Mom & Me Four Archive

    People often kid me about the amount of trivia I collect and post about my mother, especially at The Dailies. My mother is one of the most active of these kidders. I've never understood why I was driven to collect it, but when I take vacations from collecting and posting it I feel as though I've missed something I'll later wish I'd posted.
    Today (actually, yesterday) I realized that at least some of that trivial data will come in very handy as my mother's physician and I decide whether it's time to change her oral type 2 diabetic meds. This morning I was stressing about how to present my observations to her doctor in a way that would be more than "sensing", or short term observations, both of which are usually waved away by almost all physicians (although not necessarily or usually her PCP). Suddenly I realized, all that meal data I've got over at The Dailies, combined with the BG readings, might give both me and her PCP a better idea of how her glipizide is operating, now, and whether she could use a change of med. It occurred to me that if I searched each dinner meal we'll be having from Friday through Monday (since her breakfast and lunch meals usually remain the same) through all the data I've collected since September, 2004 [when she was officially off Glucophage and put on her present med and dosage regimen], listed her morning BG's after each incident of each meal, I'd be able to tell whether her BG has really become less responsive to her medication. Since I've been recording Mom's daily meals and BG's doggedly for at least three years I've got everything I need.
    Turns out, her A.M. BG's are showing a steep upward trend through August and September of this year. I've already compiled the one for the dinner we had last night, Cobb salad. The one for tonight's dinner, More Than Mac & Cheese, is ready except for "tomorrow morning's" reading. I've also listed the Assumptions that can be made about circumstances surrounding the dinners, as well as of exactly what each dinner consists. I chose her four day dinner menu by searching through the The Dailies site to determine what meals she most often wants and in which she indulges, as well as keeping in mind those meals which she is most likely to eat during the upcoming fall and winter months.
    Often, when I think something in her medical routine needs to be changed, I am greeted with a "wait and see" attitude, primarily because of the medical assumption that patients and their medical advocates don't have the hard data to which to point to back up their considerations. This is frustrating, especially since I'm usually right but it takes a long time to wait for medical professionals to compile enough data, over occasional appointments and tests, for them to observe the same thing I've been observing. Sometimes, even when I have the data and compile it to a particular observation, it's ignored. My mother's PCP, though, usually pays attention to the data I've collected and compiled, thus, appropriate decisions are made in appropriate time.
    I've got to say, I never thought I'd be quite this thrilled about being so meticulous and detail oriented. Although I usually have my head too far up my ass to realize that it has made my job as my mother's medical advocate much easier than it could have been, this morning (actually, yesterday morning), when I thought of compiling her meal-to-BG comparisons, I got it. All that Trivial Detail Collecting renders me much more effective and assures that medical management of my mother, by me, by medical professionals, by anyone, will be as timely and appropriate as possible.
    Let's hear it for geeks and nerds, for people equipped with pocket protector pen sets (I have one filled with several colors of my favorite type of pen, although I never have a pocket in which to wear it) and lovers of cocktail party facts whose minds obsessively collect infinite bits of data! Those of us who do this are often chided for not being able to see the forest for the trees. Funny, though, we're the ones who not only make it through the forest easily and safely, but usually lead the lost through it, as well.
    Later.

...United 93 from our movie rental company. We received it Thursday while we were having Mom's blood drawn. My mother was curious about my excitement. I was thorough in explaining the subject of the movie, realizing that she has no memory of September 11, 2001. I was also careful to mention that the event of the United 93 disaster was devastating, would no doubt include a lot of violence, and didn't have "a happy ending". The movie, though, I said, has been hailed as a scrupulous fictionalized account of what probably happened on that flight, thus, it would probably be realistic. Mom said she wanted to watch it "anyway". We made plans to watch it immediately after breakfast and after I finished "morning" chores.
    Mom found the first part of the movie confusing. There is a lot of overlap conversation which isn't eased by subtitling and lots of quick switching between locations. As well, since the first part of the movie is a sort of docu-style recording of people boarding a plane and the activity in a flight control tower and NORAD, the obvious clues that many shocking things are about to happen and the simultaneously ominous and reverential music completely flew by Mom's attention. About half an hour into the movie Mom announced, "Well, this doesn't seem to be going anywhere. I think I'll take a nap."
    I decided to contiue watching the movie it while she napped. I was riveted. What I'd heard and understood, of which I'd not been disavowed until watching the movie, was that the passengers revolted in order to make sure that the plane didn't reach its intended destination, despite the fact that they knew this would mean simply moving the intended fatal crash to a less politically devastating site. In fact, it seems, up to the moment of the crash, the passengers had every intention of righting the flight, landing it safely and continuing their lives. The Final Problem was that the terrorists in the cockpit became aware of the passenger revolt before the cockpit was invaded and the terrorist pilot decided his only alternative was to crash the plane before reaching his target, thus having sent the plane into a steep downward trajectory to which (my mother, last night, pointed out, when she decided she wanted to watch the "active" part of the movie, the last 50 minutes or so) the plane was probably too far committed to be corrected by the passengers by the time they entered the cockpit.
    The movie ended just as Mom arose from her nap. I had just queued the "Bonus Features". After my mother was bathroomed and had her lunch in front of her, I asked her if she would mind watching these features with me. She agreed. The last feature I queued were the "Memorial Pages", all of which can be accessed through the movie site above, with a little manuevering. This is the feature I, and, surprisingly, my mother, found the most interesting. One by one, I began to read aloud the life tributes (written by loved ones) to each of the people on board the flight, minus the four terrorists. From the information given in the tributes, we discussed the lives and the tributes of each person as I read them. We got through all but eight on Thursday before dinner. We viewed and discussed the final eight last night. Our discussion involved such things as:

• Why each person was tributed the way they were and what this might say about their relationships with their loved ones;
• Exclamations about eccentric passages about almost every single one of the people;
• Noticing that, except for one exception which, as it turned out, was our favorite tribute (the one about Jane Folger), the younger the person was, thus, the more life they lost, the longer the tribute was and the more determined the tribute seemed to be to speak on behalf of the innate value of the person's life;
• At one point I said, "You know, Mom, you'd think that on such a diverse flight, there'd be at least one asshole, but these tributes make it sound as though every person was the cream of the crop."
  She responded, "Well, when someone dies like that, I think the manner of their death probably exempts them from...hmmmm...what you said (she is not one who likes to use the word "asshole") status."
• As we continued with the tributes, I began to express disappointment that "tributes" weren't also included on the terrorists.
  My mother responded, "Well, it's obvious why they weren't."
  "Yeah, I know," I said, "but, you have to remember, the terrorists considered all the people they intended to kill infidels and believed that they were committing a divinely inspired act. I would love to know what drove them to this belief, this act, and how their loved ones viewed them and their act after the fact."
  "Don't you think that's obvious?" she asked.
  "No more obvious than the tributes to the lives of the passengers and crew," I said. "And, besides," I continued, "Consider this act and its movement from the point of view of the Christian Crusades and the Holocaust. Our species seems to do this on a regular basis. During the Crusades, everyone who wasn't a particular type of Christian was the infidel. Now, Christians and those who lead and believe in a specific type of Western Life Style are the infidels. We "infidels" stand to learn a lot from "tributes" (I drew quotes in the air, on this one and the previous quoted word) to the present dead Crusaders. It might even help us figure out a way to change this horrific, continual urge our species seems to have to annihilate each other in the name of divine prescription. And besides, the terrorists probably got more screen time in the movie than anyone else. For me, at least, that makes me all the more curious about them."
  "You might be right," she said, very carefully, "but it also might trigger more annihilation."

    Last night, after viewing the final eight tributes, Mom decided she wanted to watch the movie. I reminded her that she found the first part boring and hard to follow. "Do you want me to start the movie at the point where the terrorists take over the flight?"
    She agreed.
    I expected that she might still find the movie hard to follow, her attention might wander and we'd decide to stop the movie before it was finished. This didn't happen. She was also riveted, right to the end. Interestingly, at the end when the ground came up to meet the viewer and the screen went black, she said, "Is that it? They don't show you what happened!"
    So, I explained, once again, what happened and why the screen went black.
    "Oh, now I understand," she said. "Very clever."
    It was a little discombobulating for me to hear this comment. So, I asked her, "Mom, do you understand what happened?"
    "Well, yes," she said. "The plane crashed and everyone died."
    "Yes. Do you realize that this really happened?"
    "I imagine it happens all the time when planes crash."
    "Well, yeah, sort of. Do you realize why this crash was an unusual tragedy?"
    "All plane crashes are tragedies."
    "Well, yes. Do you understand why those who died on this flight are considered heroes?"
    "Well, no, not really."
    At this point I decided not to explain the whole thing again. "Did you enjoy the movie, Mom," I asked.
    "Well, yes, but I wouldn't want to watch it again."
    "No problem. I'll send it back tomorrow."
    I am, though, considering getting a copy of it, just for me. I noticed, as I watched the last half of the film a second time, I was beginning to connect the biographies of the passengers and crew with their depictions in the movie. I also noticed that every member of the passenger and crew had some screen time. Because, I suppose, I was honing in on people by name and tribute, it also seemed to me that each person was, figuratively and literally, highlighted when shown. One of the attendants, for instance, whose tribute noted, lovingly, her tendency to be late, was, before the flight began, portrayed as being late for the flight.
    As well, my mother and I both noticed and briefly mentioned the juxtaposition of several passengers reciting The Lord's Prayer with the praying of the terrorists. At one point my mother said, "I wish they'd translate those prayers on the screen like they are the other bits of conversation."
    I have to agree with her.
    Five minutes before awakening time.
    Oh, wanted to mention, for yesterday and the next three days, my Daily entries will be filled with what may seem like unusual and trivial detail. I will be printing up these pages as the documentation I mentioned with which I intend to present Mom's doctor at her Tuesday appointment.
    Time's up.
    Later.

...while we were bathing her, if she had, indeed, prayed for herself the "night before".
    Coy glance at me, denoting embarrassment at having done so, "Yes, I did." Tone that told me she only did it because I asked her to.
    "Well, Mom, I have to tell you, in the journal about you and me I took a stab at how you probably constructed your prayer. Let me run this by you," whereupon I recited an almost word perfect version of what I'd written here.
    She hiccupped a short laugh that told me I was on the mark and she was surprised that I was. "Almost word for word! How did you know that? Do you know me that well?!?"
    "Well, Mom, first of all, it's probably thought for thought rather than word for word."
    "Whatever, it's awfully close."
    "And, yeah, I know you that well. There's some stuff I don't know, and you've still got surprises up your sleeve. Besides, you're still evolving, you know."
    By this time she was on her feet facing me for her torso washing. She performed a mean curtsy, holding on of her hands out as though she was lifting a skirt. "Well, thank you! I'm glad you think so!"
    "Oh, believe me, Mom, it's not just what I think. Your continued evolution is obvious to everyone who knows you."
    "Well, I just hope I'm e-volving and not de-volving."
    "I'm guessing the former, Mom, but, you know, I guess we all wonder that about ourselves and others, don't we."
    "True enough," she said.

    So, night before last I once again asked her to pray for herself. I'm sure she did, as, when I asked her, we got into a discussion about prayer yesterday. Her energy level was low, yesterday, so our day involved sedentary activities, which always lend themselves to conversation.
    Our conversation evolved into comparing and contrasting our attitudes toward (and, ultimately, beliefs about) prayer. My mother agrees with conventional wisdom that the best prayers are prayers for others. I'm sure she also thinks, although I believe it's a buried thought, that one receives points for prayers offered on behalf of others, especially if you pray for others when you, yourself, are in need. I asked her about this but she seemed confused about what I meant. There is a deeper motivation working in her, though, that allows her to consider the above wise: She is, and has always been, both highly independent and of the attitude that, well, whatever happens, you just deal; without sulking, without regret, without self or other recrimination, without angst, you just deal. This is what she's always done. It is to her advantage that, while she is deeply thoughtful, she is also deeply optimistic. I asked her if she believes Someone is Looking Out for Her. She said she didn't know, had never thought about it. I don't think she's ever thought she needs anyone to look out for her, even as she recognizes that many others do need This. Which, finally, is why her prayers are always and sincerely for and about others, rather than herself. She did mention that she rarely is tempted to pray for herself because she can't remember thinking that she needs Intervention. She added that the content of her prayers are usually expressions of gratitude and/or thoughts and observations "about my day."
    When I was a teenager wrangling with aspects of religion and spirituality, one of the issues with which I wrestled was the issue of prayer. I had intuited what my mother thinks about prayer; what most people think about prayer. I continually, though, snagged on the question, what if you're the kind of person for whom nobody wants to pray, who, in fact, others would much prefer to curse, maybe actively curse? Then what? At that time I had a fairly anthropomorphic conception of god, at least as far as god being "one", and sentient rather like humans. I also, however, reasoned that I certainly had more mercy for people, even the worst of people, than a god who would only listen to "unselfish" prayers. Thus, if I was at least this merciful, wouldn't it stand to reason, I thought, that a god would be powers and powers more merciful than me? Unless, of course, I considered, mercy is not a virtue. In which case, every single one of us was in serious trouble for a variety of reasons and Jesus was lying.
    "I don't think Jesus lied," my mother said, after I reviewed all the above in our conversation.
    "Because he is Divine, right?" I responded.
    "Well, I don't know about that."
    Some decades later, my conception of divinity and spirituality continually evolving, I became intrigued, having a fascination for both science and spirituality, with the dictum that one should look around one and study how the "world" "works" in order to "know god". I decided to apply this to the issue of prayer.
    Consider, I told myself at the time and told my mother yesterday, what our relationship to the parts of ourselves is. We consciously identify ourselves as units, yet we are actually complex systems comprised of googols of individuals and communities, right down to the elements we identify as the atomic structure of our cells and the void surrounding all the material bits we are. Suppose our relationship to god is similar to the relationship the unit we identify as "I" is to, say, a group of cells; the "I" being "god", our bits being, well, "I". Pretty scary thought. Most of the time, as god, we are unaware of our components. We only become even minimally aware of any of our components when we are experiencing physical discomfort or physical exhilaration. Both conditions cause us to respond to the sensation; either by doing something to attempt to alleviate the discomfort or extend and/or reproduce the exhilaration. Perhaps, if our relationship to our components is like god's relationship to us, the only prayer that god "hears" is the expression of discomfort or exhilaration. Superficially, one cannot well express someone else's discomfort or exhilaration: I.E., it initially seems like it makes little sense for a well functioning wheel to squeak on behalf of a wheel in need of repair; it takes longer to discover and correct the problem. Except, I took note, if acunpunture theory is involved. In this case, symptoms are often indicative of distress in other (considered to be related, although we often don't understand or perceive the relationship) parts of ourselves; a community perspective. Taking both these conditions into consideration, then, it is neither morally deficient to pray on one's own behalf, nor is it morally credible to pray on behalf of another; and, it seems, both intercessions can be considered "selfish".
    While I wound up my dissertation, to which my mother paid close, although, I'm sure, somewhat confused attention, I mentioned that, as I was talking it was occurring to me that perhaps "the void" that physicists have discovered comprises the bulk of any-"thing", including our-"selves", is "god". This, I said, would certainly fit with the idea that "god's" presence is in every-"thing" and every-"one". In fact, I went on, it is also most of what "we" are.
    "But," my mother said, "a void cannot forgive."
    "Hmmm..." I responded, "that is a problem. Let me think about that." I did, on the spot, and realized, "Oh, I get it! The void, because it is common to all of us, is forgiveness, of everything and everyone! Being aware of this is having the assurance that, ultimately, we are all forgiven everything!"
    "Well," she said, "I don't know about that."
    "You think, then," I said, "that some people are automatically condemned for their existence. By god."
    "I wouldn't go that far," she said. "I have no idea what God might condemn."
    "Well, the Abrahamic Bible is pretty clear on this and often states that its ideas are those of your god."
    "But the Bible was written by men."
    "What you're saying, then, is that men are bound to get it wrong?"
    "Well, yes, when it comes to knowing the mind of God."
    "Do you condemn anything?"
    "There are some things that I wonder about. There are some things I don't think are right. But I don't really know enough to be able to condemn anything."
    "Do you think that it's possible that "everyone ["might be" substituted for the original "is"] already be forgiven everything?" [I put this in quotes because it is a revelation granted me through an excellent friend in Seattle with whom I used to have mind and soul boggling conversations, who serendipitously and excitedly visited me, one day, just to share this revelation with me.]
    "It's certainly possible."
    "Do you forgive everyone everything?"
    "I try to. I'm not always successful, but when I'm not I'm aware that I should be."
    "Well, then, would you consider it reasonable to assume that if you at least see the the wisdom of Universal Forgiveness, god is not only capable of universal forgiveness but has already granted it, to the point of it being a non-issue on the level of divinity? And that reward and condemnation are strictly needs that are required by this system, not requirements of The Ultimate Reality in which we are encased?"
    "Well, you've lost me, there, child. I will say, though, that if you're thinking that we can understand the nature of God by understanding ourselves, right and wrong are important to us. So are forgiveness and not being able to forgive."
    Yep, that's right. Another thought to untangle on another day.
    Now, do you see why I stick closely with this woman, even in her Dementia-Lite, even as caring for her appears to overwhelm self-care? Finally, as I care for her, I do care for myself. I would even go so far to say that she and I are made for each other.
    Later.

    I want to mention, I'm both pleased and relieved to see that her test results are exactly normal (for her)...nothing weird or worrisome. It might seem as though I'm making a mountain out of a mole hill about her blood sugar, but the next few days will tell. Certainly, I think my concern over her BP may be a little over the top, but, otherwise, her test results tell me that my observations over the last few weeks have been of very subtle changes which don't seem to be affecting anything else. Hallelujah for that.
    The next four days will tell whether my concern about her blood sugar is overwrought. Even if it's not, though, her test results tell me that, most likely, she will only require a change in diabetic medication.
    Almost time.
    I've got a few issues about which I want to post backed up in my head. Hopefully I'll be able to get to those...
    ...later.

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:

1. 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.
   The thing is, she doesn’t receive that many refined carbohydrates, anymore, so there hasn’t been much to cut out. The reason I’m going to reinstate her regular diet is so that I can record exactly how her blood sugar is performing now, on her typical medication and typical diet. I will record all this information for you day by day, including whether or not I can get her to move (usually a walkering session in our driveway or a trip to a store), so you and I can see how and whether her normal routine is no longer being served by her current diabetic medication.
   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.
2. 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.
3. 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.
4. 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.
5. 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.

Well, [Dr.'s name], I’m looking forward to Mom’s appointment with you next week for several reasons, obviously, not the least of which is that I have ultimate confidence in you. My mother, as well, is looking forward to seeing you, again. Despite the minor problems we’re suddenly having, I think you’ll find her in excellent spirits and I guarantee you that she will tell you that she is “doing just fine”, as usual! Bless her indomitable spirit, and bless you for continuing to be her physician!

...and test results are up. This draw included both the CBC and the BMP. A test which is of particular interest to me in regards to my mother has been added to the BMP: A GFR. The link will take you to the National Kidney Foundation's very thorough explanation of what this test is and what it's results can mean. The reason I find it interesting, and, as well, hope that her BMP's continue to feature it is that it clearly indicates my mother's Chronic Renal Failure, thus also confirming for me that her anemia is, indeed, Anemia Due to Chronic Disease.
    Otherwise, the results show that she is holding steady...only one noteworthy result, which is her high normal result for potassium. I'm sure this is because I've been loading her up with foods containing sodium and potassium for the last few days in order to ameliorate what seemed to be indication of a minor low sodium episode.
    I'm going to close this post out, now, although I have a few more things to report, and set up and publish her latest health review. Everything, including the review, her Blood Pressures and her Blood Glucose Report, has been faxed to her physician in preparation for her appointment on September 12th, next week. The health review, in the OTHER ISSUES TO BE DISCUSSED AT APPOINTMENT section, under 1., includes a strategic plan for the next few days that I hope will provide her physician and me with some hard data with which to determine if she needs some sort of change in her Type 2 diabetes medication. As I type in the report I'll establish links to the two mentioned areas for quick reference for those of you who are interested, then come back to this post and place them appropriately.
    Later.

    I'm too anxiety ridden to repeat the details for today, September 6th, that is, but they're all over at The Dailies post for September 6th. Suffice it to say, it was a pretty weird day. I'm looking forward to Mom's doctor appointment next Tuesday, even as I'm dreading it.
    Tomorrow we're going for her blood draw. I'll be spending most of the day after that making hotel arrangements and getting together all the stuff for the health review I'll be faxing to her doctor on Friday when I pick up the lab results. I'm not sure whether we'll get in a walkering session tomorrow, considering her state today. We'll see.
    I'm pretty focused, now. I've gotten ahold of myself, enough, to decide to continue researching diabetic meds this weekend, although I think "something else" is going on, too, I just don't know what. I can't explain her incredible fluid shedding, which, today, appeared to affect her electrolyte levels, which I worked hard to push up throughout the day. Although her spirit remains strong, as does her will, she was pretty wasted today. I'm thinking, now, I'm just going to let her BG levels do what they will, maybe continue the walkering but that will depend on whether she continues to lose fluid almost as soon as it enters her body. If this continues, I'll go very, very easy on her from now through next Tuesday, when she has her appointment. Her blood pressure seems to be coming down, which doesn't surprise me, considering her body's sudden decision to let go of fluid. I've only taken it in the morning for the past two days, though. I haven't wanted to wrangle with her in the evening over it. It's much easier to take in the morning than in the evening.
    Hoh. Well, we'll see what happens. This evening, while I was taking her BG before dinner, I suddenly burst into tears at her feet. I did the same thing this morning just before bathing her but managed to get myself out of the bathroom before she noticed. This evening, though, I was pricking her finger for blood when it happened. She stared at me. I explained my anxiety over her health to her and said something like, "Mom, something's going wrong, your health is failing, it looks like your having some kind of a crisis."
    "Nonsense, child," she said, fairly snorting. "I feel fine! There's nothing wrong with me!" She couldn't remember the weakness she experienced most of the day; didn't connect her four hour nap, which might have gone on to five if I hadn't awakened her from an unusually deep sleep, with a health problem; wasn't at all concerned about how she was feeling.
    Luckily, I was able to let it go, except that I told her that I was extremely relieved that we had a doctor's appointment next week, and not to be surprised if he decided he wanted to see us again much sooner than usual.
    Otherwise, the evening went well. I did her hair. We watched the entire first season of Sex and the City, which we both enjoyed. I needed a reliable, entertaining diversion. So, it seems, did she.
    As you may know, if you've read me long enough, my mother prays at night before going to bed. No, she doesn't get down on her knees, but she prays. I know her well enough to know that she never prays for herself, except on those few occasions when I tell her it's time for her to do this. Tonight, as she was sitting on the edge of her bed, after we had our usual bedtime conversation, before we kiss good-night, I told her it's time; she needs to pray for herself, tonight. I repeated this a couple of times.
    She looked at me as though I was crazy, but she agreed and I could see that she meant to. I have a feeling when I ask her to do this, her prayer goes something like this:

Dear Lord (I'm sure she uses "Lord" instead of "God"):  My daughter Gail is concerned about my health again, bless her heart. I'm not worried, I'm sure everything is fine. She's asked me to pray for myself, though, so, consider this that prayer. I'm not sure what she thinks is wrong, I don't think anything is wrong, but if anything is, take care of it so that Gail can relax, settle down and things can get back to normal, again. She's very upset. She's managed to work herself into a tizzy over the last week or more. So, Lord, see what You can do to straighten things out so that she isn't upset, anymore. In Jesus' name, Amen.

    As far as I'm concerned, that's a fine prayer, the best she can do on her own behalf, and, the gods know, she's pretty maintenance free, so I'm sure it will be heard and answered. I'm satisfied.
    Time for bed.
    Later.

    It became obvious to me some time last week that one or more of a few possible things may be happening (some of these "things" I've been considering for longer than a week, as you know):

• My mother may have passed the "grace period" in which medications (both her glipizide and her lisinopril) work well to control her diabetes and blood pressure;
• Lifestyle is going to have to come into more play than before in controlling these two conditions if we want to keep her out of the clutch of physicians, as she prefers;
• The only way to receive her cooperation in this is to explain to her, in detail, every day, sometimes more than once, for exactly what we are controlling and show her evidence that either our control is working or not;
• If she and I want to control these conditions, somehow, she will need to disavow herself of the perceived safety of spending her days sitting in her rocker.

    Thus, both our lives have become, within a little more than a week, much more intense, particularly mine. Except for one day, Labor Day, I've had her out walkering on the driveway every day. If she seems up to it (I don't ask her), I have her do an additional session in the house doing laps down the hall and back. The surface is much smoother than our concrete driveway, thus there is less wheel resistance and she is less likely to push the walker with her arms and can practice relaxing with it, which is hard for her to do on outside surfaces. As well, the tight space inside actually helps her practice close-to-the-body pivoting as she turns herself and the walker. I insist on at least one outdoor session per day in order to expose her to the sun and the "nature" of our yard, though. She is more likely to keep her eyes forward and head up when she has something to look at. Conversation, too, tends to take her out of her work, which makes it easier, and there are always lots of things in our wild and wonderful yard for her to notice and mention as she walkers. Yesterday she was the first to notice that among the blanket of tiny yellow daisy-like weed flowers our yard is currently hosting, there are a few bright purple daisy-like weed flowers. She loves to grouse about what she considers to be our yard's need for maintenance, too. Frankly, my position is that the less maintenance it receives, the more likely it is to spark her notice and commentary, which is good. When we first moved here in 1997 for yearly springs, summers and falls, the yard, both back and front, was so severely maintained that it had no character, thus, attracted no notice or comment. At that time, of course, she was getting out into the community all the time so the blandness of our yard was beside the point.
    Anyway, this is why I haven't kept up much with this journal. Although I doubted that caring for my mother could become more intense as long as she isn't bedridden, I was wrong. Getting her out every day involves a good third of an hour of preparation before our trek, a good three quarters of an hour afterwards to cool her down properly so that her muscles don't seize, and then planning other movement and dietary options throughout the day to maximize control. Some of these are:

• Making sure she sleeps no more than 12 hours a night and no more than two hours for napping. So far, this has worked well with no protest from her.
• For the last several months I've allowed her to let her tissues pile up on the coffee table next to her walker. As of a few days ago I've begun to remind her to take them to the garbage across the room a few more than a few times a day.
• Reminding her, relentlessly, that when she refuses all my efforts to tempt her with activity, game playing, etc., and isn't interested in watching movies or shows, she must still remain up.
• Incorporating one or two more bathroom visits into her day.
• Spending lots of time in conversation in order to encourage whatever mental benefits are accruing from her increased movement and further decreased refined carbohydrates (although, truthfully, it's becoming difficult to scale back the amount of refined carbohydrates in her diet any further than I've managed, so far; they were already fairly well scaled back).
• Brain Age seems to have lost appeal for her within the last month or so. Looking back on it, I think I could have predicted this, as, the more games that are added, the more frustrated she has become, and, games are added even if scores remain flat or drop. However, her interest in Sorry and Scrabble remain and we play those a lot.
• I am ferocious about monitoring fluid intake, now, between not too little and not too much, although, frankly, I have no idea what effect this is having.

    We seem to be making some headway in all these efforts. The increased activity and decreased refined carbohydrates certainly aren't hurting her, although when I knock out the O.J. in the morning she asks for it, then complains when I tell her, "Not today, Mom, maybe tomorrow." Yesterday I added it, just to see if, with the increased movement, it made a difference in her BG. It did, although I'm not sure if it's a difference about which I should worry.
    How am I faring through this? It's debatable. I managed to work myself into a frustrated mess researching alternate diabetic medications and contemplating the possibility of insulin shots, thus, I've dropped this for the time being. Unfortunately, this increases my anxiety about not being up to snuff should her doctor decide to switch her diabetic med or suggests insulin. I'm rather hoping the evidence will show that she continues to not display the side effects of out of control blood sugar and he will tell me, "Don't worry so much. She's doing fine. Back off." I have reason to think this because I've become even more focused on the smell of her urine over the last few weeks and continue to notice that it does not smell sweet. It does not, in fact, smell any different than it has over the last few years. Thus, I have to assume that her diabetes is not affecting anything else.
    I am surprised at this blip in managing her BG. Obviously, her diabetes is far from "going on vacation", which is causing me to reconsider exactly how far along she is in regards to her Chronic Renal Failure. Her BP also causes me some concern in this respect; but we've had BP blip periods before, so I'm not nearly as concerned about what this indicates. As well, if a medication change is necessary to help control her BP (and this is debatable, considering Medicine's current view on what comprises "low" and "high" BP; it seems that a continually low diastolic is automatically considered "low BP", regardless of systolic readings, which, actually, makes sense, when you think about it), it will most likely involve simply upping her lisinopril, with which I have no argument. It's a gentle med, for her, and easily manipulable.
    Tomorrow we go for a blood draw. I've put this off, as, knowing that she will also have blood drawn during her appointment, I wanted to make sure that she didn't end up being stuck three times in a month and a half, rather than two. This one will include a BMP, about which I am very curious; particularly about her electrolyte and kidney function levels. I expect her glucose reading to be higher than "normal", but, you know, it usually is, by anywhere from a few to several points. Other than this, I've also begun to take her temperature rather frequently, every other day or so, to see if she is harboring some sort of internal infection that might be affecting her BG and BP. So far, she continues well within normal adult arterial range.
    I've noticed that I end day after day exhausted, both physically and emotionally. I'd like to say it's a "good tired", but, mostly, it isn't. Sometimes, in order to solicit her cooperation, I find that the only thing that works is veiled threatening, which includes:

• Reminding her, by recalling episodes of intense medical involvement, that our goal is to keep medical treatments and procedures out of her life as much as possible;
• Reminding her how long I've been doing this and that, as she resists, I become even more tired and frustrated than I already am, thus increasing the possibility that I will, finally, throw up my hands and decide I can no longer do this, which automatically puts her in the position to:
  • Come under the care of one of her other daughters, thus;
  • Having her life torn down around her literally, because her other daughters are not prepared to change their life to suit hers, they will insist that her life change to suit theirs: This particular threat is fairly effective because she has, I've discovered, up to this point, assumed that if I can no longer take care of her, one of her other daughters will "move in with [her]". She has been shocked to discover that, in fact, there is no one available to move in with her besides me; that she will be the one to move, which means liquidation of quite a bit of her property (including personal property), a move to another state and/or city, loss of me, her cats, and, mostly likely (definitely in two cases, probably in the third), she would come under the auspices of professional care, which she resolutely does not want and realizes would mean the dissolution of her strong connection to her family;
• Being absolutely up front with her about how harrowing it is for me to negotiate the medical establishment on her behalf in an intense way, how fraught with frustration this pursuit is and how, the more intense and frustrating this pursuit becomes, the more likely I am, yet again, to throw up my hands in confusion and either inadvertently keep her from solicitous treatments or allow unnecessary and disagreeable treatments.

    Sometimes she gets it. Sometimes she doesn't.
    I have a feeling I am on the brink of yet another break through in caring for her. This time, though, the feeling to which I am most susceptible is fear of inadequacy rather than anticipation of revelation. I hope I'm wrong. I want to be wrong. I'm finding it hard, though, this time, very hard, to rally what seem to be the few reserves I have left and approach this period from an optimistic standpoint. I've found myself indulging in some uncustomary and only half believed desperate praying to whatever gods happen to be floating by at any particular time for some sort of miracle that will wash through my mother's body and allow her to remain on a keel that I can easily manage from now until what I hope to be her easy, quick death. I'd love to be able to honor her desire to simply leave her alone, as she expressed a few days ago, and let her ease through her final years worry free. It has come as a surprise to me that I suddenly find I can't honor this if I want to also keep her out of the treacherous clutches of medicine. I have even considered that this recent BP spike may be, in large part, due to the fact that my anxiety level about her physical condition has risen and I am transferring this to her. Despite realizing this, I can't seem to settle myself. Thus, some of those desperate, half-believed prayers have been offered on my behalf, as well, for calm, wisdom, ease and acceptance.
    As yet, no answers that I can identify.

are, tonight, in unison, I'm sure, astonished at the startling death of Adventurer Extraordinaire, Steve Irwin, a.k.a. The Crocodile Hunter. I have no idea how many other people are stunned by this man's death after being pierced through the chest by the barb of a sting ray, but I know for sure that the conversation my mother and I had after learning this evening about his death was one of many such conversations between Ancient Ones and caregivers tonight.
    Mom [upon seeing Steve Irwin's picture while the news of his death was being broadcast]: "Oh my! I know who that is! I've watched his shows! Are they saying he's dead?!?"
    Me: "My god! Yes! I know! You watch him almost every day!"
    Mom: "You make me sound like a fan. His shows aren't my favorites."
    Me: "I know, but you've watched so many of them."
    Mom: "I think what I like [notice the present tense] most about him is how he involves his whole family in his animal adventures. I envy them. That's how a family should be."
    Me: "You know, he was criticized for feeding a crocodile while holding one of his infants."
    Mom: "Oh, that's right. I'm sure he knew what he was doing. People can be so stupid when criticizing other people on the way they raise their children. They forget how wonderful it must be to be a child in a family like that."
    Me: "Well, he certainly went doing something he loved. I'll bet he wouldn't have wanted to go any other way."
    Mom: "Except, maybe, to be 95 and go like that."
    We both laughed.
    Me: "Yeah, wouldn't we all like to go like that at 95!"
    Mom: "Please don't take me diving..."
    Me: "...off the Great Barrier Reef?..."
    Mom: "...yes, when I'm 95, just so I can see what it would be like to die like that."
    Me: "You got it, Mom."
    So, it's very interesting for me to note that Mom's idea of the ultimate in parenthood is teaching your kids how to rock and roll. With crocodiles, in whatever form you pursue them. I have to say, I'm my mother's daughter in this respect.
    Well, Steve! Crikey! What a way to go! What a grand life you lived, right through to the end! Thank you, Steve Irwin, for your life. Marvelous show! I hope you find your adventures have only just begun.