New Year's Eve update.

Mom's been eating well and Tony from Physical Therapy said she did very well today. She is much more alert this week (and some of last) and willing to participate with the physical therapy. She made two passes at the parallel bars today needing some guidance but that's good progress. Ortho consult scheduled for next week for a follow up and check up on the left/lazy foot.

Just spoke to the nurses station and at weigh in she was up another 2 pounds!  That's an 8 pound gain over the past three weeks! Not sure if it's ALL cookie weight but we'll take it however it comes.

I see a striking resemblance, but you be the judge!!

SO this is a post Christmas three day update.

Mom has been eating much better these days, nearly 100 % for breakfasts and lunches! Dinner between 90% and 100%

Clearly the two appetite increasers have fully metabolized and are doing their job now. (It can take 3 to 5 weeks for these to be effective.)

She gained 4 pounds last week and I'm expecting a few more pounds this week.
Physical therapy is a challenge still with the chair exercises doing well but the standing not as much. It's slow going but progress is being made.

Tonight found mom sitting at dinner having eaten only 1/2 an artichoke and a little fruit but none of her dinner (osso bucco and baked potato)

Further investigation and confessions by some SanRafaelian cookie enablers shows that Mom The Cookie Monster had surfaced in full form! Apparently after a wheelchair ride around the complex the suggestion was made to have some coffee and COOKIES! Like a duck to water the intrepid cookie MOMSTER commenced to eating cookies and more cookies (reports of a cookie theft have been confirmed)

Was initially worried but after the nurses confirmed the breakfast and lunch intake at 100% I just figured that mom had multiple cookies with a side of artichoke for dinner. That's cool, she's entitled to a little me/cookie time.

Merry Christmas update 3.0

Had lunch with mom today and she ate all of the plate of Pasta primavera, all of the peach cobbler, and half of her bowl of fruit!

They reported to me that she had eaten 100% of her breakfast, and after having dinner in San Rafael I arrived to her nurse Rosario telling me that she had eaten 100% of her dinner! They are all impressed with her progress on eating.  Not out of the woods yet but certainly heading in the right direction.

Physical therapy tomorrow, we'll see how inspired she is.

Christmas update 1.0 & 2.0

Monday was a decent day, I got reports that mom had eaten 80% of her breakfast and all of the staff at the Towers said she was looking better and were optimistic.

Dinner was a bit challenging although she knew exactly what she was doing!  She was feeding herself as she has been the past 10 days or so!

Tuesday was a good day in PT as mom actually walked about ten steps, she was being supported but still that's great. While one of the therapists moved her injured side, she picked up and stepped with the other foot.

Dinner was prime rib and scalloped potatoes, with creamed spinich, brussel sprouts and scrambled eggs. BIG portion and she ate nearly half of it!

And the BIG NEWS is that she gained 4 pounds this past week. I had to double check with the nurses to confirm.

It's Christmas and I'm headed over there now to spend some time before heading up to San Rafael to deliver Pies and Marges.
Report back later.

Sunday night update here:

While Sundays are usually pretty quiet and mom has been kind of low key on the past couple of Sundays, I arrived to see her eating her chicken pot pie with roasted zucchini and nearly finishing it. She also had 1/2 of a bowl of melon and asked for and finished a bowl of ice cream!

She spoke to relatives on the phone and they report that they had a nice conversation.

She is usually lucid, however some confusion still remains. I am told that that is somewhat normal for someone with this much time away from home.

Physical therapy tomorrow morning at 9 a.m.

Two day update here.

Friday saw mom a little tired from all the fun and frivolity at the holiday celebration on Thursday but she was participating in physical therapy with the team.

She ate between 80 and 90% of her breakfast (clearly her best meal) and then for lunch maybe 40%

Dinner was close to 45% and she was asleep once she hit the pillow after dinner.

Saturdays are always a little quieter (as there is no PT on weekends) so some boredom does set in.

Dinner tonight was a little challenging, the food was find but she was in a mood.

Ate all of her spinach and some risotto, a few bites of chicken (I know, chicken???) and a third of her scrambled eggs. She ate all the watermelon and then when I turned my back she had eaten ALL of the ice cream!

She was very lucid if a little combative regarding eating more dinner.

I'll update tomorrow afternoon/evening.

We had a nice time at the Christmas/Holiday celebration at the Towers. Attended by family and friends. Can not say enough about the staff and management at the Towers. Excellent and Elegant sit down dinner with several Christmas and Chanukah songs sung by the guests with Glee Club accompaniment. Tenderloin or Fish with whipped potatoes, creamed spinach, crab salad, soup, dessert.Absolutely top drawer.

Saw mom SINGING Christmas carols! WOW! Big WOW!

There were other pics from the table but as is often the case in large gatherings, communicating with individuals at the table to have them all pay attention at the same time for the picture is, well, IMPOSSIBLE!!!,  this was the best pic that didn't show someone doing some silly, embarrassing face.

It is a lot like herding cats, in fact just arranging and confirming the attendees was like herding cats.

People of a certain age have analog faces that are hard to capture with digital cameras.

Sorry for the folks who couldn't make it. We'll catch up with you soon!  Feel Better!!!

Tonight mom had a good dinner, ate over 50% of a lot of beef tenderloin, carrots, twice baked potato, and watermelon. M & H were there and we all had a nice visit.

Wednesday:

Mom had a pretty good day with Physical therapy and Kim the speech therapist tells me she ate over 80% of her breakfast!

Lunch was truncated because mom was tired after PT and HT.

HT= Permanent and Haircut.

Some quick gearhead therapy. Caddy's are really different these days! The guy in the white one should be familiar to the family.

http://www.motoringexposure.com/13477/d3-cadillac-brings-the-ruckus-with-j-r-hildebrand-tyler-mcquarrie

Tuesday update:

I used to say better living through chemistry, but in the elderly LESS is MORE.

Three days removed from the Ritalin and mom has shown a lot of improvement.

Physical therapy was early and I had zero notice so missed it but the reports were that she was very alert and working with the therapists. They approached me when I got there in early afternoon and if not effusive, were quite positive.

The charge nurse Helen saw me in the hall and stopped me to tell me that she had seen a big improvement. Noticing how much more alert she was.

Weigh in today and moms weight was UP 2 lbs. ! So we may have turned the corner and arrested the weight loss finally. A combination of medication adjustments and the dietician making changes to moms meals.

Tonight's dinner was pretty good, mom ate some chicken and broccoli, she ate ALL of the minestrone soup with noodles, nearly licking the bowl.

She also ate half of the ice cream for desert.

Again a word to the wise, be careful of forming opinions on someones state of health with a few visits intermittently. Clearly if you happen in on one of her low moments you'll see one thing but day in day out, the doctors, nurses, therapists and myself all see progress. Everyone can have a bad day and clearly Saturday night was one of those.

All for now.

Thursday Holiday Celebration at the Towers is at the normal dinner time of 5 P.M. so as to not upset the residents normal dinner schedules. Friends and family ARE invited... PLEASE RSVP to me tomorrow TUESDAY!

Monday night? Yep.

Mom ate a pretty good breakfast today (her favorite meal) and then didn't do too bad for lunch, ate chikin a la king and fruit and drank a carton of milk.

Dinner was pecan encrusted baked chikin breast with baked potato and scrambled eggs as well as fruit and panna cotta for desert.

Physical therapy was okay, she's still favoring the left ankle with the blister on the heel. We'll have a report from the podiatrist tomorrow.

All in all a decent day.

Word to the wise, they get folks up pretty early there so by the time dinner is over mom is getting sleepy and sleepy mouth ensues.

Communication it at it's peak between 11 and 5 when she is usually very lucid.

Continuing with my theme of more tolerance for people stressed for the holidays, when you're out at the mall, shopping, whatever, pay attention!

Pay attention to your phones, you're packages, your cars, etc.

And really pay attention to others who may have their own issues that are overwhelming them.

Case in point; In Sears got a watch repaired and leaving the store, tons of people. Along comes this little tyke just a walking along. She was like not even two feet tall and just wandering along without a care in the world. So I start to leave but something seemed odd. Trust your intuition! I kept my eyes on her and looked for store personnel and found a Sears guy. Got his attention and we started looking for her mom. TWO sections away we 're shouting "anybody lose a child" and around the corner comes her mom, FRANTIC. Tearful reunion time. Whew!

If something like that looks weird, makes you feel uneasy, Stop and do something about it!

FYI for the Bay Area folks, there is a Holiday Dinner at the SF Towers on Thursday the 19th.

All family/friends invited. I just NEED a headcount by Tuesday the 17th!  Please rsvp!

Yes I have cancelled the trip to N City for the cowboy match. Didn;t make sense to pass up this opportunity for celebrating Christmas with Mom.

Had dinner with mom tonight and she was eating pretty well, grilled chicken, mashed potatoes with gravy, scrambled eggs, strawberries and a chocolate Sunday for desert.

She ate pretty well and then got tired, was awake but not too much energy for talking.

Sunday in the city. Indian Summer in full swing. 62 degrees.

Had lunch with mom and then took her out to the patio and sat for 20 minutes and talked.

She was much more lucid and conversant than last night. More positive and also less negative at the same time.

I relayed that the doctors and physical therapists  and of course her family are all pulling for her and are positive about her outlook.

She's clearly not going to run any marathons and may likely continue to live at the towers going forward, but unless she made a huge turnaround, likely would not be returning home.

That being said, every day is different and she usually has 1 bad day a week, hopefully that was yesterday.

I asked her about wanting to continue fighting since the doctors outlook was positive and she said "well if that's the case it would be stupid not to try."

Other than a small bit of confusion, she is quite lucid. The discontinuing of the pain meds is starting to show results.

Needed a laugh, really, really needed a laugh.

http://www.youtube.com/watch?v=4BMUC4Yb4z4

Follow up on Ritalin, unlike many of the other drugs (anti depressants such as mirtazapine, Zoloft, etc.) Ritalin starts working quickly and doesn't need time to build into the system.
MOTL

Saturday? Days blend together lately.

Visited mom tonight for dinner, which apparently she had refused to eat at all. I had the nurses aide bring some soup back and she ate the whole bowl with a little prodding, also drank 1/2 ensure and had half a dozen bites of egg salad sandwich.

She was in a very different mood/condition from every day of the past week. At a complete loss to understand what exactly had changed excepting the newest drug that she was put on to stimulate her appetite. Turns out it is Ritalyn and she has been on since Thursday. With the change I saw I called the doctor and am having it put on hold until I speak with him about the side effects.

She seems more confused/disoriented today than at any time in the past 10 days plus, additionally she was leaning forward in her wheelchair complaining of being very tired.

Marge and Herb were there and spoke to her also. She made mention of wanting to just go.

Again, this is a radical change from yesterday when she ate all of her meal and was in decent spirits. Basic sea change today.

We'll see tomorrow when tomorrow comes. We did say goodnight and see you tomorrow and she said "I'll be here"

Friday update:

Mom had about 70 % of breakfast today, LIKES scrambled eggs a lot.

Physical therapy today limited by blister on left heel (Sleepwalking??)

Christine the PT worked with mom in the wheelchair and got good responses from her. She is MUCH more talkative and engaged today (and most of this week) and actually laughed at a couple things that Christine said and got a couple smiles out of her. Was real good to see that.

Lunch was decent though not enormous, kinda turned up her nose at the real nice chicken (I know...chicken?? WHEN does mom not like chikin??)

Dinner was major improvement! Got back there about 5:30 and they had already served her meal and she was eatin away!!! Was halfway through the meatloaf! (And mind you, she IS a meatloaf SNOB!!)

She ate all of the meatloaf and 2/3's of the carrots as well as half of the fruit cup watermelon. Also half of the bowl of scrambled eggs that they prepared specially for her.

She is much more engaged today and answers and asks questions. Night and day from last week.

A word of caution; if you visit after a meal you can expect that she will be on a low. She went straight to sleep after dinner and a linen change. Out! Snoozin. She was tired.

All for now.  zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Another thought!  It's the holiday season and lots of folks driving are CRAZED!!

Leave yourself some extra time if you're going to travel. Even if you're just going to the mall.

Take your car to a mechanic/tire shop and have it inspected (AAA does this) before your embark.

Get new wipers! And if you're having to use your wipers, turn your headlights on, it's the law, and it's a smart thing to do.

Make sure you have AAA coverage, AAA Plus is really good!

Oh! And on another tangent, Can anyone tell me while the vast majority of sport utes, cute utes, crossovers, etc ALL have to run around with the "Auxiliary /fog lights" on 24/7?? Really?

Is it just as simple as all of those drivers are colossal dumb asses too stupid to find the switch to turn them off? (Psssst, a little secret, there is most likely a warning light on the instrument panel that lights up with a pictogram of a fog light)

Today, Thursday, mom was more alert, have it on good authority that she ate her usual 60% of breakfast and a health shake/ensure.

Lunch not as much, although she did eat all of the fruit and 6-7 bites of zucchini. Drank 1/3 of ensure.

Seemed more alert than yesterday. Occupational therapy worked with her in the a.m. and PT in the afternoon.

Dr. Mayberry came by and is fully engaged, spoke with mom, and she responded cogently with him.

We're adjusting her Mirtazapine up from the lowest level a notch and adding a very low dosage of an amphetamine (name tomorrow) that has shown good results with elderly patients for appetite also.

Going to DC the lisinopril because she doesn't really have significant HBP now and it's thought that BP medicines in the elderly can decrease cognitive activity somewhat.

Lots of fine tuning going on to get her appetite back. Dr. Mayberry is positive and really staying on the case. Clearly he views mom as someone worth trying to save.

Today we got confirmation that the other anti depressant is discontinued. No more Zoloft. May take a few days to normalize that.

Spoke to Dr. Mayberry and will follow up with him tomorrow.

Physical therapy was cancelled today due to a care management team meeting.

The dietician was there and is really engaged. She has gone over the choices on the menu and made some changes. Their goal is to get patients to eat, which is critical at this point. So she will be replacing some of the more esoteric menu options with simpler choices.

Mom's energy level was low today, possibly reflecting the lack of PT and any exercise.

She did have a visitor and was having a good enough conversation when  I had to go into the meeting.

When I came out she was sleeping.

She's been good for breakfasts usually eating 60% Lunches less though she did have a can of ensure. Dinners have just recently become real challenging. She'll eat a couple bites and then say "I have to go to the bathroom" Which is great for stopping dinner dead in it's tracks! By the time the get two people to get her into and onto and back again 30 min have passed, dinners cold and she convinces them to put her to bed.
 arrrrrggghhhhhhhhh!

Still working on getting the medication situation under control. Good news is that the narcotic/opiod pain meds are discontinued for good.

Bad news is that there still may be some colliding with the anti depressant/mood enhancer/appetite increasers. Perhaps the Zoloft is counteracting the mirtazapine and cancelling out the benefits.

Her appetite was not so good excepting breakfast which she always seems to do good with.

Dinner found her distracted/sleepy and not hungry. I'll have a report when I talk to the nurses tomorrow a.m.

Physical therapy was not bad but not outstanding and seemed to take it toll on her energy level for the rest of the day. She worked hard getting out/up from the wheelchair to a walker and standing straight 2 of 4 times. Bent over butt out defensive the other two times.

She has been able to vocalize well and has said several times when asked who the most important person is in the team. A clear "I AM"

Today we had physical therapy and got mom to stand up three times. Of course she was tired and stiff from no PT over the weekend. I heard that she ate about 60 % of breakfast. Lunch was a little more challenging as the choices were really not to her liking. The hamburger was probably on another day just fine but today was a little too medium and a little too dry. The soup was beer and cheese and while she ate about 1/3 of it she was not enamored of it. Will not be ordering that ever again.

She was more lucid again today with some back and forth with PT and even initiating conversation!!

Paul called nd she talked to him and they had a good conversation! She participated in all of it.

Dinner found her a little groggier but still able to hold up her end of the conversation. Could sense that she was getting tired.

Despite eating 2/3 of her peas and carrots and most of the broth of the chicken florentine soup, the lamb did not agree with her and she vomited up most of the new flavor of ensure that I brought. We will go over with the dietician about the spicy selections that are just too much for moms tastes.

Today had lunch with mom and she didn't eat much although I was told she did eat a pretty good breakfast!

Interestingly she could tell me everything that she ate and was very much more responsive and conversational. Answering most questions without hesitation and little confusion. Not 100% but much much better than weekdays last week.

She also had several forkfuls of fruit that she actually fed herself! The lunch was corned beef hash and sounded better on paper than the actual delivery. She did eat half of her bowl of soup.

Dinner found her alert and conversational as well as hungry.

She ate ALL of the chicken and dumplings with lemon ginger beets and ALL of her corn chowder as well. She also drank all of a can of ensure and even had a few bites of chocolate sundae.

Again was alert and able to answer all questions and interact through most of dinner.

This just made me laugh out loud.

http://www.ispot.tv/ad/7bfj/chick-fil-a-bustid

Today found mom a little better with regard to the confusion/disorientation that she had been exhibiting for the past couple of days. It's likely that the removal from the tramadol and percoset from her regimen will take a few days to fully manifest. Today she had lunch with Scott and Quinn, then went for a wheelchair ride around the 2nd floor. Apparently with a kitten on her lap named Jobi (resident cat therapist).

She did pretty well at dinner, drank an entire Ensure and ate 1/3 of the Coq Au Vin and brussels sprouts and half of the tomato lentil soup.

She was much more conversational today although a bit tired, had several conversations about the need for continued nourishment and how that would help her to feel better. She was easier to understand by 90% from yesterday.

So the synopsis of my earlier post re mom is that in my conversations with her doctors, I get the strong feeling that they are optimistic that she can recover and that at this point it is dependent on nutrition mostly, getting fluids in/toxins out and getting nutrition. She has drank 6 to 7 ensures in the past two days and has eaten about 50% of her meals. It takes encouragement but she'll eat spoonfuls after spoonful of vegetables when fed. Like 15 to 20 of corn, peas, carrots etc. With protein, flavor and moistness are key. Gravy is important. She usually does real good with breakfast.

Follow up on mom's condition/progress over the past week. Apologies for not updating sooner but 7-8 hours a day at the Towers is like double that ITRW.
The physical therapists, Tony, Brandon, and Lauren have been calling me in advance of the sessions in the morning so that I can come down and assist. Sessions are never at the same time, more like in a two and a half hour window.

Monday we got her to stand up at the parallel bars once and a couple of half attempts. (PT doesn't happen on the weekends so pretty stiff) Monday also was the day she slipped out of bed early A.M. and she was on the first of the Percosets and an Tramadolso was pretty disinterested in PT overall.

:Sidebar... They gave her another percoset at 1 p.m. and then again the next morning at 8 a.m. and combined with the Tramadol has contributed greatly to the confusion/disorientation/groggy state she has been in this week. The Percoset and Tramadol have been DC'd as of mid afternoon yesterday after speaking with Doctor Mayberry.
These drugs (heavy narcotic) were carryovers from her stays in the hospital when she was in a ton of pain.

Tuesday we had her stand up at the parallel bars three times and take a couple baby steps.

Wednesday she stood up once but then needed to attend to bathroom issues and the session was abbreviated.

Thursday we got her to stand up 4 times and that was very productive.

Friday she stood up 3 plus times and took 6-8 good steps with assistance.

I had conferences with two of the doctors on Thursday and Friday and we have made some significant changes to the medicines she is on, essentially discontinuing the pain meds in favor of simple Tylenol to control the pain so as to give her appetite a chance. Dr. M reviewed her chart extensively and thought that the Tramadol could be affecting her appetite. He added an appetite enhancer/anti depressant mirtazapine which will work alongside the Megase for her appetite. It will take 5 to 10 days for this to absorb and start helping.

Okay now. May have gotten a couple clues as to why Mom was so dopey and disconnected today and yesterday. She fell out of bed late Sunday night early Monday morning (off the Whamo Slip and Slide mattress) They gave her percoset for the pain, somewhat understandable, however they followed that up with another percoset Monday afternoon and then another percoset this morning at 8 A.M. !!  ARRRGGGGHHH!

That's three persosets in basically 24 to 30 hours. Stoopid with a capitol Stoopid!
So I told the nurse on duty to discontinue that completely. Will review with doctor on thursday at our meeting. The percoset would explain the shakes/tremors that I have observed over the past two days.

She is supposed to be on Tramadol every 6 hours for pain and has the okay to ask for a 50mg Tramadol PRN.

Clearly some notes/meds/doctor orders have been carried over from St. Francis that were relevant and necessary when she was there but are not at this point.

Update more on this tomorrow.

Notes on traffic in the city. Word to the wise who ride scooters. Have a little civility and don't pass cars on the right! It's more than just illegal, it's extremely unsafe and RUDE. Please don't think because you CAN squeeze up the lane between cars and put yourself at the head of the line that it's okay to DO that. It's not and it's extremely rude. And if you're a FAT ASS (you know who you are) and your FAT ASS is on a wimpy little scooter don't do this going up a hill 10 miles an hour slower than the rest of traffic! (Pine st comes to mind) There should be a rule for scooter riders, call it the Cyclecratic Oath! First, do no harm with your little putputputz mobile.

Nothing much to report other than mom had a smallish dinner and was resting. Staff is going to address the slip and slide mattress tomorrow a.m. The heater thermostadt is finally fixed. Had a good visit with Marvin the nurse.

And apparently there is a great CNA that works during the lunch time and serenades all of the folks. Good singer and great personality.

So Mom had two sessions with occupational and physical therapy today and pretty well tired her out. She did stand up a few times with Brandon the PT guy and am told she stood a few times earlier in the morning.

She managed to fall out of bed again! Yes, AGAIN.! Between her attempting to reposition herself without pushing the call button and the slip and slide mattress situation she hit the floor again. ARRRGGGHHHHH!!!

The bed situation is going to be resolved as soon as the doctor for the SNF gets back to them and discontinues the "air bed" and they replace it with a normal non slippery mattress.

She ate pretty well for lunch and I spoke to the dietician about some other things to try regarding appetite. We are on the 2nd week of the Megace to address that but it works best when the patient is eating larger portions (stimulates AFTER intake) We also discussed having her eat dinner sitting in the chair rather than trying to eat in bed. That should make a difference in her desire to eat for dinner at least.

So today was definetly a low energy day for Mom after 4 pretty decent ones in a row.  Didn't eat too much for breakfast (25%) lunch was better (50%).
She was pretty groggy for dinner and it took a big effort to get her to eat 4-5 bites of meatloaf, 4-5 bites of Brussels sprouts and 4-5 bites of spinach quiche.
She drank 1/3 of the coffee ensure that I brought and a few drinks of milk. Mostly the groggy/drowsiness was the culprit.

7:15 P.M.