Update of 11/17/14

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Update of 11/17/14

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Question-MarksMonday: On waking the temp was 35 F with a wind chill of 30 F. The high for the day was 43 F. with a wind chill of 36 F. Dialysis today also had a care meeting with the dialysis team, her MCO care team and us. Set appointment for tomorrow afternoon with podiatry for Mom as a follow-up to her ER visit of last night.

Tuesday, Veterans Day: On waking the temp was 25 F with a wind chill of 12 F and snow falling. The high for the day was 33 F with a wind chill of 17 F and an accumulation of about 2 in of snow. Took mom to podiatry for her ER follow-up for plantar fasciitis. Podiatrist sated the pain she was having was not from plantar fasciitis that she had more going on and called mom’s PCP and then instructed us to go to ER and they were calling down there to let them know we were coming and what was happening. From ER they rushed her to interventional radiology for an angiogram and determined that she has peripheral artery disease (PAD) and had very little blood flow to the foot. They ballooned them open and admitted her to the hospital. I got home at midnight from a 3:30 PM appointment.

Wednesday: On waking the temp was 18 F with a wind chill of 5 F. The high for the day of 27 F with a wind chill of 16 F. 7 AM back to hospital to meet with doctors. We met with the doctors who stated that she only has one small vain open in her lower right leg and if they cannot get drugs to work to open some of the others they would have to take her foot. She is in denial right now about this. I look at it as they need to do what is best for her and will be there for her no mater what happens. Dialysis was as inpatient at the hospital. I got out of the hospital about 9 PM.

Thursday: On waking the temp was 24 F with a wind chill of 12 F. The high for the day was 27 F with a wind chill of 15 F and light snow. I was back to the hospital by 7 AM to meet with the doctors. Possible discharge today depending on a consult that was to occur prior to discharge. I had to leave for four hours today to take care of one of my other paid clients. When I came back the consult had not happened yet. About 6 PM the doctor for the consult showed up and left about 7:30 PM. The determination was made that by the time the discharge paperwork could be completed that it would be medically ill-advised to discharge her tonight as she would have to be at the dialysis center by 6:30 AM so would not get proper rest. Dialysis was scheduled for the next morning (8:30 AM to 1230 PM) at the hospital with discharge planned for after dialysis. I got out of the hospital about 9 PM

Friday: On waking my room was cold. I got up to find the heat was out in our apartment so made a call to building management 24-hour maintenance. They came and let me use the guest apartment to get ready for the day as they would have to call a contractor in to look at the heat. The temp outside was 21 F with a wind chill of 11 F. the inside temp in our apartment was 45 F. The high for the day was 25 F. Back to the hospital by 7:30 AM. No doctors came in before she went to dialysis. I went back to the apartment when she was at dialysis to check on the heat.

On the way home I had a tire blowout and when I went to changed the tire the jack in the car failed so I had to call a service company to come change the tire. I got back to the apartment to find the contractor working on the heat. I went back to the hospital to be there when she got back to her room by the time she got out of dialysis. When I left the contractor was still working on the heat but the building management had some space heaters in the apartment running to keep the temp from freezing in the apartment.

The doctor came to the room right after I arrived back at the hospital and right after he came in Mom was brought back from dialysis. It was decided that she would eat lunch and as soon as the order was placed for lunch he would put in the discharge orders. We went and ordered her tray before he even left the room. The discharge order was placed at 12:45 PM. Her food tray arrived at 12:50 PM. 1:00 PM received call from building management that the heat was fixed in the apartment. 1: 15 PM Went though all the medication changes, care required, called the MCO to get my authorizations changed for the care needed. (A temporary authorization was made until a care conference can occur.) At 3:00 PM I was sent down to the pharmacy to get her new meds as they would not release her until we had the new meds. (We regularly use the pharmacy in the clinic so I just had to go downstairs.)

At 3:30 PM we were on our way down to the discharge area. I was prepared for the discharge and parked just down the lot from the discharge area and went and drove the car up to the discharge area. We proceeded home when I arrived home it was obvious the heat was working as it was over 90 in the apartment. The continues operation switch was flipped on the thermostat so I shut it off and had to open the windows for a short time to cool it back down to a more tolerable level.

I proceeded with getting Mom her pain medication that was now due and make her comfortable. I then started supper, made some calls on getting tires for the car and have an appointment for during her dialysis Monday about two blocks from the dialysis center. They are even going to come over and get the car and bring it back to me. When finishing up supper I picked out the medication that she needed for supper and bed time tonight.

After supper I started our night-time routine and got her off to bed. I then took all of her meds that were set up apart and started over with the new regimen. I then spent some time catching up on email and caregiving.com.

Note as I stated in the comments on the question that Denise posted about what you would do if you had the house to yourself. I stated “I had the opportunity when mom was in the hospital to have the apartment to myself. I found it a nice time to have an uninterrupted nights sleep and I could take a shower with the bathroom door open so I could hear the radio from my room.” I found this very relaxing.

Changes in care that have come with this discharge: I need to check her foot for any type of injury daily, I have to check her O2 saturation 4 times a day, I need to check her blood pressure 4 times a day instead of daily, an additional time to take medications on a non dialysis day on dialysis day I have to be sure to take the med with us as they will administer it at dialysis. We also have 4 follow up appointments to see her PCP, the vascular doctor, occupational therapy, and physical therapy. The occupational therapy and physical therapy appointments are the initial consultation appointments and may cause more appointment once they do their assessment. We also have a care conference set for Monday with her MCO, dialysis, PCP and vascular doctor to discuss her cares on the longer term basis. The MCO also stated that they want to develop a plan for if she does need an amputation so that we know if they are going to have me keep doing everything or if it is time to bring in some help for me. Mom is very reluctant to have help brought in as she feels that they do not care and are only in it for the money. In some ways form what I have seen with my other clients this seems to be a very common thing in this area. I have also seen very little consistency in personnel or care provided by many of these company’s. Per mom’s living will and health care power of attorney paperwork they only way she is allowed to go to a nursing home is if it is for a short therapy stay only (not to exceed 30 days) and if she gets to the point she can not be cared for at home that she then wishes to be taken off of dialysis and allowed to dye as she does not want to live like that.

Saturday on waking the temp was 12 F with a wind chill of 2 F. I did regular cares for the morning and headed off to the Laundromat as that did not occur last night do to the discharge. Wail at the laundry light snow started falling. The high for the day was 25 F.

Sunday on waking the temp was 21 F with a wind chill of 12 F and light snow and fog. The high for the day was 26 F with a wind chill of 15 F. Regular cares today. Homemade turkey chili, homemade bread, and Carmel apple cupcakes. On leaving our friends place (about 1 block from the hospital) from our Sunday get-together my mom became short of breath and begin having chest pressure as I was getting her in the car. I took her straight to the ER. She was directly admitted. EKG suggests heart trouble but labs suggest medication reaction and the pulmonary doctor is thinking it may be bronchial spasms from the cold air. The air temp at this time was 14 F with a wind chill of 0 F.

Monday on waking the temp was 12 F with a wind chill of -4 F. Off to get tires fixed, then to the hospital to see what is up. Pharmacological stress test, multiple EKG’s, dialysis and many lab tests scheduled for today. I also have 2 clients to care for today. After clients headed back to hospital and she was just coming back from the stress test. We are awaiting test results and dialysis. As of 5 PM the high for the day was 16 F with a wind chill of -1 F and the sun had set for the day and the temp is already falling.

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PshYesICan

I agree with Chaya! It's a marathon and a sprint at the same time. You're doing a fantastic job taking care of your mother. I am especially impressed that she was out and about at your friend's house. I'm sure it lifts both your spirits to be somewhere other than a medical appointment. I am hoping you are still able to do so.