Saturday, October 11, 2008
Staying Plateaued
Movement for 10/11/08:
- So far, the same as previous days, pretty much. We've done two PT sessions so far. I'm not sure if I'll ever get her to raise her legs slowly. She continues to have slight edema in her feet. I don't know, maybe that's going to be permanent. However, the furosemide I gave her Wednesday night took the excess fluid off her chest and she has been breathing easier since then, until about an hour before she went down for her nap, today. I dialed her up to 5/lpm sitting, although I haven't given her furosemide. I'm just going to wait and see on that. She was pretty tired when she finally went down for a nap. Could be she's recovering from the visit. I wheeled her up the ramp instead of having her negotiate the foyer steps, but she decided to walk into the bedroom for her nap, although she was noticeably slow and shuffling. I'm going to wait for at least 2.5 hours before trying to arouse her. I think she could use the extra sleep. I have a feeling it's going to be a drowsy night for her, possibly even an early retirement. We may not get a third PT session in today.
Visiting Days
Movement for 10/8 - 10/10/08:
- MPS visited from early 10/08 through early 10/10. Mom moved very much as in the previous post every day: Into the bathroom on her own after night sleep and naps, into the dinette on her own, into the living room after breakfast on her own and using the walker, in the wheel chair between the rocker and the foyer steps, up the steps on her own and into the bathroom before bed. The only difference was Thursday night, when she had some difficulty breathing, I gave her 10 mg furosemide because she appeared to be retaining water in her chest, and I wheeled her into the bathroom, although she decided to walk into bed on her own (within environmental and me support assumed whenever I write "on her own").
- We didn't start the PT exercises until yesterday. She did two sessions yesterday. She does them easily and well, except that she isn't particularly slow on the leg raises, so we're working on that.
Tuesday, October 7, 2008
Plateau-ing
Movement for 10/7/08:
- I think we've reached a movement plateau. Today was essentially the same as yesterday, including using the walker only to the rocker from the dinette steps. When it was time for her nap she was so tired that I was reluctant to allow her to walker from the rocker to the steps, although she insisted on walking up the steps, into the bathroom and into bed, and did well, even singing on the way to the bedroom.
- I was able to let the PT know, pre-visit, Mom's feelings about PT. She was fine with Mom's feelings and said that she had already intended her main thrust to be evaluation of safety issues a Mom moved about the house.
When she arrived Mom was still at the dinette table, having stayed there after breakfast through the Hospice RN's visit. This gave us a chance to display our technique of movement from the dinette to the rocker in the living room, including standing up, walking around the table as Mom used the table, and the chairs, and me, for support, going down the steps, taking possession of the walker, moving toward the rocker, our technique for releasing the walker, getting her into the rocker and rising from the rocker. The PT was happy with our strategies.
She also confirmed that if I have the tiniest bit of reservation about Mom walkering the distance from the rocker to the foyer steps, best to go with my instincts and wheel her there. She also surveyed the bathroom, the hall, Mom's bedroom, had me go through all our movements through each room and said she was satisfied with our "system".
She did, indeed, introduce three leg exercises and two shoulder exercises, all of them to be done of which can be done sitting, to help keep strength in mom's quads, keep her ankles flexible and able to handle balancing and keep her shoulders and back relaxed. They are as follows:- Rocking the ankles by pushing the feet to tip-toe while sitting, then reversing to toes up, heels down;
- extending each leg from the knee and lowering it, slowly;
- marching in place;
- shrugging the shoulders;
- rolling the shoulders.
She suggested, speaking to both Mom and me, that we do 10 reps of each exercise twice a day. She solicited Mom's opinion about whether she thought she could do this. Mom responded, "Oh, I think so." Since this isn't so much of an exercise regimen as we've previously performed, I think Mom may not have any objections to doing these. I will, of course, do them, too, and I'll see to it that we do them to music.
I showed the PT the ankle rolls I've been having Mom perform. The PT told me that these are twice as difficult as the ankle rocking exercise she showed us because they require using the quads as well as the ankles. She cautioned that we'd probably have much more success with just the ankle rocking. - Mom was her usual gracious self. When the PT rose to leave, Mom thanked her for the visit. She's not only a trooper, she's a charming trooper!
Monday, October 6, 2008
Later Start than Expected
Movement for 10/6/08:
- Despite the late start and a little sluggishness upon awakening (her night was interrupted at 0400 with the need to call me and talk for awhile) she's been on her feet all day. Even so, there's been a little less walking than usual, and no walkering, yet. We decided to watch an old movie during breakfast, so instead of moving initially into the dinette then into the living room, from bathing she went straight to the living room. I gave her a choice of walkering the distance from the foyer steps to the rocker and wheeling it. Much to my relief (I was very tired) she chose the wheelchair. "I'm not sure I have it in me this morning," she said of the choice of the walker.
When she went down for a nap she was so tired she again felt that wheeling it to the foyer steps would be "best". When I gave her the choice of walking or being wheeled from the steps to the bathroom, though, she said, "Oh, I can walk that!" And, she did. - The evening proceeded exactly as Mom's earlier day; walking with environmental and me support except between the foyer steps and the rocker. I didn't ask her if she wanted to use the walker; I simply took the initiative of having the wheelchair available at the steps when she descended and at the rocker before she went to bed. I was seriously tired, frankly, and was concerned about my ability to help her if she faltered with the walker. Better luck tomorrow.
- A PT from Hospice will be arriving tomorrow to evaluate Mom's movement profile and recommend exercises for balance and leg strength. After talking to her this morning and moving her Monday appointment to Tuesday, I didn't think any more about it until: I've been keeping Mom informed about her visit since PT was suggested. I made a huge mistake, though. I told , I didn't ask. When I mentioned to Mom, as we were indulging in our usual bedside chatting as she was arising for the day, that the PT would be coming "tomorrow" and explaining the purpose, Mom sneered at the need for exercises and questioned the need for a PT at all. I didn't argue with her. She is, after all, moving well, from her perspective, and well enough, from mine. I didn't trot out my usual so-you-can-help-me-help-you argument. Instead, I suggested that we go ahead with the appointment in order to take advantage of the evaluation and, maybe, if Mom is agreeable, the exercises she might recommend. I promised her that if she was not interested in exercising, I wouldn't make her do it. I decided, also, when the PT calls pre-appointment on Tuesday, I'll confess my oversight, and let her know what Mom said and what we decided. It is becoming ever more obvious to me that it is important for Mom to make these decisions. The time is long past for me to attempt to force her to do anything, within reason, anyway, and, at this time, reason covers a huge tract of land. At any rate, we'll see how the appointment goes, whether the PT even wants to keep it once I let her know Mom's feelings in the matter. I will definitely let the PT know that this glitch was due to my oversight, not Mom's.
Short Report
Movement for 10/5/08:
- Mom was tired, today. Altogether she was only up 7 hours and retired at midnight, very early for her. Despite this, she moved well, went through all her ordinary paces, including using the walker unusually well after descending the dinette steps to advance to her rocker. I, too, was tired, and distracted, so I decided not to chance the walker, for her or me, going between the foyer steps and the rocker. Otherwise, though, she did fine.
