Saturday, September 20, 2008
Better Little by Little
Movement for 9/19/08:
- She not only walked to the bathroom after awakening, this morning, but to the dinette, as well. As well, she had a bowel movement and standing for the extension this adds to groin cleaning did not appear to involve any more effort than usual. However, she decided to turn for front groin cleaning, which we haven't been doing, winced and found it necessary to sit back down on the toilet before standing up, again, and continuing. She was a little iffy going into the dinette. I kept the wheelchair close and pulled it up to her once, about halfway through the kitchen, but she refused it, straightened on her own without a reminder, and continued, slowly but surely. It was obvious that this took effort and courage.
- Wheeled, again, until she awoke from her nap. She insisted on walking into the bathroom. After dinner I suggested that we start doing some "very simple and easy" therapy on her left arm: Simply trying, four times, to lift it in front of her and out to the side. She is having much difficulty and can't raise her arm very far in any direction, but she tried. She gets extra points for effort and courage. Overall, though, her pain is less. She even mentioned that transferring is no longer painful. The caused her to decide to rise from her rocker on her own for transfer to the wheelchair before bed. It was hard and I'm sure there was pain involved, but she did it. At one point I suggested she sit back down for a minute, when she was having trouble getting her balance before straightening up. She refused and worked it out on her own. She was, however, so tired by the time we made it to the bathroom that she opted for the wheelchair into her bedroom.
Thursday, September 18, 2008
Recovery Plateau
Movement for 9/18/08:
- Today began much the same as yesterday, except that it started later: Walking to the bathroom; being wheeled to the dinette; transferring to a dinette chair. Some painful twinging on transferring. A reluctance to stand because the arm effort it takes to stand hurts her left shoulder. Leaning to the right in order to compensate for left shoulder pain; her right side being her weak side, constantly iffy right knee. To alleviate yet another painful twinge, I suggested that when she move into the living room after breakfast, we leave her in the wheelchair, as we did, last night. She agreed. I'm noticing, now, though, as she's taking her 2nd breathing treatment in preparation for her nap, that the arms on the wheelchair are a bit too high and create yet another problem for her left shoulder. So, I just discussed with her the possibility of transferring to the rocker this evening instead of doing a full wheelchair evening, again. She agreed. I told her I understand that transferring causes some temporary and sometimes sharp pain, but it looks as though the wheelchair is causing long-term discomfort. She agreed with this as well. So, we'll try transfers, tonight. As yesterday, I'm keeping her "hopped up" on acetaminophen, as much as I dare and as much as she'll take. More later.
- She walked to the bathroom after her nap. After this, it was wheeling all the way. She did transfer to the rocker for the evening. Transfers remain momentarily painful, but she's stalwart. By the time she goes down for the night she is very tired.
Wednesday, September 17, 2008
Recovery Continues
Movement for 9/17/08:
- This morning, upon awakening, Mom decided an aching shoulder shouldn't stop her from walking to the bathroom for her bath. I supported her, even though I know that most of her pain happens when she's rising, sitting or using her arms for support as she walks. She seemed to do fine into the bathroom, though. I asked her about pain and she claimed she had none, except when she arose from the bed. It was difficult for her to find exactly the right way to rise with the least amount of pain. She also felt, after bathing, that she "should be able to walk" into the dinette for breakfast. I didn't discourage her but made sure the wheelchair was set up and handy, just in case. Once she'd made it from the toilet to the bathroom door, looked out and saw the wheelchair just to her left, she sighed and said, "I'm glad that's there," and moved to sit in it.
- Needless to say, I also wheeled her into the living room from the dinette. She leans heavily on the banister with her left arm and it just didn't seem like a good idea, to me, to encourage her to take the steps, yet, although I felt she sure could walk around the kitchen table; but, we didn't try that. For the same reason, we used the wheels to get her into the bathroom before her nap. I asked her if she'd like to try walking into the bedroom, but she said, "I think I've had enough of that for today," and that was that. Recovery from shoulder injuries can be protracted, so, at this point, I'm happy with whatever we get.
I will, of course, report back later on our evening. - It was wheeling all the way this evening. She has begun leaning to the right, which often happens when she is feeling weak and/or in pain from an injury. This increases her difficulty in walking substantially. She made a valiant attempt to walk into the bathroom, of her own accord, but it was clear to me just from her rising-from-the-bed technique that she was going to have little luck. After the second time of her giving up when trying to move her feet forward and sitting back on the bed, I suggested that maybe a wheelchair night was in order. She agreed.
It's always important for Mom to be allowed to try to accomplish whatever technique her spirit tells her she can accomplish before we seek another avenue. After two challenging transfers, one involving a change of underwear, in the bedroom and bathroom, I suggested that we not try a transfer from her wheelchair to the rocker in the living room. She agreed. She reported very little pain, though, and, believe me, I ask her obsessively; so much so that last night she piped up, "I wish you'd stop asking me that! Can't you figure out, yet, what hurts?!?"
I laughed, and begged off the question, sort of. I defended myself by telling her that I need to keep a mental catalog of what hurts when, especially after an injury.
"Well, I think you're catalog is mighty full, by now!" she scolded.
Transfers going to bed were much easier. She was standing straighter, although with effort, and was able to move her feet to turn from wheelchair to toilet, toilet to wheelchair and wheelchair to bed. She was also significantly more alert through the second "half" of her day than through the first "half". The naps and night sleep are certainly accomplishing a healing purpose.
Tuesday, September 16, 2008
Excellent Recovery
Movement for 9/16/08:
- At my insistence, and to my mother's initial displeasure, "I don't walk on my hands," she argued, which is funny because I kid, and sometimes scold, her for "standing on [her] hands" in the bathroom when she supports herself with the various bars and the counter and hangs on them for foot purchase, we are using the wheelchair for all ambulation between transfer points today. As Mom's morning progressed, though, and she discovered the circumstances behind my reasoning: She injured her left shoulder, it is still causing her moderate to sharp discomfort, and she uses her shoulders substantially for keeping her balance when she's walking or walkering. Even transferring causes a noticeable twinge, so we've just about decided, for today, at least, to avoid standing up and sitting down as much as possible, although she insisted on greeting the Hospice RN from her usual chair at the dinette table. In the bathroom, just before her nap, we did not transfer from wheelchair to toilet to wheelchair. I simply had her stand, took off her slacks, changed out her underwear, she sat back in the wheelchair, and off to bed we went.
- Her pain is significantly less than last night. Her bicep no longer hurts, just her shoulder, toward the back. She is having trouble lifting her arm, although she's leaning on it as usual without pain. No problems with her left thigh, about which she complained last night; no problems with any other part of her body, except that she had a minor lower back ache this morning upon arising, but that has disappeared since the regular acetaminophen, which I will continue throughout the day, kicked in. I think the back ache occurred because she was trying to transfer some of her use of her left shoulder for rising to her back. Didn't work as well as she hoped.
- I was very impressed with Hospice's response, both last night and today. Our RN took a full and detailed report of the fall, the paramedic visit, everything that occurred from the time of the fall to her going down for the night and conducted a Prevention Assessment, the upshot of which was: Make sure Mr. Man is secured before Mom arises from her chair to "ambulate". I didn't mention that in last night's report did I? The reason I wasn't right by her while she was walkering (I usually am), is that Mr. Man has taken to stretching out right in our path every night when Mom rises and heads north for her bedtime ritual...so I always move him while Mom is standing at the ready at her walker. I saw her lose her balance. It was such a gentle collapsing that, had I been where I usually am when she moves, I would have been able to catch her before she went down.
- We've got a gait belt. I learned how to use it in rehab and we've used it a few times here. Mom, though, doesn't like it and I don't blame her. I don't, either. No matter how tight I secure it, because of her shape, it invariably slips up just underneath her breasts. Very uncomfortable when I have to grab and pull it for security reasons. Most of the time, in circumstances where a gait belt would be used, my fingers are locked around the waistband of her slacks. That works well. I just wasn't doing that last night.
- She's up for the evening, as of 1700, on her own. She's been wary of transferring because of the sharp twinges it causes in her shoulder, but with a bit of "working up" to them, she's doing them. As it turns out, after reminding her (while I was wheeling her toward the bathroom) that we wouldn't be doing any more transfers until bedtime, as we'd decided to substitute sitting in her wheelchair in the living room for sitting in her rocker, she nixed that idea. "This is too uncomfortable," she said, patting the arms of the wheelchair.
"That means two more transfers this evening," I reminded her.
Fine with her.
Actually, out of four total transfers since her nap, only two of them have hurt her. I'm noticing that she's sequeing from "hurt shoulder" to "iffy legs", so I have to remind her that her legs aren't injured and she can use them as she usually does. This has surprised her each time it's proven to be true.
So, it looks as though we're in for an evening that will be only somewhat more sedentary than usual. I'll report back later, after she's down for the night. - Despite being a little rum-dumb from the constant acetaminophen I fed her throughout the evening, she did well. She registered pain in her shoulder (seems that area took the brunt of the blow when she fell, not her bicep) only twice: Once the first time she attempted to transfer from sitting on her bed after her nap to the wheelchair, then, again, going from a standing position (so I could pull up her underwear) to a sitting position in the wheelchair in the bathroom while going through her bedtime ritual. A few more movement quirks of the day:
- She asked if I could wash her face and neck for her while bathing. This is something she usually does and, a few times in the past when I've offered for various reasons, she's refused the offer with disdain. So, it must have been particularly difficult for her, today.
- I decided against taking her BP this morning, as the best way to do it with my equipment (a wrist cuff) is using the left arm. I was concerned that the position in which I hold her arm for a reading would cause some stress on her shoulder and I'd get a false reading. The RN took it at 1400, though, and it was normal for my mother (although the diastolic was a little low): 132/56.
- Including last night, my mother has not brushed her teeth since yesterday morning. She simply isn't interested in using the spit bowl routine. I think this is okay. I anticipate that she'll be feeling better tomorrow than today and we may be able to include this, again.
- I am learning a lot about how much she actually uses her arms for balance and how much she depends on them in transfers (I always help in transfers; I have been for quite some time, now). She depends on them so much that, today, I had to coach her into remembering that, once she's on her feet, with me giving her support she doesn't need her arms in order to use her legs. "Your legs can support you on their own," I told her. This is true. She just hasn't been used to doing this.
- I brought up the three-month-tabled suggestion of maybe checking out Hospice for a little in home therapy for her arms and legs after her shoulder has healed to the point where it can take some exercise. Surprisingly, this time, she was enthusiastic. I don't know how long that will last, but I'm going to keep talking it up.
Monday, September 15, 2008
Getting Mom Up Was the Big Problem
Movement for 9/15/08:
- Once I was able to rouse her, although she's been slow all day and took a three hour nap as well as all that night sleep, she moved fine. No wheelchair so far. She complained a little about her "iffy" right knee coming into the living room from her nap, but nothing major.
- Life turns on a dime, that's for sure. She did well, but was slow and iffy, walking and walkering, at her insistence, all evening, all the way up to her normal move into the bathroom just before bed. Then, walkering on her way to the foyer steps, just past her rocker she lost her balance and collapsed to her left, falling into the coffee table. She knocked the bejesus out of her left bicep, so she wasn't able to hang on to my neck with that arm, thus, it was impossible for me to pull her up with me as I rose from a full squat. We called the non-emergent paramedic squad. They checked her out and although they felt that she probably hadn't broken anything, as the squad leader said, "I don't have X-ray eyes, M'am; do you want to go to the hospital and be checked out?"
Of course, she refused. I don't think this was necessary, either. We'll discover, tomorrow, how bad it is. I don't think anything's broken, though.
Thus, our bedtime routine was changed, a bit. The squad moved her to her wheelchair. I wheeled her into the bathroom. It was here that we discovered that Mom wasn't going to be able to rise out of the chair without considerable left arm pain, even though she was trying not to use it and I was helping her. So, the paramedics suggested that we move her into the bedroom, upon which they held her up while I changed out her underwear and lifted her from the wheelchair to the bed.
At that point, with many thanks, they left. I gave her 650 mg of acetaminophen with a croissant and a cup of decaf coffee. The four of us (including the kitties) visited while she relaxed and ate.
Both Mom and I got the idea that, since she usually sleeps on her left side, it might be a good idea to reverse her bedclothes for tonight, at least. Turns out, though, she couldn't get settled comfortably on her right side, so we switched her back. She found a position for sleep that allowed her left arm to relax so it wouldn't hurt. She asleep, now, at 0223, 9/16/08 as I write this; The Little Girl is sleeping with her, for observation and healing purposes.
While she was eating her croissant and drinking her coffee, we brainstormed ideas about how to allow her some mobility tomorrow, even though I'm sure we'll be using the wheelchair most of the day. The mobility will be for purposes of transfer from bed to wheelchair and back, wheelchair to toilet and back...and, if our technique works and she wants to try, to the dinette chair and the rocker. I'm not sure how we'll do her bathing, but we'll figure out something; maybe have her lean on the walker while I wash her groin. Something will come to us in the nick of necessity; it always does. We figure it'll be an interesing day, at least. We're good at negotiating what seems like the impossible, so neither of us are thrown by this.
Sunday, September 14, 2008
State of Grace
Movement for 9/14/08:
- So far, today, Mom has stood well, moved well, but she's seemed a bit winded. I've upped her O2 most of the day. Just before her nap, after some observations covered over at The Dailies in the Medication Changes section, I decided to give her 10 mg furosemide. I also decided, considering that she still appeared to be a bit breathless even while sitting and on 5/lpm O2, that it would be a good idea to wheel her into the bathroom and into bed. Her spirit and will were high, though, so I figured I'd better talk her into this.
I stood in front of her, sitting in her rocker shielded by her TV table. "Mom," I said, spreading my arms for dramatic effect, "here's my dilemma."
"Most people call that their body," she said, her eyes twinkling and the corners of her mouth on the verge of an ironic smile.
I laughed. "Well, mine's a dilemma, today," I said. "I know you've been moving well, but I'm concerned that your breathless has continued even when you've been sitting."
She nodded confirmation.
"So, I'm thinking, even though you're fine on your feet, maybe it would be a good idea to wheel you into the bathroom and your bedroom for your nap. I know you don't like to do this, but I don't want you to get so winded that, halfway through the trek, you discover you can't make it. Do you see what I mean?"
"Yeees..." she said, making it obvious that she didn't completely believe my assessment of her abilities.
"So, what do you think? Do you mind if we use the wheelchair?"
"No, I think that'll be all right." It was obvious from her tone that she was merely humoring me but, I decided, that's good enough.
In the bathroom, my mind still whirring about what to do about her fluid retention and breathlessness, I announced that tonight was a good night to finish off the Appetizer Dinner ingredients from night before last. "Lots of sodium and potassium," I said, "and you'll need that to counteract the furosemide."
She grinned. "Oh, I don't need a reason to eat appetizers," she said.
"So, pineapple upside down cake or chocolate squares for dessert?"
"Do you even need to ask?" she chided.
Chocolate squares it will be.
She transferred well, so I know she's not having any limb problems. Once she made it to her bed, despite being wheeled, she was still winded. So, it was a good decision. We'll see how she's feeling after her nap.
In the meantime, the reason I labeled this post "State of Grace" is that, when it was all over and she was settled in bed, I did an auto review of everything that had happened so far today:- Noting, early, the high blood pressure trend, the breathlessness, the slight edema and the "kecking";
- regardless of what else I was doing, keeping a keen third eye focused on Mom;
- adjusting conditions, sometimes moment to moment, to address this symptom or that symptom;
- keeping Mom "in the loop" in order to test my observations, allow her to be aware of my concerns and why I was tending so closely to her and allow her to participate in her care;
- consulting with her on strategy, especially the wheelchair use, that I knew she wouldn't particularly like;
- automatically adjusting meds and meals to handle circumstances;
- performing, in every moment, so smoothly that neither she nor I felt as though any part of our day, individually or "corporately" experienced, has been out of whack.
"Wow," I thought, quickly scanning through all the years of experience I've had being my mother's companion and caregiver. "I'm constantly in stride, now!" Good feeling.
We'll see how the evening progresses for Mom. It usually takes the minor doses of furosemide I give my mother several hours, sometimes a day or a bit more, to work, so she may still be winded tonight. In the meantime, I know it'll be an even keeled evening, because, well, we're living in a state of grace. - She awoke on her own from her nap much earlier than the time she'd asked me to awaken her. She alerted me that she was up by walking, with environmental support, from her bedroom to the banister, hanging over it and asking me, while I was publishing the first part of this post, "So, what're you doing for fun?"
I was surprised but pleased. This happens every once in awhile, and it always pleases me that she's still capable of mobilizing on her own. I leapt to my feet, headed up the foyer steps and noticed that while she was standing at the banister, leaning heavily on it, her knees were sinking. I directed her to "hang on" and headed to get the wheelchair. It was obvious she wasn't going to be able to stay on her feet long enough to head back down our short hall for the bathroom. From that point on, she spent the evening being wheeled around in the chair, although she did transfers with no problem. She opted for bed early, though, for her, and was clearly tired. I wheeled her into the bathroom. She insisted, though, that she could stand at the sink to brush her teeth, and did. She also insisted that she didn't need the wheelchair to get to bed. She didn't, but it was a close call. I'd say it's about 25 feet from the sink in the bathroom to her bed. I had her stop every few steps and "stretch up", just to make sure her legs were able to get her to the bed.
No Wheelies Today
Movement for 9/13/08:
- Although a little to the heavy side of "spry", she refused the wheelchair today through all her movement episodes, and rightly so. Nothing notable about her moving, today, really, except that, at the breakfast table, surveying the day from her perch through a long, narrow window to her left that gives a generous patch of a view, she said, "What a beautiful day!" Which it was, we're in our yearly fall batch of beautiful days, now. "I think I'd like to go outside for awhile today."
"Great!" said I. "How about after breakfast? You're all ready except for you new hat."
She flashed me a mock look of disdain. "I was thinking later," she said.
Although I guessed that I was on the losing side, I continued, teasing, "After breakfast will be later. Mom, you won't have to do anything. I'll set up the big umbrella and the outdoor table in front, we'll wheel you down the ramp, I'll make you a fresh glass of iced tea, we'll be Porch Ladies without a porch. Maybe I'll do a little close yard work. You can supervise."
"How about after my nap?" She grinned.
Considering when she arose, "after [her] nap" will be after dark, but I agreed.
I suppose I should just hunker down and do it, force her out, regardless. Once out, I'm rather sure she'll be pleased. And, maybe I will. But, I didn't have the heart, yesterday. She seemed so comfortable and settled and satisfied looking out, versus being out.
