Yesterday was one of Mom's "longer up" days...
...much to our surprise, especially since, despite being up a full 10 hours, movement was iffy, primarily because of her breathing. We've more and more tended to dialing her up to 5/lpm when sitting, but, previous to a couple of days ago, 5/lpm seemed adequate for moving, too. Yesterday, after two episodes of unusual breathlessness both times that she walked (she only walked twice yesterday, see post for yesterday over at the current movement journal), I wondered if I should boost her to 6/lpm when she wants to try moving, although my guess is that she's probably not going to do as much moving as previously. Today, just to be safe, I'm going to make sure that I don't encourage movement immediately after she arises; which means I'll be insisting on the wheelchair at least after night sleep and nap sleep. It's also possible, of course, that the last two days are a blip and she may settle down, for a bit, before "settling up" permanently.
    In the meantime I couldn't help but recall that our Hospice MD and our Hospice RN have sternly cautioned me about hyperoxia, also referred to as oxygen toxicity, the receipt of too much oxygen. Both times, when I've asked what the symptoms and dangers are, they've demurred. One of our Hospice people, in fact, responded that, all things considered, it was likely that my mother would not ever receive enough oxygen to put her in danger of hyperoxia. Their responses were obviously unsatisfying, so, since I'm considering asking to have her oxygen Rx rewritten to include a boost to 6/lpm when necessary, I did a little research last night. I bookmarked a few of the links that pretty much summarize what I learned. It seems that there is some controversy regarding hyperoxia and COPD/Emphysema/Lung Cancer patients. One side is full of dire warnings about situational dementia, lung damage and death. The other side, which maintains a slightly larger balance of concern, is over the possibility of causing hypoxia, the critical lack of oxygen, in these patients. That last link is to an online discussion among emergency response technicians regarding oxygen delivery procedure. I found it interesting because one of my brothers-in-law is a volunteer firefighter in a rural area and has been receiving training for some time in EMT procedure. His latest information has been that he and his cohorts are instructed not to deliver oxygen at levels higher than 4/lpm during on-the-scene emergency care and transport, and to be particularly attentive to irritation due to extremely low humidity delivery. Some sources are indignantly on the side of delivering the oxygen necessary to prevent breathlessness above all other concerns. I also wanted to know how all this translates into liters per minute. I found that information here. You'll notice that this link recommends humidification above 4/lpm. When my mother was in rehab (during the monsoon season, it should be noted) a humidifier was attached to her concentrator. Within minutes she became breathless and began gasping. At that time she was at around 3/lpm. I detached the humidifier and she recovered immediately. We have a humidification attachment for our concentrator, although I haven't yet used it. I'm running a free-standing humidifier in her bedroom at full blast when she's sleeping, which seems to help; certainly, it significantly reduced nasal membrane bleeding. During the day, though, I don't use anything except liberal applications of water soluble lubricant; mainly I hadn't thought of anything else until last night. So, today, I'll be moving the humidifier around the house as Mom moves, hoping to increase the humidity, at least slightly, in her immediate vicinity. It occurred to me to use the concentrator humidifier attachment on the tanks; I may even try it on the concentrator today while she's napping, keeping a close eye on her to make sure she doesn't become breathless, again...it could be that direct delivery of humidity to her lungs isn't a good thing for her. At any rate, I examined the attachment and the mobile tank set up and can't figure out a way to use the humidifier with the tank. I think I may need a cord adapter, if such a thing exists. Then again, I may be missing something.
    So, this will be a subject for discussion during tomorrow's Hospice RN visit. Come to think of it, this is a good time for me to list the things I want to talk about, as a reminder:

• Boosting Mom's O₂ delivery above 5/lpm, when necessary, discussing how far we can go with addressing air hunger with O₂, when to consider addressing it with morphine and how to handle the humidity factor (humidity is notoriously low, here, in fall and winter; during the summer, of course, it wasn't a problem). This will also involve getting another concentrator, as the one she currently uses only goes to a little over 5/lpm.
• I want to go through the "Comfort Pack" and be thoroughly apprised of all medications contained what types of pain and discomfort, specifically, they are designed to address and, if possible, exactly how they work.
  I may have to do my own research on this, although, I have to say, our Hospice RN, when I can get him to cooperate with my desire for knowledge, has shown himself to be formidably technically informed and an excellent teacher. As an aside: I'm not sure why I have such trouble getting specific information from the medical people involved in my mother's care, including Hospice people, except for one, the weekday evenings on call Hospice RN. My guess is that it is a general medical concern that lay people are going to inappropriately latch onto bits of unrelated data and somehow compromise the patient's condition. Get over it guys! I've seen plenty of nurses and doctors do this, on my mother, I've even intervened during certain instances, when it's not too late, and, believe me, I do it far less than Medicine does!
• Why, I'd like to know, are "we" considering dropping the glipizide at some point?
• Am I accurate in my assessment that Mom's condition is moving along fairly quickly, now? At this point, can I still count on at least a few "Good Cancer Day" cycles or are we moving past that point?
• As of yesterday, I'm switching back from General Purpose Ibuprofen to General Purpose Acetaminophen. Over previous days of using ibuprofen, it's occurred to me that Mom actually does better on acetaminophen. Making the switch yesterday seemed to confirm this observation. I'm not counting the ibuprofen out, but, you know, we'll just take it moment to moment.
  Oh, yeah, that reminds me, I want to check on the advisability of using acetaminophen and ibuprofen in "close quarters", i.e., within the same 12-24 hour period. I asked our RN about this last week because it seems to me I've heard or read that there are certain concerns about mixing these two analgesics too closely, but he led me through a vague Socratic discussion that could have been labeled "An Analgesic Is An Analgesic, Does It Seem Likely That Mixing Matters?" This accomplished nothing in the way of actual information. I think I'll do that when I finish this post, assuming I have time. I'll report back if I discover anything of interest or concern.
• If there is anything, besides what I'm already doing, that I can do to make nose blowing easier and less breathless for Mom.
• Re-up breathing meds.

    Other than all that O₂ stuff, up there, and her touchy breathlessness, Mom and I had a good day, yesterday. She almost got stuck on Hallmark Holiday Movies in the evening, but after the first she became irritated with the overly sentimental tone, so I popped in Miracle on 34th Street, which I've, lately had a yen to watch, and she was delighted. As is often the case, she said, "I don't believe I've ever seen this movie!" I'm always pleased when she forgets previous viewings of favorite movies because her "innocent" reactions are so much fun, and not necessarily the same as during a previous "innocent" watching. After that I switched on Christmas music while we wound down our evening. We both sang along, rocker danced, and talked about the lyrics of some of the songs. "I think I'll start turning the cable to Christmas music every day," I said, "I love singing along with it." In case you're wondering, I don't have a great voice, but it's loud and enthusiastic and sounds better when I'm singing along with others than it does on its own.
    "Good," she said, "it's better than your griping."
    Oops! "Have I been griping a lot, lately? I thought I'd mellowed out over the last few weeks."
    "Weeeellll...let's just say you've had your moments, lately. Several."
    No matter. The holiday season has officially begun in our home as of yesterday evening. Although I'm not what you'd call a devotee of holidays, even though I love winter (somewhere where it rains and snows, actually, which often leaves out Prescott) and holiday lights, since my mother is Mrs. Christmas, living with her has sweetened my previously grinchy attitude toward The Holiday Season, especially the movies and the music. Although I'm still known to contemplate their approach with dread, once I can sing the songs and join my mother in dancing the dance, well, suffice it to say that ushering my mother through the holidays on her terms has its perks.
    Today is open-ended. I'll be awakening her around 1300, unless she rouses earlier on her own. We have no plans, I haven't even figured out what we're going to do for dinner, so it might be a Fast Food night. I'm hoping that she feels fairly good and that constant Christmas music in the background (or foreground, depending) will allow her to feel "better", regardless.
    Oh, by the way, The Mom & Me Journals dot Net has received a touching, surprising, lovely write-up over at Dethmama Chronicles, for which I am ever grateful. If you haven't yet visited over there, do. Although it's full of lots of interesting stuff, her stories about dealing with her Hospice clients are riveting and do much to pull back the drapes on the mysterious world of those ensconced in death watches and the wake of death. And, I repeat, it's highly readable...you're not going to be overwhelmed by words, as can happen over here. Go. Now. Just do it.
    I peaked in on Mom at 1215 because I heard her sneeze. I asked her if she was ready to get up. She wanted more time, so I gave her a choice, 45 minutes to 1300 or an hour and a quarter to 1330, which would be her 12-hour-sleep-mark. Any wonder what she chose? Guess I have a little time to research analgesic mixing.
    Later.
- posted by Gail Rae @ 12:45   email  this post