Chapter 310 - A Week on Apomine
We have established a routine around apomorphine. At the time of her 0600 meds we rise, she with some difficulty, she showers sometimes wheeled in on the commode, other times sits on the shower chair kept in the bathroom. I help with drying then she puts on her incontinence pants and bra before reclining on the bed for my gentle administrations positioning the needle, covering it with sticky film, holding down the thin hose with sticky tape and starting the pump held in a pouch. Prior to all that I had already filled a syringe with the required quantities of apomorphine and saline for a 10 ml solution, actually two syringes because the quantities involved means that I need to use about 1 1/2 ampules of apomorphine so I prepare an extra syringe for the following morning. That means three 2 ml ampules are used per 2 days. The arithmetic does not quite work out for the exact quantities required but then again, the precision of drawing 2.7 ml of fluid into a syringe calibrated in 1 ml graduations 2 mm apart leaves a lot to be desired. After "2.7" ml are in the syringe sufficient saline solution is drawn up to the 10 ml mark.
Some nights we have both slept well, some nights wide awake. For instance, she woke at 0300 on Monday for the commode then remained awake and at 0730 I found her using the pedals then she showered before the Apo pump was in use at 0830. At 1315 she was asleep in her chair, to be woken by a need for the loo at 1400 at meds time delayed till 1410 when she felt cold, was very slow, tremors in her legs but no pain. Since she wanted to attend her physio session at 1430 I pushed the button to give her an extra shot (professionals call it a "bolus" dose) so that she was in a fit condition. Unfortunately when we arrived we were told that physio had been cancelled but nobody had bothered to ring her.
Since we were out, we went around the corner to see the District Nursing people to ensure some of them will be given Apomorphine training so she can be given support if I become indisposed for any reason. The person I wished to speak to was away for the week and the person that attended to us was more interested that we be given information about respite care etc and then diplomatically suggested that her management be contacted by a professional as the better way of implementing any training and perhaps we should contact the local Alzheimer's support nurse. I think that is what I heard, for I was fuming yet keeping my cool.Back at home I contacted the Apomine Nurse Support Service and the nurse responsible for our area said she would speak to our good support people in Hot Air City about training in our country town.
During Monday she remembered bumping the injection point with the pump held in its supplied "holster" and elastic waist band. I presume that caused the trace of blood I found beneath the adhesive when I took the pump down that night.
Tuesday was an uneventful day when she was at respite. I didn't make any notes. I remember buying some alcohol swabs, a large bottle with pump on top of hand rinse stuff, a large jar of skin cream and other consumables and our friendly chemist rang the local hospital to ask whether they will be able to fill the scripts for Apomine, since he had checked the other day and found he cannot. The head pharmacist at the hospital said although the hospital has never used or stocked apomorphine they should be able to supply. I will need to front up there well before our supply runs out.
Same on Wednesday, I don't remember anything about Wednesday, perhaps this week lacked one? Now I remember, that was the day I took a lot of video clips of her during the day to be sent to Hot Air City as examples of her performance since I find we are unable to convey in words the tremors, wobbles, foot turning, walking steps and all such in technical jargon; maybe the experts can't either.
Thursday morning she was very immobile and showered on the commode. By 0635 the Apo was set up and running. She has found the Apo pump holster and an elastic band around her waist uncomfortable so we went to a bag store at our local mall where we bought a money pouch/passport holder with a band to go over the shoulder. She was pushing her walker out of the shop when suddenly she wobbled, began tilting to the left and her left knee folded. She was saved from falling by hanging on tightly to the handles of her walker; I was a few paces too many behind her to help her. Back home this worried me, the first time I had seen her left leg "collapse" even though she had mentioned it several times, the first really notable time was at the pathologists prior to beginning apomorphine. So I contacted Polly our PD nurse in Hot Air City, she suggested her seeing our local GP. Our fantastic Dr Flower was booked up solid and was leaving town for home (she lives in Big Smoke) so we had to see another GP. He quizzed her about all the usual body functions, BP & stethoscope on chest and carotid arteries then when she mentioned frequent nocturnal urine voiding he assumed she possibly has a UTI, prescribed antibiotics and referred her for blood tests. He gave her a plastic container to piddle in so I took her to the surgery's ladies, cold, cramped and not disability friendly. Even after 4 paper cups of cold water, many litres of water splashing down the hand basin, she was unable to piddle. At home I used one of the test sticks left over from her previous UTI saga of a year or so ago but no UTI evidence appeared.
At 0800 Friday morning we were at the pathologists where 5 vials of blood were taken and it was suggested she go home with a container to piddle in comfort because the nurse assumed she was likely to be unsuccessful in their loo as well. So I returned with the sample later when I also collected the antibiotic script. This is how excessive usage occurs; give the medication before its use is proven to be needed. Anyway, he's the expert.
She had made some special chocolate dishes for we had two friends around for afternoon tea for they wished to help us celebrate our birthdays. By 1645 she felt very shaky and then began to feel insecure on a normal chair, so retired to her tilting chair where she was more secure. By 1800 she was nauseous but not sick and by 1915 was more squeamish and cold. We both went to bed about 2000.
Yesterday, Saturday she remained awake after taking a Sinemet 250. She had 0600 meds, showered and the pump set up by 0620. By 0800 she was planting some flowers bought a few days ago. She did some washing on and off during the day; I did the hanging on the line. After 1400 she dozed in her chair. At 1800 she was dozing , feeling squeamish, "keeps coming over cold, feeling chilled from the inside out, no pain in the legs but the tingling in legs and feet comes and goes" in her words. In the middle of the afternoon (she told me later) while standing in the laundry her left foot turned, as if something tugged her foot to the side and she needed to grab the laundry sink to support herself. In her words "my foot felt thick and felt as if someone was pulling it". I fear leaving her out of my site, yet I can not be always close enough to help, as experienced on Thursday.
Today has begun well. Her tummy has two sore "bumps" at injection sites. There are various patches of bruising where the rectangular sticky film was positioned over the injection sites but these quickly fade.
She says she is OFF prior to her 1400 and 1800 meds so from tomorrow I plan to give her a bolus dose near those times when she begins to sense the OFF commencing.
Some nights we have both slept well, some nights wide awake. For instance, she woke at 0300 on Monday for the commode then remained awake and at 0730 I found her using the pedals then she showered before the Apo pump was in use at 0830. At 1315 she was asleep in her chair, to be woken by a need for the loo at 1400 at meds time delayed till 1410 when she felt cold, was very slow, tremors in her legs but no pain. Since she wanted to attend her physio session at 1430 I pushed the button to give her an extra shot (professionals call it a "bolus" dose) so that she was in a fit condition. Unfortunately when we arrived we were told that physio had been cancelled but nobody had bothered to ring her.
Since we were out, we went around the corner to see the District Nursing people to ensure some of them will be given Apomorphine training so she can be given support if I become indisposed for any reason. The person I wished to speak to was away for the week and the person that attended to us was more interested that we be given information about respite care etc and then diplomatically suggested that her management be contacted by a professional as the better way of implementing any training and perhaps we should contact the local Alzheimer's support nurse. I think that is what I heard, for I was fuming yet keeping my cool.Back at home I contacted the Apomine Nurse Support Service and the nurse responsible for our area said she would speak to our good support people in Hot Air City about training in our country town.
During Monday she remembered bumping the injection point with the pump held in its supplied "holster" and elastic waist band. I presume that caused the trace of blood I found beneath the adhesive when I took the pump down that night.
Tuesday was an uneventful day when she was at respite. I didn't make any notes. I remember buying some alcohol swabs, a large bottle with pump on top of hand rinse stuff, a large jar of skin cream and other consumables and our friendly chemist rang the local hospital to ask whether they will be able to fill the scripts for Apomine, since he had checked the other day and found he cannot. The head pharmacist at the hospital said although the hospital has never used or stocked apomorphine they should be able to supply. I will need to front up there well before our supply runs out.
Same on Wednesday, I don't remember anything about Wednesday, perhaps this week lacked one? Now I remember, that was the day I took a lot of video clips of her during the day to be sent to Hot Air City as examples of her performance since I find we are unable to convey in words the tremors, wobbles, foot turning, walking steps and all such in technical jargon; maybe the experts can't either.
Thursday morning she was very immobile and showered on the commode. By 0635 the Apo was set up and running. She has found the Apo pump holster and an elastic band around her waist uncomfortable so we went to a bag store at our local mall where we bought a money pouch/passport holder with a band to go over the shoulder. She was pushing her walker out of the shop when suddenly she wobbled, began tilting to the left and her left knee folded. She was saved from falling by hanging on tightly to the handles of her walker; I was a few paces too many behind her to help her. Back home this worried me, the first time I had seen her left leg "collapse" even though she had mentioned it several times, the first really notable time was at the pathologists prior to beginning apomorphine. So I contacted Polly our PD nurse in Hot Air City, she suggested her seeing our local GP. Our fantastic Dr Flower was booked up solid and was leaving town for home (she lives in Big Smoke) so we had to see another GP. He quizzed her about all the usual body functions, BP & stethoscope on chest and carotid arteries then when she mentioned frequent nocturnal urine voiding he assumed she possibly has a UTI, prescribed antibiotics and referred her for blood tests. He gave her a plastic container to piddle in so I took her to the surgery's ladies, cold, cramped and not disability friendly. Even after 4 paper cups of cold water, many litres of water splashing down the hand basin, she was unable to piddle. At home I used one of the test sticks left over from her previous UTI saga of a year or so ago but no UTI evidence appeared.
At 0800 Friday morning we were at the pathologists where 5 vials of blood were taken and it was suggested she go home with a container to piddle in comfort because the nurse assumed she was likely to be unsuccessful in their loo as well. So I returned with the sample later when I also collected the antibiotic script. This is how excessive usage occurs; give the medication before its use is proven to be needed. Anyway, he's the expert.
She had made some special chocolate dishes for we had two friends around for afternoon tea for they wished to help us celebrate our birthdays. By 1645 she felt very shaky and then began to feel insecure on a normal chair, so retired to her tilting chair where she was more secure. By 1800 she was nauseous but not sick and by 1915 was more squeamish and cold. We both went to bed about 2000.
Yesterday, Saturday she remained awake after taking a Sinemet 250. She had 0600 meds, showered and the pump set up by 0620. By 0800 she was planting some flowers bought a few days ago. She did some washing on and off during the day; I did the hanging on the line. After 1400 she dozed in her chair. At 1800 she was dozing , feeling squeamish, "keeps coming over cold, feeling chilled from the inside out, no pain in the legs but the tingling in legs and feet comes and goes" in her words. In the middle of the afternoon (she told me later) while standing in the laundry her left foot turned, as if something tugged her foot to the side and she needed to grab the laundry sink to support herself. In her words "my foot felt thick and felt as if someone was pulling it". I fear leaving her out of my site, yet I can not be always close enough to help, as experienced on Thursday.
Today has begun well. Her tummy has two sore "bumps" at injection sites. There are various patches of bruising where the rectangular sticky film was positioned over the injection sites but these quickly fade.
She says she is OFF prior to her 1400 and 1800 meds so from tomorrow I plan to give her a bolus dose near those times when she begins to sense the OFF commencing.
posted by Kilpike | 11:17 am
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