The Official Joyce Update Blog

Dusty arrived at farmhouse ~8:15 a.m. after stopping by his office to unlock it for his work study student and dropping off documents at Moscow Medical. Found Joyce asleep in her recliner, curled forward, with oxygen line in place. Joyce was fairly alert and reported that she had a wonderful dinner with Connie last night when asked but could not recall what they had to eat.  Joyce was able to stand and travel to the bathroom ~8:50 a.m., disposable chair pad was wet - Dusty replaced it. Joyce's skirt showed signs of urinary incontinence but diaper was dry. Skirt replaced. Dusty assuming that Joyce must've had an accident overnight/earlier in the morning and either didn't notice she had wet her skirt or had released her bladder when sitting on toilet riser and not noticed. Urine passed, wounds cleaned, fresh barrier cream applied. Joyce did a PT walk with Dusty to living room and returned to recliner ~9:12 a.m. Changed Joyce into fresh clothes for the day at her request. Lido...

Dusty arrived at farmhouse ~7:45 a.m., found Joyce hunched over in her recliner without oxygen line. Joyce was roused with great difficulty and remained confused/disoriented. Dusty worked on breathing exercises with Joyce after getting her oxygen line into place but she was slow to recover. Joyce stated that she was unable to stand under her own power to get up and use the bathroom. 7:52 a.m. - Blood pressure 179/97, pulse 80. Blood glucose level 119. 8 a.m. - Breakfast (Vanilla Ensure, 1 slice whole wheat toast with butter and apricot jam, 1/2 banana). Morning medication (Carvedilol, Metformin, 2 Tylenol, Multivitamin, Iron, Potassium). Joyce finished picking at her breakfast ~10 a.m. Joyce continued to remove her oxygen line and remained confused/disoriented, stating she was unable to get up and go to the bathroom under her own power. 8:27 a.m. - Scam phone call to farmhouse landline intercepted by Dusty.  10:49 a.m. - Scam phone call to farmhouse landline intercepted by Dusty. N...

Dusty arrived at farmhouse ~7:48 a.m., found Joyce in bathroom attempting to clean herself up after urinary incontinence issue. Joyce stated she was uncertain how long she had been in bathroom. Joyce passed urine and Type 5 bowel movement. Dusty assisted in getting Joyce changed into fresh clothes, cleaned wounds, and applied fresh barrier cream. Joyce taken for brief PT walk to living room before being returned to recliner ~8:17 a.m., citing her arms and knees were hurting and so she could not do the full PT walk.  Dusty replaced lancet cartridge in Joyce's safety lancet. Blood glucose level 120 at 8:25 a.m. Dusty applied lidocaine patch to Joyce's back.  Blood pressure 169/99, pulse 82 at 8:35 a.m. Breakfast (Oatmeal with peanut butter and 2 packets of Equal, 1 slice whole wheat toast with butter, 1/2 banana, 1 bottle strawberry Ensure). Morning medications (Carvedilol, Metformin, 2 Tylenol, Potassium, Iron, Multivitamin).  Dusty sanitized bathroom floor and toilet seat...

Dusty arrived to farmhouse ~8:18 a.m. (9/27) after purchasing supplies in town for Joyce from Walgreens (bread, disposable gloves, Tylenol, 2 packages of diaper inserts). Joyce found awake in her recliner without her oxygen line in, having just seated herself. She had taken the remaining hardboiled egg from the refrigerator, along with one of Craig's Baby Bell cheese rolls, and set them onto the tray Dusty prepared last night before leaving the farmhouse along with a mug of tea. Joyce had also picked up the bowl that had been used for burning votive candles during the last few days on the stovetop and had set to work on chipping out the old wax with her fork. Dusty took the bowl of wax away from Joyce as she was in danger of stabbing her stomach with the fork as she attempted to chip it loose. Dusty unpacked the supplies he brought and Joyce gave him $100 cash from her purse to replenish his errand envelope after Dusty explained that he had used the cash Joyce had previously given ...

Dusty arrived to the farmhouse ~8:15 a.m. on 9/26 (taking morning shift for Jess who was out with a migraine), found Joyce sitting upright "waking up" in her recliner with oxygen line in place. Joyce reported she took herself to the bathroom sometime earlier in the morning when it was still dark outside, passing urine. Vitals taken @~8:27 a.m. - Blood pressure 176/95, pulse 95. Blood sugar levels at 115. Breakfast given to Joyce at 8:30 a.m. - 1 slice toast with butter, 1/2 banana, 1 hard boiled egg, 1 bottle strawberry Ensure. Morning medication administered (Carvedilol, Metformin, 2 Tylenol, Potassium, Iron, Multivitamin).  Craig arrived to visit mom, bringing in and skimming weekend newspaper ~8:35 a.m., departing ~8:48 a.m. Joyce stated she was tired after finishing breakfast and requested to be allowed to sleep. Joyce napped until roused for bathroom trip at 11:45 a.m., urine and Type 6 bowel movement passed. Dusty cleaned Joyce's wounds and applied fresh barrier cre...

Connie texted Dusty last night (9/24) ~9:13 p.m. to let Dusty know she thinks Joyce has Thrush in her mouth again, recommending that Dusty bring it to the nurse's attention tomorrow to see if a prescription for treating it could be obtained from Dr. Collins before the weekend. Connie will call Dusty tomorrow. --- Dusty arrived to farmhouse ~8:20 a.m. after picking up Kleenex, wound cleaner, and hand soap refill bottle from Walmart. Craig informed Dusty that Joyce had traveled to the bathroom on her own earlier in the morning and he had given Joyce a whole banana to tide her over until Dusty arrived to farmhouse. Dusty found Joyce awake and alert in her chair with her opened whole banana sitting on a tray on her walker in front of her. ~8:40 a.m. - Breakfast. 1 slice of toast with butter, 1 hard boiled egg, 1/2 banana (cut whole banana Craig provided in half), Earl Grey tea. Morning medication administered (Carvedilol, Metformin, 2 Tylenol, Multivitamin, Iron, Potassium).  --- Conni...

Dusty arrived to farmhouse ~8:35 a.m. after traveling to several stores in Moscow while attempting to locate appropriate carpet cleaning solution for his spot cleaner machine for use on Joyce's carpet. Found Joyce sitting hunched over her legs in her recliner with oxygen off.  Bathroom trip for Joyce at ~8:40 a.m. without incident. Joyce reported that she believed she had already gone to the bathroom by herself sometime around 6 a.m. Joyce passed urine. Dusty assisted in cleaning out Joyce's wounds of fecal matter from some previous bowel movement and applied fresh barrier cream to afflicted areas. ~8:54 a.m. Dusty noticed missed phone call to his cell phone from Craig. Craig had attempted to call Dusty ~8:05 a.m. to let him know that he and Carol had already taken Joyce to bathroom before 8 a.m. this morning when Carol brought Craig to the farmhouse. Joyce taken for PT walk to family room, into kitchen and back to her recliner post-toileting. Joyce requested boiled eggs for br...

Dusty arrived to farmhouse ~7:40 a.m., finding Joyce sleeping in her recliner curled forward over her knees with oxygen line in place with one of her extra pillows under her bottom. Joyce commented that it was "quite late" for Dusty to be arriving to see her and Dusty informed her that it was morning time. Joyce laughed at her misjudgement of the time of day, citing the ambient light levels of the kitchen living room threw off her thinking. Joyce fairly alert. 7:53 a.m. - Blood pressure 175/94, pulse 83. Bathroom trip at ~7:54 a.m. without incident. Joyce's diaper pad insert changed due to urinary incontinence. Dusty cleaned out the open blister wound on Joyce's buttocks using wound cleaner he picked up last night. Fresh barrier cream applied.  Returned Joyce to her recliner after PT walk to family room, to kitchen window and into living room area ~8:19 a.m. Dusty placed the extra pillow Joyce had been using under the waterproof pad for Joyce to continue using to alle...

9/22/2020 7:30 a.m. - Dusty arrived to farm and found Joyce hunched forward in her recliner without oxygen line in place. Joyce was very incoherent/confused. Joyce had soiled herself at some point during the night or early morning hours. Joyce unable to focus or stand for travel to bathroom. Dusty applied Lidocaine patch to Joyce's back ~7:45 a.m. while she was "working on waking up." Joyce continued to remove oxygen line from herself after Dusty helped walk her through how to get it back into place. When Dusty asked why she was doing that she stated she did not know why and would inform Dusty that she did not know how to get it back into place.  Craig arrived into farmhouse ~9:40 a.m. to visit with Joyce.  Joyce felt well enough to stand and traveled to bathroom ~10 a.m. Dusty assisted her with cleanup, provided fresh diaper and diaper pad insert, and changed her skirt and shirt. 10:35 a.m. - Joyce pushed herself to do a PT walk into family room, out to kitchen window, a...

Dusty returned to the farmhouse ~8:15 p.m.  (9/20) following conclusion of meeting in Moscow. Found Joyce awake, alert and responsive and she asked for an update on the meeting Dusty had in town as they were both excited about it. Joyce was taken to bathroom at ~8:49 p.m., soiled diaper (Type 6). Dusty helped clean Joyce up, applying fresh barrier cream.  Joyce lamented her body failing her. ~ 9:13 p.m. vitals taken on Joyce. Blood Pressure 153/83, pulse 81. Blood sugar 122. Joyce declined eating earlier in the evening when Dusty first arrived. Dusty continued to negotiate and got her to accept for sake of having something for her evening medication to digest with. Dinner at 9:16 p.m., 1 cup potato salad and 1/3 banana. Joyce continued to insist she was not very hungry but did eat her potato salad and banana. Evening medication given with meal (Carvedilol, Metformin, 2 Tylenol). Joyce was quite awake and talkative, Dusty remained on site with her as she wished to continue thei...

Dusty arrived at farmhouse ~8:22 a.m. after stopping by Rosauers to pickup groceries he forgot to get last night on his way home. Found Joyce mostly in the position he left her in, reclined in her chair with oxygen tubing in place. Joyce reported some pain in her legs when Dusty roused her for the morning bathroom trip, Joyce requested that she have time to collect herself. Dusty suggested they remove her compression stockings for a while and after breakfast they'd soak her feet in Epsom salt. Joyce liked that idea. Joyce asked to remain seated in her recliner for a while longer as she didn't quite feel awake enough to stand up safely. Joyce was very lethargic and slow to respond to verbal directions, taking off compression stockings, or getting slippers on eventually. Requested additional time to "sit and wake up." Joyce continued to be slow to move or process conversation. ~8:40 a.m. - Blood pressure 159/89, pulse 77. Blood sugar 140. ~9:08 a.m. - Applied lidocaine ...

Connie arrived to farmhouse and found Joyce without her oxygen line in place. Breakfast was had at 8:30 a.m. (oatmeal and 1/3 banana, tea). Morning medications given to Joyce with breakfast (Carvedilol, Metformin, 2 Tylenol, Potassium, Iron, Multivitamin). Zac, Nichole, and Miranda visited at 10:30 a.m. Joyce given haircut by Nichole after 11 a.m. bathroom use. Joyce held Miranda.  Dusty texted Connie ~12:49 p.m. to let her know he was running late and she could depart farmhouse if she had not done so already. 1:15 p.m. Connie woke Joyce from napping to feed her lunch (Cougar Country hamburger).  Connie took Joyce to bathroom ~2 p.m. and departed ~2:35 p.m. --- Dusty arrived to farmhouse ~2:40 p.m. Found Joyce rolled forward and napping on top of some of the magazines Dusty had brought out for her yesterday. Dusty discussed her haircut and what Joyce thought about seeing Miranda in person for the first time. Joyce thought it was wonderful. Expressed that it had happened yester...

Dusty arrived to farmhouse ~7:47 a.m., found Joyce sitting hunched forward in her recliner without her oxygen line in place and somewhat incoherent. Dusty asked if anyone had been in to visit with her today and Joyce indicated no. Dusty asked if Joyce had gotten up to take herself to the bathroom and she indicated no. Dusty replaced Joyce's oxygen tubing and went through some breathing exercises to get her perked up.   Joyce traveled to bathroom ~8 a.m., a little unsteady on her feet but made transition from standing to sitting on toilet riser. Urine passed. Urinary incontinence occurred sometime during night or early morning. Diaper and diaper pad insert replaced, fresh barrier cream applied. Joyce changed into clean skirt and fresh top for the day. Joyce given breakfast at 8:25 a.m. (toast slice with apricot jam & butter, 1/3 banana, V8 juice, and Earl Grey tea). Morning medication given to Joyce (Carvedilol, Metformin, 2 Tylenol, Iron, Potassium, Multivitamin) before Du...

Dusty arrived to farmhouse ~7:47 a.m., found Joyce rolled forward over her knees in ball position in her recliner with no oxygen line in place. Joyce responsive but slightly delayed in processing verbal interrogatives. Dusty asked Joyce how long she had been like that and she stated that she did not know. Joyce stated she had taken herself to the bathroom at some point during the night or early morning, had a bowel movement (odor strong in house) and doesn't think she cleaned herself up well enough.  Breakfast served at ~8 a.m. (slice of toast with apricot jam and butter, 1/3 banana, 1/2 KFC biscuit leftover, V8 juice, Earl Grey tea). Joyce threw out the 1/2 KFC biscuit when she didn't think Dusty was looking. When Dusty asked why she did that she stated that it was "too plain" for her to eat. Joyce finished breakfast ~8:35 a.m. Lidocaine patch applied to Joyce's back ~8:40 a.m. Joyce had minor coughing fit shortly afterward, expelling some mucous.  Blood pressure...

Joyce requested Dusty remove the Lidocaine patch from her back, stating that it had been on for 24 hours. Dusty reminded Joyce they just put it on at 8 a.m. Joyce then stated that she had thought it has been on 24 hours and then changed her mind when Dusty asked if it was bothering her and if she wanted it removed. She stated that it could be left if they just put it on at 8 a.m. today. --- Bathroom trip made ~2:15 p.m. Joyce had an issue with urinary incontinence, insert pad appeared to have caught it all. Joyce requested to leave diaper on and only replace the soiled pad with a new one. Joyce able to clean herself and make all transitions unassisted. Joyce declined application of barrier cream on this trip. --- Joyce requested Lidocaine patch be removed at 2:29 p.m. when Dusty changed her shirt. Dusty removed it as she stated she was "done with it." Dusty trimmed Joyce's fingernails, vacuumed the kitchen carpet, took out the bathroom trash, placed a prescription re-orde...

11:13 a.m. - Marshall from Kindred arrived to do initial evaluation with Joyce. Reviewed plans to improve strength, posture, and balance. Vitals taken (96% O2 Level; BP 130/80, pulse 78; normal temperature). Confirmed zero use of stairs in Joyce's daily life with Dusty. Confirmed family present with Joyce during daytime hours (8 a.m. - 8 p.m. at minimum). Marshall checked Joyce's legs. No pain reported in legs, slight swelling noted. Marshall asked of Joyce felt she tired easily, Joyce said that she did. Confirmed that she does not get short of breath in going to the bathroom. No cough, fever, or sore throat reported in last 14 days. Confirmed sore/rash/skin breakdown on buttocks and inner thigh and noted it was being treated by the family using barrier cream. Joyce reported no numbness in hands or feet. No sensations of pins/needles in her hands and feet. Confirmed fall down basement stairs in June 2020 and injuries sustained. Marshall tested Joyce's legs for range of move...

Dusty retrieved Joyce's remaining items that Aspen Park had failed to send home with her ~3:30 p.m. (2 skirts, shirt, blanket, etc.) on 9/15. Dusty will add those to the load of laundry he will do for Joyce tomorrow at farmhouse. --- Connie spoke with Dusty via phone ~ 7:18 a.m. (9/16) and provided an update to Dusty about her shift with Joyce last night. Reported that Joyce had issues with keeping her oxygen line in place later in the evening and might be removing it as she slept, alerting Dusty that if she was disoriented in the mornings when he found her that could be the cause. --- Dusty arrived at farmhouse ~7:47 a.m., finding Joyce without oxygen line in place and hunched forward in her recliner, balled up forward over her knees. Dusty got Joyce upright and restored oxygen tubing into place. Joyce stated that she had had an issue with urinary incontinence earlier but could not recall at what time. She guessed it was about an hour before Dusty arrived. Joyce stated that she ch...

Marshall (Kindred PT) called Dusty at ~4pm to schedule appointment for Joyce tomorrow at 11 a.m.

Dusty arrived to the farmhouse ~8:02 a.m. and visited with Craig, who was on-site at the shop for a few minutes. Dusty headed inside farmhouse shortly afterward and found Joyce hunched forward in her recliner with oxygen line off. Joyce was responsive but a bit disoriented. Joyce stated that she had not gone to the bathroom and thought that she took off her oxygen line sometime earlier in the morning when she was "thinking about getting up to go to the bathroom" but stopped and fell back asleep in her recliner.  Dusty assisted Joyce with rising up from her recliner but Joyce was able to move to the bathroom and transition onto the toilet riser without assistance. Urinary incontinence and minor fecal matter (most likely involuntarily expelled with flatus) occurred at some point after Carol's departure last night. Joyce's pull-up diaper had been augmented with a heavy-duty pad/liner insert, which had captured most of the urinary discharge and all of the fecal matter. Jo...