Friday, January 5, 2007

medical update on Dad (and other stuff)

We talked with Dad (and among ourselves) at Thanksgiving about the fact that Dad has what is called Congestive Heart Failure and therefore is at risk for stroke (cardiovascular accident) and heart attack (myocardial infarction). I tried to scare him a bit with the idea that his having a stroke would be debilitating and make him quite dependent (a state I'm sure he abhors), hoping to get him to take an interest in more aggressive treatment of the condition, which he had rejected a couple years ago after starting on Coumadin treatment down in SC. I have tried several times to convince him that he should re-consider.
We had missed connections with Doctor Coch this autumn, but I set up an appointment with him for earlier today, so now I have much to report:
I have gone into the interview with Dad for his last several visits, and did again today. Dad told Dr. (Bill) Coch he was having problems with orientation and when Bill asked more about it, Dad said something about not knowing how he fits into the community, rather than "I start downtown and can't figure if I'm on North Main or South Main" or something like that. Then he said he was having trouble remembering things, but it wasn't until later that we clarified that, when I gave a couple examples (like not remembering how to turn off just the TV (he keeps turning off the cable tuner, which makes the TV screen dark but the TV is still very much ON) or run the computer. I didn't get around to mentioning that he has mixed up when Jill's wedding was to be, when a dish-to-pass was happening, and so on.
Bill asked him a number of questions about himself but Dad's answers were more about the lack of "moral energy" in the world than about how he felt and how he was doing. Bill inquired about what else was bothering him and then had to go work with other patients and come back to us, during which time I tried to coax out some more personal, specific answers from Dad. As Jeanette said, later today, Dad just doesn't know how to talk about how he feels, much.
When Bill came back, I was able to help Dad convey that he sometimes feels like he should be in a time or place that he's not, or that he starts to do something but forgets what it was, and that sort of thing.
Bill asked him to remember three items and then did some other stuff, like cleaning out his ears, which were both jammed with wax. He said that was not the cause of the ringing in his ears, but that it was just tinitis, and not unusual for his age.
I entered into the conversation more by this time, and Bill asked Dad if it was ok for him to talk with me about Dad, with Dad right there; Dad said that was fine, so I told Bill I felt Dad's mental keenness has gradually declined over the last 6 years or so, among other things. Then Dad answered most of Bill's memory questions pretty well (and Bill said he had done better than he thought he might), but could only remember one of the three things Bill had asked him to.
After we had talked a bit more, Bill reported his findings: Dad's CHF is worse; specifically, he is fibrillating (muscular twitching involving individual muscle fibers acting without coordination OR very rapid irregular contractions of the muscle fibers of the heart resulting in a lack of synchronism between heartbeat and pulse) and his valve leakage is worse than the last time Coch saw him. Bill thinks Dad is depressed, and noted edema (fluid retention, swelling), especially in his right leg. He used a scalpel to remove a callous from the right side of Dad's right foot, and didn't find any moles or other dermal conditions worthy of concern, and expressed pleasure that Dad hadn't had any more cancer since his surgery. He thinks Dad should go back to Dr. Greenberg about his eyes (Dad says the eye he thinks has early cataract formation is "seeing" better than the other eye) and should call Bill if he notices shortness of breath and swelling together, especially if it's when he's lying down.
We talked more about medications and treatment and such, and Bill said he didn't think Coumadin (blood thinnner) would be very beneficial at this point, whereas he had thought so the last time we met with him. Part of this is because Dad is living alone and any accidental injury would tend to bleed uncontrollably. Speaking of such things, did anyone know Dad fell in the tub this fall? When he mentioned it at the Doctor's office today, he said it was three weeks ago, but when I asked him more about it over lunch, he said it was probably September, and that he had not told me because he didn't want to worry me (us). Yeah, right.....and I told him (again!!!) that I HATE it when he "protects" me by not telling me something (which means by the time I learn about it, it's too late to help), and that I would forgive him this time but to please NEVER do that again.
At this point, Dr. Coch recommends an ACE (angiotensin converting enzyme) Inhibitor (Lisinop -- see and look for Lisinopril) and an antidepressant (Fluoxetine, otherwise known as Prozac). He also recommended reducing sodium intake and said he might prescribe a diuretic later. We set up a follow-up visit for February 19th.
After some lunch, we filled his prescriptions for the ACE Inhibitor and Prozac, and Tony is enrolling Dad in a program that reduces what he pays SIGNIFICANTLY.
Dad was already on a daily aspirin regimen, but Bill said he should be taking coated baby aspirin. When I got to the drug store, I found that baby aspirin is only 80mg, but he'd been taking 325mg aspirin. Anyway, I got him the right stuff and he set up a daily pill-taking container for himself.
Jeanette is concerned that he is falling asleep an awful lot -- sitting up, mid-conversation, etc. -- and that he might actually fall out of his chair sometime. And I am even more concerned, after he dozed off right in the middle of a sentence I was speaking to him, and then 4 or 5 more times within a half-hour, today, even though he was trying to accomplish something. I had stopped over at his house sometime a week or two ago, and he was sound asleep at 8:30pm. Not like the man I remember who was up late, writing in his diary but still up well before me in the morning.
Anyway, I wanted to let you all know about this stuff.


shermaniac said...

That wasn't much fun to read but of course it wasn't intended to be fun. Doug, your assistance in these matters is most appreciated. I would probably stumble and clam up with the doctor too. When I'm at Dad's state (if I get there, wherever there is), I fear I'll be just the same: I won't want to talk about my condition with caregivers and health folks, I won't want to worry people. I'm not so worried about Dad falling asleep while watching TV or something; he's always done that.

It would be good if I was learning but I really hope that I can just be working and then disappear. No, I'm not really suicidal in this, just practical and hope not to live beyond usefulness.

Doug said...

Hi Sherm,
I don't want to worry people either -- I'm the one who will have busted a knuckle open and be bleeding on my work, and Jeanette will walk up and ask what happens and offer to bandage it for me and I'll say "it's fine" and mean it -- but I am not stoic in the same way as Dad. I will complain about things but still choose to handle them myself.
Jeanette and I are worried because Dad has very nearly fallen out of his chair in such a fashion that he could bust his head open or something, several times recently, and he falls asleep so quickly, abruptly, and completely -- NOT like he always has.
We talked quite candidly with Dr. Coch about there being circumstances in which lengthening life would be undesireable, so we're not avoiding that. I just wish to avoid Dad having a debilitating stroke or fall that is preventable. I don't look forward to having to move into 33 or move him here, but we know that it could come at any time.
Not pleasant, but it is the reality that is intruding upon us here in it or not.

Barb Crumb said...

doug, i really appreciate all you do for dad and his care. please remember that barb and i are only an hour away and we can assist. we could have him here too and were just discussing last night if that happened that we would find a way to have him sleep downstairs so he was not having to go up and down our stairs.

lotsa love all around, cmc

Doug said...

Hey Carol,
Thanks for the reminder and offer. I don't know if/when any of this may/may not be needed. I did connect a printer to his computer and set him up so he can work on his book and write letters and stuff. He can print from the old DOS program that he learned fairly well and then copy on the other printer if he wants. I gave up trying to get him used to anything newer/faster/different, and I think this will help him feel like he's "doing something".