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.

Dad talked a lot today. He was talking about Jennie putting the dust in the water. (was he talking about ashes?). I think he was talking about Uncle Allen. I am not sure. He then said a lot of nonsense, like the dust was in his bed, etc. But then we went and played Scrabble, and he played fine with no problems.

Dad had a rough week at the hospital, having to have an IV and a catheter. He still doesn't really want to drink water though, so things do not look good. He does eat okay though.

Hopefully the nurses will try to get Dad to drink.

I sat with Dad while he ate his breakfast. He seemed bored and played with the eggs and grits, mashing them up. He had already eaten his cereal but denied it. He did drink some of his orange juice and the bacon and a bite of toast.

Not much going on this month. I played Scrabble with Dad. We didn't keep score. It was just as much fun.

Not much going on this month. Dad seems to be doing okay. But I am tired a lot.
We had a nice meal at the home of pizza, roasted red potatoes, chef salad and ice cream sundae!
I hope to write more next month!

Russ, Faye and I visited Mom and Dad for a few days around New Year's 2005. He was very glad to see us, and recognized us right away, saying our names. Dad played dominoes with us, needing a fair amount of direction, but had fun. Russ and I took him to play miniature golf. He wasn't sure if he should, but we said "come on," so he did. We went to Cedar Pointe which is nearby and not too hilly or too many steps. We had a great time - Dad would put the walker aside to putt, and took good care to putt. He got the only hole in one, and pars and birdies, too. It was a beautiful day for Dec. 30, about 65 degrees.

We also had dinner at Mom's with Suzie and her boyfriend, Jacob, along, too. Dad thought he needed to save some of his spaghetti for "the fellow" at the unit, and we couldn't convince him otherwise, so gave up. We played Scrabble with Cathy/Mom and Suzie, and Dad won, although I did help him a bit, but he put out some good words and combinations on his own, too.

On New Year's Eve, we all went over to Beau and Page's new house, which was quite beautiful; Dad enjoyed walking around it, and even went upstairs without the walker to see the rooms.

Just some random thoughts from Alzheimers' Group Meeting. It was a nice meeting. Only a few showed up but there was an ombudsman who works as an advocate for nursing home patients in North Carolina. Jean, the leader, talked about how it is a mistake to put a pacemaker in a person who develops alzheimers. It keeps his heart beating long after he is brain dead. And it can be painful as it constantly shocks a person over and over. (and a pacemaker can not be removed!).

Also, I mentioned that Dad sits on the toilet backwards. She said that Alzheimer's patients can not see the toilet behind them so backing up feels frightening (they might fall down on the floor, even if a person holds their arm and tells them that there is a toilet there) Also, they want to "see" what is going on. Strange, but helps to understand what they are going through.

Mom and Dad came over on Sunday for anniversary party. Suzie and her boyfriend Jacob came over as well. I made brownies for dessert. Mom brought over some ice cream for dessert. I made chicken barbecue in crockpot, peas, orange marmalade carrots, and rolls. It was easy to make! (good since I am getting over a cold).

The nurse has to remind Dad to drink still, he doesn't want to drink. Mom reminded Dad that if he doesn't drink he would have to go back to the hospital!

We played some cribbage yesterday. One of the ladies there, Virginia, said he was the greatest!

I asked the priest if he would pray for Dad. Dad isn't sure he wants to see a priest, but the priest said I could give Dad Holy Communion if I wanted to. Anyway, the priest thought that perhaps Dad might be hesitant to see a priest because maybe he was thinking that this was last rites?. Not sure, what to do. But Dad did say a couple of years ago that he wanted me to call a priest at Holy Family Church (after he died!). But I don't want to wait that long.

Well, Dad just spent the last week at the hospital for dehydration. The IV didn't work too well, so after sticking him multiple times and complaining that his veins were too small, the IV was removed after about four days. One time his hand blew up like a balloon. He had a hard time eating and Mom had to feed him breakfast one day. I was able to talk him into eating his dinner that night. Mom said a volunteer helped him eat as well. The rest of the time I just had to nudge him a bit to get him to eat. He had trouble for a while (since he was hooked up to IV) using the bathroom and the Depends from the hospital were very leaky. But with someone walking him and helping him he got better. Though he tried to walk too fast and later to eat too fast as well. He seemed to enjoy chatting with the nurses though when one nurse took his blood pressure he kept trying to pump his arm (like when he gives blood). The nurse had to hold his arm down firmly. While in the hospital, Dad seemed very talkative (his Zyprexa was also stopped last week). He asked about how much money he makes, also that Mom should turn in his guns to the police, that they were not safe to keep around the house. (I am not sure if Ken wants his hunting rifles and bb guns).

Dad keeps saying Hollin Hills and Hollin Meadows when he means to say Homestead Hills. I also say Heather Hills when I mean to say Homestead Hills!

Yesterday I couldn't find Dad's cribbage board so we played a form of dominos. I couldn't remember the exact rules but we managed some type of game. I have another cribbage board that I will bring in.

Dad got a special shoe that looks like a Birkenstock for his right foot. It is supposed to help the "foot bone get back in shape", but the doctor at Homestead says maybe he shouldn't wear it because he might lose his balance wearing it. So Dad is not wearing it anymore. But he still wants someone to fix his foot! Maybe the podiatrist can do something about it. It seems like a bone that got injured a while back and healed badly.

I ate dinner with Mom and Dad at The Homestead. It was quite tasty, fish cabobs, french fries, cole slaw, vegetable capri and ice cream. Dad mentioned that he thought he saw Justine's car in the parking lot. I am not even sure what kind of car she has but sadly I had to say she was not coming here (at least not this weekend!).

After Dad used the bathroom I had to use it as well. He was worried that I might pee on myself!

We played cribbage, but I had to go home after one game I was so tired. Mom stayed and played another game with Dad.

I played cribbage with Dad yesterday, but we were unable to finish the game. We were about even though during the game so it was fun anyway.

The nurse hurt the side of Dad's foot while putting on his support socks. I am not sure why it hurts so much to pull over the side of his foot, but the socks themselves did not hurt his foot once they got put on. We also thought it was his toe nails catching that caused the pain. Dad then started talking about prices of Homestead Hills and taxes going up and she responded by addressing his foot pain.

I noticed that my right ankle is also causing me some pain when I push down on my foot (but only during yoga class doing the downward dog position!) Could this be some kind of sympathetic pain. Strange!

I did not have Mom and Dad over for dinner on Sunday, I slept most of the day. Not sure if I am sick or just tired. But I plan to have them over next week.

I played another game of cribbage yesterday with Dad.

He has some sort of hard skin on the back of his ankle, probably a callus of some sort. I hope he talks to the doctor about it. He doesn't seem in too much pain about it anymore (or else he is very stoic).

Mom and Dad had dinner again last Sunday. I fixed Breaded shrimp, Cajun rice, Squash and brownies. Also some homemade mint chocolate chip ice cream that Suzie made in her ice cream maker.

We watched the golf game on tv. Since I am taking lessons, it seems more interesting to watch now!

Well, Dad has his new walker with wheels. He seems to like it better. Going up the front stoop is a little tricky but we manage. When he left, his ankles hurt him for a second or two though when I move the walker away, until he can grasp it again at the bottom of the stoop.

We had a nice meal of meat loaf. I use a recipe that calls for a layer of mashed potatoes and cheese in the middle.  Dad has started leaving food on his plate, I think he is imitating Mom. (I never know for sure how much to serve Mom, since her appetite is small).  He said "should I leave food on my plate?" I wasn't sure whether that was a question or a remark. I also had Boston Creme Pie which I made thinking about Justine's birthday. (not to slight Ken. I will be making brownies later this week in your honor). 

I practiced my putting in the house using a ping pong ball. Mom gave me some good tips about differences in golf clubs and hitting underneath the ball when I was practicing my drive. (I am not sure that hitting a ball in the house is a good idea though) 

Suzie and her boyfriend Jacob stopped by.  Suzie took her Scrabble turn and then left shortly. (we are having a revolving scrabble game).