Yesterday Dad and I did something different. I set up the plastic bowling pins. Dad bowled a couple of times making a strike from a chair! I made a spare. He then walked around the room a bit like he was trying to exercise.

I'm heading back to Vancouver today. Yesterday, we took Dad to Cathy's for supper. She made a very nice soy-marinated steak, with fried rice - strawberries and ice cream for dessert. Dad was pretty much the same as he has been most of the week, not really able to have too much of a conversation. We watched golf and some basketball.

On Thursday, I was able to review Dad's chart at Homestead Hills. I was primarily interested in reviewing the notes from his recent hospital stay and seeing what medications he is currently on. The records include an admittance record, and also a detailed report upon discharge. Here is the information on diagnosis of condition (by hospital doctor, Jamehl Demons):
1. Acute renal failure with secondary hypernatremia
2. Coagulopathy
3. Diverticulosis
4. History of GI Bleed
5. Benign prostatic hypertrophy (BPH) with urgent continence
6. History of acute renal failure
7. History of recurrent hypernatremia
8. History of deep venous thrombosis and pulmonary embolus
9. Microcytic anemia
10. Hypokalemia

The acute renal failure was likely the cause of Dad's symptoms (confusion and lethargy, not eating or drinking, and eventual dehydration). His creatin level was 2.5 on admittance (normal range .5 - 1.4).

Dad was given a CT to determine if there was evidence of stroke - none. He was given fresh frozen plasma, and the coumadin medication was stopped (the level appeared to be too high - the doctor noted the condition of DVT/PE (?) was 2 years ago and there was no documentation of hypercoagulable state persisting).

Dad was prescribed Oxybutynin for the urge incontinence associated with the BPH.

His current medications include:
Aricept (donepezil hydrochloride) - 10mg 1xday
Namenda - 10mg 2xday
Norvasc (amlodipine) - 5mg 1xday
Vit B12 injection - 1xmonth
Oxybutynin - 5 mg 2xday
.
The aricept and nameda are for the dementia. The norvasc is for hypertension.

I've done a little research on the ARF and BPH to try and better understand what is involved and what potential treatment or preventive measures might be useful. Probably need to to do more to really understand - and then have a discussion with Dr. Herman as well.

BPH is essentially an enlarged prostate. This apparently causes problems with urination - constant urge without ability to fully empty the bladder. The fact that the bladder is not fully emptied is what can cause the kidney problems, or urinary tract infection. Although Dr. Herman mentioned UTI to Barb when she talked with him following Dad's hospital admittance, the records do not actually mention this at all - nor any indication that he received antibiotics for an infection. However, the ARF I think must be related to the BPH condition - which likely has existed for some time. I certainly remember Dad complaining about having to pee and not being able to for some time before he entered Homestead Hills. I haven't reviewed many earlier records to determine if he was treated for this. Research indicates several drug treatments to reduce the symptoms of BPH and in some cases to reduce the BPH itself. Surgery is also sometimes done to treat the BPH.

It appears Dad has had ARF before according to the records. I'm not sure if this was also the cause of his hospitalization in November of 2003 or not. And it would seem there is some danger of this becoming Chronic Renal Failure, As near as I can tell this is the most serious concern with Dad's physical health.

As to his mental state, I'm sorry to report that after my first visit on Wednesday, when he seemed very alert and coherent, he has reverted to a very confused state during the past 3 days. He talks in nonsensical terms (e.g., going to the toilet so he could make payments on the mortgages) much of the time when trying to have a conversation. (Mom and Cathy cofirm that this is his state more often than not). Nonetheless, he is still quite capable of playing a mean game of scrabble - and he never has any difficulty knowing who people are. He gets caught up in the other residents' problems - which are also quite confused of course - but Dad doesn't recognize that they are not aware of reality. He gets rather angry with one woman who has a habit of coming up and wanting to touch him (and others), fiddling with his clothes. When I mentioned that she really didn't know what she was doing, he insisted she did it on purpose.

Dad is still somewhat better than when he was in his worst condition. He uses a walker - but doesn't really need it much of the time. He is able to take care of his personal needs for the most part, though some prompting is required sometimes. The nurses' notes indicate that he occasionally gets up at night, and of course is not fully aware of where he is.

I noted the discharge record indicated a follow-up visit with Dr. Herman should occur wihtin 2-4 weeks, but I did not see any record of such a visit. Wanda said the record might be in someone's office and she would check into it on Monday. Mom will follow up with her, as I am travelling back to Vancouver that day.

I arrived in W-S last night. Went to visit with Dad this morning. He seems very well and alert - happy to see me and Cathy. We had quite a nice chat. Dad started telling stories about his youth in NO with his family. I can't recall what led to this, but I found it very interesting. I never really talked with him about this before and didn't have a real sense of their life. Apparently (like many families in those days, I imagine) there were a number of related family members living with them from time to time (other than just the immediate family). He mentioned how Grandpa's clients often sent turkeys or chickens (live ones). When I asked if Grandma had to pluck them, he said no - her mom was living with them and did most of the cooking. There were also apparently several young Spanish women who stayed with them at one time - he seemed to think they were related to John Rosado. There was also a woman and her son, who he couldn't recall the exact relationship to (some relative of his father's). He talked about helping out a dairy man with boxes, and how he hung out at the drug store (soda fountain) with his friends. He claims he had figured out how to tell which candies had prizes inside (apparently some of the candies contained a coupon for a free dixie cup ice cream) - by the sheen on the chocolate. Dad always was pretty crafty, I guess. He said he never shared this secret, but did hand out prizes to his friends sometimes. Cathy said she couldn't believe all those people lived in the house - which she has seen (I haven't), but Dad mentioned he slept with 3 or 4 others in the same bedroom.

Dad does seem to be inconsistent in some things. He looked at his watch at one point. He couldn't seem to figure out how to tell the time - and was trying to work it out somehow. I noticed the watch was way off - so I reset it and told him the time. I also just reminded him about counting the minutes by five with the numbers. Later, when he looked at the watch again, he didn't hesitate in saying what the time was.

I'm heading back again to visit this afternnoon - we'll play scrabble, I think.

We played Scrabble today. It went well.

We played Cribbage yesterday. Dad was ahead but Mom and I were right behind him at the end.

I try to visit once or twice a week and Dad usually comes over on Sundays for dinner.

We played Scrabble yesterday. This was the first time in a long time that I didn't want to win! I was ahead at one point though (naturally). But Dad pulled out ahead and won the game!

Dad seemed happy afterwards. He walked fairly fast (with walker) down to the dining room like he knew where he was going.