General Update #112

08/12/2020

Dusty called Joyce on his walk home from work ~4:35 p.m. to check in. She reported that she had been feeling better, even if the Aspen Park team hadn't figured out what was going on with her overall. She lamented memory troubles she has been having. She stated that she had done quite a bit with the therapists today, riding the stationary bike for around ten minutes and doing some walking and resistance exercises.

Dusty asked if she had been reading her Redwall book. Joyce stated that she had not but that it had been seen by one of the orderlies and they had a conversation about the Redwall book series and the author.

Dusty reminded Joyce that he and Jess would be traveling tomorrow out of the area for Jess' grandmother's memorial service and that if she needed anything she just needs to tell the nurse.

The upcoming doctor's appointment for Joyce with Dr. Collins was reviewed. Joyce stated that she did not recall that she was told she was having an appointment with Dr. Collins. Dusty suggested that they might have told her already or possibly would tell her tomorrow. Joyce agreed that they may have already told her. Joyce concerned about what they say about her overall condition to Dusty and the family, believing that maybe they are making her appear worse that she actually is in actuality. Dusty reviewed the injuries Joyce sustained from the fall and made general comparisons to Alice and June's decline in capabilities due to age, suggesting that the doctors just want Joyce to be as good as she can be before returning home and Joyce agreed but emphasized that getting older is terrible. 

Joyce ended the phone call, citing need to use the bathroom.

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Dusty called Joyce to wish her a goodnight. Joyce in a semi-coherent state. Dusty assumed lateness of hour and/or oxygen line or Joyce's sleeping position may have contributed to her lethargic and strained responses to conversation. 

08/13/2020

Carol provided brief update via text about Joyce's appointment today with Dr. Collins. Carol was able to accompany Joyce for her appointment with Dr. Collins at Moscow Medical. Aspen Park nurse was not on site. Dusty to follow up with Aspen Park as to what occurred and why Joyce was left alone on-site in a wheelchair prior to Carol's arrival. 

Nothing new to report on Joyce from the appointment. 

Blood draw taken by Moscow Medical staff from Joyce. If nothing comes back from blood draw, Joyce should be cleared to return to farmhouse from Aspen Park as long as she has care at home.

Dusty will call Carol direct once he is not driving and in area with reliable signal.

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Dusty and Jess called Joyce to let her know they arrived safely to Shady Cove, Oregon around 7 p.m., briefly reviewing the trip down and Joyce's appointment experience before Dusty and Jess had to depart to Jess' grandfather's home where there was no cell phone reception.

08/14/2020

Dusty called Carol around 8:44 a.m. and spoke about Joyce's appointment with Dr. Collins yesterday. With nothing discovered about Joyce's condition following UTI tests, things remain a mystery. Joyce reported to be fairly quiet during Carol's interactions with her. Joyce reported her pain levels to be 7-8 (potentially related to discomfort from the Aspen Park wheelchair being used). 

A CT scan has been scheduled for Joyce for August 21 for Joyce's brain, back, abdomen and pelvic areas. A blood draw was scheduled for August 20 and Joyce has an appointment with the cancer doctor on August 24.

No new discharge data has been provided to Dusty from Aspen Park team at this time. Connie, Carol and Dusty will find time next week to meet and discuss care plan for Joyce.

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Dusty called Aspen Park day nurse, Maggie, around 9:04 a.m. for update on Joyce and to follow up on information provided via Carol about Joyce's appointment with Dr. Collins yesterday. No answer at nurse's station after multiple attempts, nursing staff unavailable/engaged, so Dusty's information was taken down. Dusty informed staff that he would be in a no-service area and confirmed that Maggie would leave detailed message later on. 

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Dusty attempted to call Joyce to check in with her around 9:14 a.m. but received no answer at her room phone.

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Memorial service for Jess' grandmother in remote location of Rogue River Valley area prevented afternoon or evening phone calls to Joyce or Aspen Park team for check in on update due to no/weak cell signal and late return to hotel. 

Maggie had returned Dusty's phone call from earlier in the day but only left her name and number for call back in the voicemail once it came through, no information on appointment Joyce had with Dr. Collins.

08/15/2020

Dusty attempted to call Joyce at 9:50 a.m. before his online training session but was unable to make contact. Dusty called and left message on Aspen Park voicemail requesting update on Joyce. Due to poor cellular reception in Rogue River valley and lateness of return to hotel that evening from in-laws' home, Dusty was unable to contact Joyce today.

08/16/2020

Dusty attempted to call Joyce to let her know that he and Jess were returning to Idaho but was unable to reach her (assuming she was asleep or using the bathroom). Dusty was unable to make contact with Joyce due to return travel, unreliable signal, and delays in reaching Moscow until late in the evening hours of 8/16.

08/17/2020

Rachael Kimble at Aspen Park sent Dusty a brief email ~11:50 a.m. stating that there is no new information in regard to Joyce's condition.

Joyce has a CT scan for August 21 at 10:30 a.m. and the Aspen Park team should know more after that. 

Joyce continues to use cuing and needs to remember to lock her brakes on her wheel chair. Joyce is continuing work with therapy teams. Her weight continues to go down, but she still is eating about 50-75% of her meals.

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Carol texted Dusty to provide update from Dr. Collins' office that the blood draw from mom collected showed nothing new.

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Dusty called Joyce to check in with her during his walk home ~4:50 p.m. 

Joyce started strong in tone and energy level during the conversation and trailed off toward end of call.

Joyce confirmed she had visited Dr. Collins at Moscow Medical and had Carol there on site. Joyce expressed that she was thankful Carol had been there as she "asked a lot of good questions." 

Dusty reviewed his recent absence with Joyce. She confirmed she knew that he and Jess had traveled out of the area for a funeral service and were glad that they had made it back to Moscow safely.

Dusty asked how Joyce was progressing through her Redwall book. Joyce stated that she has not been reading, just mostly watching television shows on the Home and Garden channel that she doesn't get at the farmhouse. Joyce ended the phone call with Dusty citing she felt like watching TV.

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Online evening meetings ran long and Dusty unable to call Joyce due to lateness of hour for usual evening check-in.

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Linda called with an update that Estes Club would be moving virtual (via email) owing to COVID-19 safety protocols and unique situational circumstances of most remaining members. Dusty will coordinate Estes Club messages for Joyce on her behalf.

08/18/2020

Maggie from Aspen Park called Dusty around 11:46 a.m. to confirm that they will be taking Joyce to the CT scan at 10:30 a.m. on Friday. Joyce's chest, abdomen, and brain will be examined, looking for any metastasis to rule them out as a cause for the mental issues Joyce has been facing recently. The CT scan of Joyce's chest will also look at Joyce's spine. The results of the scans should provide idea on how to proceed for Joyce's care and discharge planning. As the CT will occur on Friday, Maggie is estimating that Dr. Collins should be able to review the results and provide information to Aspen Park by Monday. 

Joyce is currently walking down hallway now with the occupational therapy team, her average for walking before exhaustion sets in is ~350 feet

Maggie reported that yesterday evening the Aspen Park staff was providing education regarding insulin and blood sugar checks to Joyce, part of what she will need to be able to do when she returns to semi-independent living. Joyce stated she doesn't remember anyone educating her regarding the sliding scale, doesn't want to learn it, and just wants nurses to manage insulin. Maggie stated that this would be problem in regard for independent home care for Joyce. 

Maggie reported that Joyce is still having incontinence with urine output but is still taking herself to the bathroom regularly. 

Blood work that Aspen Park did on August 6 showed that Joyce's WBCs were low. Dr. Collins was informed about this but was not concerned. Likewise there are signs of minor kidney dysfunction and minor liver dysfunction in Joyce but this is common for her people in her age bracket. 

Dusty asked about why a nurse from Aspen Park did not accompany Joyce to her appointment at Moscow Medical last week and Maggie stated that the Aspen Park nurses don't go to "in-house" appointments, only tele-health conferences. Dusty asked why he was told that he could not attend the appointment but that Carol was told that she could. Maggie was unable to provide information. Dusty asked about the Friday CT appointment for Joyce and Maggie stated that family should not be present, even after Dusty cited Joyce's memory issues and items of concern raised in his 8/14 phone call with Carol following her interactions with Mom. Maggie stated that the no-contact directive is to help ensure the protection of Aspen Park community members and staff during COVID-19. Maggie stated that if Dusty was concerned about Joyce being left alone/dropped off at Gritman while she waited for the CT scan she could have the Aspen Park van driver remain on-site with her until the Gritman CT tech would come out to get Joyce. The Aspen Park van driver would then depart and return when Gritman contacts them at the conclusion of Joyce's appointment. 

Noting that Maggie only listed the CT scan appointment, Dusty asked about the scheduled blood draw at Gritman for Joyce on Thursday, as well as the cancer appointment on the 24th. Maggie stated she did not have those on her schedule. Dusty said he would attempt to determine the origin points for those appointments and get back to Maggie about confirming them on Aspen Park's calendar for Joyce.

Maggie said that would be good as the 24th is a busy day for Aspen Park for scheduling appointments and she would need to work out things if there was something scheduled for Joyce that she did not know about.

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Dusty called Carol around 11:57 a.m. to confirm information on the two appointments that Aspen Park was missing from their calendar for Joyce (8/20 blood draw and 8/24 cancer appointment). These two appointments were scheduled by the St. Joseph Regional Medical Center's team back in February. 

Potential cause of scheduling issue confusion that they may not have been put onto Aspen Park's radar due to miscommunication from Gritman's coordinator of Joyce's records and appointments (blood draw occurring at Gritman and their partnership with the cancer center team) or that as Joyce was originally due to have been discharged at that start of August they weren't intending to be taking Joyce to either appointment and so didn't schedule out that far.

Dusty will call back and confirm with Maggie. Carol prepared to fax cancer center's appointment orders to Aspen Park team as needed.

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Dusty called Aspen Park at 12:09 p.m. asking to speak to Maggie. Maggie unavailable and Danielle will relay Dusty's request for contact onto her for follow up.

Dusty attempted to call Joyce's room phone. Joyce answered but OT or PT was still ongoing and so Joyce ended the call with Dusty promising to call back during his walk home from work.