To MFASRF: I have a bit of down time,
(which is actually up time, for me, but, I think I mentioned that to you once before) so thought it might be a good idea to update you on what's going on with my mother, and, by association, me.
    We finally went to Prescott on August 23rd. On September 16th we were back in the Valley. It soon became obvious that we would be here for fall and winter. The initial reason we returned is that my mother, quite suddenly overnight, became very pale and her legs swelled like balloons from the feet to the knees (at this point no one is quite sure why the swelling, which was water retention, happened; congestive heart failure has, for the meantime, been ruled out). I let her doctor know we were on our way down and was able to make an immediate appointment for her. He put her on a variety of medications to take care of the swelling and to combat severe anemia, which became apparent after one full blood panel and one special blood panel were taken a day apart, and to keep a mild case of bronchitis from turning into pneumonia. The medications included but were not limited to a steroid, a diuretic, an antibiotic, a heavy duty iron supplement, a bronchial dilator and oxygen. He also began scheduling her for a series of tests including a chest X-ray (done, small spot on her lung located in such a way that it required a chest CT without contrast in order to see if it was on her lung or a calcification on a vertebra), an echocardiogram, an occult blood stool test, a very special blood panel done by a hematologist, and a colonoscopy. The latter two have not yet been done, the CT has yet to be read.
    A week later, to the day, of having been started on all these medications my mother had what is now being termed both an "Alternative Level of Consciousness Episode" and a TIA (which, by the way, isn't a stroke; many people, including me up until now, think it's a stroke, but it's not). On Wednesday morning while I was preparing breakfast and she was sitting at the table bantering with me she suddenly stopped her rapid fire response. I looked over and noticed that her head was slightly forward and shaking slowly back and forth, her eyes were bugging, her mouth was slack and she was unable to respond to me. The episode peaked and began to subside in less than a minute, but I was immediately on the phone summoning paramedics, who arrived within three minutes of being called (the fire department is just down the street). By the time they arrived my mother had trotted into the bathroom and was busy evacuating her bowels (I am telling you this to a purpose). In fact, the paramedics had to wait an entire 10 minutes for her because her bowels were completely cleaning themselves out.
    I had called the episode in as a possible stroke, but, rather than her blood pressure being very high (which, for her, would have been extremely unusual), it was quite, quite low. Anyway, at the hospital they spent several hours administering more tests, including a digital rectal exam (a medical way of stating that the doctor stuck a gloved finger up her ass), a head CT and an MRI. It was determined that she had not had a stroke, so the episode was labeled a TIA and she was admitted to the hospital overnight for observation (and, as it turns out, semi-starvation and a little more dehydration, which did her little good).
    Interestingly, that evening, after I got home (as it turns out, as well, I should have spent the night there, but, not having ever dealt with hospitals, I didn't catch the warning signs and went home after she went to sleep, that night), I called all my sisters to let them know what had happened. MPS was the one who actually pegged what happened. She and I had been trading a series of shit jokes back and forth. When her doctor asked for stool samples, he asked for three separate samples within a 36 hour period, which everyone, including my mother, thought was a hilarious request. In fact, because I spent those 36 hours with my nose up my mother's ass, he got none, until 24 hours after his deadline, and then only two; both of which were inconclusive. Anyway, because of this and the family hilarity it generated, I told MPS that Mom held up the paramedics for 10 minutes while she shat her brains out on the toilet. Immediately MPS, who spent several years as a kidney dialysis tech, said, "That sounds like a dialysis crash," and went on to explain to me what such a crash is. When a person with renal failure is being dialyzed, there is a very fine line between how much of the fluid being taken off is just enough and how much is too much. It is very difficult to tell. Typically, techs try to end a session leaving a bit of fluid "on" to make sure the person hasn't been dangerously dehydrated, but it not infrequently happens that the line is crossed, which causes a person's blood pressure to drop to almost nothing (the crash). Most of the time, the patient is revived and within minutes (sometimes only one minute) evacuates their bowels, because the drop in blood pressure relaxes their bowels (such a drop is, actually, a sort of mini-death) and total evacuation occurs.
    As it turns out, the hospital doctor (my mother was taken to a hospital where her own doctor has admitting and treatment privileges but not ER privileges) had told me that she was severely dehydrated and it happened very quickly, because of the combination of medications she'd been on. Although she'd been drinking water like a fiend and I'd been encouraging even more liquids on her, the medications were so effective in her already weakened state that even salt was not being retained in her tissues. So, at this point, I called the hospital doctor and told him what my sister had told me and he had an Aha! moment. He agreed that this was exactly what happened and said that the reason everyone missed it is because none of us had connected the violent bowel evacuation with the actual incident. Unless one works with dialyzing patients (doctors rarely work with them, usually only dialysis techs and RNs do this) one doesn't connect immediate bowel evacuation with an emergent situation (usually, if that happens, the patient just died). So, her diagnosis was changed to ALOC Episode/TIA Resulting from BP Crash. The thing about TIA is, it covers every reason for a stoppage of blood to the brain except stroking out, so he left that on the chart.
    The resolution to all this is that my mother is quite weak but home, pinking up, still on oxygen [which is difficult for her for several reasons, not the least of which is that it severely limits her smoking; but, also, she's having a big problem getting used to the cannula and tends to mouth breathe on the machine (which is a concentrator that takes oxygen out of the air, rather than tanks)]. She's on a limited schedule of medications (nothing that has anything remotely to do with diuresis), still on mega doses of iron, her appetite is on the mend but still not good, although she craved a hamburger, french fries and a salad yesterday and I almost danced when she announced this, and immediately took her out for a big, juicy, almost raw hamburger (much to my surprise; she has always preferred her burgers well-done to the point of being death gray) with all the fixings.
    Despite the seriousness of her dis-eased physical state, there are many, many things which came out excellent on the tests. Her blood sugar, for instance was (until the hospital got ahold of her; they "forgot" to administer her diabetic medications then, by mistake, as well, put her an a near starvation diet, which included forgetting to put her down for breakfast and delivering a salad tray for dinner when a full dinner with meat and vegetables had been ordered) perfectly controlled, thank you very much. Her liver, kidneys and pancreas are doing very well. Her cholesterol, which has always run high, was in fact normal. Her blood pressure, until the crash, was quite good. Her bone marrow was busy at work producing extra cells to counteract her low blood oxygen level, which is why she's on oxygen, although her blood oxygen is actually high-low (87, when they put her on). 90 and above is considered normal (although 90-93 is considered low normal, cause for concern). The spot on her lung may or may not have been there for a long time and could be one of several things, including vertebral calcification, the beginning stages of emphysema or lung cancer, simply due to her bronchitis, or scarring from a previous out-patient operation she had on her back several years ago to remove a benign fat tumor that formed itself over her upper spine and around the back of her ribcage). The severe anemia is the thing that is concerning everyone the most. It could be a variety of things but, it is looking as though it is not intestinal bleeding, which is why, after reading the preparation for colonoscopies, I decided to put that one on hold until everything else had been ruled out, simply because the procedure requires the ingestion of a laxative so severe that the pamphlet says the patient can expect cramping and to spend the entire night before the procedure on the toilet. Although her doctor really wants this done, I think, unless other more innocuous, non-invasive tests show positive evidence of intestinal bleeding or blockage (and, so far, none have), or nothing else can be discovered and the anemia continues, I'll only consider it if the preparation is done while she is admitted to the hospital under close observation, with me right there. The thing is, she's already had one crash due to dehydration and is very weak. She does not need to risk another. Her heart, by the way, is still very strong, a thing of beauty to watch in action during an echocardiogram. As I watched it and listened to the echocardiogramologist exclaim, several times, over its strength and ability to remain within remarkably healthy parameters all on its own, I could not help but think I was witnessing the soul behind metaphor. Her heart is, literally and figuratively, her cornerstone (actually, it is more like the stone in an arched bridge without which the entire bridge would collapse, but I couldn't think of that term, and cornerstone is a foundation stone, so, with this long addition, it should fit).
    I thought my mother had just about reached the limits of sleep without being considered comatose, but apparently I was wrong. She is very, very tired and weak. Care, for her, has become much more intense very quickly, and I'm pushing myself to the limits of physical endurance, as well, although, as this becomes routine I am (slowly) figuring out how to maintain my own health while seeing to hers. Since she's been taken off Detrol, too, in order to prevent further dehydration, I spend a lot of time mopping up after her. Today, I should be able to get out of the house and get some of that absorbent underwear for her (and, for that matter, me...it will make my job much easier than it is with the pads my mother insists on using out of pride).
    Interestingly, it was discovered, during the head CT and the MRI, that at sometime in the past she suffered a mild stroke to the left back, bottom quarter of her brain. It was, obviously, so mild that neither she nor I noticed it, but, now, I think it might have happened about a year and a half ago. About that time she began shuffling a bit with her right leg, and her right eye opened up more than the left and became uncontrollably teary. Both conditions still exist. At that time I had her evaluated for possible bone fractures/breakage and/or sprains and strains, none of which had occurred. She underwent evaluation by an allergist for her eye, which also yielded nothing. Now, we think, we know why this stuff occurred.
    As usual, my mother is taking all this in stride, is upset by none of it, is in good humor (a bit more argumentative, right now, because of the oxygen, but still in high spirits) complains about nothing (which, actually, makes things a bit difficult for those of us trying to evaluate her health) and remains mentally creative with a pronounced tendency toward naps and a continued preference for the Animal Planet channel on TV. She, in fact, worried about The Girls the entire time she was in the hospital (so did I) and couldn't wait to get home to them (neither could I).
    I have learned a few things from this.

1. I will not ever leave her alone for any significant length of time in the hospital, again. Period. I won't go into what happened but suffice it to say her primary doctor has very good reason for trying to keep her out of the hospital and I still wonder if I shouldn't have nixed the recommendation of the ER doctor to have her admitted overnight for "observation". Some observation. They observed her, overnight, right back into the beginning stages of dehydration.
2. I am capable of performing extraordinary feats of emotional strength and physical endurance when I am called upon to do so. I actually didn't think I was capable of some of the stuff I have ended up doing.
3. It is time for me to become my mother's legal guardian. Although I have been performing this function, taking on the legal status seems daunting. If she were in a persistent vegetative state or losing who she is to Alzheimer's or some other type of debilitating senility, I think it would not feel strange to have to do this. But the woman remains herself, in control of her will, with definite opinions predicated on her 85 year old character, sounds perfectly lucid, so much so that last week she took a couple of calls and confirmed some appointments that I didn't find out about until we missed them. When people talk to her they don't believe she isn't capable of handling her own business. I know she isn't, my sisters and brothers-in-law know it, MFA and Ma finally acknowledge this, but no one else, including her doctor (oddly), who set up one of the missed appointments, believes it. But, nonetheless, it's time.
4. I have become so inundated by the phrase, "take care of yourself" and so aware of the thoughtlessness behind it (I know, in most cases, the thoughtlessness is actually a result of feeling helpless in the face of someone else's trials) that I will never utter that phrase to anyone, again, and I am considering buying a .38 and shooting the next person between the eyes who says it to me. I still like, "take care", that still works for me, I consider it the same as saying, "head's up, the enemy's on its way", but I now realize that saying "take care of yourself" to someone who is struggling is worse than useless, it's irresponsible. MFASRF, I know I've said "take care" to you, but I hope I've never said, "take care of yourself". If I have, forgive me. I know better now. From now on, if I am ever in a situation where I feel as though this phrase might have, at one time, been warranted, I think I'll say something like, "Damn, I feel helpless watching you go through this. I want you to negotiate this successfully and I promise you I will apply my mind and heart to figuring out some way to help you, but, if this is beyond my ability, let me know I am doing you no good, know that I am full of love and concern for you, that I will keep trying and forgive me."
5. Old age becomes even more amazing, the further my mother delves into it. I am, once again, in awe of what my mother can take and remain standing, literally. When I saw her at the table slack jawed and bug eyed, I was sure that she was on her way out. But, without breaking a sweat, she's turned around and is back in the game, despite being in outfield and even though she has, for some time, not been able to be counted upon to use the "correct" ball.

    She just arose. Stations, everyone.
- posted by gail rae @ 13:18  0 comments   email...this post