Saturday, October 4, 2008
A Little Bit Hard, A Little Bit Easy
Movement for 10/4/08:
- When Mom first awoke, even after an exteeeeended time on the edge of the bed and despite the fact that she thought she'd walk into the bathroom, once on her feet she eased herself back to the bed. "What's the problem?" I asked.
"I'm not sure what to do with my feet," she said. She had a curious do-I-even-have-legs look on her face. Seemed reasonable that we should use the wheelchair. She transferred well, both from the bed to the wheelchair and from the wheelchair to the toilet. When we got her settled for bathing she said, "Well, that was easier that it looked!"
She must have figured out that she had legs and what to do with her feet by the time we got to groin bathing, though, because she stood well and sturdily for that. I even complimented her on her stance, saying, "You're standing well today," to which she jauntily replied, "Well, thank you, so are you!" She had a slight problem imagining herself walking into the dinette, so I readied the wheelchair to her left outside the bathroom door and the oxygen caddy to her right. Once she'd made it through the bathroom she chose to use her feet and went right when she exited the bathroom.
She did well going into the living room after breakfast, too. She used the walker once she'd descended the dinette steps. Her technique was so surprisingly good I couldn't help but compliment her about that, too.
She cocked her head to the side and responded with one of her thin-lipped, ironic grins. "You know," she said in a tone of comic confidence, "this really isn't as hard as it looks."
She headed in for a nap early. I was surprised by that, too, but didn't flinch. We used the wheelchair to the foyer steps but after that she was on her feet all the way to the bathroom and all the way to the bedroom.
We'll see how this evening goes. I'm not even going to guess. - Movement went well this evening. Although I was ready to handle her using the walker from steps to rocker and rocker to steps, she felt iffy about it, so I followed her lead. Otherwise, though, she did well transferring and walking with environmental and my support in all the areas where she usually walks.
Friday, October 3, 2008
And Up
Movement for 10/3/08:
- Surprisingly, today Mom has been up and about more than in the previous three weeks. The only time she used the chair, at my insistence, because I was too physically rundown to spot her on the walker when she was heading in for her nap, was from the rocker to the foyer steps. Otherwise, it's been walking and the walker (from the dinette steps to the rocker) all day. She's rising well, standing well, walking well...I'm relieved.
- It was a slow evening (although I can't really explain to what I'm comparing this evening...I think most people would consider all our evenings slow) but she did all the walking. She was up for walkering, too, but I was not...I'm feeling "under the weather", although the weather isn't the problem. So, I wheeled her from foyer steps to rocker after her nap and back before bed. Otherwise, though, she did well.
Thursday, October 2, 2008
Falling. Up.
Movement for 10/2/08:
- Well, today's movement profile had a spectacular start. My mother managed to arise about a half hour before I planned to awaken her without me realizing it, despite the fact that I had the monitor on full blast right next to me in the living room, felt good enough to walk out of her bedroom, presumably using her dresser for purchase with her left hand, as she usually does, turned left heading into my bedroom, instead of right toward the bathroom and where the grab bars are (my guess is that she was headed toward the Arcadia door to have a look into our backyard, she always pauses at her bedroom door when exiting to look out back, enjoy the view and comment), made it as far as my bedroom door (about three feet from her bedroom door) and, in her words, "let myself down slowly to the floor". I'm guessing that she lost her balance, realized it, grabbed onto the door frame and sunk to the floor. By the time I heard her calling my name (which I couldn't hear through the monitor since she was out of range, so mistakenly thought was Mr. Man yelping at the Arcadia door at something outside, which he often does), probably a couple of minutes after she "let herself down", she had grabbed an errant pillow from the floor of my room that I'd missed when putting my bedding away for the day this morning and was settled on the floor in exactly the same position she usually takes in her bed.
After hearing her description of what happened, I mentioned to her, "This is the opposite way from the bathroom. What were you doing going this way?"
She pointed toward the Arcadia door. "I was going for...something..."
That's what makes me think she simply couldn't resist a closer look at our backyard.
Needless to say, I couldn't get her up on my own. She was in good humor, though, very alert, looking bright eyed and bushy tailed. I did a survey of her legs and arms and back, having her move everything. Everything worked as well as usual. She reported absolutely no pain.
When the paramedics arrived they easily lifted her into her wheelchair (although I cautioned them about her left arm and I assume they were easy with it, she had no problem with it when they lifted her from under her arms), did a body survey similar to mine, left, and off we went to the bathroom for bathing.
Bathing went well. Although she saw no reason why she couldn't walk into the dinette, I cautioned her that it might be best not to "push things" for a little while. I allowed her, though, to walk from the toilet to the door of the bathroom "as a test". She passed it, although she had a momentary wobbling of her right knee, but nothing that isn't common for her.
She stood well, transferred well. After breakfast she walked around the table and down the dinette steps into the living room, although I wheeled her to the rocker. I'm still leery of her using the walker.
She also walked from the bathroom into the bedroom for her nap without blinking twice, and into the bathroom after her nap. She intended to walk from the toilet to the foyer and down the steps into the living room but peered around the bathroom door, narrowed her eyes measuring the distance (which is maybe five feet from the bathroom door), looked at me, looked at the wheelchair I'd parked outside the bathroom door just in case, and opted for the chair.
She's still up. She's been alert and lively, today. She mentioned, once, this evening, that she feels "so much better than yesterday."
Although I don't remember that she felt other than good, yesterday, I responded, "Amazing what chocolate ice cream for dinner can do, isn't it?!?"
She rolled her eyes and grinned. "We should do that more often," she said.
She's still up. I'm not sure what kind of movement is in our immediate future, tonight, but I'll report back later, spectacular or not. - Mom was very tired, tonight, by the time she went to bed, which was a little early, for her. We decided to go with the wheelchair all the way, including spit bowl tooth brushing. She didn't complain, as she usually does, when we do this. I take that as a measure of her exhaustion. She continues to be pain-free from the fall, though, and moving as usual. Tomorrow will tell, of course, but my assumption is that she folded, rather than fell, and, typically, she doesn't suffer any ill effects from folding to the floor.
One Step Back
Movement for 10/1/08:
- Today was a wheelchair day all the way, even though my mother was sure, once we were ready to go to the bathroom for bathing after awakening, that she'd be walking a fair amount. She'd complained of side back pain this morning, several times, so much so that I asked her if she wanted acetaminophen at breakfast, to which she said yes. When I gave her the choice of "regular" or "extra strength" she chose "extra strength". Frankly, I think her back pain is a result of the way she's been sleeping, lately: Flung diagonally across the bed, feet and lower calves dangling off the side of the bed, half on her upper back, half on her left side, back arched in a way that looks uncomfortable. I think this finally got to her last night. I've been trying to ameliorate this over the last some days by being careful how far I scoot her into the bed at night. Today, I think I finally figured out the optimal distance because, during her nap, she didn't end up in the above position; and, her back sides didn't hurt.
Otherwise, she transferred fairly well, had some but not much difficulty rising and sitting and raised herself easily before leg rubbing down using the arms of her rocker. Oh, yeah, I also lowered the cushion on her rocker, not as low as it was originally, but lower than I had it when she was wheelchair bound while developing pneumonia and having difficulty "ambulating".
Tuesday, September 30, 2008
Looking Better
Movement for 9/30/08:
- We've already had some movement, today, and things look promising. She awoke at 0730 to go to the bathroom soon after I awoke. Although we used the wheelchair, there were no problems with transfers or with standing to have her underwear pulled down and up. She went to bed at 2330 last night, so, considering her half hour bathroom visit this morning (which included conversation, kitty time and a breathing treatment, since we skipped one treatment yesterday), I'm planning on rousing her at noon. More later.
- Mom surprised me today, upon awakening for her "regular" day at 1300. When I asked her how she felt about walking to the bathroom versus being wheeled, assuring her that I'd go with her instincts, she said, "I think I'll walk. I should be walking."
I'm wondering, now, if she not only heard but registered the part of the discussion about her feet swelling that the Hospice RN and I had yesterday in which he said that, in my mother's case, in which she normally doesn't suffer extremity edema and, when she does, rarely suffers it to the "pitted" extent (although pitting did occur the night that I gave her 20 mg of furosemide), the best antidote is movement, specifically walking. We didn't spend much time discussing this, although the RN delivered a story about this regarding one of his clients, a man who typically was on hit feet quite a bit "visiting the ladies" at his facility. He was bedridden for two days and developed foot edema. Once back on his feet, the exercise worked it off in quick order. Perhaps my mother registers, in mysterious, unrecallable ways, much, much more than I think.
Anyway, she walked to the bathroom, to the dinette (commenting on how "nice" it was to have the grab bars along the hall) and, after breakfast, around the table and down the dinette steps. Because she's moving so slowly and carefully I decided against having her walker to the rocker, even though the distance is very short, maybe seven or eight feet. As I told the RN yesterday, walkering is the hardest thing she does. That can wait until she exhibits her usual confident step.
When she decided it was time for a nap, though, her choices were different. I told her that if she'd like, once I wheeled her across the living room and up the foyer steps, if she wanted to walk to the bathroom, that would be fine. Before arriving in the foyer she thought this was a good idea but changed her mind when it was time to rise to her feet. She chose to "try" walking from the bathroom to the her bed. She only made it to the door of the bathroom before she declared she was "ready to sit".
"That's fine," I told her. "Yesterday was the first day you have been on your feet walking for a couple of weeks. You did great today. You walked more than I expected. You should be wheeled to your bed, in style."
I have no idea what to expect after her nap. It's obvious she's still working off both the effects of my over-enthusiastic use of furosemide and she's still a bit hazy from battling pneumonia. As well, this bout of pneumonia may signal that we're turning yet another corner and wheelchair use will be more frequent than it has been. Whatever happens, I'm there, and here. - Oh. Wanted to mention, in regard to her left arm, she extended it for washing and for shirting exactly as she had been doing pre-fall. No wincing, no faltering, no reaching for her left bicep with her right hand. I think we've negotiated that bump. I'm still seeing to it that we're very careful with the slip on shirts, but as the days go by I expect our shirt dressing, for awhile, anyway, to return to normal.
- After Nap: More movement! She walked from her bedroom to the bathroom, then from the bathroom to the banister separating the foyer from the living room and took the steps. Although she elected to be wheeled all the way from the rocker to the bathroom, she insisted on standing to brush her teeth, did so well and steadily using one of our new grab bars that was installed on top of the vanity, then walked to bed. It was obvious she was tired, but she gets mucho extra points for doing it despite her tiredness. She even tried, when my back was turned, to transfer herself from the rocker to the wheelchair on our way to night prep. She got stuck in the middle of the transfer, half up and half down, a little dangerous, really, but I didn't scold her; I congratulated her on making the effort. I pointed out, too, that she may not be ready, yet, to do stuff like this and it might be a good idea if she waited for my help. I made a mental note to myself not to leave the wheelchair in transferring distance unless I plan to be there the whole time.
Monday, September 29, 2008
The Furosemide May Have Been Too Much
Movement for 9/29/08:
- Mom wasn't interested or ready to try walking, today, until after breakfast and the RN's visit, when she was ready to retire for her nap. She did pretty well: She walked all the way from the dinette table into the bathroom, then walked from the bathroom to her bed, at her insistence. She was slow and deliberate, but not wobbly. After her nap, though, she had significant difficulty even trying to remember how to stand. She seemed unable to grasp the concept of throwing her weight forward onto her legs, both when sitting in preparation for standing and when standing. Transfers were very difficult. From the bed to the wheelchair she claimed she was unable to move her legs and remained standing only with my strength. I took her weight on me and swung her to the chair. In the bathroom she managed standing and moving a bit better, but only a bit. I expect the rest of the evening to be spent in the wheelchair.
- An informative and pertinent lecture by the RN about furosemide (which I don't like to give my mother, anyway, but, it seems, have probably been relying on more than I should, for the little I use it) signaled me that the difficulty she's having this evening may very well be due to the "innocent" "whiff" of 10 mg I gave her last night. Although I've known its powerful stuff, which is wy I don't use it, the nurse gave me a thorough rundown of how it works on the body chemically and systemically, what it's half life is and how severely even a little bit can deplete the body of a variety of electrolytes and other things and how this process happens. He recommends using it only when swelling reaching the "pitted" stage. For the swelling Mom exhibited, even, he suggested the edema that led to the 20 mg dose, elevation of feet, walking and the stuff I usually do (rubbing down her legs, having her rotate her ankles in the air three times now and then). Elevation is a little different than usual because my mother doesn't like to sit with her legs elevated, which is why we don't have a recliner; but, I figure, when she's laying down, her legs are well elevated, and she spends lots of time in a prone position. It hurts her back. Mom's did reach that stage last week, quickly, just prior to her beginning "empirical" treatment for pneumonia. At that time 20 mg was probably justified. The 10 mg last night, I figured out, was not. As well as not having worked very well, it probably drained the recovery of strength she was exhibiting yesterday from her. Oh well. Live and learn. I have no idea how she'll do this evening on the way to bed, or tomorrow. I'll let her surprise me.
- Mom's evening was wheeled out in style. She had some difficulty with transfers, specically balancing her weight, and so much difficulty raising herself from the rocker for slacks pulling in order to rub down her legs that we abandoned that for the night, although I rubbed lotion into her feet and up to her calves. "It's better the other way [meaning full leg rubs]," she said. I agree.
Sunday, September 28, 2008
Baby Steps
Movement for 9/28/08:
- Can't put my finger on what it was. She had a longer night sleep than usual, primarily because when I attempted to awaken her at 1300, then at 1345, she wanted more time and it seemed a good idea to give it to her. Her night, though, was supremely restful, unlike last night. Maybe it was that she announced to me, "I'll walk," to the bathroom, even though she was so iffy on her feet that she had trouble gaining her initial balance and opted for the wheelchair before taking her first step. Something about her spirit. So, as we were bathing her, I mentioned to her that I thought maybe she was ready for a little "foot time". "Just from the toilet to the bathroom door," I assured her. "The wheelchair will be right outside the door. If you start to falter in the bathroom, we can take care of that, too."
She was a little wobbly at the beginning and the end, but she was steady walking through the bathroom and even remembered to "stretch and straighten up" before starting the walk. She was grateful for the wheelchair, but she looked pleased with herself...and I was pleased for her.
AFter breakfast I suggested we walk her around the table to the banister and down the dinette steps. "The wheelchair will be waiting at the bottom of the steps. We won't try walkering to the rocking chair, yet. I think you'll be fine." She was. Slow, and fine. And ready to sit at the bottom of the steps. She wasn't wobbly during any of it, including descending the stairs. During transfers, today, so far, they've appeared to be more difficult than usual but, instead of leaning waaaay over while sitting in order to throw her weight onto her legs and lift her ass before she stands, she's been working, on her own, at doing most of the rise with her leg muscles. I'm pleased to see this. That means they feel to her like they're ready to work, again.
In addition, today, for the first time since her fall in the living room in which she injured her left arm, I decided it was time to try wearing one of her regular slip on shirts, devised a method for putting it on that put the least stress on her left arm, and it went smoothly. So, she doesn't have to wear pajama tops, anymore, or baggy, long assed shirts. She isn't able to "do it" on her own, yet. Maybe she never will. But we've got a work around that makes her feel normal, again.
I know it's going to be a late nap-late night tonight. I expect her nap will be deep and restful. I'll report back later. - She walked from her bed to the hall, tonight, and was glad that I had the wheelchair waiting right outside her bedroom door. No problems turning to place herself in the chair. Transfers, for the most part, went well. The first rising to her legs after sleep, whether night or nap sleep, is a bit difficult to manage, but after that her legs "remember" what they're supposed to do. We didn't do any more walking after that, but she wasn't abnormally tired or hard to rouse after her nap.
