General Update #310 - Tuesday, February 16, 2021

7:55 a.m. - Dusty arrived to farmhouse. Craig on-site. Joyce using bathroom, sitting in the dark unaccompanied (urine passed, Type 1 bowel movement). 

Joyce showered.

Weight 160.4 lbs.

PT walk to living room.

8:56 a.m. - BP 164/86, pulse 79. BGL @ 119.

9 a.m. - Morning medication with nutritional shake. Breakfast (donut and whole banana).

9:30 a.m. - Bathroom trip without incident. Urine passed.

9:40 a.m. - Departed farmhouse for footcare appointment at Palouse Foot & Ankle with Dr. Capawana. 

10 a.m. - Joyce's toenails trimmed, feet appear to be in good health. No diabetic extremity concerns. Next appointment set for May 4, 2021 at 11 a.m. Dusty will update appointment calendars and request time off to cover taking Joyce.

10:15 a.m. - Bathroom trip declined while preparing to depart doctor's office.

10:23 a.m. - Joyce soiled herself in the car.

10:40 a.m. - Craig assisted with getting Joyce into farmhouse. Bathroom (urine and remainder of Type 6 bowel movement passed). 

Joyce showered.

11:32 a.m. - BP 150/83, pulse 69. BGL @ 240.

11:35 a.m. - Lunch (cheese burger, fries, fry sauce, V8). 2 Tylenol.

12:13 p.m. - Lunch paused. Bathroom trip (urine passed).

12:25 p.m. - Departed farmhouse for appointment at Moscow Medical with Dr. Collins.

12:40 p.m. - Appointment with primary care provider, Dr. Collins. Joyce was fairly alert during the visit and vocalized her concerns with Dr. Collins and Dr. Collins' nurse, Wendy. Joyce's primary concern was if "all the medications that people are making [her] take are causing nightmares and voices." 

  • Joyce self-reported that the "nightmares have been bad" and "happening for about 2 months"
    • Dusty confirmed that Joyce had been reporting nightmares for several years to him at times, but relayed what Craig and Dusty had experienced with Joyce a few days ago during breakfast
    • Nightmares suspected to be related to dementia/Alzheimer's and not medication related according to Dr. Collins
      • Only possible medication related issue could be that previously used Alzheimer's medication used on Joyce, Aricept, was preventing nightmares from occurring.
        • Tramadol (pain reliever), Losartan (high blood pressure), Carvedilol (high blood pressure/heart failure) do not have cognitive or neural receptor affecters
      • Dr. Collins recommended prescribing Prazosin (used to treat military personnel for PTSD and nightmares, making users fall into a deeper sleep by blocking stress response receptors) - Joyce refused more medication, almost in paranoid manner
    • Family to monitor Joyce, checking in with her each morning and seeing if nightmares/voices in Joyce's head increase and disturb her sleeping - log if occurring
      • In 30 days, if Joyce's nightmares continue, Dr. Collins will prescribe Prazosin to try for Joyce
  • Left knee checked - confirmed Tramadol appears to be working for Joyce, no major mobility issues noted since Tramadol has been reintroduced to Joyce's medication plan
    • No noticeable side effects seen in Joyce from Tramadol use
  • Joyce's overall flexibility is very good.
  • Joyce's general lethargy and daytime sleeping noted - potentially due to disrupted overnight sleep? 
  • Dr. Collins and Wendy interested to learn that Kindred Home Health stopped seeing Joyce as they had just renewed the home health visits to continue. Dusty provided updates from Kindred nurse (Carole) that it was deemed that Joyce had stabilized and was no longer in need of weekly nursing visits
    • Joyce health log reviewed, appreciated by Dr. Collins and Wendy - praise to family for collecting detailed and useful information, deemed a good replacement for Kindred visits and daily contact/care for Joyce - Family care providers are collecting data that Kindred would have provided to Moscow Medical and family care providers are treating and documenting any injuries/illness/odd behaviors in Joyce and calling in with concerns - much better than other elders being cared for by their kin
    • Dr. Collins will renew Kindred Home Health order visits if family desires, just call Moscow Medical and ask for Wendy and the renewal orders will be setup
  • Miralax is acceptable to give to Joyce 2-3 times per day to soften stool and counteract constipation effects most likely occurring due to Tramadol
  • Cranberry nutritional supplement pill approved to add to Joyce's diet
    • Dusty will add to mid-day pill cups
  • Joyce put onto Moscow Medical's wait list for COVID-19 vaccine
    • Pfizer vaccine depleted, most inoculation sites are now using the Moderna vaccine
  • Next appointment scheduled for May 18, 2021 at 9:20 a.m. Dusty will update appointment calendars and request time off to cover taking Joyce.
1:30 p.m. - Returned to farmhouse. Craig on-site and assisted with bringing Joyce inside. Bathroom trip declined.

1:43 p.m. - Lunch resumed, finished by 2 p.m. Joyce began napping.

3:48 p.m. - Dusty departed to pickup prescriptions from Walmart pharmacy. 

5:48 p.m. - Dusty returned to farmhouse, found Joyce awake in recliner without oxygen line in place. Joyce claimed that she had taken herself to the bathroom ~ 30 minutes prior, reporting urine passed and that she had to replace her diaper and diaper pad insert. 

5:55 p.m. - BP 184/100, pulse 76. BGL @ 118. Evening medication with nutritional shake.

5:58 p.m. - Dinner (2 small square slices of Domino's Philly Cheesesteak thin crust pizza, 1/2 can peaches). Finished by 7 p.m. and began napping.

8 p.m. - Bathroom trip declined.

8:30 p.m. - Bathroom trip declined.

9 p.m. - Bathroom trip declined.

9:30 p.m. - Bathroom trip declined. Informed Dusty that she "would take herself when she felt like going to the bathroom and didn't need help."

9:45 p.m. - Joyce made ready for bed.

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