Chapter 335 - Where Are We Two Headed?
I subscribe to both the CARE and PARKINSN listservers although of late I very rarely read any of the messages; some are too close to home, some suggest where we are going. A little too depressing and perhaps to be avoided. Perhaps I am too with my scribbles here? A rhetorical question because I do not seek answers.
Intending to write a lot yesterday, Sunday, I became bogged down searching for pleasant music to play for her from a laptop through her TV. And other things, as someone once sang "If I only had time".
I needed to give Polly our PD nurse an update and ask a question by email this morning so here the messages are suitably edited.
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[She] had another catheter replacement on Thursday 3rd March, the 4th catheter beginning with the initial insertion on 6th March in Re-hab. This last due to UTI/bladder; lots of sediment and dark colour, some spots of blood. The nurse at District Nursing that did this last recommended more anti-biotics so we had the script provided by Re-hab for Clamoxyl Duo Forte 875/125 twice a day so had that filled (except I just checked, counted, to discover someone has been only taking one per day!). The same nurse said there were signs of thrush, recommending the appropriate cream from the chemist plus a tablet. When I consulted with our very helpful chemist he advised against the particular pill because it had complications for many other medications so only the cream has been applied. Today, Sunday, the colour in [Her] leg bag is reasonable. She complains that the catheter is uncomfortable at times when she is seated, and I think this may occur in the time leading up to needing a bowel movement.
On Saturday I needed to visit the doctor again (in recent weeks my ears have been clogged, clear now) so [She] saw him as well, to discuss the existing catheter and the possibility of a supra-pubic catheter. He was prepared to refer [Her] for the latter but since she is a bit hesitant about that he prescribed Ditropan 1/2 tablet twice a day to see how she reacts to it. [She] took Ditropan from circa 1997 and benefited from it at the time (she was taking PD meds while doing so), and ceasing Ditropan after she had a successful operation on her bladder in [Sunny Western City] in 2000.
I had the Ditropan script filled before [She] remembered that Dr D at Re-hab discussed Ditropan with [Neuro] who recommended against Ditropan, so thus [She] had a catheter inserted.
[She] has not begun taking the Ditropan.
Dr Google indicates problems taking Ditropan and PD meds.
Please confirm that [Neuro] advises against [Her] taking Ditropan.
[She] comments very little about tingling and burning in her legs and feet, often finds her hands too sluggish to sew, and I suspect her thought processes are very slow at similar times. I doubt she is able to walk 20 metres or so using a walker without sensing that her left leg/foot is failing her. Once or twice she commented that her right foot is developing the same symptom. T, the [Aged Care] bloke, offered to take [Her] for the catheter replacement last Thursday mid-afternoon but we were unable to get her into his vehicle so had to resort to using ours. Each time she goes to the loo for poo she needs assistance on and off, sometimes having to remain there longer until I am able to help her onto the wheel chair. She frequently needs the wheel chair to get to the loo and back again anyway.
This morning she decided she was capable of going to the loo on her own; an anguished call on the CB indicated other wise, I rescued her standing, holding for grim death onto the fireman's pole with one hand the other holding her pants halfway down.
In helping her off the loo the other day I dropped my CB radio into the bowl and without thinking I quickly grabbed it then washed it off in the hand basin. On this occasion after drying the CB worked, not like last time when another CB died an early death.
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Reply to the above email not included.
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Thanks for the reply. Ditropan will remain in the cupboard in its bottle; [She] hasn't taken any.
I just went out to see how [She] was after her breakfast. She was attempting to to attach her catheter bag to her right leg which was shaking vigorously for her, mildly in the left; an hour & a bit before her 10am meds. On the whole I think dyskinesias have eased. I just asked her how her shakes were going and she said "Some days are good, some aren't."
What I have noticed is the lack of comments from her about leg/foot tingles and burning sensations. Perhaps fewer comments about her left foot "turning in" and cramping.
Of great concern to me though is her inability to stand readily from a chair or the loo. She is unable to walk very far (with walker or trolley) without her left leg beginning to "give way" and she has made several comments that her right foot/leg is beginning to feel the same way. At least once a day I need to take her to the loo in the wheel chair because of her leg problems. As she attempts to stand her legs don't straighten to support her weight. So then it's a matter of breaking all OT rules, linking arms and slowly pulling/swivelling her into/out of the wheel chair. She wants to independently get to the loo and back; I really fear a serious fall.
Recently she has been using her bowels twice a day, and sometimes she goes to the loo to get rid of bloated/flatulent feelings. Just now she is sitting in her recliner suggesting the current bout of shakes is causing her to feel bloated. Shortly I expect her to wish to go to the loo "just in case". This morning she had a poop at 6.30am, earlier than usual, so I didn't give her Metamusil in her fruit juice this morning, although that may not be a good idea either, because often she sits on the loo for maybe half an hour waiting for a "pebble" to pass. Usually the stools are well formed but fragmented.
Urine colour is good and is not showing any signs of sediment since the catheter was replaced last Thursday. Unfortunately, [She] was only taking one antibiotic until Saturday, rather than the two prescribed per day. As usual, little enters the leg bag until lunch time.
The catheter fitted on Thursday occasionally causes her discomfort when she is seated but that may be only when she has a full colon. Pam is drinking plenty of water and her urine is staying clear.
She just called for assistance to the loo; she pushed her trolley there, a lot of wind during 15 minutes.
Phone reviews? Hey, let's be 21st Century and talk your bureaucrats into using Skype ;-))
Now 10am.
***********************************************
Reply to the above email not included.
***********************************************
Yes the left foot turning/pointing inwards is probably dystonia, it is there whether or not there is dyskinesia, but the loss of tension in the left leg is another matter altogether, usually happening after she has walked at least a few metres.
Probably the inability to rise from chair or loo is freezing; her lower half is as responsive as a sack of spuds.
I stand corrected; I just queried what [She] meant by "it's happening in my right foot now" and she means the slow twisting/inward pointing dystonia. Her right leg is not failing her (a relief to me).
OK I'll keep the Metamusil up to her. She seems unable to let off a pleasurable fart without fearing she will mess herself and then stays longer than necessary on the loo just to make sure. I don't think she ever strains, even when I query "how much longer?" and she says "there feels like something there". Although the expulsion of a catheter complete with still inflated balloon suggests otherwise, but that may be female plumbing. I have never seen her red-in-the-face when I poke my head in the doorway to check on her.
**************************************************
Reply to the above email not included.
**************************************************
If I checked my notes I can write more but 'nuff is enough; except to say she has been wearing compression stockings since someone suggested them over a week ago. Expensive they maybe but I still laddered one with a thumbnail. Today she chose not to wear them because she dislikes the tightness, sometimes she mentions mild aching and has always requested them removed by late afternoon.
Intending to write a lot yesterday, Sunday, I became bogged down searching for pleasant music to play for her from a laptop through her TV. And other things, as someone once sang "If I only had time".
I needed to give Polly our PD nurse an update and ask a question by email this morning so here the messages are suitably edited.
**************************************
[She] had another catheter replacement on Thursday 3rd March, the 4th catheter beginning with the initial insertion on 6th March in Re-hab. This last due to UTI/bladder; lots of sediment and dark colour, some spots of blood. The nurse at District Nursing that did this last recommended more anti-biotics so we had the script provided by Re-hab for Clamoxyl Duo Forte 875/125 twice a day so had that filled (except I just checked, counted, to discover someone has been only taking one per day!). The same nurse said there were signs of thrush, recommending the appropriate cream from the chemist plus a tablet. When I consulted with our very helpful chemist he advised against the particular pill because it had complications for many other medications so only the cream has been applied. Today, Sunday, the colour in [Her] leg bag is reasonable. She complains that the catheter is uncomfortable at times when she is seated, and I think this may occur in the time leading up to needing a bowel movement.
On Saturday I needed to visit the doctor again (in recent weeks my ears have been clogged, clear now) so [She] saw him as well, to discuss the existing catheter and the possibility of a supra-pubic catheter. He was prepared to refer [Her] for the latter but since she is a bit hesitant about that he prescribed Ditropan 1/2 tablet twice a day to see how she reacts to it. [She] took Ditropan from circa 1997 and benefited from it at the time (she was taking PD meds while doing so), and ceasing Ditropan after she had a successful operation on her bladder in [Sunny Western City] in 2000.
I had the Ditropan script filled before [She] remembered that Dr D at Re-hab discussed Ditropan with [Neuro] who recommended against Ditropan, so thus [She] had a catheter inserted.
[She] has not begun taking the Ditropan.
Dr Google indicates problems taking Ditropan and PD meds.
Please confirm that [Neuro] advises against [Her] taking Ditropan.
[She] comments very little about tingling and burning in her legs and feet, often finds her hands too sluggish to sew, and I suspect her thought processes are very slow at similar times. I doubt she is able to walk 20 metres or so using a walker without sensing that her left leg/foot is failing her. Once or twice she commented that her right foot is developing the same symptom. T, the [Aged Care] bloke, offered to take [Her] for the catheter replacement last Thursday mid-afternoon but we were unable to get her into his vehicle so had to resort to using ours. Each time she goes to the loo for poo she needs assistance on and off, sometimes having to remain there longer until I am able to help her onto the wheel chair. She frequently needs the wheel chair to get to the loo and back again anyway.
This morning she decided she was capable of going to the loo on her own; an anguished call on the CB indicated other wise, I rescued her standing, holding for grim death onto the fireman's pole with one hand the other holding her pants halfway down.
In helping her off the loo the other day I dropped my CB radio into the bowl and without thinking I quickly grabbed it then washed it off in the hand basin. On this occasion after drying the CB worked, not like last time when another CB died an early death.
***************************
Reply to the above email not included.
***************************
Thanks for the reply. Ditropan will remain in the cupboard in its bottle; [She] hasn't taken any.
I just went out to see how [She] was after her breakfast. She was attempting to to attach her catheter bag to her right leg which was shaking vigorously for her, mildly in the left; an hour & a bit before her 10am meds. On the whole I think dyskinesias have eased. I just asked her how her shakes were going and she said "Some days are good, some aren't."
What I have noticed is the lack of comments from her about leg/foot tingles and burning sensations. Perhaps fewer comments about her left foot "turning in" and cramping.
Of great concern to me though is her inability to stand readily from a chair or the loo. She is unable to walk very far (with walker or trolley) without her left leg beginning to "give way" and she has made several comments that her right foot/leg is beginning to feel the same way. At least once a day I need to take her to the loo in the wheel chair because of her leg problems. As she attempts to stand her legs don't straighten to support her weight. So then it's a matter of breaking all OT rules, linking arms and slowly pulling/swivelling her into/out of the wheel chair. She wants to independently get to the loo and back; I really fear a serious fall.
Recently she has been using her bowels twice a day, and sometimes she goes to the loo to get rid of bloated/flatulent feelings. Just now she is sitting in her recliner suggesting the current bout of shakes is causing her to feel bloated. Shortly I expect her to wish to go to the loo "just in case". This morning she had a poop at 6.30am, earlier than usual, so I didn't give her Metamusil in her fruit juice this morning, although that may not be a good idea either, because often she sits on the loo for maybe half an hour waiting for a "pebble" to pass. Usually the stools are well formed but fragmented.
Urine colour is good and is not showing any signs of sediment since the catheter was replaced last Thursday. Unfortunately, [She] was only taking one antibiotic until Saturday, rather than the two prescribed per day. As usual, little enters the leg bag until lunch time.
The catheter fitted on Thursday occasionally causes her discomfort when she is seated but that may be only when she has a full colon. Pam is drinking plenty of water and her urine is staying clear.
She just called for assistance to the loo; she pushed her trolley there, a lot of wind during 15 minutes.
Phone reviews? Hey, let's be 21st Century and talk your bureaucrats into using Skype ;-))
Now 10am.
***********************************************
Reply to the above email not included.
***********************************************
Yes the left foot turning/pointing inwards is probably dystonia, it is there whether or not there is dyskinesia, but the loss of tension in the left leg is another matter altogether, usually happening after she has walked at least a few metres.
Probably the inability to rise from chair or loo is freezing; her lower half is as responsive as a sack of spuds.
I stand corrected; I just queried what [She] meant by "it's happening in my right foot now" and she means the slow twisting/inward pointing dystonia. Her right leg is not failing her (a relief to me).
OK I'll keep the Metamusil up to her. She seems unable to let off a pleasurable fart without fearing she will mess herself and then stays longer than necessary on the loo just to make sure. I don't think she ever strains, even when I query "how much longer?" and she says "there feels like something there". Although the expulsion of a catheter complete with still inflated balloon suggests otherwise, but that may be female plumbing. I have never seen her red-in-the-face when I poke my head in the doorway to check on her.
**************************************************
Reply to the above email not included.
**************************************************
If I checked my notes I can write more but 'nuff is enough; except to say she has been wearing compression stockings since someone suggested them over a week ago. Expensive they maybe but I still laddered one with a thumbnail. Today she chose not to wear them because she dislikes the tightness, sometimes she mentions mild aching and has always requested them removed by late afternoon.
posted by Kilpike | 2:10 pm
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