About My Mother

145769-425x395-80th_bdayMy mother turned 80 last Saturday. In the weeks and days leading up to her birthday, I held my breath, hoping she would stay healthy enough to attend her birthday party. Each time I spoke with one of her caregivers in the weeks and days leading up to her birthday, I told them, “The goal is to keep her out of the hospital at least through her birthday.” She’d been doing better since her last hospital admission over Thanksgiving. A couple of weeks before her birthday, she and I had a forty-minute telephone conversation. The first real conversation we’d had in many months. A snippet:

“What day is tomorrow?” mom asked.

“Saturday,” I replied.

“You get to sleep in, then. Catch up on some rest.”

“A little,” I said. “At least until the cats start jumping on my head asking for breakfast.”

“Here’s what you do,” she said. “You put a can of food under your pillow, and then when they start bugging you, you pop it open, put it on the floor, and go back to sleep.”

Mom was feeling good enough on that call to problem solve, and be funny doing it.

Mom’s 80th birthday fell on a Saturday. I took off the Friday before the big day so I could make the dishes I was bringing to the party and be all set for the drive to Houston first thing in the morning. I wanted to get to my sister’s house early to help her get ready for the party. At at 8:30 Friday morning, as I was still lolling around in bed, the phone rang. A Houston number. Shit.

“Hello?”

“Hi, Ella. It’s Susan. Your mom’s okay.”

Susan is the head nurse at mom’s assisted living (AL). Whenever her calls begin with “Your mom’s okay,” my mom is not okay. She’s not at risk of imminent death. But she’s definitely not okay.

“She had a fall on the way down to breakfast. We found her on the floor by the elevator. She’s okay, but she bumped her head. She has a little scratch on her cheek. And she says her knee hurts. The paramedics are here.  I know tomorrow’s the big day, but we’re sending her to the emergency room to get her checked out.”

I’d recently had a long conversation with the physician’s assistant (PA) about mom’s frequent trips to the emergency room, and had asked if we could do anything to try to limit them. I asked about hospice. The PA didn’t think my mom would yet qualify for hospice, but she would ask the doctor to evaluate her if I wanted him to. I asked her if we could better manage her care without frequent trips to the ER, short of getting her on hospice care. The PA told me that AL erred on the side of sending people to the ER, and that I always had the right to refuse. The problem was that oftentimes, it’s hard for family members to make the call whether it’s medically necessary, particularly when family members aren’t there. She told me in the future, I could text her at any time, and she would help us determine what was best for my mother. We left it that we would hold off on the hospice evaluation for now, unless mom’s condition changes. And meanwhile, I would enlist her help if AL was contemplating another hospital visit.

If there’s one thing I’ve learned, sending my demented mother to the ER alone was not ideal, if it could be avoided. Invariably she would be admitted and subjected to all manner of diagnostic tests. Usually they’d determine she had a urinary tract infection (UTI), put her on an IV antibiotic, and send her back to AL days later. Each time she returned to AL after a hospital visit, it took her weeks to get back to “normal,” and often that normal was a step down from her previous cognitive function. The last time she went to the ER, in early December, they kept her for two nights “on observation” and a battery of tests, and then sent her back to AL with an oral antibiotic for yet another UTI.

I didn’t tell my sister right away I’d had the hospice conversation with the PA. I remember her losing it when my father was put on hospice care. It was as if she thought he was going to pull through until the moment they said he could be moved to hospice. So I knew if I mentioned hospice for our mother, she’d panic. She’d think the end was nigh. Even though the end might not be nigh for six months. And even then, it was difficult to predict. She still could be with us in six months, and be certified for another six months of hospice care. The goal was to stop sending my mother to the hospital every few weeks for another round of tests and antibiotics. To treat her for whatever infection she had at AL, and to stop running all the damn tests.

Eventually I told my sister about the hospice conversation. I needed to prepare her. I needed to plant the seed. To get her thinking about shifting my mother’s care from aggressive to palliative.

“She’s not anywhere near that point,” my sister protested.

“It’s not about mom being near imminent death. Hospice care for dementia patients isn’t like that. It’s not like with dad. And we learned a lot with dad. I would never put mom through what we put dad through. Brain surgery on an 83-year-old man in late-stage dementia? Even the surgeon was upset we’d done that to him.”

“Well if we’d caught it earlier,” she said, “dad would have been okay.”

My dad had hit his head three weeks before the surgery was done. They’d waited three weeks after the fall to admit him to the hospital. When they found out he had a subdural hematoma, they did emergency brain surgery, rather than calling hospice. We didn’t know any better, then. We know better, now.

“He was 83 with late-stage dementia. He would not have been okay. He spent most of the day sleeping. He couldn’t dress himself. He was incontinent. They removed his eyelid due to cancerous cells and he was wearing a bandage over his eye because the doctor couldn’t do the repair surgery in his condition. We were turning him into a Frankenstein. We were struggling with the idea of a feeding tube.”

“That was for mom,” my sister said.

“Yes, that was for mom. And luckily she did not do that to dad. She let him go. And we need to start thinking about what we’ll do if these issues come up with mom. If she falls and hits her head and they tell us she needs brain surgery, I’m not going to do that to her. She can’t walk. She often can’t carry on a conversation. She keeps getting infections.”

“She’s doing great, now. She’s not there yet,” my sister said.

“You’re right, she’s not there yet. But she will be. And I don’t want us to wait too long to get her on hospice care. I want her to have the benefit of the best care possible as soon as possible. I don’t want to put off getting that care for her because we can’t come to terms with losing her.”

“Okay. But she’s not there, yet.”

So here I was, the day before mom’s 80th birthday, a big party was planned, something my mother had looked forward to for months, and the paramedics had her on the gurney getting ready to send her to the ER and AL was seeking my permission.

“Can I talk to the paramedic?” I said.

She put the paramedic on the phone.

“How are her vitals?” I asked.

“Her vitals are fine.”

“Does she seem in distress? In pain?”

“Well, they said she was complaining of knee pain. But she seems okay. She’s talking. Smiling.”

“Is she bleeding?” I asked.

“No, no she’s not bleeding.”

“I don’t want to send her to the ER just as a CYA for the AL facility. Please send her back to her room and we will wait and see how she’s doing.”

And so that’s what they did. Following which, my sister and I had a text argument. My sister wanted them to run tests, do x-rays, make sure she was okay. I told her I was not putting mom through that unless it appeared necessary. I then contacted the PA who agreed we should “wait and see” and if mom appeared to be in pain, she could order mobile x-rays. She also advised they’d done a urine culture on Wednesday because mom seemed a little off, and we were waiting for the results to determine whether an antibiotic was necessary. She’d let me know as soon as the results were back.

Mom made it to her 80th birthday party. I picked her up on Saturday at AL, put a tiara on her head and wrapped a hot pink feather boa around her neck, and wheeled her out to the car in all her birthday-girl splendor. Mom visited with friends she hadn’t seen since my father’s memorial service over three years ago. She got to spend the day with grandchildren and her great-granddaughter, surrounded by balloons and streamers, and a sumptuous chocolate cake I picked up at my favorite bakery in Austin. (My sister gave me a hard time for spending money on an expensive bakery cake and not making it myself. I felt some satisfaction, therefore, when mom said it was the best chocolate cake she’d ever had in her life.) Later, mom would tell me she had the best day she could remember having for a very long time.

When I took her back to AL early in the evening, she was tired. The nurse checked her blood sugar (sky-high from the cake) and helped her get dressed for bed. I noticed in her night-gown that her knee was black and blue where she’d fallen. The nurse didn’t think anything was broken, but said she would order a mobile x-ray to be certain. She didn’t have an ice-pack, so I ordered one from Amazon and put a loaf of frozen bread on her knee. (We hadn’t yet gotten the urine culture back.) I stayed with mom until she was ready for bed, and then headed back to Austin to give Sadie an overdue-dose of subcutaneous fluids. (Sadie is doing spectacularly.)

On Sunday afternoon, my phone rang. A Houston number. Shit.

“Your mom’s okay. We found her on the floor by her chair. We don’t know if she fell, or if she just slid down. She seems fine. She’s smiling and laughing. I just wanted to let you know.”

This time, they didn’t recommend sending her to the ER. Instead, they promised to follow up on the urine culture and the mobile x-ray. Moments later, my sister called me.

“Why am I getting another call that mom has fallen again? What is going on?”

“She’s okay.”

“She’s not okay. I saw her today, and she was not okay. Her knee was black and blue. And now she’s fallen again. If we had sent her to the emergency room, we’d know now what we were dealing with.”

“You and I have a fundamental disagreement about how to deal with this. I do not believe it is best for mom to send her willy nilly to the emergency room by herself every time the slightest thing is wrong just to cover AL’s ass. Wait-and-see is a perfectly okay approach. And they are doing mobile x-rays tomorrow and waiting for the urine culture. What could the hospital do that we are not already doing for her?”

She stared yelling at me then.

“If you’d let her go to the hospital, we’d know what was wrong by now. We’d know what we’re dealing with. We’d know if she’s okay. Nothing’s been done. No x-rays. No urine culture.”

“Why are you yelling at me?” I asked.

“Because I have no control over anything. I have no control over what happens with mom. You say she doesn’t go to the hospital, and she doesn’t go. And I had a hard day. I am tired. I don’t want to deal with this now. I don’t want to talk about this.”

And she hung up on me. The second time in the past few weeks she’s done so.

On Monday, the mobile x-rays were done. Negative, except for osteoporosis in her hip. The urine culture came back. Mom has another UTI. They started her on an injectable antibiotic, which the home health nurse will give her at AL for the next ten days. No hospital visit necessary.

Mom had a good 80th birthday. She made it to her party. She ate chocolate cake and ice cream and her blood sugar went sky-high. She said it was the best day she’s had in a very long time. Hallelujah. This is my goal. I’m going to do everything in my power to make sure mom gets the bits of joy within her reach for as long as she has left. And if that means forgoing a trip to the hospital for another round of tests, that’s what I’m going to do. Because my mother’s joyous moments are more important than stemming my and my sister’s anxiety with hospital visits and doctors and tests. This is not about us. It’s about my mother. Let her eat cake.

Posted in Alzheimer's, Assisted Living, Dementia, Elder Care, Elderly Parents, Feeding Tube, Health | Tagged , , , , , , , , , | 49 Comments

Better Living Through Science

I take back every bad thing I ever said about antidepressants. OK, maybe not everything. Abilify did make my hair fall out. Viibryd gave me sleestak dreams. Wellbutrin plugged me up until I began looking like a snake who’d swallowed a rat. But this new one, Brintellix, has had no side effects. Zero. And, I feel better. I’m fairly astonished it’s working as well as it is.

Lunch-time walk around the Texas Capitol

Lunch-time walk around the Texas Capitol

I began the Brintellix in November, slowly increasing to the current dose of 20 mg per day. Several weeks ago, Dr. McEnroe added Deplin to the mix. I noticed a difference, a brightening, within days of adding the Deplin. I feel so much better that I’ve actually begun walking at lunch every day. I haven’t done that since my lovely boutique law firm merged with BigLaw five years ago. For the past couple of years I’ve had it in my head that I could catch up on my health and fitness when I retire. But emerging from the depression has made it clear how far I’ve fallen since the death trifecta, not only so far as my mental health goes, but my physical health as well. (And, of course, the two are inextricably intertwined.) Waiting to get serious until I retire is no longer an option.

I started with the easiest task first. I went to the dentist and got my teeth cleaned. Building on that momentum, I made an appointment with my doctor for a physical, something I haven’t done for three years. That’s right folks: I had not been to a doctor since early 2013. My blood pressure was fine, but she confirmed, as I already was well aware, I’ve packed on the pounds. The doctor ordered blood work, a mammogram, and a colonoscopy. I’ve already suffered the indignities of the mammogram, which was negative. I have a pre-colonoscopy appointment on Tuesday, following which I’ll schedule the test. It will be my first. I’m trying to put a positive spin on it, and so am looking at it like an insurance-paid colonic. Gwyneth Paltrow swears by them, so I expect I’ll be feeling super fresh afterward.

I am, however, burying the lead.

The blood work was not so good. My fasting blood glucose was high. Not diabetes high, but not normal, either. The doctor said: “Cut back on the carbs and get some exercise.” My mother is a Type 2 diabetic. I do not want to follow in her footsteps. My genetics, once again, are stacked against me. This is, therefore, a health emergency. “Cut back on the carbs and get some exercise” isn’t quite a complete enough recommendation. Naturally, I have spent the past seventeen days totally flipping out. Flipping out and researching the disease as if I’m writing my dissertation on it. I have totally immersed myself in learning everything there is to know, and doing everything I can possibly do to stop this thing before it gets started. Here’s what I’m doing, so far:

  • Daily walks, minimum 30 minutes
  • No sugar or starches (including potatoes, pasta!, flour, bread!, beans, corn, lentils, peas, and beets)
  • No alcohol (luckily, I already quit that)
  • No fruit, except berries, for now

Since I saw the doctor on February 4, I’ve lost 16.6 pounds. (I weigh in the buff at home, and was fully clothed at the doctor’s office, so we could subtract 2-4 pounds from that number to account for it.) My energy is steadily improving. I have been able to get out of bed in the morning without hours of self-negotiation. And, according to the glucose monitor I bought, my fasting blood glucose (as well my as my blood glucose throughout the day) has been normal for the past seven days. Normal! The doctor will re-do my blood work in early August. I’m looking forward to it.

Meanwhile, Sadie, my favorite cat, has had her blood work done twice more since last I posted her numbers. Each time, her numbers improve. Currently her BUN is high normal. Normal! Her creatinine, is still high at 3.1, but considering we started at 4.9, she’s come a long way. She’s also turned out to be the poster-cat for fluids. She gets excited, following me around meowing, when she sees me preparing to heat the fluid bag. She bounds up the stairs ahead of me when I go to hang the heated bag on her IV pole. She jumps up to our spot by the window, waiting for her Greenies and her 100 millilitres. Sadie seems to know when we’re nearing 100, as she starts to get a little antsy toward the end. Since we started fluids just before Christmas, she’s generally been pretty darn frisky.

But, like me, once a little piggy, Sadie has turned into a terribly particular eater. Currently, sardines in water are a hit. Since they’re good for me, too, I sometimes share a can with her. Alas, I cannot share her Greenies. Too carby.

 

 

Posted in Alcoholism, Antidepressants, BigLaw, Brintellix, Cats, CKD Cat, Death and Grief, Deplin, Depression, Grief, Prediabetes, Subcutaneous Fluids | Tagged , , , , , , , , , , , , , , , , , , , , , , , | 32 Comments

Cat Number 4?

Several months ago during a bad thunderstorm, I heard a loud, repeated thunking on the side of my condo. After the worst of the storm had passed, I went outside to investigate. Tucked behind the a/c, up against the side of the building, was a pile of kittens. We spotted each other at about the same time, and they took off under the fence.

I know the mama cat. I often catch her hunting in my bird feeders. I’d investigated trapping her to get her spayed and released, but before I got around to doing it, I noticed her ear was tipped. Someone had beaten me to it. (When feral cats are caught and spayed, they cut the tip off one ear so you can tell they’ve been taken care of.) Whenever I catch the mama hunting, I tap on the window and she takes off. She’s frightened of people, so it doesn’t take much to shoo her away.

Several weeks ago, I spotted a small gray and white kitty harassing the birds and squirrels. She looked to be about four months old, and I’m fairly certain she was one of the kittens that had been piled up behind the a/c. Like her mama, her ear has been tipped. When I tapped on the window, she looked at me and carried on sitting on the fence in stealth mode. I opened the door, thinking the moment I did, she’d take off. She didn’t. Instead, she jumped off the fence and came to me.  She wasn’t the least bit frightened of me. She meowed and begged for petting, which she got. I brought her bowls of kibble and water, and she seemed to eat hungrily. But she wasn’t thin. In fact, she looked quite healthy.

Since then, she comes around often. She tries to talk to Sadie through the glass in the back door. Sadie gets a bit agitated, but the little kitty is friendly and not the least bit aggressive. Today, I captured some images of her through the back door.

Aren't I pretty?

Aren’t I pretty?

Let me in!

Let me in!

I promise I'll be a nice kitty. You could call me Stella.

I promise I’ll be a nice kitty. You could call me Stella.

Today, I did let her in. Sadie hissed at her a few times, and little kitty looked quite perplexed, as if wondering how anyone could hiss at a kitty as sweet and cute as herself. I suspect little kitty would get along with Sally and Sadie much better than Sophie (the stray I took in nearly three years ago) has. First, because she is quite young, and also, because she’s not a scrappy aggressive little nutter, like Sophie is. (Sophie is lucky I didn’t put her back out on the streets years ago. Okay, not really. I would never do that. But she is a pill.)

So here I am, in danger of taking on Cat Number 4. Because she seems to be healthy and well-fed (perhaps the Buddhist monks at the temple that adjoins my property are looking out for her), I don’t feel any urgency. Other than I don’t like the idea of the little kitten living outside. But Sadie doesn’t need any added stress right now. (Sadie’s test results last week improved once again. Her BUN was down to 32—within the range of normal. Her creatinine was down from 4.0 to 3.6. Still room for improvement, but better.) And as Sophie often reminds us, there is hardly room for three cats in my 1500-square-foot condo, let alone this adolescent interloper. (Not to mention, at some point, my mother’s kitty will need a loving home.) So I’ll keep an eye on her, and act if things take a negative turn. Meanwhile, I’ll give her lots of pets and make sure she remains healthy and well-fed.

Is more room for cats a bad reason to move from a condo into a larger house? I’m thinking something in the country, so as to keep expenses low, and not derail my early-retirement plan.

Posted in Animal Rescue, Cats | Tagged , , , , | 57 Comments

Mom and Sadie Health Reports

Lake Superior Sunset

Lake Superior Sunset

I think my mother has moved into the next phase of dementia. The end phase.

Mom has had repeated infections over the past year: multiple urinary tract infections, and more recently, MRSA. The MRSA hospitalization over the Thanksgiving holiday appears to have taken a lot out of her. Mom has become withdrawn and doesn’t want to talk. Caregivers have reported that she rarely speaks. When she’s asked questions, her responses, when she gives them, mostly are limited to, “Yes,” “No,” or “I don’t know.” But if I ask her about her cat, I usually get something more; something along the lines of, “He’s right here, he’s sleeping.” Often when I call, like today, she doesn’t answer the phone. She rarely calls me any more, and when she does generally she’s agitated and confused. She refuses bathing. She refuses to go down to meals. She’s losing weight. Her pants are falling down. I’ve ordered pants and pull-up diapers in a smaller size.

Last week, the occupational therapist called to tell me she found mom sitting in her chair and had had a bowel movement. She was a mess. But she did not appear to realize it. She didn’t push her button for assistance. She didn’t seem to understand how the call button worked. The therapist got mom into the shower to get her cleaned up, but mom had trouble following instructions. She wasn’t able to focus; to take instructions in.

Of course I’ve plugged all of these symptoms into a google search. The hits are along the lines of: Late-Stage Dementia, End-Stage Dementia, Palliative Care. I think we’re getting to the point where mom might qualify for, and benefit from, hospice. I hesitate to bring it up with my sister, however. The last time I mentioned hospice, it was for my father, and he died within six days of being moved into the hospice wing of the nursing home. I don’t think death is imminent with my mother. But I do think it could be within six months, and so she might qualify for hospice. I spoke with her physician assistant last week, and learned mom will be getting a complete Medicare physical in the coming weeks. When that’s scheduled, I’ll ask them to consider whether hospice is appropriate when they examine her.

Meanwhile, Sadie, the chronic-kidney-disease kitty, continues to hold her own. Some days she eats better than others. Always she refuses to be pilled, whether it’s an antacid, anti-nausea medication, or appetite stimulant. I’ve chewed a piece of the antacid, and to me, it has no taste. How Sadie knows I’ve crushed it up and put it in yogurt, or put a tiny little chunk in a piece of cheese, is beyond me. Last night, I gave Sally a similar tiny piece of cheese to show Sadie the cheese was a sought-after delicacy. Sally scarfed it down. Sadie was unmoved.

I continue to give Sadie daily subcutaneous fluids. Unlike with pills, Sadie is a very good girl with fluids. I do them every evening at around the same time. When she sees me leaving the kitchen with the warmed fluid bag, she follows me upstairs and jumps up onto her spot on her sheepskin by the window. Everyone knows when fluid time is. Everyone gets treats. When Sophie sees me come into the bedroom with the fluid bag, she jumps up from her nap and licks her lips. Sally winds herself around my legs meowing. I give everyone their pile of Greenies, including Sadie’s on her sheepskin. Once Sadie starts munching on her treats, I insert the needle and let the fluid flow. She’s usually still having snacks when we reach her 100 ml dose and doesn’t notice when I remove the needle. Yesterday, she’d had enough and got restless before we finished, so I opted to let it go at that, rather than forcing her to be still and take the last little bit. Hopefully she won’t do a repeat tonight. Tomorrow we have a checkup with the vet. Here are her numbers from when she was first diagnosed (and feeling very poorly) and after one week of fluids:

BUN               50  — 49

Creatinine    4.9  — 4.0

As of tomorrow, she’ll have been on the fluids for three weeks. I’m crossing my fingers for a Creatinine reduction to somewhere in the low 3s.

Oh yeah, I almost forgot: I’ve been off booze for well over a year now. It’s nice that it’s an afterthought.

Posted in Alzheimer's, Cats, CKD Cat, Dementia, Elderly Parents, Subcutaneous Fluids | Tagged , , , , , , , , , , , , , , , , , | 47 Comments

My CKD Kitty

Sadie on Fur

Sadie on Fur

Sadie’s urine culture and urinalysis came back negative. Which means she doesn’t have pyelonephritis (kidney infection). The good news is, we stopped the antibiotic so I no longer have to put her (and me) through the trauma of giving her the nasty Baytril tablet. The bad news is, Sadie has chronic kidney disease (CKD).

The signs were there for quite some time, I just had no idea she was so sick.

  • Drinking a lot of water

Sadie drank more water than the other kitties for quite a while. I just thought she was more fascinated with the bathroom faucet and the fountain.

  • Urinating a lot

Recently I noticed a lot more (and larger) pee clumps in the litter box. I use World’s Best Cat Litter, which makes better pee clumps than any litter I’ve ever used. So when I started scooping out massive pee clumps, I knew something was going on.

  • Hanging out in litter box

Sadie hung out in her litter box a few times. She just sat there in the morning when I was getting ready for work, blinking at me. “What are you doing sitting in the litter box? Silly kitty.” If only I spoke cat, I would have understood she was telling me, “Mom, I can’t poo. I’m totally constipated. Give me some Miralax, will you?” (This can also be a sign of a urinary tract infection, so if you see this behavior, get kitty checked by the vet.)

  • Pooping outside the litter box

Recently, I began finding poo on the floor near the litter box (and sometimes, not so near). I figured this was more litter box shenanigans caused by Sophie’s (the former stray) presence in our household. Once Sophie became more adventuresome (which took nearly two years) and starting exploring the upstairs and using all the litter boxes, Sally retaliated. Sally began lifting her bottom at the end of a pee, shooting jets of urine onto the floor around the boxes. Sometimes I catch her in the act, and gently push her bottom down below the side of the box. More often, I’m mopping up little puddles of urine, followed up by spritzes of Nature’s Miracle. So, when I began seeing poo several weeks ago, I figured Sally had escalated. It turns out, poo outside the box is another sign of constipation. Poor Sadie.

  • Loss of appetite

Sadie is a chubber. She eats anything. She begs like a dog, staring at me, transfixed, when I eat my dinner. So when she began turning her nose up at poached chicken and tuna, I knew something was up. She’d walk up to the food saucer, take a bite or two, or just lick the broth, and walk away. Or sniff the food and take no bites, and walk away. Finally, a sign I could not ignore.

  • Weight loss

Sadie appeared to have lost some weight. I wasn’t sure, seeing as she’s quite fluffy, and also, as I mentioned, she’s a chubber. So I initially thought, if she had slimmed down a bit, this was a good thing. As it turns out, it was yet another sign something was wrong.

The vet suspected pyelonephritis or CKD. Until we got the urine culture and urinalysis results on Monday, I was holding out hope Sadie had a kidney infection. A kidney infection is curable. CKD is not. CKD can be treated, however. Learning to do that is how I’ve spent my Christmas vacation.

Sadie and I went to the vet on Monday so they could teach me how to give her subcutaneous fluids. This entails injecting fluids under Sadie’s skin with a small needle. If you want to see how this is done, watch this video of a cute kitty named Gus. I watched this before I gave them to Sadie for the first time, and based on how she reacted to being given pills, I figured there was no way she’d be as chill as Gus. In the vet’s office, Sadie stayed in her carrier, which is soft-sided and zips open on top, giving me access to administer the fluids. I made the skin tent on her back near her shoulders, took a deep breath, and slid the needle in. Sadie remained calm. The vet tech was holding the IV bag, and began squeezing it to make the fluids flow more quickly. Sadie appeared to be a little uncomfortable at one point, but she didn’t move or try to escape. I gave her pets and talked softly to her, and before I knew it, we were done. I gave her some treats, which she wasn’t interested in. But it’s the thought that counts.

The vet gave us samples of various prescription kidney diets, the bag of fluids, and a baggie full of clean needles, and instructed me to give Sadie 100 ml every day for the next six days (for a total of seven days straight). We are to go back on Monday for a retest of her blood work. The hope is that after a week of fluid therapy, Sadie’s BUN, and more importantly, her creatinine levels will go down.

When we got home, Sadie casually exited the carrier and walked straight to the food bowl. I opened up a can of Hill’s k/d and spooned a little onto the saucer. What happened next was astonishing: the kitty who has been disinterested in food for days began chowing down. She ate nearly three-quarters of a can in one sitting. I was jubilant. The last time Sadie ate with any gusto was when she returned home from the vet after her initial testing. She’d had sub-Q fluids that day, too, but I didn’t fully understand how beneficial it was until this moment.

On Tuesday afternoon, it was time for me to give Sadie her sub-Q fluids for the first time at home, without the vet tech’s supervision. I was a little nervous, but determined not to show it, lest Sadie pick up on it. I warmed the fluids (which the vet tech did not do) and brought the bag upstairs and hung it on Sadie’s very own IV pole ($30 from Amazon). I put her carrier on her favorite sheepskin window seat, thinking this would help keep her in one place during the treatment. I put a handful of Greenie’s in the carrier and went downstairs to fetch Sadie. I carried her upstairs, set her in the carrier, made the tent, slid the needle in, opened the flow valve, and waited. Sadie was totally chill. It was as if she’d channeled Gus. I watched the level on the bag drop, and when she’d gotten her 100 ml, I turned off the valve, slid the needle out, and reminded Sadie of the treats. Instead, she jumped out of the carrier and went downstairs. I figured she was headed for the food bowl, but she curled up on her furry blanket on the back of the sofa and went to sleep.

Uh oh. Had I done it wrong? Why wasn’t she eating? Was 100 ml two days in a row too much? Was she dying? Was she unconscious? Every now and then I’d give her a pet, which she’d barely acknowledge, and go on sleeping. I fretted while she slept and googled, “Kitty sleeping after subcutaneous fluids.” I learned that while many kitties are quite active and hungry after fluids, some are not. Still, I thought maybe I’d done something wrong, since she was so energetic the day before when I’d given them. After an hour of stressing over the sleeping (dying?) cat, Sadie awoke and nonchalantly walked into the kitchen, and proceeded to devour the food on her saucer.

Yesterday’s sub-Q session did not go as well. My neighbor, back from England, came by, and I decided to show her how it’s done. Sadie growled and flinched when the needle went in, and took off out of her carrier shortly after the fluids began to flow. (Sadie never growls at me.) I gave up and decided to try again later without my neighbor present, after Sadie had calmed down. (It later occurred to me the fluids may have been too warm.) When I tried again, I did not put Sadie in her carrier, figuring we’d likely formed a bad association during the last session. I set her on her sheep skin on her window seat and piled some Greenie’s in front of her. This time, it went off without a hitch. Sadie lay still. She did not flinch when the needle went in, she did not try to escape, and she actually ate treats during the process. The only snafu occurred when I took the needle out and forgot to turn off the port, squirting the fluid around my bedroom like a broken fire hose. All the while, Sadie lay on her sheep skin and ate the rest of her Greenies. When she finished them, she went downstairs and ate a bit of food before settling down for her long nap. This time, I didn’t worry death was imminent.

Aside from giving sub-Q fluids, I’ve spent these past days experimenting with various foods (she likes the Hill’s k/d best), and holding Sadie while I read. She’s always been a cuddler, but she seems a bit clingier than normal. I have no objection, except I hate disturbing her when I need to get up.

On Monday, we’ll get a better picture of how far along Sadie is on the CKD scale, based on the IRIS staging system. The vet said based on her current levels, she thinks Sadie is a 2-3. Some cats can live many years at this level. So I’ll do my best to not catastrophize, and instead direct that energy toward helping Sadie feel better.

Who knew I’d be so cool with poking a needle into my cat? If I didn’t know before I’m a strong amazing woman, I know it now.

Along with my vet, this site on CKD cats has been an incredible resource to help me understand the signs and symptoms of CKD, and how to treat Sadie and make her feel better: www.felinecrf.org.

Posted in Cats, CKD Cat, Subcutaneous Fluids, Uncategorized | Tagged , , , , , , , , | 45 Comments

In-Between Christmas

Yesterday was the first Christmas morning I have awakened in my own bed in sixteen years. I had planned to sleep in my parents’ bed in the home they lived in for nearly forty years. No one is living in the house now. We’re working on clearing it out and doing cosmetic repairs before listing it for sale. Because Queen Sadie is feeling poorly, I didn’t want to leave her overnight. So I put off my trip until Christmas morning.

I explained this to my mom a few times throughout the week, and reminded her during the day on Christmas Eve that I’d be there the following day. She likes to stay on schedule, so I told her I’d arrive right after lunch, which is from 12:00 to 1:00 p.m. Later that evening, in the midst of roasting Brussels sprouts, whipping up my famous from-scratch Caesar salad dressing, and wrapping my mother’s gifts, I noticed I’d missed four calls from her in a thirty-minute period, so I called her back. She doesn’t always answer the phone these days, and when she does, she just holds it, waiting for the person on the other end of the phone to speak first.

Hey, mom. What are you up to?

I’m waiting for you guys to come and get me!

Mom, I’m not coming until tomorrow. One of my kitties is sick so I don’t want to leave her.

But today is Christmas.

No, tomorrow is Christmas.

How do you figure that? It’s today.

I promise I wouldn’t forget you on Christmas, mom. I’ll be there tomorrow and we’ll go to Brenda’s for Christmas dinner, and drive around afterward and look at the lights.

It’s today.

OK, mom. I’ll pick you up tomorrow right after lunch and take you to Christmas dinner.

You’ll pick me up tomorrow?

Yes, right after lunch. I’ll call you in the morning.

After lunch?

After lunch.

OK.

On Christmas morning I called her at 11:45 and let her know I was on schedule to arrive just after lunch. She’s been skipping meals of late, and I had to convince her to leave her room and go downstairs for lunch. I arrived at her assisted living at 1:15 and knocked on her door. I could hear her tv, but she did not answer despite my repeated knocking and calling to her through the door, so I phoned her.

Mom, unlock the door.

Who’s at the door?

Me, Ella. I’m here.

OK, I’m coming.

Still, nothing. I called again and again she said she’d open the door. But the door remained closed so I went downstairs and asked a care assistant to let me in. When I finally got inside, she was on the phone with my sister.

I kept telling her to let you in.

It’s OK, a care assistant let me in. She’s having an off day.

Yes, she is.

I gave her a kiss hello and sat down on the sofa. Her kitty immediately jumped up and lay down beside me, begging for petting.

Who else is outside? Do we need to let anyone else in?

No, it’s just me, mom.

Who else is there?

No one else. Just me, mom.

Ella is going to be here any minute. We’ll need to let her in.

I’m Ella, mom. And I’m in. It’s OK.

Mom opened her gifts, one of which was a new sweater. She was wearing a rather ratty cotton jacket, and I suggested she might want to wear her new sweater out for Christmas dinner. She said she wanted to save it. Later, when we were leaving, she asked me to get her new sweater so she could wear it to dinner. I was glad she forgot she wanted to save it. If Christmas dinner isn’t a special enough occasion, what is? Her two favorite gifts were a calendar of the Lake Superior coastline with a dozen photos taken near the family cabin in Northern Ontario, and a piece of homemade banana nut bread. It was always her favorite, and so I put my mushy bananas to good use. I gave the cat two furry mice, one blue, one purple. I put them on the sofa next to him. He responded by giving me a swat.

We arrived for dinner forty-five minutes late. I should know by now that it always takes much longer to get mom out the door than anticipated. My nephew (not the free-loader) pushed his grandmother into the house, where we were greeted by my niece, my ex-sister-in-law, and her mother, whom I haven’t seen (they reminded me) in twenty-seven years. It was lovely to see Bertia and listen to her speak with her gorgeous Swedish accent. They had made a traditional Swedish Christmas dinner of Swedish meatballs, pea soup, and mashed potatoes, to which we added my Brussels sprouts and Caesar salad. It was delicious and a nice change from a hunk of meat. (My father always insisted on prime rib.) Dessert was a cake made of layers of crepes and whipped berry topping.

Brenda offered me a glass of wine.

Ella wants a glass of wine, I’m sure!

No, I quit almost a year ago.

What? You quit?

Yep. It started off as an experiment, and I was sleeping so much better, I decided if that was the only benefit, I’d keep going. (It seems I doth explain too much.)

Really? Maybe I should give it a try.

Brenda had divorced my brother because of his drinking many years before he died. She confessed to me after he died that she still loved him, and she wished things could have been different. When he died, in March 2013, he was a few days shy of ninety days sober. Brenda divorced her second husband recently. If my brother was sober and still alive, who knows? Renewing our friendship has been one of the good things to come out of his death.

Throughout the afternoon, I was acutely aware of everything. My mother’s red shirt with white polka dots. The way she kept tucking the bejeweled fox on the end of her new necklace into a fold in her shirt. (Keeping him safe in his foxhole, to be sure.) How she ate every bite of her mashed potatoes, soup, and salad, leaving the meatballs and Brussels sprouts. How she smiled when my brother’s dog licked her hand.

After dinner, Brenda took some sweet photos of my mom, my niece, my nephew, and my brother’s dog (she adopted him when my brother died) in front of the Christmas tree. Mom and I then headed back to her assisted living, taking lots of side-trips to look at the Christmas lights. I played a Christmas music radio station, and mom sang along to Baby It’s Cold Outside. She remembered the words.

Back at assisted living, I got her settled into her chair and put the tv on a channel she liked—an old black-and-white Shirley Temple movie.

Where’s my nut bread?

It’s right here on the table next to you. Whenever you’re ready for it, mom.

OK.

I gave her a kiss and the cat a pat, wished her Merry Christmas, and headed back to Austin to take care of the ailing kitty. Not bad for an in-between Christmas.

 

Posted in Alcoholism, Alzheimer's, Dementia, Elderly Parents, Sobriety | Tagged , , , , , , , , , , | 30 Comments

Nursing Sadie

Twas the night before Christmas

And all through the house

Sadie was meowing like a banshee due to a medication called Mirtazapine (Remeron).

Here’s what happened at the vet on Tuesday:

  • Sadie had an ultrasound, which was unremarkable.
  • Sadie’s bloodwork showed normal white and red blood cell counts.
  • Sadie’s kidney values were elevated: BUN 50 (normal is 10 – 30) and creatinine 4.9 (normal is 0.3 – 2.1).
  • Sadie’s blood sugar, even in the midst of all the vet stress, was 129 (normal 70 – 150).
  • Sadie was given subcutaneous fluids.
  • The vet gave Sadie a dose of Mirtazapine (Remeron) to stimulate appetite.
  • The vet sent Sadie home with two prescriptions: Baytril (a broad-spectrum antibiotic) and Cerenia (for nausea).

Sadie’s kidneys aren’t feeling good. The vet opined she either has (1) CKD/CRD (chronic kidney/renal disease) or (2) pyelonephritis (kidney infection). Because the ultrasound showed normal kidneys, the vet said if she does have CKD, it has not caused significant damage to either kidney. Also, if she has pyelonephritis, it likely has not caused much permanent damage, for the same reason. The vet put Sadie on an antibiotic, Baytril, while we await the results of the urine culture and the urinalysis. At that point, we may switch (or stop) antibiotics. If she does have pyelonephritis, she’ll need to be on antibiotics for at least four weeks. Which means I will have to get a better system down for pilling Queen Sadie.

When Sadie got home from the vet Tuesday evening, she seemed to be feeling better. She was less lethargic and went straight to the food saucer and began eating more heartily than she has in days. The vet instructed me to feed her whatever she’ll eat at this point, so I gave her her favorite tuna. Once she’s gotten her appetite back and her diagnosis is certain, we’ll adjust her diet. I’m also to make sure she’s drinking plenty of water, which she is.

Yesterday, Wednesday morning, she walked to the fresh tuna I put out, took a sniff, and walked away. I tried Greenies treats. I tried Temptations treats. Nothing. I went to the store and bought three different kinds of Gerber’s stage 2 baby food (chicken, turkey, and ham), three kinds of Fancy Feast (I hear cats love the stuff), and a freshly roasted chicken. Sadie ate about a teaspoon of the ham baby food. I then gave her a plate with two more kinds of baby food and three kinds of Fancy Feast. She was interested in none of them. I brought out the big guns: freshly roasted chicken, and a few bits of skin. Sadie took one sniff and walked away.

I tried to feed her off and on until early afternoon, at which point she’d taken a few more licks of baby food, a bite of chicken, and a handful of Greenies. She’d eaten enough to take her antibiotic, which I managed to get her to take in two parts. (The pill is huge.)

Pilling has gotten more difficult each time. This morning, in an attempt to dislodge the pill and my finger from her mouth, she bit me. She drew blood. My, what nice teeth you have. I tried to hide the pill in pill pockets. She wouldn’t eat them. I tried again to put it in her mouth. She kept pretending she’d swallowed and would then spit it out. I tried nose-blowing and throat-stroking. Nothing worked. At one point, I did this and held her for five minutes. She appeared to have swallowed so I put her down. She spit the final 1/3 of the pill (or what hadn’t disintegrated in her mouth after five minutes) out. Yes, Sadie held the pill in her mouth during five minutes of petting and promptly spit it out when I set her down. We’re going to have four to eight weeks of this? Oy.

Because Sadie’s appetite had faded again yesterday and the vet was going to be closed from Thursday until Monday, she called in a prescription for the same appetite stimulant she’d given her in her office on Tuesday: Mirtazapine, which goes by the trade name Remeron, a human antidepressant that is well-known to stimulate the appetite in humans. (For this reason, it is an antidepressant I will never take.) Mirtazapine is also a popular appetite stimulant in CKD cats.

Sadie is to have 1/8 of a 15 mg pill every other day. (Trying to split a tiny pill into 8 somewhat uniform pieces was challenging.) Since she’d had a dose on Tuesday, I waited until this morning to give her another dose. Remember, the first time she had it, the vet gave it to her when I was not present. So this was my first time giving her this particular drug. It was a tiny little sliver and so I managed to get it down without too much trouble. But within two minutes she began drooling profusely. It could almost have been described as foaming at the mouth. I freaked out and hopped on the google. Apparently this is not uncommon and passes quickly. And it did. The next thing I noticed, Sadie started taking more of an interest in Sophie (something she hasn’t done since she’s not been feeling well), looking like she was ready to chase her down and tackle her. I redirected her, and the next thing I knew, I could hear her downstairs rifling around the food saucers, clink clink clink. I hurried downstairs, and sure enough, Sadie was chowing down on the uneaten tuna from earlier in the morning. When she finished, she ate Sally’s leftovers. When she finished that, she meowed for more, so I gave her some roast chicken. When she finished that, she ate some Greenies.

Sadie is quite a Handy Cat when she is feeling up to par.

Sadie is quite a Handy Cat when she is feeling up to par.

After Sadie finished with her feast, she jumped up on the back of the sofa and lay down. But then she began meowing repeatedly. Based on my research, I knew this might happen. The appetite stimulant is referred to as Meowzapine in cat circles. She’s also very clingy on the drug. She wants to be held and cuddled closely, burrowing into my neck. She’s getting no objections from me. Right now she’s back to lying on the back of the sofa, staring out the window, watching the birds.

So, the appetite stimulant is a success, although a little weird. Sadie is eating, drinking, peeing, and pooping just fine. The anti-nausea medication is working, as she’s keeping everything down. My biggest challenge has been to get her to take the Baytril (antibiotic) without taking off my finger. Next time, I’ll try to get the hang of the pill-popper contraption I bought from the vet. If only she was one of those cats who can be tricked by a Greenies pill pocket.

In the midst of all this, it’s Christmas Eve. With the 75-degree weather here in Central Texas and my focus on the cat, I can hardly tell it tis the season. Because I don’t want to leave Sadie overnight, I’ve scrapped my plan to go to Houston today. I’ll go tomorrow morning just for the day, and be back in time tomorrow evening to give Sadie her medication and some Christmas cuddles. Perhaps we’ll have a Christmas miracle, and she’ll take it without a fuss.

Wishing a Merry and Happy Christmas to all my friends in the Blogosphere!

Ella xox

 

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Sadie’s Reign Continues

Na Na Na Na Na

Na Na Na Na Na

Sadie, my favorite cat, is going to be OK. Instead of being bad luck, it seems this black cat has broken the family curse. She does not have cancer. She does not have diabetes. She does have elevated kidney values (BUN and creatinine). We are awaiting the results of the urine culture and urinalysis to tell us whether she has a kidney infection or chronic renal disease. But, if she does have chronic renal disease, it is early days and it has not yet caused significant kidney damage. We know this because she had a perfectly normal ultrasound. All of this girl’s internal organs are A-OK.

The vet put her on an antibiotic and an anti-nausea medication, while we await the remaining test results. She also gave her subcutaneous fluids.

The vet did not make me wait until I picked her up to give me the news. Instead, she explained everything over the phone. When we hung up, I picked Sally up, began repeatedly jumping up and down, all the while kissing the top of her head and yelling, “She’s going to be OK. Your sister is going to be OK!” Sally responded, “WTF is all this kissing and jostling? Put me down, woman, and go and pick her up.” So I did.

Sadie is home. And she’s eating tuna and Temptations treats. I even tricked her into eating half her antibiotic by putting it in a pill pocket and hiding it in the middle of the treat pile. She hasn’t fallen for it a second time, so I fear I will have to break out the pill popper to get the second half of the jumbo antibiotic down the hatch. Meanwhile, Sally keeps sniffing her and hissing. Yes, she smells funny. Yes, she’s had a tummy shave. And yes, she is on the mend and will kick your ass, so show some respect.

Long Live Queen Sadie!

Afterward: Uh oh. It turns out Sally sneaked to the treat bowl when I wasn’t looking and ate all that Sadie had left, including the pill pocket.

Queen Sadie and Her Royal Subjects, Sally and Sophie

Queen Sadie and Her Royal Subjects–Pill-Popping Sally and Surly Sophie

 

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Favorite Cat

photo (4)This is Sadie. Of the Three Black Cats, she’s my favorite. It may be impolitic to have a favorite cat; but still, I do. Sadie and her sister, Sally, came to me in December 2003 from a local shelter. I had just lost one of my two current cats, Hobbes. Calvin was sad, and so I thought a kitten might cheer him up. (Or perhaps I was projecting.) When I went to the shelter, I saw two nearly identical fluffy black kitties together in one of the enclosures. I visited with them both for quite some time, attempting to choose which one to bring home to Calvin. Sadie was curious and playful, scampering around the visiting room, coming close for petting and cuddling, and running off again. Sally was shy and frightened, nuzzling my neck and clinging to me, now and again crying with her high-pitched kitten mew. (The shelter had named them Choctaw and Cheyenne.) Well, of course I wanted the gregarious Sadie. But how could I leave needy, frightened little Sally behind, and split her up from her litter-mate, Sadie, with whom she had bonded? So I did the only reasonable thing, and took them both home.

Poor old Calvin died only a few short weeks after I introduced him to the girls. The illness came on quickly and he died before the vet could get the ultrasound technician in. I expect it was his kidneys (compounded by the grief of losing Hobbes), but we never found out for certain.

Sadie and Sally have continued true to form. Sadie is still the sociable explorer, and also has turned out to be quite a lover. Sally remains somewhat shy, but she’s gotten better over the years. Sally still clings (she likes to sleep draped across my neck), and her high-pitched kitten mew hasn’t deepened much.

In late 2012, when Sadie and Sally had been enjoying their two-cat household for ten years, scruffy emaciated Sophie showed up on our doorstep. Like Sadie and Sally, Sophie was fluffy and black. Unlike Sadie and Sally, her coat was dull and matted. After three months of wooing with tuna and Greenies, she came in from the cold and joined our Black Cat Troupe. Now, three years later, her coat is soft and lustrous, and she no longer runs to cower in the corner at the slightest movement or sound. In fact, Sophie has become quite the cuddler.

But Sadie. Sadie is my girl. And Sadie is sick. At this very moment, she’s at the vet having blood work and an ultrasound. Over the past several weeks, she’s been drinking and urinating a lot more frequently. Last week, she vomited twice, and her appetite has decreased significantly. She seems lethargic, not even bothering to chase Sophie out of her territory. My mobile vet suggested that I take her in right away for the testing, and mentioned things like “kidney disease” and “cancer” and “subcutaneous fluids.” When I dropped Sadie off at the vet this morning, they said things like “urinary tract infection” and “diabetes.” So here I am, hoping Sadie has diabetes. The lesser of the evils.

Yesterday, I googled kidney disease and watched YouTube videos on administering subcutaneous fluids at home, imagining Sadie has only months or weeks to live. And then I stopped myself, opting for meditation and Sadie cuddling, instead. Today I am intent on staying in the present moment, not catastrophizing, and laying off the google searches as I await the test results. It’s going to be okay.

Sadie, my favorite cat, is going to be okay.

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The In-Between

in-between

: a state or position that is in the middle between two other things : a middle position

Merriam-Webster.com. Merriam-Webster, n.d. Web. 13 Dec. 2015.

Transitions are excruciating. Sitting. Waiting. Seemingly stuck in the current place and longing for the next. Dr. McEnroe said, at our visit last week, that the antidepressant has begun to work. It’s difficult for me to see, being that I’m currently mired in the muck. He upped the Brintellix from 10 mg to 15 mg for a week, and then on to 20 mg, which begins this evening.

“You want a remarkable transformation,” he said.

“I do. It doesn’t seem right that it should be as slow-going climbing out of the pit as it was climbing in, given the meds are supposed to give me a bit of a push,” I answered. “Then again, I had a bit of a push going in, given my family.”

I suspect he saw my smartassity as a hopeful sign.

Besides being in between depressed and not depressed (or less depressed), there are larger transitions taking place. In fact, I suspect these transitions are, in part, the cause of the depressive episode. There’s the much-desired transition between practicing law and not practicing law. Leaving the suffocating profession behind for (hopefully) a more creative life. And then there is the transition between my mother being alive and not being alive.

My mother was in the hospital for the third time this year (or maybe it was the fourth, I lose count) from the Tuesday before Thanksgiving until the Tuesday following Thanksgiving. She received IV antibiotics (Vancomycin) for MRSA, a staph infection resistant to most antibiotics. The following Friday, three days after she was released back to her assisted living, she was back in the hospital. This time, they kept her only two nights for “observation” and more antibiotics, and she was back at her assisted living, and her cat, by Sunday evening. With any luck, mom will steer clear of the hospital through Christmas. An “in-between” Christmas that my mom and I will spend at my ex-sister-in-law’s (ironically, the ex-sister-in-law who was the subject of my sister’s verbal vomit at Thanksgiving), while my sister spends hers in Dallas with her daughters and grandchild.

In-between. I don’t like this place. These half-Christmases. This half-life. Wanting to move out of this place and into the next phase of my life. It’s a difficult thing to acknowledge. That I find this in-between place, caused in part by my obligations to my mother, undesirable. A daughter is supposed to embrace this remaining time. Cherish every moment. But, in truth, I feel ambivalent. Each time she’s admitted to the hospital with a new infection, I brace myself. Is this it? Is this the one? And when it’s not, I feel relief. And also, anxiety. How long will this go on? How many more years of my life will I exist in this state of suspension? When do I get to start making my own Christmases? I know when she’s gone, I’ll look back on this ambivalence with horror. I’ll realize fully that these in-between Christmases are “my Christmases.”

And I’ll wish I had just a few more years of “in-between.”

Posted in Alzheimer's, Dementia, Depression, Elder Care, Elderly Parents, Long Distance Caregiving, Mid-Life | Tagged , , , , , , , | 17 Comments