Saturday, February 4, 2017

Medication Resolution

I was waiting in line, 4:00 pm, at Wall Greens when the heart doctor’s office called. The heart monitor had a good recording for all afternoon and night, including the fall in the morning.

Maggie’s heart is being protected from fibrillation by Sotalol and her resting pulse never went below 50 bpm. The problem seems to be over medication. A call to South Hampton Place would be made next.

Wall-Mart, Wall Greens, and D&H Drug all said they had socks with gripper soles. They did, but not over the heal. Flow’s, near the Boone Hospital did not have them either. So to the main desk at Boone Hospital I repeated my problem with phone photo in hand. They giggled. “Try the Emergency Room, but they will be yellow.”

The place was busy. The triage lady was too. Across the way, the two sign out ladies were visiting. I showed them the photo: no grip on the heals. “No problem. Is H___ here?” Another voice said, “Yes”. He appeared and then returned with two pair of real gripper socks. “No charge.” We may also have these in our storage from the flood.

Now Maggie can easily get up out of bed, and be helped up from the floor, without having her feet slide across the slick floor. I was again assured at supper time that SHP had proper gripper socks in the laundry. No one has found them yet.

The pill delivery man on duty at 5:30 pm informed me that the heart doctor’s office had called the nurse on duty here at SHP. They arrived at a management plan that is characteristic of memory care. 

The ridged delivery of Xanax three times a day, and at over four times the dose used at Provision Living, was replaced with use-as-needed but no more than one pill every 12 hours. This order now gives the nurse at SHP the same ability to manage as at PVL

The traditional skilled-nursing approach works, after a dramatic initial adjustment period, The only catch is the side effects: weakness, sedated, and falling.

We have been up since 4:30 this morning. First a walk up and down Hall 300 in our PJs. Then on shadow duty and remarking clothes for the laundry. Maggie is now walking around normally. Her slow shuffle is gone. She actually picks up her feet again.

I marked with inch high letters: HART; silver on black clothes. It then occurred to me that people who do not read English may have a problem. They will now see: HART, R Hart, R HART, M HART and M Hart; and, more than one on some garments. To add to this, is the fact that three different people have helped mark our clothes.

We have yet another week before we return to a modern memory care environment where Maggie is a resident, in her world, rather than a patient existing in our world. Supper, yesterday, may be a preview of what to expect, unless we are now seeing the effect of reducing the dose of Xanax. Mood controlling drugs are unpredictable: help, no help, and harm.

From time to time she becomes fixed on something or on a container of things. She has a concerned expression on her face. If it is someone’s phone, she will grip it or the person so hard that it is nearly impossible for the owner to get her free. “Richard.” 

Distract and re-direct are the magic keys to behavior management. This works like a charm in memory care with familiar caregivers. The tools and timing can be readily manipulated. Timing here is measured in seconds. As in baseball, you have to hit the ball when you swing to get a home run.

A more disturbing observation of the past two weeks is an inappropriate behavior: eating with a knife rather than a fork or spoon, attempting to eat something other than food, and putting on a second pair of socks over her socks or her shoes.

We now have two days to see what happens before our next PCP checkup on Monday. That office was also concerned about over medication when Maggie and I stopped by Thursday. I wanted all parties to confirm they had received a FAX containing Maggie’s med list. We have a PCP, in charge of our Medicare insurance, and a house doctor with conflicting judgments: falling and behavior.

1 comment:

  1. Don't worry about the non-English readers. If they are literate in their own language, and their language uses the same alphabet as English, they'll get it. (I have taught ESL to a variety of nationalities.)