Mom's down for a nap, already.
    She's been down since 1430, which is a little early for her, even considering that she arose on her own at 1130, but, considering, as well, how tired she's been, lately, and that she was so tired after the Hospice RN's visit, that she decided she wanted to be wheeled into the bathroom and into bed, "I'm just too tired to walk," she said, I figured, hey, if I was 91 and had lung cancer, maybe I'd be tired.
    So, considering that today is blessedly quiet, I'm thinking maybe it's a nap day for me, too. I can't remember the last time I had a nap, although it's probably only been a couple of months. I'm not usually a nap person, actually, but, today, I could easily disguise myself as one.
    I wanted to get a few things down, though, from the RN's visit, today.

• It seems that my concern over my mother's BP is likely not indigenous to my mother's actual BP, which has wavered little since Hospice began taking it at the end of June. The RN recommended that I slip back from 20 mg of lisinopril at night (her only daily dose, to which I boosted her on 10/25/08 from 15 mg). Truth is, I hadn't noticed that the extra 5 mg was doing much for her BP, but it's possible that it is one of the ingredients responsible for her increased tiredness, of late. Whether it is or not, 15 mg is just fine, thank you, so, as of tonight, we go back to that.
• My concern over her rising Blood Glucose readings was also addressed. Changes are excellent that the initiation of a daily, evening dose of 4 oz prune juice is responsible for the overall rise. But, since this dose is necessary to manage her evacuation profile and since Mom's diabetes continues not to affect anything else, the nightly prune juice is recommended and continued diabetic management consisting of a 3rd glipizide in the evening, if necessary (which has been necessary over the last half week or so), is fine. I don't know why I didn't think of the effect of the prune juice. I know that fruit juices are notoriously high in sugar. I use a sliding scale of her morning O.J. to water to control her blood sugar throughout the day but I forgot about the prune juice at night.
• Regarding my mother's recent (a bit less than a week) bouts of lethargy: The RN said this is common with cancer patients. For a number of days they'll feel good followed by a number of days when they don't feel good. You'd think this would have been obvious to me. This is the pattern my mother has been following for some years now. I can't say I've been particularly stressed by it, but every time we fall into one of her fallow fields, I automatically, and autonomically, as well, begin looking for reasons. Not that my searches are not recommended. But, if I look around a bit and can't seem to find anything that looks like it's in a stage of development beyond where we are at the moment, chalk it up to the typical cancer pattern and forget it. Good advice.
• The subject of the Detox teas, which contain licorice, and, as well, the Egyptian Licorice tea my mother loves so well, was broached, again. As part of a more general conversation I mentioned our former use of these teas to the Hospice RN (one of our regular subs when our regular is OOT, which he is, at the moment). Immediately upon mention of the Detox teas, she responded, "Good!" She's familiar with the teas we use. I continued, though, explaining that she's been off them for a little over a month because of our usual RN's, and Mom's Hospice MD's, concern about the licorice content, which slows the heart beat. I mentioned that a couple of weeks ago, while cleaning up the Dailies site, I'd noticed that two years ago Mom's heart was 20 bpm slower than it is now. Taking into consideration the breathing meds, which raise one's heartbeat, I suggested that reinstating the Detox tea might not be a bad idea; I wondered out loud if it might not do my mother some good to include an agent in her diet that slowed her heart beat a bit. The nurse said that reinstating the Detox teas would be fine, but maybe every other day rather than every day. It seems, even the package (which I hadn't noticed) advises against long term daily use. So, I think I'll be doing that, again.
• A few miscellaneous observations which were covered during the appointment:
  • Mom is, occasionally, now, (within the last two weeks) eating a bit less at dinner than before. This doesn't preclude dessert, of course. It's become such a habit with her that if I forget to bring out a dessert, which often happens if she wants to put it off, a bit, after dinner, I am vociferously reminded that dessert has not yet been served. But, overall, this is an expected development in the process of a terminal illness. So far, she's not skipping meals but, you know, it could be said that the lowering of her appetite has been going on for a couple of years, since it was a few years ago when lunching dwindled to nothing.
  • There were some "crackles" in her right lung. Not unusual, but a good idea to be aware that of them, which indicate fluid build-up. This could be the cause of her labored breathing, of late, combined with the difficulty of getting three breathing treatments in, since she's been sleeping a bit more over the last week.
  • Regarding the breathing treatments: I can count down the four hour intermediary period from the beginning of one breathing treatment to the beginning of the next. Because I'm aware of the particular virulence of Ipratroprium, one of two ingredients (the other being Albuterol) in my mother's breathing treatments, and because the treatments last for a good 15 minutes, I was counting from the end of one for 4 hours until the beginning of the next.
    As well, I can "fudge" a half hour early on the dual breathing treatments, assuming I'm using the Ipratroprium. I can also choose to use only the Albuterol if I feel the need to administer one earlier than the 3.5 hour interim. Albuterol can be administered more often than Ipratroprium without risk.
  • The RN was in favor of my reintroduction of a 1,250 mg (500 mg concentrated, which equals half a clove of garlic) garlic tablet to my mother's supplement regimen. I explained to her that I'm adding it for its antibiotic properties and she nodded throughout my explanation. If I feel the need to boost her dose to two tablets a day (equivalent of a full clove of garlic), that should be fine.
  • I asked if I should also maybe reintroduce the vitamin E. She said that it is primarily an antioxidant. Since my mother's diet and supplements are loaded with antioxidants, I decided there's no reason to further irritate my mother with yet another pill.
• The nurse also reconfirmed what I learned a little over a month ago about the contraction in time between bouts of pneumonia. Looks like the last opportunity passed us by without taking advantage of us; but, with the continued crackling of Mom's lungs and her increasing tiredness, I remain on alert.
  During this discussion I told the nurse about the conversation Mom and I had about whether or not to treat this last possible bout of pneumonia, which I held with Mom on a just-in-case basis. I assured the RN that, each time we confronted yet another possibility of a bout, I would reinstitute the conversation, in order to keep on top of Mom's wishes. I was surprised and pleased to note that the RN diligently noted about this in her online files.

    So, you know, we continue to hang in there.
    And, with that, she said, I think I'll see if I can steal a nap this afternoon.
    Later.
- posted by Gail Rae @ 15:33   email  this post