General Update #79

NOTE: Joyce has been moved out of the quarantine hall and is now in Room 208. Her new phone number is now 208-892-5855.

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Joyce had her teleconference with her primary care provider (Dr. Collins) today, which happened to occur as Dusty was calling Moscow Medical around 12:15 p.m. 

Dusty spoke with staff member Wendy at Moscow Medical (unaware Joyce was concurrently meeting with Dr. Collins at that time) about the discharge summary notes Gritman had setup for Joyce about her potential spinal cancer. Dr. Dickinson was listed as the radiation oncologist Joyce was to have follow up. Dusty inquired if that appointment had been scheduled. Moscow Medical staff was unable to determine from Gritman documents if the oncologist appointment had been scheduled but took down Dusty's phone number to call him back with updates once Dr. Collins finished with Joyce's teleconference. Wendy anticipated that Dr. Collins would most likely arrange the oncology appointment with Dr. Dickinson given the referrals that had been initiated by Gritman upon discovering the potential spinal cancer. Wendy asked to confirm if Joyce had preference of cancer doctors and Dusty stated that she had been going to the one in Lewiston but that he (Dr. Morgan) might have left/be leaving the area and so would be open to seeing whoever could be arranged. Dusty reconfirmed that he was just looking to determine if Joyce actually had spinal cancer at all as the Gritman doctors suspected. 

Wendy attempted to follow up with Dusty at 12:37 p.m.and left a message (as Dusty was in a meeting and could not answer his phone at the time Wendy called back). It was determined that Joyce needs to have her injuries from the fall heal first as at this point before appointment with oncologist can be scheduled. When Dusty returned Wendy's phone call around 12:48 p.m. for clarification she stated that at this point it cannot be determined if Joyce does have an active spinal cancer or if the damage to the bone is merely a result of her fall down the stairs. Joyce will conclude her stay at the Aspen Park facility and they will schedule Joyce for oncology follow up according to Wendy.

It was anticipated that Aspen Park would follow up with Dusty about today's appointment Joyce had with Dr. Collins as well. 

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Dusty called Joyce to check in with her around 1 p.m. but received no response. Dusty suspects that she was either out of her room using bathroom or working with physical therapist and so will call back later on.

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Dusty attempted to call Joyce at 3 p.m. but received no response. Dusty then called Aspen Park main line to speak with staff about an update on Joyce. Jennifer Trout confirmed an appointment was scheduled for August 24 with Dr. Dickinson for Joyce. An updated schedule of appointments will be digitized and sent onto Dusty when time permits. 

Jennifer then transferred Joyce to speak with Maggie, the nurse that had sat in on the tele-health conference with Joyce and Dr. Collins. She confirmed that a visit to an oncologist was slated for Joyce after she had been discharged from Aspen Park (August). Some other tests and lab visits are to be setup for Joyce to have performed ahead of that visit with the oncologist (most likely will be in list that Jennifer Trout will provide). 

Dr. Collins has requested an additional urine analysis for Joyce to be scheduled for July 1 (this will give time for the latest round of antibiotics to be out of Joyce's system to avoid skewing test results) to ensure that Joyce is free from UTI following removal of stint by Dr. Keizur yesterday. Today will be the last day for the current course of antibiotics from treating the UTI Joyce recently had. 

It was determined during the visit with Dr. Collins that Joyce may have issues with low sodium, low magnesium, and low potassium levels. Aspen Park's lab will be running tests tomorrow morning to confirm. 

Joyce's blood sugar levels have been elevated throughout the documentation by Gritman and then Aspen Park staff since her accident. Dr. Collins would like to increase Joyce's metformin (oral diabetes medicine) dosage instead of increasing insulin injection levels.

Joyce expressed concerns to Dr. Collins over her low appetite. Dr. Collins did not deem this a concern. 

Joyce asked Dr. Collins about a timeline for her return to the farm. Dr. Collins confirmed that Joyce would be able to return to the farm when her physical therapists at Aspen Park approve her as functional enough for independence. Currently it appears that Joyce is on target for return to farmhouse at previously set discharge date.

 

Maggie stated that Dr. Collins would see about coordinating Joyce's charts to ensure the different facilities (oncologist, Gritman, Aspen Park, etc.) are "in the know" about Joyce.

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Dusty attempted to call Joyce at 4:26 p.m. but the telephone to Joyce's room appeared to be non-functional. 

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Jennifer Trout called from Aspen Park at 4:31 p.m. and left a message (Dusty was restarting his telephone at that time and missed that phone call). Joyce has been moved out of the quarantine hall and is now in Room 208. Her new phone number is now 208-892-5855. She is still in a private room (no roommates). 

Jennifer provided a reminder that outdoor visitation with Joyce can be scheduled 24 hours in advance in addition to visiting with Joyce through her room window via phone.

Dusty will follow up with Jennifer to determine which new window people can arrive to visit at Joyce through.

Dusty attempted to call Joyce's new number but received no response. Dusty assuming that Joyce is either in the bathroom or working on her PT. Dusty will attempt to call later in the day.

ADDENDUM:

Dusty and Jess tried to call again and made no connection around 5p.m. 

Dusty contacted front desk and it was determined following investigation by the nursing staff that the phone was not fully plugged into Joyce's new room. Joyce said that they moved her into the new room this morning. It is a nice room, she reports. Oak cabinets inside and some green bushes outside her room. She could not recall what she had for breakfast or lunch owing to the room shuffle, cognitive therapy, PT, and preparation for appointment with Dr. Collins. Joyce stated that she does not recall much of what was said with the visit with Dr. Collins. Dusty assured her that Dr. Collins and the nurse who sat in with Joyce (Maggie) through the tele-health conference have logged the information discussed and Dusty has that information from Maggie.

Dusty let Joyce know she has a card from Steve and Colleen and he would bring it by when he stops by tomorrow to get oriented to the new room's location to relay to family for visits.

Joyce reported that her PT today involved a lot of walking and leg exercises (range of movement, resistance). Joyce asked the new therapist to remind her to stand upright when she hunches over while walking. 

Joyce confirmed that she remembers to ask for pain relief medicine when needed and not to try and tough out the pain in her back. Sitting in her chair following PT Joyce stated that she has zero pain at the moment. She estimates that it initially spikes up to an 8 out of 10 when she moves around for a while, then it tapers down and she settles again. Joyce apparently forgot that she has an electric recliner in her room that assists her in standing up. Jess encouraged Joyce to use the electric recliner to rise to a standing position.

Dinner was delivered to Joyce. Potato salad and chicken strips. Joyce stated that she had been hoping they would bring potato salad, which is pretty good there. Some sort of a vanilla pudding with a graham cracker crust for dessert.