Mom & Me Four Archive

    The following are some short observations from our doctor's appointment trip on September 12, 2006:

Dogs vs. Cats
    As you know, my mother has wanted, for some time for us to host a dog as a pet. She mentions it fairly often, especially since she watches Animal Planet a lot, which always has lots of animal commercials, particularly those featuring dogs, and she's a fanatic about not missing the dog shows. She loves our cats, but, although she's never able to put her finger on exactly why (believe me, I've asked her), she still would love to host a dog. I think it's because she imagines that a dog would be much more interactive than cats, and she's probably right, although we're very involved with our cats and they're just about as interactive as cats can get.
    I've been blunt with her about my desire not to host a dog. I like dogs. My born-into family has hosted some wonderful dogs. I know several dogs through friends, all of whom I enjoy, and all of whom seem to enjoy me. The problem with owning a dog, now, for me, though, is that my care of my mother is so intense that I have no desire to up the ante by adding a pet to our small menagerie that requires anymore daily care and attention than I already mete out to my mother and our cats. As well, owning a dog would mean having one more not particularly small detail to negotiate when we go on trips: How to make sure the dog is cared for while we're away. We don't have to worry about this with our cats, since we always take short trips. But, a dog would continue to require walking, etc., while we were gone. Yes, I know, there are pet sitters, and kennels, all of which cost and require a level of trust that would have to develop. As well, there would be the added detail of arranging for these services and either delivering the dog to them or making sure the services arrived, on time, to us. So, I've always said, "No." This doesn't cause my mother any permanent disappointment, but she never forgets that she wishes we had a dog.
    Whenever we're traveling, we never forget our cats. We often speculate about what they're doing, joke about them and talk about how they'll meet us at the door, complain about our absence, even though the evidence will indicate that they slept the entire time, probably with relief. We also talk about how good it will be to see them, again. We did all this while we were traveling on September 12th. Once we had turned onto State Route 69 and were on the short stretch home, as usual, we talked a lot about our cats and the upcoming exchange of greetings. When we were in Prescott Valley, about 20 miles from home, Mom suddenly said, "You know, it's a good thing we have cats and not dogs."
    Whoa, I thought, I can't wait to hear what she has to say about this, since it's the complete opposite of what I'm usually hearing from her. "So," I coaxed, "tell me, Mom, why are cats better?"
    "Well," she said, "if we had dogs, they wouldn't be at home to greet us, and there's nothing quite like being greeted by your pets when you arrive home."
    "If we had an at-home pet sitter, they'd be home," I said. Not that I wanted to argue with her, but I was curious how she'd developed this position.
    "That's true," she said, "but then we'd have to immediately walk them, pay all kinds of attention to them, dodge them as we bring our things in the house, you know how dogs are. All I really want to do when we get home is sit. Cats are great at greeting you when you're sitting. Dogs sometimes aren't. And, they require extra work when you get home. Cats just require your acknowledgment."
    True enough. So, I guess, I can trash the small measure of guilt I carry about not making it possible for Mom to have a dog. Although the guilt over this was insignificant, the relief over being able to dump this guilt is huge.

"Cute" Is As "Cute" Does
    When we arrived in Mom's PCP's waiting room, there were a fair number of people waiting either for appointments or walk-in visits, about half elderly and about half other ages. As is usual in medical waiting rooms, every one was quiet. Except for Mom and me. There is virtually no situation that has the ability to put a damper on our conversation, public or private. As well, Mom, when in public anywhere, is a constant observer of and commenter on human behavior, so we find plenty to occupy us, magazines or no. I also continue all my automatic caregiver routines that apply to whatever situation in which we find ourselves. One of these routines involves the stretching and hip wiggling through which I coach her as she arises to her walker and before she sits after a walkering session. I don't even think about this, now, I just activate it.
    The first time I put her through her paces at the doctor's office was immediately after she arrived, just before she sat in a chair. She was a little shy about doing this in public, so I said, "Come on Mom, let's give the public a sample of what they'll be getting for their money." She grinned, looked around expectantly, and hootchy kootched with the best of them. I noticed, peripherally, that several of the waiting clients smiled appreciatively. From that point on I had no problem running her through this routine.
    Her name was called for her appointment and we headed through the door, which the new nurse held for us, into the hall where her weight was taken. As always, my mother mentioned that she should take off her shoes, the constant insistence of probably every woman on the planet who finds herself standing before a scale. The nurse said, no, then winked at me and said she'd take off a pound for her shoes. This satisfied Mom. Then, we headed further down the hall to an examination room at the end. The nurse headed our parade and I took up the rear while Mom walkered assertively on, pausing to peer into other examination rooms, acknowledge staff standing to the side and notice and comment on posters hanging on the wall. As we proceeded, I noticed the nurse's grin widening. She stepped aside as Mom entered the proper examination room, then said to me before I entered, "I know it sounds demeaning to call old people 'cute', but I hope I'm as cute as your mother when I get to be her age."
    It's true, I've often internally bridled when hearing Ancient Ones referred to as "cute". Sometimes, the object of the observation has been my mother. But, this time, as I looked at the nurse, I found myself exchanging eyes with her. I saw my mother, impeccably dressed in her green "go-to-meetin'" suit; hair styled fashionably askew, her pastiche disguised with two pearl barrettes fastened to one side like an indignant tiara; her blazing blue eyes darting about, noticing everything possible; tiny, yes; bent to the Ancient Art of Walkering, yes; determined to register her environment, formidable in presence and, undeniably "cute". Yes.
    I grinned back at the nurse. "That's okay," I said. "I see what you mean. I think I hope the same thing for myself."

Caregiver Compliments
    After Mom's appointment with her doctor, we were back in the Waiting Room Holding Pattern previous to being called for her blood draw. Most of the people who'd been in the waiting room when we arrived were still there.
    One of my mother's obsessive habits is checking her watch against any clocks in her vicinity. I always kid her obliquely about it by asking, "Got a date?" To which she always replies, "Yes, I don't want to be late." Normally, her watch agrees with clocks displayed. That day, though, she noticed that her watch seemed to be 10 minutes off, according to the clock in the doctor's office. She fussed, a little about this.
    She was overheard by a woman sitting catty corner from us in the office (the chair arrangement in this waiting room is peculiar, to say the least). "Hold on," the woman said, "I have atomic time. I'll check." Suddenly a computerized voice called the correct time through the room. Turns out, my mother's watch was right, the doctor's clock was wrong.
    "What was that?!?" Mom asked the woman.
    "I'm blind (which was astonishingly inobvious)," replied the woman, "so I have a satellite device, here, attached to my pants. All I have to do is press a button and it tells me what time it is." She registered my mother's intense interest and continued, "Want to come over and see it?"
    Whereupon, we went through yet another brief stretch-and-wiggle routine and Mom walkered over to take a look and exclaim her astonishment.
    In order to make room for her and make sure the door was clear in case someone entered, I stepped across the threshold to the other side of the room. This placed me in front of a woman, probably in her mid thirties, who was tending to a sick son, stretched out across a couple of chairs without arms, covered in a blanket. She'd also been there since we'd arrived. As I stood there, keeping an eye on my mother, the woman reached out and touched my arm. "I've been watching you with your mom," she said. "I hope my kids," she lovingly patted her son's head, "handle me like that when I'm her age."
    It's not uncommon for strangers to notice my mother and I together and say something similar to me, or a slightly different version to my mother about "[your] daughter." It doesn't happen all the time, but I've written about more than a few instances of this throughout these journals. The reason I'm always moved to write about them is that, when someone goes out of their way to comment on my mother's and my bond, I'm surprised, as well as grateful. Such comments always render me fairly speechless. I can usually only manage a smile and a quick response, "So do I." I, also, often, find that the comments trigger tears, which I quickly disguise and inhibit.
    On the 12th, when this woman reached out to me, I had an instantaneous revelation. I think the reason we all notice bonds like that between my mother and I and often feel the need to acknowledge them verbally and wistfully is because we all know that it is more than likely that we will not be "handled", in our Ancient years, as I handle my mother. It isn't something that works in this society. It is so uncommon that my mother's doctor, yet again, felt moved to thank me for "taking such good care of [my] mother." It wasn't an automatic gratitude, either. Although he's thanked me once before, this time when he said it he sounded like he was choking on surprise that I was continuing to do this in the face of so many obstacles.
    Many of the people who have stepped out of line to approach me on this subject have mentioned that they do not do this; their families do not do this. It's mostly impossible, the way this society's set up, to consider indulging someone in the kind of "handling" I do. And yet, most of us wish we could offer this "handling" and we all hope we will be blessed with someone who offers it to us.
    I know the dynamics, economic, cultural, social and spiritual, are complicated. Nonetheless, I hope, soon, our society will awaken to our desires regarding our Ancient Ones and being Ancient and begin to make it possible, by changing this maniacally consumerized culture, for relationships to flourish that silently guarantee that none of us ever, again, feels compelled to say, "I hope..." but will be able to say, "I know...".

...but, since it's mine, it doesn't get tooted unless I put it to my lips and fingers. Late last week and early this week a marketing tool for "The Senior Living Industry", the Goldman Mature Market Report, published a series based on three interviews with Anne Robertson, the author of Monday's with Mother: An Alzheimer's Story, one of the blogs in the Memory Lane Webring. An announcement of the upcoming articles was sent to members of the ring and one of them forwarded the announcement to me. So, of course, I followed the articles. I was pleased to note that a PR company that devotes some of its resources to the "Senior Living Industry" was paying attention to the blogophere as it pertains to real world seniors and their real world circumstances, even if it is in order to drum up business. In the second part of the article, the last paragraph admonished the industry for lagging on understanding the potential impact of such blogs, then devoted a bit of wordage to suggesting how individual businesses in the industry can begin to mine this resource for information. This paragraph bothered me. It was way too short-sighted. So, I decided to leave a lengthy comment on why businesses in the industry should look further, replete with some suggestions on what to look for and what they might find. Since the Goldman Mature Market Report moderates their comments and I'd left, as a comment, what amounted to a mini-article, I wasn't expecting to see it show up. But, it did. If you're interested, you can access it by clicking on the link above to the second part of the article, then further clicking into the comment. So far, mine is the only one.
    I mention it in case other members of "the industry" visit here and could use a little inspiration.
    Funny, though. Mona, the author of The Tangled Neuron recently reminded me of a PBS show she viewed, "And Thou Shalt Honor...". I saw it a few years ago but couldn't remember much about it, so clicked into her link. I remembered so little about the show that I'd forgotten that Dr. Bill Thomas, the author of What Are Old People For?, was a featured guest. At that time, I hadn't read the book. This time, since I've now read him, I was intrigued about what he might have said, so I clicked on his name. In this interview, he makes no bones about what his intentions are [scroll to the his response to the last question on the page] toward what he derisively refers to as the "long term care industry" [to read his specific comments, click here and scroll down to his answer to the last question on the page]. As I read through the interview, it was hard for me not to contrast it with one of Goldman & Associates goals, to nurture the same industry Dr. Thomas intends to bury.
    What interesting times in which to live!

    Although I can't remember how I came across it, I recently listed three of these journals at Medical Blog Network. No, it hasn't generated much in the way of visits, but it's a pretty active community that includes loads of blogs dealing specifically with medical issues. I figured, participation couldn't hurt. It can be a confusing site, but, interestingly, there are sections which address the confusion.
    Anyway, just thought I'd mention it.
    Time to awaken the Mom. Not sure if I'll get her out today. We discussed going to Home Depot today after our exhilarating trip to Target, yesterday. It's windy and cool, though, which may significantly dampen Mom's internal fires, so we'll see. I'm also anxious to see how her BG is doing, this morning, so, I'm off.
    Later.

    Although I'm cutting back a bit on carnival participation, to a purpose, I wanted to mention a couple that picked me up recently.
    After I decided to cut back, out of curiosity I clicked into Grand Rounds last Sunday just to see if this next week involved a theme. It did; an interesting one, medical education, both formal and informal. I'd just written the post about trivial detail a day previous and decided to submit it. It was picked up and placed in yet another interesting, post packed, readable format, for which Grand Rounds is famous. The immediately previous link will take you directly to this latest edition of the carnival. I honestly haven't gotten around, yet, to perusing the posts, although I will; the theme is a special concern of mine, as you can well imagine, if you've read me, here, for even a little while.
    Another carnival of which I am especially pleased to be a part is an unusual one, posted September 9th on a delightfully unusual journal. The carnival is Carnival of Healing, originated by Spiral Visions. The edition in which I participated is themed Life, Death & Rebirth. Aside from this edition having some provocative "other maps" type posts, it is hosted by Other Lights - Journey of the Liminal Being, to which I have become recently attracted and like to read and consider for it's soul adjustment properties. It's written by Scott Smith, with whom I've corresponded. Spiral Visions, the overseer of this carnival, as well, is an interesting and unusual site, as well, with lots of alternative healing information. I recommend all, for those of you who like to wander off the beaten path.

    Today is one of those, "Hello, it's fa-a-a-ll, I'm here early!" days. Thus, I'm exhilarated, delightedly anticipating the possibility of a cold, snowy winter. At the moment, at least, I don't feel like dwelling on other give-ups, so I'm going to start down my appointment trip list, bullet by bullet, although not necessarily in order. I'll link the bullet subjects forward to their discussion locations as I go.

    The Plebotomist started the blood draw session with: "Okay, Mrs. Hudson. Medicare has sent out a whole bunch of forms with questions that I have to ask you. Sorry about this, but you know how the government is, forms, forms, forms."
    "Oh, yes," Mom said, rolling her eyes. "Everything has to be recorded on a form."
    I was, frankly, surprised by her response: First, because she heard him clearly even though, through half his introduction, his head was down while he shuffled through the forms in question; second because her response indicated that she understood what he was saying. I was primed to help her respond but decided to "stay back" unless she had a problem with a specific question.
    "Do you have Black Lung Disease?"
    She registered shock. "Black Lung?!? What is that?!?"
    The Phlebotomist looked at me as if to say, "You want to handle this one?"
    Instead of answering, I decided to go with the optimistic assumption that she'd never heard of Black Lung and answer her directly. "It's a disease that coal miners get from exposure to coal dust in the mines, Mom," I said.
    Mom chuckled. "Well, let me think...back in the old days when I was a coal miner..." her voice trailed off, her eyes twinkling as she glanced at the Plebotomist for an appreciative chuckle.
    Instead, the Plebotomist gave me a frantic glance, as if to say, "She's pretty far gone, isn't she?!?"
    I laughed.
    Mom noticed his confusion and said, with humor but a distinct corrective tone, "Well, of course not!"
    And we were off and running. I knew, at this point, she would probably make it through the entire stack of questions on her own and settled back into my chair.
    "Are you a veteran?"
    "Oh, yes!"
    "Do you have any service related disabilities or illnesses?"
    "Well, no, not that I can think of," upon which she looked at me for confirmation.
    I shook my head, "No."
    "My daughter's saying 'No,' so I guess not."
    "Are you receiving any special compensation from the government or the military for any service related disabilities or illnesses?
    Mom registered surprise. "Well," she said, "if I don't have any, I'd better not be!"
    The Phlebotomist smiled, nodded and looked at me for quick confirmation, which I gave him with a shake of my head.
    "I notice you're a former smoker," the Plebotomist said.
    Mom started. "I still smoke," she asserted, proudly, as though it was a badge of honor.
    The Plebotomist rifled through her file and directed at me, "Is that right? It says here that she quit."
    Mom: "That's wrong."
    Me, to Plebotomist: "That's right." Me, to Mom: "Mom, you did quit, without realizing it, about two years ago."
    Mom, to me: "Well, we'll have to do something about that!"
    Uh oh, I thought, I can see we're going to have a looking-for-cigarettes day, but, you know, whatever.
    The Plebotomist continued: "Did you start smoking in the military?"
    Mom hesitated on this one. "Hmmmm...I think so, but I'm not sure. I knew about cigarettes before going into the military, but..."
    The Plebotomist looked at me.
    "As far as I can tell," I told him, "she probably did. She didn't live in a family or community that smoked until she joined the military."
    Without making a mark, the Plebotomist asked Mom, "Do you have any lung conditions or diseases related to smoking?"
    "Well, goodness, I don't think so!"
    As she said this, I could see the Plebotomist focus on the cannula attached to her face and the oxygen tank attached to her walker. "It says here," he continued, "that you have COPD."
    "Well, if it says that there, I guess I do."
    The Plebotomist looked at me.
    "Yes, she has COPD. It's much improved, though, since she, you know," I lowered my voice, although I'm sure my mother heard me, "quit."
    The Plebotomist nodded.
    "The doctor just listened to her lungs and said they sounded very good but, you know, she still needs oxygen, especially when she moves. I'm surprised by that question, though. Do you know why they're asking that?"
    "I think it's because some WWII veterans have attempted to sue the government for their smoking habits after contracting lung cancer."
    "Oh," I said. "Well, I don't know what to tell you to put down. She can't remember and I wasn't there."
    "You weren't where?" my mother asked.
    "With you in the military."
    "You weren't?!?" she exclaimed, clearly indicating, by her tone, that she knew I was lying.
    "Well, no, Mom, I wasn't even a gleam in your eye."
    "Oh, well, no," she confirmed. "I guess you were still at home."
    The Plebotomist and I exchanged grins. He asked me, "To the best of your knowledge, would you say your mother started smoking in the military?"
    Mom said, "I believe I'd like a cigarette."
    I asked, "What difference would it make?"
    The Plebotomist responded, "Not much, since she's already covered by TriCare."
    "Okay," I said, "to the best of my knowledge, yes."
    That was the last question/discussion before the blood draw. Within moments Mom had forgotten her catalyzed desire for a cigarette.
    The blood draw continued without incident, except that Mom and the Plebotomist had a minor debate about which arm he should stick, which he controlled by saying, "Well, I see a good vein right here," touching her inner elbow, "so let's use this one for a change."
    She agreed. As she watched him stick her with a butterfly needle, she exclaimed that he was doing, "...much better."
    He looked surprised.
    I said, more for his edification than hers, "You're thinking of last week, Mom. You had a trainee and he wasn't experienced with veins like yours. This guy is an expert. He knows what he's doing."
    "You sure do," Mom confirmed. "I wish I could take you home with me. My daughter," she continued sotto voce, nodding toward me, "makes me do this every month."
    I was surprised that she remembered this. The Plebotomist nodded toward me and smiled.
    As we exited the room, the Plebotomist drew me aside. "Sorry about that," he said, referring to the cigarette memory triggering. "I hope you don't have problems, today."
    "No problem," I said. "I can always count on her dementia to make my life easier in that respect!"
    "Your Mom's pretty aware, though."
    "Yeah," I said, "Not too little, not too much, I guess!"
    In summation, she only looked for cigarettes twice more that day, once after dinner at the restaurant and once in the evening at home as we were leisurely and appreciatively reviewing our day. Both times she looked but didn't register what she was looking for. Both times I simply ignored her efforts and the moments passed without verbal incident.

    That's the first of my "give ups". Yes, Mom's doctor's appointment went well, considering. Yes, although lively, the debate about exenatide was resolved in favor of not starting my mother on it. Considering how some of my questions were answered and one of my fears allayed, and, as well, considering that the "try it, it's possible it will work on your mother" suggestion (which I'll cover in a minute) does show promise of working, I am satisfied. Some things happened, though, during the appointment that caused me to realize that The Medical Industry is Medicine is Entrenched and it isn't going to change increment by increment. It is only going to change by way of the sea (meaning, a sea change), which hasn't yet swelled against The Shore of Medicine. Let me review what happened.
    Mom's PCP told me he was not displeased with her blood sugar levels. Yes, he said, it looked like they were rising, but he felt that this could be addressed by adding a third 10 mg glipizide ER to either her morning or evening dose if necessary. I was concerned about this because glipizide, specifically the extended release form, has a tendency not to expand its capability when dosages are upped, but, as he pointed out and as I've read in certain obscure references, some of this depends upon the patient's chemistry. Thus, his first two arguments, let's not fool with success and let's try upping the dose when necessary, I considered legitimate and agreeable. His third argument, which I also considered legitimate and agreeable, was that when one fools around with medical regimens one risks side effects which are not known, especially with a medicine that hasn't been in use that long. I agreed with this and confessed that, although I'd not been able to find any evidence that Exenatide reacted with volatility to any of her other current meds, I wondered if this was because it simply hasn't been out there long enough for any evidence to have been collected. He nodded his agreement. His fourth argument was that he was more concerned about my mother going too low than too high. He'd prefer, he said, to see her between 70 - 134 in the morning, but she is doing so well and showing none of the consequences of high blood sugar so we have to assume that what we are doing is working for her body. I couldn't disagree with this but his argument made me realize something: He wasn't informed about exenatide and hadn't bothered to look anything up about it. One of the startling hallmarks of exenatide is that, because of its structure, which is unlike the structure of any other diabetic med on the market at this time, it protects against hypoglycemia. This effect was mentioned, sometimes shouted, in every single article I researched on the medication. As well, I mentioned it in the stuff I faxed him. Yet, he was unfamiliar with this. I realized, ahhh, he hasn't read up on the medication, even though I mentioned it to him first more than a week ago. He also didn't read the short (it was very short, less than half a page in 12 point type and bulleted, so it would be easy to read) supplemental blurb I sent him the day before the appointment along with the data I compiled. I actually tried to mention this to him again at the appointment but he waved me off.
    Then, he honed in on the "morning after" salmon blood sugar and ignored the "morning after" blood sugars for the other three meals. When I brought them to his attention he shuffled through papers, quickly scanned them, at which point I realized he hadn't previously paid them attention, and said, "You have to remember, macaroni is very starchy."
    Well, yes, I said, repeating what I'd written in the "Assumptions", this was the point. With cooler weather and the holidays coming up, I purposely surveyed starchy meals because they become fairly standard fare during these months, not to mention sweets. He repeated his advice to add an extra glipizide. At this point, in fact, he suggested splitting the pills. Luckily, I had the bottle in my purse and showed him that they are tiny and constructed so as to render this impossible. I didn't express my surprise that he was unfamiliar with the construction of this medication. That's when he said, okay, just add 10 mg, if necessary.
    Then, he asked me if I had yet found a doctor in Prescott for Mom. This surprised me. It's an issue we've discussed before and about which he also has notes in Mom's file. He knows the problems I've had with doctors for Mom. He knows all about my preference for continuing with him. He even has all that in print in the file. I repeated all this, briefly, and he said he was concerned that if something "should happen" to Mom she wouldn't have access to care.
    I assured him she had access to the Urgent Care Clinic, as well as the hospital. I also wondered, silently, why he was concerned about this because his policy is to send patients with urgent concerns to the nearest ER, whether or not he is on staff. In fact, even when we lived in the Valley, Mom always went to the nearest ER, on which he is not on staff, and this didn't matter. I'm not even sure that he is on staff at any hospital in the Valley.
    Then, he dashed about the office, checked her ankles for swelling, of which there was none, which surprised him, listened to her lungs and heart, which sounded "very good", mentioned that he'd look at the "old things" to which I'd referred both in my appointment agendas and in the office, but he got busy and forgot, then he left the examining room and never returned. He also forgot to renew her glipizide prescription, which we'd discussed needed a refill, so I sent the nurse back for that.
    All these little oddities roiled through my mind for about 24 hours. Finally, yesterday evening, I realized, he, too, doesn't want Mom as a patient, no doubt because of me.
    And, you know what? I'm too damned tired of going through doctors like Grant went through Richmond. It's possible there is a doctor out there who would appreciate my medical advocation for my mother, how I care for her from a medical standpoint, how meticulously I observe and report on her, etc., but, you know, if you've read very far in this you know what I've gone through to try to find her a doctor here. I even sent out letters to offices explaining my care of my mother, her insurance, her conditions, her age, everything, and asked physicians who were interested to respond. None did. Two weeks later I called each office, referred to the letter, with which all were familiar, and followed up. None were willing.
    So, I give up. Mom's PCP is stuck with us, unless and until he decides to tell me he's no longer interested in tending to her, which I now consider a possibility, although he did tell us he wanted to see her again in March, at the six month point, for a routine appointment.
    See, the thing is, I haven't gone to medical school. I haven't taken and passed the boards. I can't write prescriptions. Medicine has the power and the passwords and, at this point in Medicine's life, I have the distinct feeling that It has decided It is in a position to strong-arm patients back into prostration. Isn't going to happen, of course, but Medicine has way too much clout for It to back down any time soon. And I'm tired. Really, really tired. I'm not interested in being considered a combatant, anymore, when, in fact, I know that if Medicine would pay attention to me and those like me, It would discover a valuable ally. For Christ's Sakes, I even do Its work for It!
    So, last night, I had a long discussion with my mother about this problem. I explained it all to her, including my surprising and new disillusionment with her PCP and why that's happening. I told her that I know that, at this point in her life, there is every reason to believe and count on the possibility that, at some point, she is going to need intensive (although probably short term) Medical care. I explained that, yes, it would probably be better if we had a physician here but I was too tired to look for what is probably the one and only one physician, if there is even one here, who would accept my involvement in her care. I told her that there is every reason to believe that my medical vociferosity on her behalf might actually keep physicians from treating her. I explained that, because of this, I needed to be ever more vigilant about making sure we do everything at home that we can to make sure she remains as healthy and physician-free as possible. Finally, I asked her if she trusted me enough to allow me to give up on physicians and Medicine whenever I think I can and keep her care as home based as possible.
    "You can't do worse than the doctors, Gail," she said. "In some cases you've done better. I trust you."
    "Do you understand, Mom, that this might mean that there will be times when it appears that you need a physician but I will delay seeking one out?"
    "Oh, yes," she said. "I'm fine with that. I don't want to see doctors unless it's absolutely necessary and, even then, I'd wait (which is true...she has a history of doing this, occasionally to her temporary detriment). I always have, and I've always gotten better. Do what you have to."
    So, Medicine, I give up on You because You've given up on us. You don't need to give up on us, but You're afraid of us, so You have. I'll treat You exactly as You've treated us, with absolutely no deference to the Sacred Art of Healing, which You seem to have forgotten. I'll use You when we need You. I'll ignore You when we don't. If You don't want to cooperate with us, well, all I can tell You is that until You figure out that You're biting the hand that feeds You, You're going to continue to have problems, huge problems, much bigger problems than we'll have without You. My mother chooses the problems we'll have without You over the ones we've had with You. I choose the problems we'll have without You over the ones we've had with You. I believe our choices will enhance our lives. I believe Your choices have already and irrevocably endangered Your Life. If You want to have some choice in the Revolution of the Healing Arts, which is upon You whether or not You concede this, You need to embrace us, rather than trying to force us to embrace You, which, ultimately, isn't working. As You do so You will guarantee that You will become, once again, humane and honor the Healing Spirit Which You once embodied and Which awaits Your return.

...To Do Tomorrow:

1. Give up.

...was just posted over at The Dailies. If you're interested, the link will take you directly to that post. Just a few extra stats and conversations. I'll talk about the bulk of it, here, later today and probably into tomorrow.
    For now, Mom requested, last night, as I was rubbing down her legs, "something special for breakfast" this morning. I expect she'll not open her eyes until noon or perhaps after (she asked that I let her sleep in today, which I will, up to a point, anyway). So, I'm headed off to gather a favorite of hers, Wildflower Bread Company's cranberry scones. I'll be back later reporting so extensively on our day some of my readers will probably glaze over, but, in the meantime, it's off to see the Wizard, the Wonderful Wizard of Scones.
    Later.

...the trip was successful beyond my wildest imaginings, Mom had a great time, so did I and both of us are pleasantly exhausted. Her light went off a few minutes ago at 0012. I will be following suit, shortly, when the first load of drying ends and I'm able to start the second load, with all other house lights, including my own. I want to post some reminders to myself, though, so I'll remember what I want to write about here:

• A startling conversation she had with the phlebotomist and why it was startling;
• Related to the above, "What is Black Lung?!?"
• Also related to the above, to report or not her former cigarette habit;
• No exenatide...lively debate, instead, in which I deferred to her PCP, with satisfaction;
• between 70 and 134;
• Better high than low, for Mom, anyway;
• "I can't think of anyone I'd rather be with."
  "I was just think the same thing, only I couldn't find the words."
• Mom's suggestion on further trips; including a road trip to Iowa (unlikely, but, still, her spirit is willing);
• Lab tests ordered and results being awaited, which should be mailed to me by the middle of next week;;
• Her PCP's concern, expressed again, about Mom not having a PCP in Prescott, and why he is concerned;
• The strategy that worked a bit better than marginally regarding, repetitions of, "Breathe through your nose, not your mouth."
• My discovery about Mom's abilities and inabilities regarding relaxation and anticipation;
• Mom's surprising evaluation on why it is better that we have cats instead of dogs;
• Her amazing energy level today;
• I'm ready to post on our care, as a society, of the elderly, now, as a result of some of today's incidents;
• Related to the immediately above, there's a time for independence and a time for family, featuring "Mr. Weidel" and others;
• Her PCP once again thanked me for "taking such good care of [my mother];
• My "cute" mother;
• "I hope my kids handle me like that when I'm her age."
• Doing the hootchy kootch in public;
• The big mistake I made in regard to deciding not to notify or visit friends on this trip and the last trip on August 30th;
• Dinner at 1520 and honoring my schedule and hers simultaneously;
• "Leisure World East" or "Palmas del Sol";
• "Does this city ever end?"
• Stats taken at the office, and commentary;
• The value of walkering practice.

    I think that's it. Serendipitously, I also just heard the dryer clicking off. Reminders unrelated to the above reminders:

• Update on carnival participation;
• Update on a series and a comment
• Medical Blog Network
• Woman at Walmart with Poise Bladder Control Pads

    Huge, satisfied sigh.
    Later.

...until sometime this evening or tomorrow, but, this can't wait.
    If you have ever, EVER thought about nursing homes from the point of view of them caring for someone you love or, eventually, for you, READ THIS at The Yellow Wallpaper.
    Later.

...tomorrow night, at the latest, Wednesday morning. But, but, I wanted to extend some credit where credit is due and celebrate yet another business that has made my job as my mother's caregiver easier more than once. As you know, I rent cars when I take my mother to the Valley for anything. Although there are several reasons why I do so, the primary reason is that neither of our cars is a comfortable fit for my mother on a two and a half hour drive; neither for sitting nor getting into and out of. I rent from just one local business, the local Enterprise franchise. I've been renting from them for about two years, now. Let me tell you why I continue to use them.
    I called today to check on my reservation for tomorrow and make sure they'll have the type of car with which we are currently very pleased, the type we rented on August 30th, a Nissan Sentra. My reservation was set up so they'd pick me up at 0800 in the morning, we'd use the car for the day, I'd return it the following morning and they'd give me a ride home. When I inquired about getting a Sentra, Stacy told me that they are having an unusually busy day tomorrow. Generally, it's first come first served, she explained, but, they had a Sentra on the lot today for which no one had spoken. "If you come in today between four and six, I'll set you up with it and won't charge you for tonight." They were even willing to pick me up at four, if I called to let them know I was ready. I agreed.
    When I hung up the phone I got to thinking, wait, that can't be right, surely I misunderstood and I'll be charged for an extra night. So, I immediately called back and explained to Stacy that I think I misunderstood, surely I wasn't going to get an extra night free; that didn't seem fair to the car company; but, if making sure I got the Sentra required an extra night, this time, I was willing.
    Stacy confirmed that I'd heard right! I was thrilled and, of course, took advantage of the offer. Then, when I checked out the car, she and I got to talking and she forgot to run my debit card. I realized this immediately upon arriving home and returned with my card. She told me she'd realized it, too, but figured, you know, she knew where I lived, she'd just run it when I returned the car.
    Other wonderful things have happened to me using this company. They are extremely understanding about the seating situation with my mother and, through experience, are very good about finding just the right fit. As well, a couple of times when I returned the car, because I always top it off as we leave Prescott and we don't do a hell of a lot of running around, we just do our business and leave, I've returned cars with well over the amount of gas with which I've checked them out. I never mention it, but they always notice and I've been granted a card with a free part of a tank of gas, which I was finally able to use on August 30th.
    Ray, Shannon and Stacy, the three people with whom I've consistently dealt through this franchise, are super and always willing to, literally, go the extra mile with and for their customers. I'm so pleased with Prescott's Enterprise franchise, I want to give them a plug, here. You guys rock! Thank you ever so much for always performing above and beyond my mere expectations!
    And, for those of you readers who remember, we will be staying, once again, at the Superstition Springs La Quinta Inn, the hotel that was so extraordinarily generous they treated us to a reduced our rate since we had no intention of staying the night and left early enough so that, if they wanted, they could re-rent the room.
    It's time. I've got to hit the sack.
    Later.

    That's what my research both on my mother and on the drug, has revealed. I hope Mom's PCP agrees with me. I kind of think he will. In April of this year too few studies were out to indicate that it, too, is kind to the elderly, likely kinder than glipizide, especially to those with challenged kidneys. Now, those studies are out there all over the place. And, the timing is prime. Mom's fallen into that Type 2 Diabetic Gulf that renders her usual medication insufficient. After spending many hours over the last few days looking up everything available, I was finally reminded of exenatide (Byetta), looked up all the links I'd bookmarked in April, then pulled the same searches I did then which were not fruitful at that time. Now, there's information all over the place about exenatide and the elderly, exenatide and chronic renal failure, exenatide alone or with an oral med, exenatide and its effects on other meds...and, from my mother's body's point of view, it's all positive. There's even the possibility that her kidney functions will remain stable much longer through the use of exenatide and may even show some improvement. Hallelujah!
    I expect that her PCP will probably recommended starting her on the minimum dosage, 5 mcg/twice per day, within an hour before breakfast and dinner, cut back her glipizide ER 10 mg to once a day (not sure whether morning or night would be better; I think, with Mom, it'll six of one and half a dozen of the other), keep her on both for awhile to see how exenatide affects her, then modify treatment according to what is revealed. I'd like to think that within some months we'll be able to get rid of the glipizide, but I'm taking a conservative position. As well, from sorting through what I've read and interpreting the entrails, so to speak, it's possible that under the influence of exenatide her bouncing blood pressure will settle down without further medication. That would be nice.
    There was no reason in April to consider exenatide, since Mom's BG was under excellent control at that time, even though exenatide would most likely have been fine. Now, there's a reason. While it's true that there are, yet, no long term use studies available on the drug, well, you know, that's how it goes with drugs. I'm willing to take the risk; more importantly, I've talked to my mother about it and she's willing to take the risk, as well, especially, as she said, if it means the severe restrictions in diet, sleep and mandatory exercise over the last few weeks will be lifted.
    So, despite my fears and frustration, I am, yet again, emerging from this health bump of my mother's with flying colors. I'm finally beginning to see a pattern: The more agonized and inadequate I feel just previous to working out one of her health problems, the more I apply myself to the problem, despite my fears, and the more deliriously satisfying is the solution. I still have two heavy duty days ahead of me, including her appointment. My assumption is that her PCP will agree with me, may have already easily come to the same conclusion over which I've been sweating. I'm prepared for the possibility of a lively debate. Both days are decidedly downhill days, though; treacherously steep, true, but they lead to a restful valley. I've always preferred the climb to the descent. I have, in fact, a literal history of falling on my face during steep hiking descents. But valleys are as exhilarating to me as summits, so I'm not complaining.
    Well, I'm going to bed "early" tonight. I need some sleep.
    Later.