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.