Friday, May 12, 2006

Catching Up

I haven't written in about six months and several health adventures have occurred in the meantime.

In November 2005, Miss Dixie's skin ulcers turned serious. Mother's feet have always been awful. Hammer toes. Bunions. Callouses etc. And, even though I had been rolling her through a podistrist's office regularly, one spot in particular became infected. It took about three different batches of antibiotics to get them under control. And, what started as a month of morning and evening wound care is now a regular part of our routine. Cleaning. Topical treatment of sulfa cream. Fresh bandages. Morning and night.
In the meantime, I've learned a bit more about the perils of wound care to the elderly and those confined with long-term illness. Someone in my support group said Christopher Reeve actually died from an infection from a bed sore.
In January 2006, we had the urinary tract infection. Since I have never had a urinary tract infection, I was blindsided by this health care adventure. Fortunately, the folks at day care gave me a head's up.
"Could I speak with you a moment?" always sends tremors to my very soul. "You might want to have her checked for a urinary tract infection." That was Friday. We were visiting the doctor on Monday anyway and I thought that would work. As we got going on Sunday, it was clear there was something going on medically. I called into the oncall internist. He suggested that I take her into the ER.
In we went. The minute Mother got in the hospital bed she fell asleep. I left the room as the nurses inserted a temporary catheter. The labs came back in about an hour and a urinary tract infection was confirmed and an antibiotic was begun. The infection cleared up only to flare up again in about a week, so another trip to the doctor and another protocol of antibiotics ensued. This time I was smart enough to figure out that there was a urinary tract infection before it got too far.
In February 2006, the spot on the leg turned out to be minor-league cancer -- squamous cell carcinoma. The spot was identified by her internist as suspect in a routine exam. I had completely missed it. I bathe her four to five times a week and I never saw the spot!
The spot was removed in the biopsy. The dermatologist urged follow-up treatment with an anti-cancer medication to be applied twice a day for six weeks. The six weeks passed, we returned to dermatologist, and the spot was not sufficiently nasty looking. Yes, it's apparently supposed to look nasty. Counter intuitive though it is, the medicine is supposed to turn the site red and raw and it had not done that. So, now we have four more weeks of twice a day applications. I'm piling the stuff on, but it still isn't red and raw, so I don't know what will happen when this four-week period is up.
In April 2006, we began preparations for cataract surgery. Another physical; blood tests, etc. Five days before surgery, a huge skin ulcer on her left leg above her ankle emerged. What caused it? Taking a bandage off. First, I tried to put bandages on it. Changing the bandage re-opened the wound. It literally stuck to the gauze. That didn't work. I needed non-stick bandages, which frankly I didn't know existed. After a couple of days of trying my regular bandages, I finally wised up and decided no bandage ... despite the nasty look. Sure enough, a scab started to form. An area of redness was expanding, however, despite the sulfadiazine topical medication.
May 2, 2006 ... cataract surgery on her right eye. Originally, the surgery had been scheduled for January. I hung up the phone with the scheduling person and decided I wasn't being heard and that I would cancel surgery and re-schedule it in the early spring. The January conversation was fascinating and annoying:
"Be at the hospital at 6:10 am," the scheduler said. I said something like: she has mid-stage dementia and needs some special handling, like a time that is closer to 9 o'clock. She's afraid of the dark etc. Needs 12 hours sleep at night. I got NO cooperation. Stone silence. I repeated it. She couldn't schedule the surgeries like that, she told me. As it turned out, what she really meant was she didn't want to schedule a surgery like that. What make an accommodation!
So, I am supposed to get a 90-year-old patient up three hours before her normal wake up time, no water, no breakfast, drag her out in the wintertime dark and into the bowels of a miserable parking garage, and tell her she's going to get her eyeball slit open. Yes, indeed-de, that certainly sounds like a winning combination to me. I called the next day or maybe I sent a fax and canceled the surgery.
Alas, on May 2, we arrived at the hospital (now in daylight since it is spring) at 8:10 am. Sometimes you just have to find a way to take charge!
By the way, the operating room nurse seemed perplexed and disturbed that Mother fell asleep the minute we got her into bed and this was only one hour before her normal wake-up time. After surgery, Mother ripped the bandage off the minute my back was turned. I put it back on three times and then gave up. By this time, fortunately I had jumped up and down enough to get some attention: Dementia patient needs special handling. The surgeon had heeded my shrieks and put an extra stitch in the lens area, I believe, so that rubbing, etc. would not harm the new lens.
More on the skin ulcers at another time...