The Official Joyce Update Blog

Dusty arrived ~9:25 a.m. at farmhouse after running errands and refueling Jeep. Joyce found awake and exiting bathroom (urine passed following urinary incontinence issue). Joyce had been awake for a while and been "working in the kitchen" (moving things around and "investigating what had been done in there the last few days"). Joyce expressed concerns over Dusty cleaning her kitchen and items in cupboards. Joyce had been "exploring the kitchen" this morning, looking through old pill box, moving things and "inspecting" things that she had noticed had been moved from where they belong. Joyce expressed concerns over location of items in the kitchen and Dusty explained that much of it was temporary and would be put away as cupboards were restocked with cleaned items or as they were washed.  Joyce declined breakfast and negotiations ensued following her return to her recliner. 9:39 a.m. - Breakfast (1 banana, nutritional shake) and morning medication....

8:15 a.m. - Dusty arrived to find Joyce in the hallway, sitting on her walker. Joyce stated she had gotten up "at some point" to use the bathroom and then could not make her legs work after toileting and sat herself down on the walker, remaining there until Dusty arrived. Evidence Joyce had a bowel movement. Dusty assisted with moving Joyce back to recliner by rolling her on her walker.  8:27 p.m. - BGL @139. BP 165/94, pulse 81. 8:30 a.m. - Breakfast (leftover McDonald's sausage and biscuit from yesterday). Hotcakes were not eaten and put back into refrigerator. Craig arrived to visit ~9:30 a.m. 10:35 a.m. - Joyce soiled herself in her recliner. Remainder of type 5 bowel movement passed in bathroom. Dusty assisted with cleanup, Joyce was showered and put into fresh clothes. Shoes cleaned and sanitized. Weight 157.4 lbs. PT walk to living room before returning to recliner.  Dusty departed to  take out recycling, drop off Good Will donations Joyce sorted out from her dress...

9:30 a.m. - Dusty arrived to farmhouse late after picking up supplies for Jess and the farmhouse, and picking up breakfast from McDonald's for Joyce. Joyce found sitting awake in her recliner, without oxygen, eating pumpkin pie with Cool Whip topping. Joyce stated that she had to fend for herself as "the girl who usually arrived to ask [her] what [she] wants for breakfast" was late and had not shown up to take care of her this morning. Joyce thought that Dusty needed to talk to "that nurse" (forgot it was Jess, even after being reminded twice) so that it did not happen again. 9:40 a.m. - 2nd Breakfast (hotcakes, scrambled eggs, sausage patty) - Joyce too full from eating her large slice of pie, only ate the scrambled eggs and then requested remaining breakfast platter be put into fridge for her to eat later in the day. 10 a.m. - Morning medication administered with grape juice (Joyce had gotten it out earlier in the morning while getting pie for herself but did ...

8:40 a.m. - Joyce awake, up and working on putting her last stack of sorted shirts away when Dusty and Jess arrived to farmhouse.  8:50 a.m. - Bathroom. Urinary incontinence. Remainder of urine passed. Wound cleaned and fresh barrier cream applied.  9:14 a.m. - Morning medication administered with nutritional shake. 9:19 a.m. - BP 171/82, pulse 78. BGL @ 121. 9:30 a.m. - Breakfast (4 pancakes with syrup and butter). 10:48 a.m. - Bathroom. Bowel movement (type 5) passed. Wound cleaned, fresh barrier cream applied. Joyce emotionally upset but had difficulty in communicating why she was upset. Joyce eventually expressed that she thought people were accusing her of doing things she was not doing. Joyce also stated that bathroom bowel movements upset her (the way the family puts on masks, uses air fresheners, turns on the bathroom ventilator fan - all make her self conscious). Joyce worried she was going to be put into the shower and she did not want that. Dusty worked through Joyc...

8 a.m. - Jess arrived to farmhouse, finding Joyce awake and coloring. Joyce was wearing her oxygen line, very awake and talkative. 8:29 a.m. - BP 149/82, pulse 82. BGL @ 129. Joyce provided recipe book to Dusty so he could travel to town and procure supplies for making pies. 9:20 a.m. - Morning medication with nutritional shake. 9:22 a.m. - Breakfast (4 small pancakes with butter and syrup). Breakfast finished by 9:50 a.m. ~11 a.m. - Bathroom trip without incident. Urine and type 5 bowel movement passed. Dusty assisted with cleanup. Open wound cleaned and fresh barrier cream applied. Joyce very excited that her diaper was dry. PT walk to living room, into kitchen, and back to recliner by 11:15 a.m. Joyce resumed enrichment activity (coloring) but quickly passed out. Old food emptied from fridge. Old potatoes emptied from cupboard. Kitchen counter cleaned for pie making preparation. ~12:30 p.m. - Craig arrived to visit and eat lunch, stayed to watch NCIS with Joyce. 12:46 p.m. - Bathroo...

Monday, November 23, 2020 - Addendum 4:30 p.m. - Joyce found asleep in her recliner. 6 p.m. - Bathroom trip. 7 p.m. - Finished dinner (Famous Mashed Potato bowl without corn and 1/2 biscuit). Joyce at over half of the bowl of food. 8 p.m. - Evening medication. +++ Tuesday, November 24, 2020 8:30 a.m. - Jess arrived at farmhouse, finding Joyce awake and planning projects for the day. Joyce was in a slightly cranky mood. Jess talked to Joyce about needing a shower and this increased Joyce's crankiness. Jess let Joyce know that the nurse was arriving to visit her today and that Dusty would be out this afternoon. 8:42 a.m. - BP 135/77, pulse 79. BGL @ 110. 9:15 a.m. - Morning medication administered with nutritional shake. 9:17 a.m. - Breakfast (2 slices of French toast and syrup). All but four bites of breakfast finished by 9:45 a.m. 10:05 a.m. - Bathroom (Joyce soiled herself, type 6/7 bowel movement). Jess assisted Joyce with cleanup, putting a fresh skirt onto Joyce and sanitized t...

8:45 a.m. - Jess arrived to farmhouse and found Joyce awake with no oxygen line in place. Joyce claimed she had just returned from taking herself to the bathroom. 8:54 a.m. - BP 139/88, pulse 81. BGL @ 119. 9:27 a.m. - Morning medications administered with nutritional shake.  9:29 a.m. - Breakfast (egg in toast with syrup). Breakfast finished by 9:43 a.m. Jess spoke with Joyce about the need for a shower. Joyce was not receptive.  Joyce excited to work on her sorting project again. 9:55 a.m. - Bathroom trip without incident. Urine passed. PT walk to living room and back to recliner. 10:07 a.m. - Compression stockings put onto Joyce and she was set to nap until Dusty arrives. 12:17 p.m. - Dusty arrived to farmhouse to find Joyce napping without oxygen line in place. Joyce stated that she had just returned from taking herself to the bathroom. 12:25 p.m. - BP 136/67, pulse 79. BGL @ 179. 12:28 p.m. - Lunch (1 slice whole wheat toast with butter, 1/2 banana).  12:30 p.m. - Te...

8:30 a.m. - Dusty arrived to farmhouse after purchasing meal supplies and refilling 5-gallon water jug for the water dispenser, finding Joyce in the bathroom. Joyce had urinary incontinence issue requiring diaper pad insert replacement. Urine and bowel movement (type 5) passed. Dusty assisted with cleanup, cleaned out open wound on right buttock and applied fresh barrier cream. PT walk into living room and back to kitchen after bathroom trip. 9 a.m. - BP 145/87, pulse 80. BGL @ 120. 9:22 a.m. - Breakfast (6 mini pancakes with peanut butter and banana slices). Breakfast finished at 9:36 a.m. 9:40 a.m. - Morning medication (carvedilol, metformin, multivitamin, Mucinex, potassium, iron, 2 Tylenol) with nutritional shake.  10:20 a.m. - Craig arrived to farmhouse to visit, have breakfast, and read newspaper. Departed ~10:40 a.m. 10:55 a.m. - Bathroom trip without incident. Urine and bowel movement (type 5) passed. Weight 165.2 lbs. PT walk to living room and back to kitchen. Began enric...

Connie provided all day care for Joyce. 8:30 a.m. - Bathroom. 9:30 a.m. - Breakfast (Uncrustable peanut butter and jelly sandwich).  9:50 a.m. - Medicine with nutritional shake. 12:30 p.m. - Bathroom. 12:45 p.m. - Lunch (macaroni & cheese). 4 p.m. - Bathroom. 5:10 p.m. - Dinner (1 slice of pizza and apple juice). 7:30 p.m. - Bathroom. 

9:10 a.m. - Jess arrived to farmhouse to find Joyce awake and coloring. Joyce had her oxygen line in place. Joyce reported she has a sore in the upper right side of her mouth. 9:12 a.m. - BP 165/102, pulse 81. BGL @ 110. 9:25 a.m. - Bathroom trip without incident. Small bowel movement and urine passed. Pressure wound scab came of. 10 a.m. - Morning medication (carvedilol, metformin, Mucinex, multivitamin, 2 Tylenol, iron, potassium) administered with nutritional shake. 10:03 a.m. - Breakfast (3 small pancakes with butter and syrup). Breakfast finished at 10:20 a.m. 10:35 a.m. - Bathroom trip without incident. Urine passed. PT walk to living room and back to her recliner by 10:45 a.m. 10:46 a.m. - Lidocaine and Tiger Balm patches applied to Joyce's back and knee respectively. Joyce asked to nap for a while.  1:17 p.m. - Dusty arrived to farmhouse after being delayed from departing his campus office and found Joyce in the bathroom. Urinary incontinence requiring diaper pad insert rep...

8:55 a.m. - Jess arrived and found Joyce awake and reading yesterday's newspaper. Joyce was very perky and talkative. Joyce was very excited to discover that Jess was going to be baking muffins for breakfast. Joyce stated she had already used the bathroom earlier in the morning. 9:05 a.m. - BP 160/92, pulse 80. BGL @ 124. 9:15 a.m. - Morning medication (Carvedilol, metformin, Mucinex, multivitamin, potassium, iron, 2 Tylenol) with nutritional shake.  9:16 a.m. - Snack (1/2 banana) while waiting for muffins to bake. 9:30 a.m. - Joyce faded and napped for a bit after finishing her banana. Joyce seemed to have to force the banana down. Joyce didn't say anything about an upset stomach but did say her head hurt a bit today. 9:45 a.m. - Joyce woke and ate a muffin. ~10:15 a.m. - Craig arrived to visit. 10:30 a.m. - Bathroom trip without incident. Urine and small bowel movement (type 5) passed. Joyce changed into clean shirts. PT walk to living room and back, returning to chair by 10:...

9:10 a.m. - Jess arrived to farmhouse finding Joyce awake and without oxygen line in place. Joyce was very talkative. 9:18 a.m. - BP 155/92, pulse 83. BGL @ 135. As Joyce was very coherent, Jess took time to talk with Joyce about the importance of eating more. Joyce agreed, willing to eat more than toast. 9:41 a.m. - Morning medications (carvedilol, metformin, Mucus DM, 2 Tylenol, potassium, iron, multivitamin) and nutritional shake. 9:50 a.m. - Breakfast (egg in toast with syrup). 10:35 a.m. - Bathroom trip without incident. Urine passed. Barrier cream applied to open wound on buttocks. PT walk to living room and back to recliner. 10:57 a.m. - Lidocaine patch applied.  11:05 a.m. - Joyce began napping. 1:05 p.m. - Dusty arrived to farmhouse, finding Joyce just getting up to use the bathroom.  1:08 p.m. - Bathroom. Urinary incontinence requiring change of diaper and diaper pad insert. Urine and small type 5 bowel movement passed. Joyce declined showering. Dusty assisted Joyce ...

9 a.m. - Jess arrived to farmhouse finding Joyce awake without oxygen line in place (she had pulled it down and was wearing it like a chin strap).  9:11 a.m. - BP 163/92, pulse 84. BGL @ 118. Jess replaced the lancet cartridge. 9:25 a.m. - Carole (Kindred nurse) called Dusty to let him know she needs to adjust her schedule, now planning to arrive around 2 p.m. to 2:30 p.m. today instead of 12:30 p.m. Dusty contacted his director and received permission to do remote work at farmhouse this afternoon so he can be onsite for nurse's visit. 9:45 a.m. - Breakfast (Egg in toast), morning medication administered. Breakfast finished by 10:14 a.m. 10:30 a.m. - Bathroom trip without incident. Urine and small bowel movement passed. PT walk to living room and then back to recliner. 10:50 a.m. - Joyce hopped up from recliner to use bathroom, narrowly avoiding soiling herself. Type 6 bowel movement passed. Returned to recliner ~11:07 a.m. 11:12 a.m. - Joyce settled down to nap until Dusty arrives...

9 a.m. - Jess arrived to farmhouse to find Joyce awake in her recliner without oxygen line in place. Joyce was distressed about the family having problems. Jess sat down with Joyce and worked to calm her. Joyce was fuzzy about what had occurred over the weekend regarding two separate accidents involving family members that occurred recently and was concerned with interpersonal interactions between family overall. Joyce was eventually calmed. 9:18 a.m. - BP 149/81, pulse 78. BGL @ 128. 9:43 a.m. - Morning medication administered with nutritional shake. 9:50 a.m. - Breakfast (1 slice toast with egg and syrup). Finished at 10:06 a.m. 10:25 a.m. - Bathroom trip without incident. Joyce did not have a diaper pad insert in her diaper. Small amount of blood in the back of her diaper. New diaper and diaper pad insert put onto Joyce. New open wound on her right butt cheek (pressure sore). Jess cleaned it out with wound wash and applied barrier cream. 10:45 a.m. - Joyce given fresh blankets and s...

Dusty arrived to farmhouse ~8:45 a.m. after purchasing supplies for farmhouse in town (diaper pad inserts, blood glucose testing strips, disposable chair/bed pads) finding Joyce awake in her recliner with her oxygen line out of position. Dusty asked if Carol had been in to see Joyce and Joyce laughed, confirming Carol had just been inside to see her a few minutes earlier. Joyce was confused how Dusty knew that Carol had been in and asked how Dusty knew, thinking he had seen her outside or if he had seen her driving off down the road. Dusty said he could smell her perfume in the entryway when he came into the farmhouse. Bathroom trip declined. Evidence Joyce had taken herself to the bathroom at least once since Dusty departed farmhouse last night. Joyce did not recall the time of when she went to the bathroom. 9 a.m.- Bathroom trip declined. BP 147/84, pulse 77. BGL @ 119. 9:23 a.m. - Breakfast (5 mini pancakes with peanut butter, banana slices, and syrup). Earl Grey tea. 9:50 a.m. - Mo...

Dusty arrived at farmhouse ~9:30 a.m. after adventuring at Les Schwab. Joyce found awake and alert in her recliner without oxygen line in place, sorting through magazines and putting them into a paper bag. Joyce claimed that she had already taken herself to the bathroom earlier in the day, passing urine only. Joyce expressed concerns about being showered today and attempted to bargain out of it. Dusty assured her it would happen this afternoon and not in the morning. Joyce became irritated when asked to put her oxygen line in place, "everyone tells me to do this or do that! I need to be allowed to live my life!" Dusty worked on calming Joyce down, she sat sulking and unresponsive for nearly 20 minutes and refused attempts at changing subject. Joyce stared at coloring book that she pulled onto her lap to ignore Dusty. Joyce finally consented to eating breakfast but had no preferences for food other than to state she was not very hungry. 9:53 a.m. - Breakfast (1 leftover biscui...

Jess unable to arrive to farmhouse due to inclement weather and vehicle unable to maneuver. Craig was on-site at farmhouse when Dusty called him - breakfast and morning medication administered to Joyce by Craig. Dusty negotiated with his director at the university to complete his morning work at office and then depart for farmhouse, switching to remote work for remainder of shift. Plans continued to alter through the day due to snow storm. Dusty arrived to farmhouse ~2 p.m. after dropping Jess off at work. Joyce found upright in her recliner, coloring, without oxygen line in place and listening to Mary Poppins . Joyce semi-coherent. She expressed concern that she would have been left alone without anyone to see her because of the snow storm that hit earlier today. Joyce stated that she made her own breakfast and has been having a quiet day at home. Joyce declined bathroom trip. Dusty returned Craig's call to his cell phone and received an update on Joyce's morning. Joyce had la...

9:10 a.m. - Jess arrived at farmhouse, finding Joyce awake. Craig was present and reported that Joyce had taken herself to the bathroom about 15 minutes before Jess' arrival. Joyce decided that she was hungry and that French toast sounded good. Joyce requested two slices of French toast. 9:35 a.m. - Breakfast (2 slices French toast with butter and syrup). Finished by 10 a.m., Joyce having eaten one and a half of her French toast slices. Joyce asked Jess to save the remainder for her lunch.  10:05 a.m. - BP 145/82, pulse 83. BGL @ 127. 10:12 a.m. - Morning medication with 1/2 of nutritional shake. Shake finished by 10:25 a.m. 10:30 a.m. - Bathroom trip without incident. Returned to chair by 10:40 a.m. 10:45 a.m. - Compression stockings and lidocaine patch put onto Joyce. 10:50 a.m. - Joyce settled down for a nap. Joyce was starting to fade at this point, her memory lapsing over previous 30 minutes.  12:16 p.m. - Dusty arrived and found Joyce sleeping without oxygen line in plac...

November 10, 2020 - Addendum 5:30 p.m. - Dinner (Chicken, gravy, stuffing). Joyce ate almost all of her dinner. 6:20 p.m. - Medication administered. 7:05 p.m. - 1/2 piece of cherry pie. +++ November 11, 2020 9:15 a.m. - Jess arrived to farmhouse right after Craig arrived. Joyce had just returned to her recliner after using the bathroom. Joyce was awake and very talkative.  9:22 a.m. - Vitals taken, BP 135/87, pulse 85. BGL 130. 9:45 a.m. - Breakfast (1 piece egg in a basket with syrup). Breakfast finished ~10:15 a.m., Joyce given a mug of Earl Grey tea.  10:22 a.m. - Morning medications administered with 1/2 of nutritional shake.  10:35 a.m. - Bathroom trip without incident. Urine passed. PT walk into living room and back out to recliner. 10:52 a.m. - Nutritional shake finished. 11 a.m. Joyce setup to color as an enrichment activity. Jess departed farmhouse. ~12:16 p.m. - Dusty arrived to farmhouse to find Joyce in the bathroom, rushing to clean up from soiling herself. J...

November 9, 2020 - Addendum 6:30 p.m. - Lasagna soup, 1/2 breadstick. Evening medication. 9 p.m. - Ready for bed. +++ November 10, 2020 8:54 a.m. - Jess arrived to farmhouse, finding Joyce awake without oxygen line in place. Joyce was very alert and had managed to get Netflix going (something she usually cannot do on her own).  9 a.m. - Bathroom. Urinary incontinence, required change of diaper and diaper pad. Urine passed. Returned to recliner by 9:12 a.m. 9:17 a.m. - Vitals taken, BP 137/76, pulse 84, BGL @ 118. 9:41 a.m. - Breakfast (3 small pancakes with syrup and butter). Finished breakfast by 10:04 a.m. 10:10 a.m. - Morning medication and 1/2 nutritional shake.  10:30 a.m. - Dr. Collins' office contacted Dusty via Debra (Kindred nurse) who called Dusty's cellphone. Dr. Collins does not want to place Joyce on a diuretic due to her mental state (confusion). Family caregivers are directed to continue use of compression stockings, elevation of legs, and walking PT exercises o...

Updated 11/10/2020 to include definition of symptoms that place Joyce in the "Yellow Zone" of Congestive Heart Failure. --- 9:15 a.m. - Jess arrived to farmhouse, Craig present. Joyce had just returned from taking herself to the bathroom and reported that she was dry. 9:42 a.m. - Vitals taken, BP 135/78, pulse 84, BGL @ 84. 9:45 a.m. - Breakfast (3 pancakes with butter and syrup), finished breakfast by 10 a.m. 10:09 a.m. - Morning medication with nutritional shake. 10:45 a.m. - Bathroom trip without incident. Passed urine and small bowel movement (type 5). Jess helped get Tiger balm and lidocaine patches applied to Joyce's left knee and back, respectively, before bathroom trip. Dusty arrived to farmhouse. 11:04 a.m. - Compression stockings put onto Joyce.  11:07 a.m. - Marshall (Kindred PT) arrived to perform the discharge visit. After today there will be no further at home PT work with Joyce from the Kindred team unless ordered by Joyce's primary care physician. Mars...

9:15 a.m. - Jess arrived to farmhouse. Joyce reported that Craig and Carol had arrived earlier in the morning. Joyce reported that she had taken herself to the bathroom prior to Craig and Carol's arrival. 9:30 a.m. - Bathroom trip without incident. Urine passed. Returned to recliner ~9:47 a.m. 9:50 a.m. - Lidocaine patch applied to back. Tiger Balm patch applied to left knee. 9:55 a.m. - BP 146/90, pulse 83, BGL @ 99.  10:05 a.m. - Morning medications administered with nutritional shake.  10:15 a.m. - Breakfast (leftover sausage and gravy on toast). Joyce ate ~1/4 of a slice of toast amount. Breakfast abandoned at 10:45 a.m. 10:50 a.m. - Joyce began napping. 11:25 a.m. - Carol stopped by to visit, woke Joyce. 11:40 a.m. - Bathroom trip without incident.  11:50 a.m. - Joyce resumed napping. 12:17 p.m. - Bowel incontinence, loose stool. Jess cleaned Joyce, provided fresh skirt and returned her to recliner.  12:50 p.m. - Joyce resumed napping. ~1:40 p.m. - Dusty arrived...

9:15 a.m. - Jess arrived to farmhouse and found Joyce awake in her recliner without oxygen line in place. Joyce reported that she had used the bathroom before Jess' arrival but did not recall when that happened.  9:25 a.m. - Bathroom trip without incident. 9:55 a.m. - Morning medications given with 1/2 of nutritional shake. 9:57 a.m. - BP 137/96, pulse 95, BGL @ 117. 10:48 a.m. - Breakfast (homemade sausage gravy over 1 slice of toast). Breakfast abandoned by 11:30 a.m. with only 1/2 eaten. 11:37 a.m. - Joyce soiled herself in her recliner. Disposable chair pad replaced. Joyce caused a mess in the bathroom while removing her diaper. Remainder of bowel movement passed (type 7). Jess suspects it was due to not eating yesterday and/or decongestant medication. Joyce was showered following toileting cleanup, returned to her recliner by 12:50 p.m. Tiger Balm patch applied to left knee. 1:55 p.m. - Bathroom trip without incident. PT walk to living room and into kitchen before being return...

9:07 p.m. - Jess arrived to farmhouse, found Joyce awake but without oxygen in place. Joyce reported that she had already taken herself to the bathroom earlier in the morning. Joyce stated that Craig had given Joyce a banana earlier "but took it away for some reason." 9:10 a.m. - Bathroom. Urinary incontinence. Leftover fecal matter in diaper from previous bathroom trip. New diaper and diaper pad insert. Urine and small bowel movement (type 6) passed. Returned to recliner by 9:35 a.m. Joyce reported that her left leg was hurting bad today. 9:48 a.m. - BP 147/73, pulse 81, BGL 105. 9:58 a.m. - Morning medication and nutritional shake given to Joyce. Shake finished at 10:07 a.m. 10:04 a.m. - Lidocaine patch applied to Joyce's back. Tiger Balm patch applied to Joyce's left knee. 10:14 a.m. - Whole banana given to Joyce (the one Craig had tried to give her). Jess negotiated with Joyce to eat all of her banana and all her lunch today. Banana finished ~10:55 a.m., Joyce kep...

9:10 a.m. - Jess arrived to farmhouse and discovered Joyce just waking herself up, no oxygen line in place. Joyce had not been into the bathroom at that point.  9:12 a.m. - Bathroom. Urinary incontinence. Diaper and pad insert replaced. Joyce returned to her recliner by 9:20 a.m. 9:25 a.m. - Joyce reported lidocaine patch from yesterday was still on her back. Jess confirmed and removed it. Breakfast was discussed with minimal deviations in conversation. 9:40 a.m. - BP 151/93, pulse 83, BGL @ 117. 9:50 a.m. - Morning medication and nutritional shake.  10 a.m. - Joyce requested to watch western films today, starting with Hondo .  10:15 a.m. - Breakfast (3 small cinnamon pancakes with syrup and butter), finished by 10:33 a.m. 10:40 a.m. - Bathroom trip without incident. Urine and bowel movement (type 6) passed. Returned to recliner by 10:50 a.m. Joyce was changed into a fresh shirt and sweatshirt and new lidocaine patch applied to her back.  11:10 a.m. - Compression sto...