Health Review: 3/11/08
Blood Pressure:
She remains on three 10 mg doses of lisinopril per day. I tried again, in January, 2008, upping her dose to four 10 mg doses per day. Just as in September of last year, to weeks into the new dosage she began collapsing, so I scaled the dose back. Because of her recent bout with very low hemoglobin, her blood pressure have been up and down. They are reviving. Frankly, I'd rather see her with slightly elevated blood pressure and not in danger of collapsing than otherwise. I have attached a short table of her blood pressures (which I've been taking erratically) which covers the last month or so.

Blood Sugar:
Control has been difficult over the last few months because of her collapsing episodes, which were sometimes followed with acetaminophen when she had muscle aches, and her bad cold, from which she is recovering. The guaifenex and acetaminophen played havoc with her blood sugar. Through the holidays and over the last couple of months on several occasions I've given her three doses of 10 mg glipizide/day. The extra is always administered in the evening. Her blood sugar seems to be coming back into line, now. An abbreviated table that covers the last few months is attached. The taking of readings has been erratic.

Urinary Issues:
No change. Macrodantin continues to keep her UTI free.

Hydration:
No change.

Energy Level:
Lately her energy level has been very low. It has been slowly but surely reviving over the last week.

Skin & Circulation:
Excellent. No recurrence of the squamous cell carcinoma that I can tell.

Appetite & Diet:
No change. Her appetite did not suffer during her cold or her critical anemia.

Dementia:
Remains unchanged:

Will & Spirit:
Reain strong and high, respectively.

Meds & Supplements:
Generally the same as before. See attached updated list.

CHF:
No furosemide administered this period.

COPD:
During her cold her O₂ usage went to to 3-4/lpm; occasionally 5/lpm if she was moving around. This is reversing itself. She is now at 3/lpm when sitting and 4/lpm when moving and sleeping.

Bowel Movements:
Continues to eliminate every 24-48 hrs; usually every 36 hrs. Fecal consistency, volume and ease of elimination remain good to excellent overall. No laxative use necessary this last period.

ISSUES FOR APPOINTMENT ON 3/13/08 @ 1400:

1. ANEMIA:  The attached CBC, taken 3/10/08, shows that she is recovering at about .5 points per week. Although you mentioned that it wasn't necessary to take her in for another two weeks and her overall demeanor has been indicating that she's recovering, I was a little nervous so I took her in yesterday. The only oddities in the report are the poikilocytosis and the anisociytosis counts. I looked them up and they are both occasionally associated with anemia, so I'm hoping I don't need to worry about these. Bless her heart, she maintains the ability to recover well from health set backs.
2. RX REFILLS:  Three refills this period:
   Nitrofurantoin MR 100 mg (administered once per day)
   Lisinopril 10 mg (three tablets per day)
   Protonix 40 mg (1 tablet per day)
3. FINDING A PCP IN PRESCOTT:  I am still trying to find a PCP for her up here. At present, I am waiting for a call back from a doctor who is supposedly taking new patients but is on vacation at the moment. At this point, if you are concerned about her current anemia profile, I'm thinking that it might be a good time to write a consult order for the Prescott hemotologist who said he would consult with you. I'll leave this option up to you. If your concern is low, you may wish to wait on this. I'm keeping my fingers crossed that we'll find someone up here within a reasonable amount of time.
4. BLOOD PRESSURE:  I am considering giving her 5 mg lisinopril before her nap, in order to up her dose a little, maybe control her systolic a little better and, hopefully, avoid the weakness that an extra 10 mg per day seems to cause, but wanted to wait until I talked to you about it.
5. Is it time for another Ha1c? Any other tests you'd like done?

- posted by Gail Rae @ 13:00   email  this post