowing Mom fairly well, congratulated her in absentia on being aware enough to come up with the idea.
      Thus, this reminded me that I still need to honor that one.
• Yep, buffalo meat...:
  Is even higher than beef in the most easily digested form of iron. MCF's brother-in-law has bagged one every year for the last couple of years. The meat is cured in a delicious mixture of spices and thoroughly tenderized, in the case of the steaks. It's great. Mom relishes it. We'll be getting some soon.
      MCF also gave me some gladiola bulbs, "miniatures, they only grow about a foot high but the blossoms unfold to about three inches". That'll be interesting.
      I think tomorrow is going to be Prepare the Ground for Wildflower Mix and Informal Walk-ways; and maybe get some of that done so that the next day sees the end of the beginning of Project Front and Back Domesticated Areas.
      It seems our one rose, the "Monet", a lavendar/violet rose, was not discouraged from being mowed to the ground in the fall. It's reestablishing itself. I'm pleased. No more roses for awhile, though.
      I might be able to get Mom out but it might still be too cold. We might aim for Friday.
      She has already announced that we're having pizza tomorrow night.

    She finally awoke for awhile at 1400. I did take stats. Somewhat surprising. I'll report on those later. She was back down for a nap at about 1600. She looked tired but satisfied. She mentioned several times how "enjoyable" yesterday was. Especially "the family get-together". I've been agreeing with her. Heartily.
    I'm letting her sleep as much as she wants today. I'm sure she'll sleep tonight. I'll probably give her another dose of Benefiber tonight, just to move things along.
    Oh. And I need to amend her medication chart. I'll do that now.
    There may be a few more mentions about Our Trip Day...
    ...later.

    Stat day today? Stay tuned. Haven't decided. Probably when she awakens. We'll see about dinner time.
    Something else. Can't remember right now.
    Later.

...detailed, are over at Mom & Me Tests & Meds, the immediately previous being a direct link to the particular post. I discuss several things, including her smoking yesterday, at that post, in case you're interested.
    I am going to go away and publish this much now, and will begin the rest of what will probably be a lengthy post, or a series of posts, uno momento.
    A little bit later. Back here.

...and a good time was had by all
    One of the reasons these trips are good for me, however much I half dread them, now, is that her doctor and our friends remind me of Mom's strengths, allowing me to polish my appreciation of them. Because I have to be on the lookout to help her negotiate her weaknesses, I tend to elevate those; although I am not oblivious to her strengths. I simply tend to give them less credit when I'm negotiating her weaknesses. I knew that no matter how long she'd been mostly sedentary and sleeping a lot she still has it in her to mobilize for a trip, to the Valley, to anywhere, probably, although an extended "thing" would be a challenge for her.
    Hold on. I think I hear her coughing. Although I doubt it, she may be ready to awaken...
    ...later.

That was Mom...
....who has since fallen back to sleep. Hell. It's only 1000.
    I decided to administer her awakening pills, including her glipizide, which is usually given at breakfast just before her food. I'll bet, as I write, her blood glucose, if below 200, is just below 200, although I could be wrong. For all her eating, only about half was starch and some of that starch was complex carbohydrates. She ate a very good amount of meat. And, much to my surprise, vegetables. At her request. She ate everything slowly and thoroughly and, working it out, I guess she ate a little about every three hours and then a lot at around 1730-1800 at the restaurant. She also had a full 16 oz of lemonade with sugar and raspberry syrup. No desserts, though. We were gifted with a pound of a See's Candy selection and a pound can of their version of Almond Roca. She was too busy with cigarettes to be bothered, though. Depending on how her blood glucose looks, I may introduce one or both of the candy selections tonight. Since she broke herself of the chocolate habit she no longer tends to gorge.

Medically Speaking:
    Her PCP was much more concerned about her low hemoglobin than me. Although she's seen the low 9's before, he was, once again, shaking his head apologetically and suggesting scoping, even noting from the file by name (impressive) Mom's colonoscopist. I had to remind him, only once though, of this very same woman's final disposition on the subject of scoping Mom, no way, not again. Imaging only.
    He was provisionally taken to task. We'd already discussed the Niferex 150 Forte by prescription, which he approved. In the face of me denying scoping, he recommended a third dose of the OTC version without extra Folic Acid and B12, although he said not to worry about overdoses with those supplements. His words folks. For the time being I'm going to take it, although I will, later, look it up.
    He took blood for yet another CBC, as well as a BMP (I could tell by the color of the tube top) and a round of iron-deficiency anemia tests.
    He was pleased with her blood sugars and blood pressures, said specifically with enthusiastic gestures, "You're doing fine. I'm very pleased. Keep doing what you're doing." He advised me not to up her lisinopril at this time. Said that "one to two pills/day" of the glipizide, discretion being the better part of valor, was fine. We discussed, briefly, exenatide. By this time he had responded to my mention of it and had begun to shake his head when, to his mild surprise, I guess, I told him I agreed with him. Too little is known about its affect on Lightly Challenged Kidneys. It is well known, he confirmed, that glipizide has a great track record with Ancients in Early Chronic Renal Failure.
    He also disavowed me of my carefully, inaccurately thought out connection between her low HA1c (although he agreed that it was probably not related to overall glucose levels) and a probable low Erythropoeitin. He said if this were happening it is caused by kidneys in much worse shape than Mom's: Her Creatinine would consistently be "around 2.0". So Mom remains at a plateau in regard to her kidneys. It's those little things, those third and fourth, etc., connections that you miss if you haven't gone to medical school. But, even with as little knowledge as I possess I realized he was right and internally scolded myself for not automatically looking for other connections to narrow the field. I, you see, didn't know enough to realize "the river is wide" with many tributaries.
    He is concerned enough about her current low state of anemia to impress upon me the importance of having another CBC/BMP done at the end of the month, even though he was drawing for these tests, as well. He also suggested, depending on how the next two weeks go, that I consider scheduling her for early August for a "routine" follow-up, but stressed to wait on CBC/BMP results at the end of the month for a final decision, thus, I assume this means if she looks like she's recovering and tolerating the extra iron, schedule her for five instead of four months ahead: September. Mom and I would prefer a September trip, although MCF, whose birthday falls the day before my mother's, confirmed that she'd be ripe for celebration either of those days in August if a quarterly seems in order. We've also been invited for 4th of July at MCF's sister's and a birthday party a month later doesn't seem half bad. We tolerated this trip very well, both of us, I stress.
    Speaking of which, yes, there was repetition, primarily reminding of proper breathing technique, and or reminding her that smoking was not to commence for a varying number of hours, but not nearly as much. I am pleased to say I didn't get touchy about it until late evening, at home, when, as her brain tried to accomplish a somewhat retarded quick switch of milieus and people, added to that negotiating mild smoking, and lots of moving, and lots of oxygen, when she entered The Dead Zone adamantly.
    Whoa. It began when she started searching the house for "Mother", her mother.
    My initial reaction? "No. No m'am. We are not going to play in The Dead Zone tonight." I caught up with her, turned her to face me, my hands on her shoulders, came with a couple of inches of her face and said, "Believe me. Just trust me on this. You'll remember it all tomorrow. You're tired. Your brain has been jogged. You know all this. It will come back to you. You're very tired. You're fogged with carbon monoxide. Give it a rest."
    However, I softened while rubbing her legs down and we did, once again, have an extended personal history legend, supplemented with a short lecture on, "The State and Mechanics of Your Memory (Inclusive)", which she only partially absorbed. She tends not to think of herself as demented, even at her demented "best", and her awareness of herself and her immediate environment remains acute, although sometimes confused, in or out of her typical Dementia Daze. When at one end of the spectrum, though, (and it is a Spectrum Illness) she has no memory of The Other Spectral End.
    I was not annoyed last night, though. I'm not sure why. Could just be a different part of the cycle.
    So, her meds have experienced only one change, which I'll try to get around to updating today:

• Two Niferex-150 Forte and one OTC Niferex-150 per day, for awhile, anyway, at least two weeks.

    I am not going to worry about Mom's current anemia state as much as her PCP. That's what he gets paid for. I consider it entirely possible that the weather will quickly be warming (although today is delightfully, heavily precipitous, of all types, and an acceptable gray, to boot) and I'll make a point of coaxing (or surprising) her out.

• I must make a note to myself to compare my mentions of more active times with her hemoglobin counts, see if there's a correlation.

    I am relieved by his assessment of her BG and BP and her kidneys. Very nice.

Impressions
    Mom continues to do well. She's slowing but apparently a lot less than I perceive, especially when she is determined and on stage, so to speak, for an audience of More than Me. Good omen for a few more years.
    Over the last few days prior to her appointment, in the evening two days before when she was remembering, with appreciation and amazement, her chronological age, I playfully asked Mom if she thought she had 100 in her.
    "No, I don't think so. Maybe 95. Maybe." Very matter-of-fact.
    The evening after, when my perception was that she felt "worse" (stiffer, slower, more apt to complain and nitpick and try to get out of moving) than the previous evening, when she was preparing for bed and as I unfastened her bra she expelled a groan of relief, I asked again: "So, I'll bet you feel like you've barely got 90 in you, tonight."
    She thought about it. "Oh, much more."
    "100?" I prompted.
    She didn't answer, "Oh. At least," as she often does. She said, "That sounds good."
    I quickly calculated that in her 100th year I'd be 65. I didn't shudder, although I had a realistic jolt of reaction to the care contingencies a decade from now. Not unpleasant, though.
    Earlier in the evening, after dinner, while I was repacking our Ford mid size van, a long time friend of MCF's sister golf-carted into the driveway. We recognized each other. He had heard of me probably as much as I'd heard about him, which is a fair amount and we met some years ago before MCF's father died. He was very curious how I was doing in my role as caregiver to my mother, considering how long I've been doing it. He had specific observations regarding the nature of caregiving for the elderly. I launched into a fairly detailed explanation of the social nature and value of what I do and what this might say about me. At times during the conversation he matter-of-factly referred to me as "courageous". I noticed that I was not uncomfortable having courage ascribed to me on behalf of my journey with my mother. I did, though, insist on explicitly defining my acts of courage and, while not disavowing their courageous character, also stressed that everyday courageous acts are no longer indications of courage by dint of their frequency, however admirable they seem. In my oral apologia I stressed some specific personal rewards:

• A realistic view of age and a chance to contemplate it;
• The Ultimate Academy of Patience, Sympathy and Empathy that is the nature of caregiving;

I did not say that, aw shucks, I ain't courageous.
    The day before, when the oxygen guy came by to check our concentrator, he took note of my carefully casual attendance on Mom and commented, as I mentioned in a recent post (Monday, April 3rd), "You take awfully good care of her. Was she a good Mom?"
    I answered simply, "Oh yeah."
    "How so?" he asked.
    I enumerated her Animal Mom traits.
    He listened. He continued to assert that she is lucky, deserving or not.
    Later that day I got to thinking about care "deserved", especially in one's Ancient years. I've met up with, and can understand, the attitude that a parent was not a good parent, they can rot in State Assisted Care Hell:

• The first time, the son of a sister-in-law cousin of my mother's, who resented his parents from way back for two large, thoughtless errors in raising and supporting him, responded to his mother's death as though he'd have preferred not to have flown out. He did, finally, with his older teenage son, consent to scattering her ashes off Wind Caves. He gladly left all the death detail to Mom, who was the executor of her sister-in-law's will and about the only person besides paramedics to have contact with her in the last months of her life. He disdained any kind of social memorium. He turned his mother's shed contents over to us without interest or inventory; a pity because her shed contained a box of letters from him during one of the horrifically difficult occurrences between him and his parent. I retain these letters.
• The second time I became acquainted with the care recipient who had been left: A woman in her early seventies who had fallen, broken her hip, and, although still sharp, lamented that she would need to go into Assisted Living because she knew her children would not care for her. She admitted to being a problem mother. She did not seem of that type to me, but I was not one of her children. She was never specific, but spoke with a pronounced sadness and regret.

    My awareness also contains specific instances of well-loved parents preferring assisted living in part because all their children work and have families and they would fall into a background that would also rob them of their independence. It includes, as well, children of well-loved parents who feel forced to submit their parents to Professional Care and suffer the slings and arrows of necessitated fortune when they become shades in their loved one's world.
    What I'm doing? It is not easy and it was only vaguely planned. My mother and I share a decidedly optimistic outlook: Hers is pure, my outlook is half hers and half a caustic foreboding, sometimes depressive, from my dad. She is a good influence on me because I am also absorbent and have a mime-like tendency to subtly imitate people with whom I'm engaged, allowing my internals to be influenced by them; a form of empathy. Occasionally my somber desperation breaks through but mostly her pull on my brighter side wins out, especially when she is not too dull and I am not too environmentally challenged with duck-biting tasks.

By the Way's:

• The appointment happened so quickly Mom commented on it...to be continued;
• a glitch accidentally discovered and not believed, until I followed up with what I knew, in her insurance information.
• Got a substantial discount from the motel, La Quinta Inn which does them credit. We'll stick with them.
• Very quiet, steady, satisfied drive up.
• Mom phased into a short, "I want to move back down there," after an equally short, intense phase, much earlier in the day, of, "Am I glad we no longer live here." My short response to her first seizure was, "Hey. This is it. This is the house out of which you will die."
      That set her back a bit. She did not ask for an explanation this time. Good thing.
      I also stressed the positive aspects of living here and visiting there, including in the summer. She likes that dead heat season. It lubricates her joints.
• Possible MCF April visit to deliver buffalo meat, steaks and ground.

    The sun is out for a bit. I feel myself winding down after a long day and two 5 hour sleep nights. I'm hoping Mom will sleep through until 1300. Maybe I can get a nap in.
    More.
    Later.

• "You take awfully good care of her. Was she a good Mom?"
• What I decided regarding Mom's diabetic meds and talking to the doctor about them, and why.
• My evening epiphany about aging.

    To bed. As my mother has often said, "Tomorrow comes early."
    Later.

...about the source of my statements regarding the risk to the kidneys of sulfonylurea diabetic drugs for Type 2 diabetes, specifically glipizide ER, there are actually several sources, including the hand out that our Pharmacy attaches to each prescription I get (yes, I read these hand outs). It's something I've known for some time. The most complete and easiest understood source which applies specifically to my mother's renal profile, though, is connected to the immediately previous link, is contained in the fourth paragraph from the top and reads as follows:

GLIPIZIDE is metabolized (broken down) by the liver and the metabolites are excreted by the kidney. Therefore, GLIPIZIDE must be used with caution in patients having, or developing, liver disease. It must also be used with some caution in patients with decreasing kidney function. However, the metabolites are relatively inactive, so GLIPIZIDE might be the sulfonylurea of choice in patients with mild to moderate loss of kidney function.
-- information from JJSDiabetes, a blog about diabetes kept by a Dr. Shelmet's office

    This is what leads me to believe that glipizide is at this time and will remain the best choice med for treating my mother's Type 2 Diabetes. I am, though, very curious about the possible discussion her PCP and I will have about exenatide.
    Busy, busy, busy.
    Later.

    I found the section of the Byetta website for "professionals". [Since this post was published, the url for the original pdf file to which I had linked has changed. If you are interested more complete technical information on this drug, click on this pdf file. (Updated 2/8/2014; Thank you, Jenn Hume.)] That was easy to print, and much more informative. However, there was the following warning: "BYETTA is not recommended for use in patients with end-stage renal disease, severe renal impairment, or severe gastrointestinal disease." My mother does not have end-stage renal disease, nor severe gastrointestinal disease, but it is questionable whether she would be considered to have "severe renal impairment", since she is diagnosed with Chronic Renal Failure and is far enough along in it to be experiencing blips in her erythropoeitin and HA1c readings, as well as having developed Anemia Due to Chronic Renal Failure. However, because of her medical profile, quite a few diabetic medications are in the "use with caution" category, including the glipizide she's on.
    Hmmm. So, I guess a thorough talk with her doctor is definitely in order.
    See, that's the thing about treating the elderly. It's a frontier, in every sense of the word, for both patients and doctors. At this point, most treatments for disease in the elderly can be said to be experimental, from my perspective, anyway, primarily because, well, the thing is, the elderly are actively dying. I mean, their bodies are doing what they're supposed to do: Breaking down. We haven't found a way around this yet, even though we're hopeful and optimistic. By the time I become Ancient, if I should choose to go that far, things should be a bit less experimental and maintenance-in-the-face-of-breakdown medicine should be more solid. But, that's not the case now. A lot of it depends upon the doctor and the patient and how many undefined risks they're willing to take.
    Weird, weird, weird, this present world of Ancient Medicine.
    I've got to go to bed, Gail. Now.
    Later.

    Most of today, when I reawaken (after finally going to bed), will be the same, including a trip to Costco to pick up some supplies. We're both looking forward to the trip. We'll be meeting friends (MCF and family) after her appointment, probably at their house, relaxing for an hour or two then picking up another "leg" of the friends' family, visiting there for a bit and going out to dinner. I don't expect we'll get home until close to 2300, maybe even later. However, it's been along time since we've seen these people and the visit will not only be pleasantly exciting, it'll keep us off the freeway until well after rush hour. I also got some tips from MCF on freeway construction, which will help us out a lot. It's too early for chip sealing on the interior streets so with just a slight jog through the city on our trip we'll get right through and hit our hotel at about 1100. This will allow Mom to have some lunch, for which we'll both surely be ready, and take a refreshing nap before we need to head to the doctor. His office is very close to where we'll be staying, which is good.
    Sweetest thing happened tonight: Mom realized Tuesday would be Mr. Man's first full day without us at home. She worried about how he'd adapt. This evening she took him into her lap and talked to him about how he needn't be scared on Tuesday, we'll be home "before bedtime", and not to worry about us.
    As I write I'm printing up information on Byetta, the brand name for exenatide, a new prescription medication for Type 2 Diabetics made from Gila Monster venom. I've been keeping an eye on this one and it has recently been approved for use by the FDA and is now in the TriCare Formulary. I'm not actually sure that it will be a good idea for my mother: Some of the possibilities will have to do with how her HA1c performs this time. It could be that keeping her on glipizide ER 10 mg once to twice a day will be the best bet. But, it has occurred to me that this medication might be a good idea once a day at night after a dose of glipizide ER 10 mg in the morning. The reason I'm thinking that it might help if her HA1c is too high this time is that one of the benefits of exenatide is that it not only controls high blood sugar but low blood sugar, as well. It also appears to correct pancreatic cell mechanics in some diabetics.
    The best, most available information is through Medscape. You have to be a member to access this information, so I couldn't provide a direct link. The link attached to the previously mentioned brand name is available to everyone, being the producing company's site, but doesn't give nearly as much information on exactly how the drug works and what is both known and not known about it. It does mention, however, that currently it is only available in two dose per day injection pens and that the shelf life of exenatide is only 30 days, which may or may not be true; thus, each pen should be thrown out after 30 days, according to the brand name website, even if there are doses remaining. This, of course, I'd want to recheck with her doctor. If it looks as though she could use some help with her current diabetic med program, I'd like to start by dosing her with 10 mg glipizide before breakfast and 5 mg exenatide before dinner.
    I've also been doing some research on her high erythropoeitin and her low HA1c levels. The first is common in anemia, including iron deficiency anemia, as the body tries to correct the anemia by producing more erhythropoeitin. low HA1c levels are common in those suffering from Chronic Renal Failure. As well, my Mosby's Manual of Diagostic Laboratory Tests suggests that what is being called a low HA1c in my mother is actually perfectly acceptable: Low, yes, but not out of the normal for non-diabetics or diabetics. So, I've been thinking a lot about exactly what I want to discuss with the doctor on Tuesday.
    Anyway, it seems, while I type here, printing is being held up on one of the documents, so I'll sign off. Not if I'll check in between now and Wednesday so, you know, as usual...
    ...later.