Millie and Mike Management

 July 15

The MRI showed that Mom did not have any kind of stroke.

The special blood test did reveal that Mom is suffering from what Dr Rudnick referred to as “ammonia intoxication.”  He liver, which has lots of scar tissue from her cirrhosis issues, isn’t filtering out the ammonia.  She has a huge build up of it.  And that is why she has suffered from slurred speech and nodding off.  This has to be cleaned out of her system.  That is being done with a strong, specialty (from the sound of it) diuretic.  She will take it for the next 3-4 days.  He said this should help her to feel better.  It will result is 3-4 lose and soft bowel movements a day. “Not watery – but very loose.”

If it fails to do the job, then he would want to put her in the hospital to get the cleaning out accomplished.  He did not say how that would be done, and I did not ask.  As far as I was concerned we will cross that road when we get to it.

I told Mom the details, but did not share with her the potential that she would have to go in the hospital if it didn’t work.  Why stress her any further.

By the way, he indicated that oddly, the liver function tests showed that her liver was functioning in a normal range.  He attributes this to some degree to her liver having a lot of scar tissue from the cirrhosis.

 

 

July 15

After a very concerning night on the 13th Mom saw Dr Rudnick yesterday.  He feels that her slurred speech and periodic stupor (my word) may be evidence of either of two potential problem.  It may be the continuing deterioration of her bad liver.  To determine if it is she will have a special and specific blood test today.  They did not draw blood at Rudnicks, because the test is so sensitive that the sample cannot be moved.  The blood must be drawn at the lab.

The other thing he wants to check is whether she has had some kind of minor stroke.  For that he has ordered an MRI - which will be done this afternoon.

 

 July 6, 2010

Dr Buchbinder notes the following:

 

-          We have come “some distance” regarding swelling and breathing.  He likes what he sees. He is starting to think about cutting back her Torsemide to 1X a day…but not yet.

-          Her big issue continues to be protein consumption, and exercise

o       He wants her to eat protein repeatedly throughout the day, even if just little one-bites at a time.  A bit of steak, a chew of chicken.

-          Her echocardiogram was pretty much unchanged since before.  Her heart function is impaired.

-          Her lungs are pretty clear today

-          He wants her to go back to Dr Wachtel specifically to talk about her sleep problems.  That appointment is now booked.

-          He wants mom to start drinking Ensure – it has some amount of protein in it.  That is not the same as the glucerna she drinks.

-          He wants her to cut back the Extra Strength Tylenol that she takes before she goes to physical therapy – not more than 1

-          Whatever the pill is that Mom has to have “before breakfast” she is unhappy at having to take it before she is even fully awake.  She feels like it is being forced on her.  So let’s start delaying that a little bit.

-          Mom has been having some kind of allergy medicine before bedtime in the hope that it will make her drowsy and will help her to sleep.  But the Dr feels that it has a bit of a “hangover” effect and does not want her to have it unless she is suffering from some allergy need.

-          The last blood work indicates that her proteins are still too low.  He took more blood today, and wants some more a couple of days before her next appointment.  But only a couple of days.

-          Unlike her last visit, where she was practically in a sleep stupor and could barley rouse her self to talk with him Mom was up and aware today.

 

 

June 9, 2010

 

Today we were back to Dr Buckbinder.  Mom has obviously lost a lot of the water/fluid.  her hands and legs look much more normal and Maria and Flavia report that she is doing better re protein.  But because they cannot throw her on a scale to judge fluid loss from there, they draw blood and take other actions to stay on her situation.

Mom had a very bad day yesterday with breathing.  Apparently a lot of trouble.

As of her last visit her heart situation is that fluid at lungs  related to lack of protein and her heart not being normal.  Buckbinder syas that last year she suffered what he thought might be "heart myopothy"  Pressure from the heat to move is low and let's fluid pool (?) at/in/on her heart.  That combined with too little proteinadds fluids andmakes it worse.

He has a lot of concern about her weakness.  Appears to be decades old. He told her, "you cannot tolerate much more of this weakness."  He wants her to get physical therapy again.  At first Mom was inclined to having the people come to the house, but she seemed to warm to the idea that she would do better if she got up, and out of the house and returned for physical therapy to Beverly Hills Rehab as an out-patient.  That is the one guy/place that really did her some good.

Today her bp is 130/70.  He ordered more blood work and another echo cardoigram.  We have booked a follow-up appointment for two weeks from now.

 

 

 

June 3, 2010

Today we went to Dr Rudnick.

 

Basically it was more of the same.    The core problem is water retention aggravated by insufficient protein in her diet.  Mom discussed symptoms like: her inability to drink more than a sip of anything without gasping;  her shortness of breath when she lies down.  Her liver function is quite good.  Her blood pressure is fine.  She actually has a number of good readings/levels.  Bottom line – she has to eat more protein and eat less salt.  Turns out she says she likes a number fo things that are recommended as protein for her: lentils, soy, and tofu.  These need to be added to her diet opportunities along with basic meats and chickens and fish (but watch the salt.)  Yes, she needs to continue to keep her legs higher than her heart when she goes to be, and her arm as well.

 

The open and bloody area on her wrist is a skin tear caused by the pressure from the fluids that built up in her arm.  It is not infected, but since it is open it will be an area where we will see fluids coming out.  He instructed Maria and Flavia in how he wants it wrapped and dressed (peroxide and Neosporin.)

 

Mom hears and gets it.  I emphasized to her that if she continues to be un-engaged in this matter she will have more of these skin tears and enormous bloatings.  For now I think she gets it.  Rudnick does not need to see her next week – because she is going next week to see Buckbinder.  He just wants to be sure she is seen.  Because she cannot be weighed without a special machine her water loss will be estimated by what we (including the doctors) observe.  He thinks she may have as much as 10 pounds of extra fluid in her system.  This could take several weeks to heal.

 

 

 

 

June 2, 2010

I went with Mom (along with Maria and Flavia) to Dr Buckbinder this afternoon.  Here is what comes out of the meeting:

Her condition is complicated and somewhat difficult to pin down because she has so many different things going on with her.

She has probably had a “silent heart attack” at some point (not necessarily recently.)  It is not unusual for diabetics in particular. .  Etc. As a result (?) her heart does not relax normally so things back-up into her chest.

He thinks a lot of this congestion and water retention (my word not his) is about a significant lack of protein.  Mom makes it clear she doesn’t bother to eat it.  She doesn’t like protein

Too little protein is a really big deal here. Because of low protein, fluid is not sucked correctly into her system, and fluids go out into the tissues everywhere.  Mom attempted a lot of negotiating about what constitutes protein.  She wanted him to approve gifilte fish as a protein.  I reminded her she only makes it once a year…and he dismissed it because it is too salty.  How about glucerna?  She then went in search of something else.  She was told clearly that she needs to eat protein.  Meat.  Chicken.  She was told in no uncertain terms by me in front of the Dr that there is no magic pill, that she has to participate in getting this corrected.

He is taking other steps to get the excess fluid out of her system:

She must take torsemide 1x every day.  It had previously been reduced to 2x a week, and he insists that it has to be daily.  He authorized the caregivers to give it to her in the morning so we do not have a repeat of last night when taking it at night resulted in her having to pee all night long.

At night she has to sleep with her legs above her heart.  Details of what that meant and how to do it were discussed with the caregivers and mom.

He gave her a Rx for a special kind of support hose (15-20lbs) that he wants her to put on when she gets out of bed in the morning.  He is opposed to pressure wrapping her legs – that has other issues about it.

He also wants her to keep her arm above her heart for some part of the night.  (arm on pillow sort of thing.)

He wants her total sodium intake for the entire day to be 2000.  She has to watch her sodium. 

He will be getting lab results from Paul.  He may decide to use antibiotics because he has some concern that the inflammation in her legs may be infection related.

At some point he may want a scan of her neck as well as of her legs.  But not right now.

We have booked an appointment for her for next week.

 

 

 

June 1, 2010

I was surprised to see that it has been so long since we used this as a place to keep running notes about Mom's health.  But here is an update so we can all see it and refer to it later on.

Mom saw Dr Wachtel last week (approx) a pulmonologist.  It was Dr Bush's recommendation because Mom has had difficulty breathing and a very congested chest.  Wachtel checked her out and indicated he thought it was not in his area - that she should see a cardiologist.  His finding was that Mom has fluid in her chest...but it is not in her lungs, it is between the lungs and the chest wall.  It suggests congestive heart failure.  He indicated that he thought it might have something to do with heart valves.

We set up for her to go see Dr Bookbinder and I am going with her tomorrow.

In the meantime she has been suffering with grossly inflated hand.  One hand is like double the size of the other, and it leaks water/fluid.  This was getting worse.  Kerry had growing concerns.  I contacted Dr Rudnick.  He indicated that this is edema and that it is more nusance than threat at this point.  He ordered us to give her a double dose of torsemide to see if that helped expell a meaningful amount of fluid.  We discovered that the Torsemide had originally been written as 2x a day, but was scratched out and changed (I am sure by Dr order) to 2x a week.  So we gave her one last night.  It seemed to do some good.  I faxed Rudnick to ask if he wants her to move back to 2x a day, and he indicated by return fax "no - just 1x."  So we are giving her one at dinner tonight, and seeing him tomorrow.

 

 

 

 

11-12-09

In the last couple of days we have heard the first inquiries as to the possibility that Mom might be showing early Alzheimer's signs.  Michale, her physical therapist,  asked me if I thought that Mom was "alright?"  It was said with a particular "attitude" in the delivery...he clearly meant "alright"...as in mentally.  The next day (11-11) he commented to Mitch that he thought perhaps there were signs that indicated she too might have some Alzheimer's working - though obviously at a much earlier stage than Dad.  Those comments caused me to recall that Dr Rapaport had previously made a reference to Mom not being "okay" either.  I took that in the broader sense of mental instability but now wonder if he was seeing something more than that.  Looks like we will have to inquire.

 

11-9-09

Mom is still in rehab.  She has seen good improvement in her ability to walk and move.  I have seen her get out of her wheelchair by herself and get into bed.  She apparently has walked up to 24' with her trainer.  There is no question her mucle tone and physical abilities are improving.  Her legs have been tightly pressure-wrapped most of the time, and they are down in size significantly.  She stil calls for pain meds, and apparenlty it is only Tylenol, though it appears that Dr Israel has allowed for something called Optima (or something like that.)

 

10-22-09

I got an early moring call from Paul Rudnick - who had meant to call Mitch, but instead dialed me inadvertantly.

He says Mom does not have diverticulitis.  That was a mis-diagnosis.  While they cannot specifcally pin down what did cause this episode, they do note that she had an undertewrmined infection which was a major root to this.  He noted that being in the hospital on a restricted diet her numbers have come well into line.  He expects her to go home either tomorrow ro Saturday.

 

 10-23-09

Last night was a bad one for Mom.  She had Vicodin midnight the night before, then morphine at 2:00 am.  More morphine at 7:00 pm.  She was whacked-out all day and into the evening.  She was really sounding like she was hallucinating with comments about "The parrot is walking the parakeet around the block for five hours" and more bizzare comments.  The hospital called Rudnick - and I spoke with him and he said he was fairly certain this was about Mom coming off of the drugs, and that he expected her to return to normal by morning.

She also had a hard and distended stomach that was bothering her and they eventually gave her a single dose of Milk of Magnesia.  Which as of this morning apparently worked since Mom had two episodes of diareha during the night and still had some discomfort in the stomach.  The nurse was quick to point out to mom that her stomach had returned to normal, and that her stomach would continue to calm down.

 

I spoke to Rudnick this morning, and was then at the hospital first thing today.

He says that she seems to have returned to more of a baseline in terms of cognizance and rationality.

He reported the following:

She does not have diverticulitis. She had an infection/inflammation in the intestine, and that combined with her fatty-liver issues and malfunctions caused all of this.

Rudnick expects to send Mom home tomorrow.

He insisted (twice) and repeated to Mom while he and I were talking, that there must be someone other than Mom handling and dispensing her drugs. Very emphatic about this. I told him we would have someone in place for that.

He wants weekly updates about her and her blood sugar and pressure readings.

He will want to see her in 2-3 weeks to run some tests.