Millie and Mike Management

Brian Hersch

I agreed with Kerry's suggestion and got a recommendation from Mark Rapaport. He feels that he should not be the person talking to Mom since she might have a sense of conflict (or whatever) so he gave me the name of someone that he thinks Mom might want to talk to. I spoke with Dr Cohen and he will be happy to meet with Mom.

Now, anybody got any ideas on how we get Mom to desire/acquiesce ?

Kerry Berger

As we all know mom is so agitated she would not agree if she thinks a "therapist/doctor" were coming. I think this is all in the presentation.
If someone were coming up to, "counsel them as to what plans they should consider for their future comfort/living conditions" (this is really true) it may go over better. Obviously, whomever goes up there would need to be prompted as to the issues. Do you think this Dr. Cohen would be willing to go under these circumstances? Perhaps even using his first name in introduction not "Dr." would be less threatening? If it is presented like, "I heard about someone who is perfect for discussing with you your options etc..." explaining the benefit of a professional who knows about all the alternatives might even be anxiously accepted at this point. If not there are other social workers who are trained to have these type of discussions and the inevitable personal feelings that are associated (though clearly we cannot use words like 'feelings'.) Gary Small, who is probably considered the leading authority in Gerontology, might be an excellent source for someone . Dad and Louise Horvitz sit on his board at UCLA, and dad did disclose his diagnosis to Gary so he is aware of the situation. If someone can go in under the guise as a skilled 'advisor' we might just succeed.

Kerry Berger

I understand mom had a terrible night and a bad day. Mom was sleeping early evening when I dropped dinner off.
She suddenly opened her eyes and announced "I am not feeling well". Martha checked her blood and it was terribly low (60). She took her temperature which was also quite low (94). I looked on the internet to see what causes low body temperature, and, while they mentioned a myriad of causes (infection, diabetes, arthritis, stress), all the websites said that at 95 degrees and below a doctor should be called. When we asked mom if she was hot or cold...she could not really move her mouth to answer. Marta immediately gave mom some glucose tablets and a glass of orange juice. When Brian was informed of what was going on, he called Dr. Bamberger on mom's behalf. The Dr. called the house and we spoke. In the intervening time period, mom started to become more responsive. Her sugars had now registered at 160 when we took them again, but her temperature remained at 94.5. Dr.Bamberger did not feel as worried about mom's body temperature being so low as he was her sugars - spiking down and then up to such degree. He wanted to know what medicines she takes. I read him the list and he has made the following changes (however they are not permanent so I am reluctant to mark them on her med.'s page.) He asked that she not take the Metformin tonight (only) resuming in the morning....and she was to stop taking Glypizide until she sees Paul on Thursday. Marta has made notes and will follow these directions from the doctor. She also must eat regular meals and admitted to him she is not eating well. Once she had some soup and the sugars leveled out, she was much more responsive. Marta will continue to monitor mom's low temperature. Bamberger said he would notify Paul of what transpired.
I am also to understand that mom may still be suffering from a urinary infection. She was up to go to the bathroom 5 times last night and is feeling a pressure and burning. The girls tell me she finished her antibiotics last week but this not necessarily mean the infection is gone. I did not know this until after I hung up so I did not mention this to the doctor.

Kerry Berger

To all,

I know each of us has our issues with one another, and our parents, and we all could pull out long lists to substantiate our personal grievances.
Like so many parents, ours did the best they could with the knowledge they had… and yes, we have all felt damaged in ways.

Now it is ultimately important to recognize that everyone is suffering the stress of our parent’s health...and no one worse then mom and dad.

I can’t help but think about what things must feel like to them. Dad’s cognitive issues worsen by the day, and we are slowly losing him, as he is himself. Mom’s uncontrollable pain and state of physical paralysis is devastating and the inability to control so many of her health problems, foreboding.

To make things worse, we are having to endure the assault of their personality changes. Daily we have had to contend with the argumentative, demeaning and hurtful things said.

Lately I find it necessary to remind myself of the sacrifices they made for us, and the unconditional love we’ve been given through the years… as if to try and maintain some balanced perspective.

However, besides the physical pain, and personal anguish of having to deal with their own conditions, they are severely suffering with your state of unhappiness. Whatever is the cause .. please don’t allow issues to drive you away.

I beg you to find a way to work them out within yourselves and make peace with your parents. This is when they need you most.
Any argumentative, or bitter spirit they may display now needs to be forgiven. At this point in their lives it is not intentional nor necessarily within their control.

I apologize if you feel I have used this forum inappropriately, there is no offense intended.

Mitchell Hersch

There shouldn't be any surprise why Millie has been suffering the significant up and down blood sugar spikes that started last Friday (the day after Thanksgiving).

It seems that despite Maria's very specific warnings to the contrary over this past weekend, she's been served lots of sugary items including chocolate pudding, a pie, and cranberry jelly.

Knowlingly giving these to a diabetic (regardless of whether she requests them) is extremely dangerous and cannot continue.

Kerry Berger

The hospital wants a paper copy of mom's (Mllie) medical directive..it is not enough to have it on "file".

Brian Hersch

Kerry -

We have managed to avoid responding to your most incendiary posts, and simply ignored the accusations you insist on making in others.

But when we call Dad because we learn that a double-staffing may have been created by your independent decision to insert yourself into hiring and firing of staff, your screaming at him that we are "trying to kill him" doesn't go by without comment.

Remember Kerry. We aren't the ones who gave our diabetic Mother chocolate pudding, cranberry jelly, and pie.

And questioning your actions is not tantamount to trying to kill Mom and Dad.

Kerry Berger

I HAVE NEVER GIVEN MY MOTHER ANY CHOCOLATE PUDDING, CRANBERRY JELLY OR "INDEPENDENTLY" HIRED OR FIRED ANYONE!! FURTHERMORE, AT NO TIME HAVE I EVER SCREAMRD 'AT' MY FATHER! THE FACT IS, I FINALLY GOT THE COURAGE TO YELL AT YOU AS I HEARD YOUR TONE THROUGH THE PHONE AND SAW FIRST HAND THE UNDENIABLE STRESS YOU WERE ONCE AGAIN IMPOSING. IF DAD IS NOT CAPABLE AS YOU HAVE WRITTEN IN ALL YOUR LETTERS TO THE PROFESSIONALS, WHY DID YOU BOTHER HIM?

STOP MAKING SUCH INFLAMMATORY STATEMENTS WITHOUT SUBSTANTIATING THEM.

AS HAS BEEN THE CASE ALL ALONG, I REFUSE TO DEFEND MYSELF AGAINST SUCH BLATANT DEFAMATION OF MY CHARACTER. YOUR CONSTANT BARRAGE AND BULLYING TACTICS ARE SELF SERVING AND SUCH INFLAMMATORY ACCUSATIONS ARE COMPLETELY DEVOID OF ANY TRUTH.
I SIMPLY WILL NOT LOWER MYSELF TO THAT LEVEL.

Kerry Berger

Since it has become evident that contributors to this forum are no longer
able to respect the guidelines set forth "avoid incendiary commentary", I withdraw my participation, effective immediately.

Brian Hersch

Dad informed us that he does not like the Leeza's Group meetings. He didn't care for them - so if anyone hears that he has dropped it let me know and I will remove it from the calendar

Brian Hersch

Hillary got sick today and was not available for her lunch with Poppy. She will reschedule.

We are posting new/expanded lunch activities on the calendar with the grandchildren

Brian Hersch

Joshua's phone and email have now been added to the household staff section

Brian Hersch

Mike is having a particularly bad day today. He called and told Mitch and I that he really isn't able to remember things at all. That he thinks he needs a full time person. But his path to telling us this stuff was all over the lot.

We told him we would be getting into it.

Less than 5 miutes later, he called me and asked where we left things.

He then turned down his lunch with Matt, and when I inquired about his lunching with me instead, he indicated that he just didn't want for Matt to (sum and substance) see him this way.

Brian Hersch

Dad started out quite well this morning. We spoke before nine and he was relatively clear and in good spirits. But by the time I called him around 11:00 and mentioned that Melanie wanted to do lunch with him tomorrow, he said he didn't feel right, that he had gone back to bed, and still wasn't right. he sounded very confused and a even down or depressed. He did not want to schedule lunch with Melanie (this follows a bad day on Friday when he didn't want to lunch with Matt because he felt this way too.) We left it that we will see about tomorrow. Mel is alerted and is on the calendar as a possible lunch date.

Brian Hersch

A suggestion has been made by Maria. Since Dad has now begun demonstrating a willingness to wander, she thinks he should have an identity wrist band. Apparently there are some Medic wristbands which would indicate Alzheimer and numbers to call. She also recommended some kind of alert button for him to wear since he often walks around without this cell phone.) I am asking Terrie to look into it.

Brian Hersch

Paul Rudnick responded to an inquiry about improving the cough medicine for Mom and he will be giving her a course of Mucinex DM. He should have already informed Rehab, but I will confirm.

He is also adding to the file that we can take Mom out for a walk, a drive, or a meal whenever we feel like it.

Brian Hersch

Dad and I met with Jose, a candidate for the caregiver role for Dad. Initially Dad wanted to "be in charge" but he quickly had nothing to ask and wasn't processing a great deal of what was being said. Add to that Jose's Filipino accent - and Dad was a bit put off feeling that he would never understand the guys English. We got past that one.

Dad first try to say he only wanted someone 4-5 days a week - I reminded him that wasn't the agenda. That wasn't what Mitch nor I nor Kerry nor Mom believed was right. It wasn't what Dr Rapaport wanted...at which point Dad said, yeah...he wants 9 days a week....okay...okay....

Then he started to say he thought someone could be there for just a handful of hours, coming in around 10:00 am. Again I had to stop and redirect his thinking, pointing out that the goal was to have someone there from the time he awakens to the time he is "home for the night." I even noted to him that it has been obvious to everyone that he wakes up in wonderful spirits every morning, but that his good mood quickly gets beaten down somehow. He acknowledged that he knew it was true, and that our take on hours was probably the right one.

Jose lives in Sherman Oaks and the drive is easy. His last client was an Alzheimer patient. He is going to get us the guys daughters number so we can talk with her.

My sense is this guy may not be the leader we might want - but that he will be an excellent guide. If someone else stakes out the calendar my sense is that this guy could guide Dad along it nicely. He is an CNA and handles medicines etc. And it appears he has had a lot of additional seminar and class work in specific areas.

Talking further Dad acknowledged that even if he turns out not to be the ultimate final guy, that won't be any different than the fact that young Joshua is turning out not to be the perfect person either.

Don will talk with Marta Perone and then with Mitch on moving this to the next stage.

Brian Hersch

January 7, 2010

Discussion with Dr Bush about Dad’s pending surgery

- Normal sodium level is 135-140
- Dad’s fell yesterday to 125
- His body is “inappropriately” holding water
- The water is effectively diluting the sodium in his system – and that is confirmed by a higher than normal level of sodium in his urine
- Chest pain can particularly set off hormone change that triggers water retention
- He checked and way down the list of side effects on Namenda is low sodium…but he doesn’t think that is a major element at play here
- Classic treatment for water logged would be to restrict fluids – which they did yesterday
- Today his sodium level is unchanged
- Sometime they will add extra salt via IV
- I told him about what we could only term hallucinations and described the various things that we have observed. He asked if I had heard of Zyproxyn – which is indicated for psychosis and used for people hallucinating.
- He said people doing this in the hospital under the circumstances do stabilize.
- Pointed out that low sodium will affect the brain
- He told me they would not be doing the surgery today

Then Maria reports that doctors came in and they are planning to go forward with the surgery this afternoon.

Called and talked to Bush who said it was a decision made by the surgeon – and that if he and the anesthesiologist think that it is appropriate they will make that call.

Called Goodman’s office and though he was in doing a procedure, did discover that they were planning to go forward today. I was told he would either call me direct when he got done with morning procedure(s) or he would talk to his office and they would call me to confirm a time.

Brian Hersch

Dad came home today.

In the evening he had dinner, and when Marta Pernone, the new night "sitter" Mimi arrived at the same time I did he seemed to get a bit discombobulated by too many people. He need assuaged and led to understand that most of the people in the house at that moment were not staying.

He insisted he doesn't need someone around at night. I explained that Dr Rapaport says he does; Dr Stein wants him to have someone at night; Dr Bush wants it; his children want it; and his wife wants it. And that if all of those people see the reason, then I am afraid he will have to see it too. he calmed and accepted.

He was coughing things up heavily when I first got there. They did not give him anything for his cough before he left the hospital, so he hadn't had anything for it for the entire day. Maria gave him some Robitussen and that actually seemed to start working even before I left.
Left him reading in the den.

Doctor updates from today (check-out day):

Herb Stein:
- confirmed he does not want Dad taking Cumodin until he checks him after his Dr Goodman post-surgical review.
- Mike is to take an aspirin at night until then.

Dr Bush:
-Confirmed no supplements for Dad
- Wants Dad to stay on fluid restrictions until he has his appointment with Dad this Friday.
- Added a new drug Demeclocycline. Per the pharmacy this is about getting excess water out. This is 3x daily for 1 week.
- Life "as tolerated." If he feels up to something fine...but don't over do anything. he can try moderate exercise for instance "as tolerated."
- Bush provided check-out directions which we have instituted. A copy is in the drawer at the house, and Dad has a copy.

THE BIG OVERALL from Bush - He thinks the sodium problem is related to chest trauma. The broken rib specifically, and the pacemaker process generally. The "trauma" causes a hormonal change and in response to it (and the attendant pain) the body changes into a state where it just keeps storing fluids. All of that dilutes the sodium level. While the pacemaker now guards the "florr" on Dad's heart rate, and while that increase may have positive affects on Dad's energy (per Rapaport), the other component to his lack of energy is this sodium level drop. I guess as long as the pain continues there may be some level of this - but regardless of that they are treating the sodium level proactively and we will see how he is doing on Friday at the doctor.

Mike reports that his pain has gone down. Still terrible, but clearly less frequent and not as severe. They said it would start to lighten up ten days - two weeks in...and hopefully that is starting to happen.

Brian Hersch

Update from Doctor Bush:

Mike's sodium level went from 125 to only 126. Not a very big increase. But he noted that he expects that medicine will not have full effect until he has been taking it for about 10 days.

He really wants Dad to restrict his liquids more. He says it would be best if Dad was "slightly parched". I told Dad, but of course he couldn't remember what we were talking about even before we were finished. I am alerting Maria now.

Dad and I are back at Dr Bush on Thursday (see calendar listings.)

Brian Hersch

as of Monday, Janurary 25th:

Per Bush, from blood work from Thursday, 24th:

Mike's sodium level went up into the 130+ range. Dr Bush was delighted and removed the fluid restriction on Mike. Maintaining the extra drug (for water removal) until this weeks visit.

Brian Hersch

A heads-up from Mike’s check-up this morning with Dr. Goodman:

His numbers were great. Heart rate steady at 60. BP 130/71, with no appreciable drop when standing. EKG fine. Non-paced heart rate was below 30. Only a single incident of A-fib since the pacemaker was installed, and it lasted for only 10 seconds. That could mean Herb Stein may hold off on continuing Cumodin...but that will be up to him. The accelerometer got goosed up a little bit to provide a quicker heat rate increase when active. May or may not actually make a discernible difference, but there was no concern at all about trying that.

However, prior to getting to their office, a serious bout of light-headidness struck. It went on throughout the appointment, and in the end we had to take him by wheelchair to the car. Upon arriving at home he immediately went to sleep. This light-headidness is starting to be an ongoing problem. This bout apparently started at some point late yesterday.

Dr Bush tomrrow. Dr Stein Friday.

Brian Hersch

There have been some problems with Dad in the last 24 hours. He has been really light headed/dizzy and last night started to collapse. Eyes rolled to the back of the head and he started to go over. Maria grabbed him and with a chair-assit from Candy got him into a chair.

He saw Goodman, Bush, and Stein this week. And none of them showed any sign of serious concern about his light headedness. They all seemed to say it was just because he hasn't fully recovered from the traumatic experience that he has been going through.

I don't think they have this right yet. These episodes are getting significantly more frequent and larger in scope. I had to hang onto his elbow (which he doesn't always like) as we left Dr Bush and Dr Stein. They want him to stay in and take it easy.

At this point I think we really need to be sure that he has assistance literally "at hand" even as we take them around the house at times. Certainly he isn't a candidate for more than a brief walk in his yard - which Maria accomplished today. I will post the numbers from his doc visits and further details later.

Brian Hersch

Per Dr Bush this morning: Mike's sodium is holding at 132. He is happy with that and feels that Dad can come off of the medicine that was added during his hospital stay.

Last Friday nights incident of dizziness leads Bush to ask for the heart surgeon (Goodman) to interrogate the pacemaker to see if there was anything going on last Friday night. I will contact Goodman's office and see about arranging for a visit for that purpose.

Brian Hersch

I went with Dad to Dr Rappaport this morning.

Several primary areas of discussion:

Dad's continuing dizziness leads to Dr Rapaport recommending that he get a work up from a neurologist. He thinks it is possible (based on Dad's description of how easily he can move his head and experience the dizzy feeling) that this could turn out to be a behind the ear drum issue. We have asked Dr Bush for a recommendation and will move forward on this expeditiously.

Rapaport got into a discussion with Dad about the possibility that he might want to take a "vacation" from Millie and the responsibilities of the house. The aggravation and stress on top of her abruptness and overt unkindness are not working well for Dad. His desperate need for socialization is not being met at home. Now that he has sufficiently healed from his hospital stay, and nopw that it is become ever ore clear that living together isn't working out as well as we had hoped, Dr Rapaport is endorsing/encouraging the possibility of Dad living for at least 60 days at Belmont to see how he does there. I had a preliminary discussion with Mom about this, and generally she seems to indicate that she understands that being at the house is too imprisoning for him and is proabbly adding to his increasingly rapid decline. We are attempting to find out more. We will be talking later today with the Belmont. This will be an altered conversation since they turned down Mom (officially). Stand by for updates.