Geriatric Depression Scale — use it and analyse the results wisely.
And no, not scales like gravity-based mass assessment or coverings on a fish’s skin.
Tag Archives: story
My father, the case in point/counterpoint
…we’re all overwhelmed with this. Today, Dad’s friend, a lawyer in south Florida, informed us that Florida law may consider Dad’s power of attorney (POA) signed in Tennessee invalid for the sale of the house in Florida because recent Florida legislation requires a POA to have witnesses in addition to a notary signature. Dad’s POA only has a notary’s signature. The Florida friend/lawyer’s investigating it more. I talked with Dad’s attorney in Tennessee this morning and he said he is willing to defend the power of attorney he witnessed as a notary.
In a little while, I’m heading over to see Dad and then drive home to attend to my wife’s health (and my sanity). Hopefully, Dad is stable enough to keep getting rehab for a few days and Mom can get some rest. Friends will bring food to Mom over the weekend.
BTW, last night, while Dad’s childhood friends, Philip and Terry, were visiting, Dad exhibited behaviour that indicates his thought patterns are very much mixed up, including putting the left houseshoe on the right foot, and then picking up a left tennis shoe to put on the other foot. He was able to tie a knot, though, and did, for the first time, lean over to kiss Mom goodbye when we left, so Dad’s thoughts are a mix of logical and illogical.
For instance, the bedrails were up and Dad kept trying to operate the buttons on the side of the bed to lower the rails, which didn’t work, but somehow he knew how to push one button to raise the headend of the bed to make watching TV more comfortable (behavioural feedback mechanisms are interested to observe, even in my father, the former professor).
He would grab the bedrail and pretend to climb over but look confused when he saw how steep it was from the bed to the floor and lean back into the bed. He saw Terry get in the wheelchair and then he decided he wanted to get in the wheelchair so we got him in it and let Philip take him for a spin around the rehab center. The nurses and techs said that riding in the wheelchair is Dad’s favourite activity right now; they encouraged us to do give him wheelchair rides as much as possible for his mental health. Interestingly, sometimes he can walk on his own and sometimes he’s like a ragdoll.
Terry said that this behaviour is normal for one of her grandchildren and we’re trying to get Mom to accept that Dad is like a little autistic child, who needs lots of love and encouragement no matter how odd his behaviour may seem at times. Just declare it Opposite Day and go with the flow. I think I’ll buy Dad some children’s books with pictures of cars — he loves to stare at the TV when a car race is on.
BTW, I sent an email to the case manager at the rehab hospital, asking for assistance in getting some questions of Mom’s answered:
- The Rehab Hospital brochure mentions having a neuropsychologist on staff. Why hasn’t the neuropsychologist reviewed Dad’s case and performed a cognitive test on him yet? Will the neuropsychologist be able to tell if Dad has FTLD in addition to ALS, bulbar option?
- Will the attending physician be prescribing Rilutek for Dad now that Dad has been diagnosed with ALS by the Medical Center staff?
- Will the Rehab Hospital be able to order a heart echo/ultrasound test that was not completed by the Medical Center? If not, can they assist in getting it performed offsite?
- Can the case manager assist Mom in filling out paperwork in order to submit a claim for Dad’s longterm care insurance policy?
There are days when I’m not a happy-go-lucky, patient man. Today is one of those days — just get me the answers I want and we can both move on to other subjects. Thank goodness I have a drive of five hours on which to focus my attention on mindless meditation.
Time to make a pledge to WETS-FM and then hit the road with tiny particles of rubber rubbed off through the heat and friction factor.
More thanks to give: Dr. Mann, NE State nursing students such as Miriam (as well as their instructor)…
Acronym of the day: FTLD
If you can’t read this, you’re either illiterate or possibly a prime candidate for FTLD.
Flowers for Algernon’s World According to Garp
Both my mother and I, tired from the up-and-down discoveries, research and changes of/about/for my father, experience back pain and stiff necks.
That in itself is not scary.
Nothing is scary.
Some forms of ALS are attributed to environmental factors.
Some neuromuscular diseases/syndromes are first diagnosed by treatment of back pain and stiff necks.
That in itself is not scary.
Some things are scary.
Writing this blog entry is scary enough without thinking there’s a local environmental factor or two (and probably not Max Factor but who can be sure that all the ingredients in cosmetics are safely influencing the environment while heating in the sunlight and mixing with methane in landfills?).
Any one who has common sense will remember that the bewilderments of the eye are of two kinds, and arise from two causes, either from coming out of the light or from going into the light, which is true of the mind’s eye, quite as much as of the bodily eye.
You see, humor is a set of scenes folded together like origami, which is, as you know, a combination of the words “original” and “pastrami,” not, as you might think, of the words “O” (as in the exclamation, not the Story of…), “rig” as in to construct something or fix a match (but possibly as in killing off large portions of the Gulf of Mexico), and “ami,” which some interpret as the acronym for the american meat institute but actually stands for the German colloquialism of the indigenous American people of Taiwan who use ambient intelligence to predict world events far in advance of us ever living as a world civilisation to prove their validity.
Therefore, watching the rise and fall of my father’s life in retrospect, with a partially predictive eye on the future, turns intelligent people into the bumbling idiots all of us are on a daily basis.
Because I’m tired, emotionally drained and otherwise able to hold a fork in my left hand while tapping the fingers of my right hand on a tablet…I’m not even sure where that image was going, it was so plain and ordinary.
Well, except to say perhaps my father, whose mental state is such that he knows how to put a shoe on and tie a lace into a knot but he doesn’t know a left shoe from a right shoe or even what type of shoe he put on one foot while picking up a different type of shoe to put on the other (and unfortunately, he isn’t Patch Adams trying to be funny), falling just short of ornery when someone tries to get him to put the correct shoe on his foot, whatever that means…I’m not even sure where that image was going, it so plain and ordinary for someone in his condition.
I took my mother to her first ALS support group session tonight, meeting professionals like Michelle, who has worked in the dental industry for over 30 years and had several useful tips for people with swallowing difficulty and/or advanced stages of ALS to maintain dental health, as well as meeting family members of ALS diagnosees and one ALS diagnosee himself.
Oh, the tangled webs we weave in our social interaction.
I just want to be that hermit living in the woods, digging ditches by day, that my mother reminded me again yesterday I said I wanted to be when I grew up.
Instead, I’m here, at this keyboard my father used for years. Well, no, this keyboard is only a year or so old, belonging to the set of accessories/peripherals that went along with the desktop minitower Dell PC labeled inspiron 531 that uses Windows XP and is probably older than I thought. Anyway, I sit in the chair that has rolled back and forth in front of this old student desk that my father has used for a computer station lo these many years.
Sounds bounce around in my thought set, mixing languages, nonsense sequences and other imagery one can associate with the upbringing of a member of our species, this set of states of energy devoted to getting more Earth-based sets of states of energy off this planet and away/out.
The opposite of the hermit’s dream.
‘Tis easy to be mixed up.
‘Tis easier to apply the mix to practical solutions, rather than figuring out the relationship between Solutia and Monsanto or ALS and FTLD.
Thanks to many, including Marc, Andy, Sagar, Barbara (happy belated birthday), Pal’s #13, Traci, Monica, Patty, Daniel, Christine, Allison, and many more…
This is Manic Rick Hill*, signing off before the caffeine overload (an ode to Pepsi is due except I don’t want to diss my cousin Barry’s employer, Coca Cola) kicks in and assists/facilitates my burst of wordiness that has no meaning in the weoinb2323:”3$^T#NdSLKER.
*you have to guess which Rick Hill am I, having a name that is rather commonly uncommon in these parts:
Fears and Retreads
In the past few weeks, I have returned to the joy of reading the local newspaper, a major source of information in my youth.
I have also sat and analysed the relationship between my father and myself, my mother and myself, and my father and my mother.
The last two sentences have given me pauses not associated with writing an app that makes Morse Code fun, exciting and optimally efficient as a modernised means of communicating.
But I digress.
No, take that back.
I regress.
I sit in front of the glowing, pixelated dots of energy one tends to call a computer monitor, although I’m not really monitoring the computer as much as I’m using its interface between myself and the wide world of webs we’ve developed as an extension of our natural need for nurturing. [Is the computer monitoring me, then?]
That is (i.e.), for example (e.g.), ergo, ipso facto, our permanent pacifiers (as opposed to Pacific pacifists) we’ve adopted as our own.
Computers of the desktop or laptop kind.
Mobile phones.
Tablet PCs/phones.
The 21st Century version of the security blanket.
WAAAAAAAHHH!!! Mommy, I can’t update my social media status!!!!
Who would’ve thunk it when we were two-year olds shouting, “No! No! No!,” that our two-year olds would be wailing for their touchscreen devices instead of plastic nipples to stick in their mouths?
Indeed.
My father values a toboggan like I value writing blog entries.
My mother hovers over my father like a nervous first-time parent.
Together, the last two sentences tell me a lot about myself and my only sibling, a younger sister.
I want to call 9-1-1 and make up some crazy tall tale in order to get my entry in the local newspaper column, the Police Blotter (which, of course, many local kids are calling the Po’ Sleaze Blighter), our own version of News of the Weird, which means we don’t have to syndicate the one which its author, Chuck Shepherd, has apparently grown tired of writing.
Well, well, well…time to go be nice to people in my hometown.
Laughter in Medicine
My father has always been a serious fellow around me but he has had his funny moments, too.
When I was in secondary school, my father chaperoned many an event, earning himself the nickname “Cool Dad.”
So, while I mentally compose funny bone ticklers to flesh out here in later blog entries, today’s info-stuffed minimal verbosity includes two links for those seeking silly respites despite serious riffs on ALS-related syndromes/diseases:
Repost of the day with word of the day: atelectasis (Gesundheit!)
As I continue the walk, with family and friends, down the path of my father’s health changes, here’s a repost of information pertinent to the issues we face:
Normal chest radiograph in terminal respiratory failure due to amyotrophic lateral sclerosis.
To the Editor: We report the case of a patient with terminal respiratory failure due to amyotrophic lateral sclerosis (ALS) who had a normal chest radiograph (CXR) 13 hours before respiratory arrest and death. This case shows that a normal CXR in the setting of severe neuromuscular disease cannot be used as evidence of even short term respiratory stability.
A 48-year-old man with end-stage ALS presented with respiratory insufficiency and weight loss. Five months before his admission, he lost the ability to ambulate without assistance and he developed progressive difficulty speaking and swallowing. He subsequently lost 50 pounds and became essentially bed bound.
His height was 73 inches and his weight was 120 pounds. His respiratory rate was 18 breaths per minute and breathing was mildly labored. Oxygen saturation by digital pulse oximetry was 97% while the patient was breathing ambient air. His speech was barely audible. His cough was weak and he was tetraparetic.
A bedside frontal chest radiograph demonstrated normal lung volumes and no cardiopulmonary abnormalities. Vital capacity measured at the bedside was 400 mL. On hospital Day 1, the patient’s breathing became increasingly labored. He was placed on bi-level positive airway pressure ventilation, but his respiratory status deteriorated progressively. He developed obtundation and arrested. Per his directive, he was not resuscitated. He was pronounced dead as a result of respiratory failure 13 hours after a normal CXR.
Patients with ALS commonly die from pulmonary complications. (1) Common respiratory sequelae include atelectasis, pneumonia, copious secretions, aspiration, and obstructive sleep apnea. Chest radiographic abnormalities are frequent in end-stage ALS. Atelectasis is seen early in respiratory failure and often persists despite assisted ventilation. (2) Conversely, clinicians may be erroneously reassured by a normal CXR. To our knowledge, no study has correlated radiographic findings with the degree of respiratory muscle weakness or with the incidence of respiratory failure in ALS.
In conclusion, clinicians should not be reassured by normal chest radiographic findings when assessing a patient with ALS for possible respiratory insufficiency. Clinicians must assess other clinical indicators, including pulmonary function, symptoms and signs of respiratory insufficiency, as well as imaging studies when trying to diagnose and/or predict respiratory failure in patients with ALS. (3,4)
Christine Won, MD
Dipanjan Banerjee, MD
VA Palo Alto Health Care System and Stanford University
Palo Alto, CA
Paul Stark, MD
VA San Diego Health Care System and University of California
San Diego, CA
Ware G. Kuschner, MD
VA Palo Alto Health Care System and Stanford University
Palo Alto, CA
References
1. Lechtzin N, Rothstein J, Clawson L, et al. Amyotrophic lateral sclerosis: evaluation and treatment of respiratory impairment. Amyotroph Lateral Scler Other Motor Neuron Disord 2002;3:5-13.
2. Schmidt-Nowara WW, Altman AR, Atelectasis and neuromuscular respiratory failure. Chest 1984;85:792-795.
3. Rabinstein AA. Wijdicks EF. Warning signs of imminent respiratory failure in neurological patients. Semin Neurol 2003;23:97-104.
4. Similowski T, Attali V, Bensimon G, et al. Diaphragmatic dysfunction and dyspnoea in amyotrophic lateral sclerosis. Eur Respir J 2000;15:332-337.
Hard work spotlights the character of people: some turn up their sleeves, some turn up their noses, and some don't turn up at all. --Sam Ewing
COPYRIGHT 2006 Southern Medical Association
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2006, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.
More people to thank
Tom, minister; Carolyn, Rosa, Kristie, Bea, Charlie, LaDonna, Yvonne, Charlie, Jennifer, Lisa, Georgia, Alan, Dr. Botu; Pratt’s Barn: Cody, Sky; Frank, Terri, Caroline; Floyd, Mary; Trevor; Beulah; more to follow…
A friend recommended…
A newfound friend some of you are familiar with, Claire Lynch, challenged me to write an app that would make communicating by Morse Code faster than texting.
Claire, I never imagined you’d influence my dreams.
I woke up from a night of coding in my subconscious — experimenting with the length of time that designates a pause and when it’s a pause, exactly what kind (space between words, space between sentences, etc.), as well as the definition of dots and dashes when one is “clicking” a touchscreen device like a mobile phone or tablet PC.
Of course, I haven’t got out to any Android or Apple app store to see if the app in question already exists. Create mine first and let the competition wait with bated breath.
treetrunkdings 