INSOMNIACS place to talk in the wee hours
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DD has a chorki (chihuahua-yorkshire terrier mix) that grew up around a male pug. So when it comes time to pee, she pees like a male dog and marks her territory as such. I've seen her squat once but by the time she finished she was going into the lean with her leg up.
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Love that picture Mags!
Went to see Theresa... Sass, I'm not sure she knew me.... It's just sooooooo sad.... She seems physically okay, other than being in a wheel-chair, but I think something happened in her brain.... She just kind of looks at you, and talks about things I know nothing about... then talks to something she sees on the floor, and said "Oh look how cute!".... Or just starts talking about something to herself... Judy says she didn't have a "stroke"... but that she isn't "the same".... I don't know.... I just know in one week, my dearest friend "isn't there" anymore....
I just don't know why everything has to go to hell when we get older.... I don't understand how things can go so wrong.... it just hurts......
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I have washed a quilt in the bathtub. The problem is getting as much water out of it as possible. The museum in Honolulu has a fabulous quilt collection and lots of advice on caring for antique linens.
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Yes... I know.... I watched my Grandma go through this.... It doesn't hurt "them".... it just hurts those that love them..... feeling them slip away.
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Chevy, so sorry, Theresa's been like a mom and sister to you. Your story of how long she's been in your life is truly amazing. The why of what happened to her isn't able to be seen by imaging, but something obviously did. Has any new drugs been added to her drug profile since just before the fall? Has she had any added since the fall? Has her kidney function changed? I'm going to call...................
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She is so cute Mag!!
Chevy, I am so sorry to hear of your friend
Other than West coast family that I never hear from, not even during this current scenario, all my family has passed except my mom. So it's just her and I and she had 3 strokes March of 2014 and hasn't been the same since. (((HUGS)))0 -
Well, don't wanna, but may be getting into confusing the computer again.
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Here's my mom with her cockeyed bow and the picture of her dad. Christmas 2002. Miss her.
Chevy, I remember when what you're describing with Teresa happened to my mom, it was like the lights just went off.
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Chevy, sorry it's so painful to see our loved ones change. Hope she is pain free and happy in her own way for the rest of her life:)
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Sssssss! Yes... Even though Judy says she didn't have a stroke, it's SOMEthing that happened pretty fast..
Mags.... it's kind of LIKE that.... Sorry about your Mom.... I LOVE that little bow in her hair.... You know, we always want to "feel" pretty! And that did that for her....
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Simplicity, give this a read. http://www.medscape.com/viewarticle/813741. It's an evidence based article on topical steroids and radiation.
Miaderm has a couple of questionable substances in it. Since you are in active treatment you'd be better off using something that is as close to chemically free as possible.
Aloe is God's gift, but using it directly from the plant has the potential for contamination from the outer skin while applying the juice squezzed(sic) from it. But it has been used for centuries this way. I've done it too in a pinch. Initially when Ds walked into Sil's cigarette as a toddler, I grabbed some aloe from the house plant. Then I got a pure aloe product, I used it twice a day for a year. Can't see the spot. A similar burn on SIl's friends kid, the poor kiddo had several plastic surgeries. I had a whole skin care protocol for a particular ortho doc that I had lot's of his patients in homecare. Aloe was part of it. Great scars.
I looked at recommendations for skin care from Mayo, Sloan Kettering, University of Penn., and BCO's. They're is a wide divergence in care as well as some commonalities. I also talked with the regional burn unit in my old town. Just as I feared the recommendations could be improved by input from standard outpatient burn center. Physical therapists in a burn center do differently than PT's at large. Also, there's next to nothing that's evidence based. Looks like another project.
A friend on another thread looked up the ingredients for me. Something as simple as a fragrance. If fragrances are petroleum based, and petroleum is contraindicated for skin during rads, this chemical that is widely used, shouldn't be.
phenoxyethanol Hmmmmmmmmvery questionable chemical.
Not sure how much I can get into. Look at the other recommened products. Try and find something that is chemically free other than the goodie chemical you are trying to use.
AS usual I'm starting to get overbearing. So, no more comments here from me on this. If I decide to do a thread I'll let you know
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Mags, the likeness between father and daughter is striking. You certainly did justice to the sketch.
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((((HUGS)))) Chevy. I'll keep you and Theresa in my prayers.
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No no no Sas-You're not being over bearing at all. You're being educational! I'll look it over
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the silva dyne is for afterwards. I'm allergic to sulfa and didn't have a problem. Bestbird? Bluebird? Recommended a website with goats milk? Foggy brain. Overloaded with ins crap. Sorry.
But the good news is your skin will recover, amazingly enough. Did you know you can join the Livestrong program thru the Y? Free for cancer survivors. Keep up with the PT. Good luck!
And yes RO has final say. He's the expert.
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Okey dokey here are the other web site on skincare
http://cancernursing.org/forums/topic.asp?TopicID=44
http://www.breastcancer.org/treatment/radiation/skin/care
http://www.upmc.com/patients-visitors/education/cancer-radiation/Pages/radiation-breast.aspx
I think when you get done with these, you will likely agree that BCO's needs some work. But the BCO team is very open to suggestion.
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My question Chevster - does Theresa have a UTI? I have seen it happen frequently in hospice. First clue with a dementia patient is a change in behavior. I know it would have to be a catheterized specimen. Most times we just treated for it and watched for an improved behavior.
And I'm so sorry for whatever has happened to your dearest friend. Prayers here for her.
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Mags - I love your mom with her dad's picture. And yes very strong family resemblance.
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Ms. CHEVY, I am sorry for the pain and the fear of losing Ms. Theresa. Ms. Sas has a point. Find out if they had changed Ms. Theresa's meds recently. As we age, the liver becomes less efficient in metabolizing drugs and the kidneys also are slower in clearing them from the system. Could she possibly hit her head when she passed out? Hematoma can cause dementia-like symptoms. She is not diabetic, is she?
http://www.mayoclinic.org/diseases-conditions/deme...
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Chevy- I feel like I don't support you enough around your struggles with Theresa. Just about everyone in my Mom's side of the family has had a stroke. I have watched so many wonderful folks full of life chopped in an instant. My Mom had a stroke at 30 and then a couple of TIAs. Mom is just 76 and pretty much has checked out with dementia. It is so strange to see the person, listen to their voice and realize they are gone. The person you knew is no longer. Lovemy goats- so true about elderly folks and UTI's!! My Mom also went wonky, disoriented and shivering one afternoon a couple of years ago. My Brother had enough sense to take her to the ER where she was darn near septic with an untreated UTI and her sugars were so high they had to put her on an insulin drip! That was the end of metformin and the beginning of shots. She is like an unruly nasty toddler... refuses to control her eating, sneaks sweets... oy. Dementia with chronic health issues is the pits. It's so hard.
My DH is a soccer nut and our local team WON in over time! DD2 was watching on a Spanish TV station up at college and texted "that game was so stressful! I never get that stressed unless I have to give a speech!" Haha.. had to laugh. Like Father Like Daughter!! DH was so quiet I expected a loss, but I think he was stunned silent! Dazed and thrilled! The two of them have Timbers shirts and jackets and go to games.. wish I could give him season tickets but the wait list oy! Sold Out for forever. Soccer is nearly a cult.
Good night all. ((((Hugs))))) to any who need one.
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YES! Lilgoats! She DOES have a UTI! Judy just found out yesterday... They had been treating her with an anti-biotic since they took her to the rehab center! She didn't have any type of Dementia before she fell... Before last week!
Just complained of weakness and being so tired... but we still joked with each other... Even after the Dehydration episode, AND the blood-transfusion for "Anemia"......
But now she is completely different... Yes Loverly, they quit the pain-pills, and she doesn't seem to be in any pain now... She got a little miffed when I said "I'm so sorry you fell".... She said "I WISH EVERYONE WOULD QUIT SAYING I FELL! I DIDN'T FALL.... I TRIPPED!" I asked if she hurt something, and she said "NO".... But she COULD have hit her head....
At this point, I don't know how many tests they will do on her.... I'm thinking not many.... No...she is not diabetic, but "anemic".... or at least she was before the 2 pints of blood....
I just keep thinking she did have a stroke....OR...... I read that article...(thanks) and it just seems like a Subdural hematoma from the fall... she wouldn't know it though.... but she was un-conscious when they found her... I read the symptoms, and she has most of them....
I'm sure Steve & Judy know all this... She called and we talked a long time. Theresa didn't know that I had been there... It all just happened so suddenly.... but she IS better than when they took her in... at least physically.....
Rosie, thank you! You are soooo sweet.... but you know how it is.... we just have to muddle around in the middle of this, and try and figure out how we can help.... Yes.... The UTI probably has a lot to do with all of this. Don't know when or how this could have happened, but they are treating her for it.... You described Theresa exactly... One minute they are "there".... and the next minute..... "gone"....
Sass, thank you... You called when I needed someone the most.... It was good to hear a calming voice, and reassurance....
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Chevy: Just chiming in with a "Phew (for certain values of phew)--it's 'only' a UTI."
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Chevy, What's odd is the standard admission orders for almost any admission is a CBC(complete bloodwork), Chest xray, Cmet(Cmp)(chemistries), and an UA. An UA (urinalaysis)will show that and infection is present. That result is available within a few hours. Really shorter. A Culture and Sensitivity is done at the time of the completion of the UA. The culture result is available in 48 hours, the sensitivity to antibiotics is available in 24 hrs. How a UTI could go this long without a dx is beyond reasonable. Originally, I said something was a miss at the hospital. But there are three possible scenario's that would need to be tracked to determine if the chain of events were reasonable or if there was an error.
The only possibility is she was negative on admission to the acute hospital and an admission UA was done at the rehab facility. This is possible. Because of Medicare rules now, all facilities are doing certain things to protect the patient and themselves. Medicare will not pay if patients have certain problems that occur while a patient is hospitalized (rehab). Other things that Medicare will deny full admission payment for are hospital acquired infections, hospital acquired bedsores. Hmmm Have Judy check with the hospital re: the admission UA. If it was negative. Than it was a hospital acquired UTI. Also, have Judy check if the hospital UA was acquired by catheterization. If the UA was obtained from the catheter and the original specimen was negative than that further supports an hospital acquired infection.
If the mental status change is b/c of a UTI, you should start to see a change back to Theresa's normal mental status within 24-48 hours after being on a sensitive antibiotic. Takes a little while for the turnaround.
Another alternative thought is she was dx'd with a UTI in the acute hospital and the family not informed and she was placed on antibiotics in the acute hospital. But that would be an error of omission (screw-up) b/c Theresa's Healthcare Surrogate should have been informed of all abnormalities.
If timing flows like this: admitted to acute hospital on Friday UA abnormal after admission, placed on broad spectrum antibiotic while UC & S done>>shipped out on Monday. The UC&S would have been available on Monday. The UA could show that the original antibiotic wasn't sensitive. This is not an error. Important need to know info. The whole UC&S is done to determine what bacteria is present and sensitive
If the patient was shipped out on Monday before the test was completed. The docs would be notified. The rehab facility would have been notified Mon sometime. The admitting doc for the rehab may have been different than the hospital, they are notified of results by rehab staff. Theres's orders received for antibiotics might be received late mon or Tues morning. Antibiotic received at rehab sometime Tues or wed. First dose not given too Theresa until late Tues or Wed morning. Reasonable 24 hours minimum to first noticed mental status change would be Thursday(likely late). Friday(today) is the first day that a significant change would be noted. Yup, conceivably likely.
When patients are shuttled around facilities, different pharmacies, and different docs delays, regretfully, happen b/c so many things have to be accomplished. With rehab/ nursing home/ assisted living facilities don't have internal pharmacies. They're can be hours of delay time when drugs need to come from an outside facility.
The whole chain of events can be tracked.. There may not have had an error anywhere in the chain of events. But as you can see from the above they're three possible scenario's for one UTI.
Hugs sweetie,
Glad we were able to talk Chevy when we did. More Hugs sassy0 -
Sending long distance hugs Chevy. I've seen the impact of UTI in these circumstances and was going to mention it but as always, the lovely Owlettes are onto it. I hope you and Theresa get an opportunity to make some more good memories for each other.
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In each hospital and tertiary(rehab/nursing home facility), there are a group of people that never come in contact with real patients. The departments are usually called Utilization Review. They are usually staffed with RN's that review the charts. They do the same type of tracking that I did on Theresa's UA, but the whole chart is done. Everything from the moment the patient is taken into the ER till discharge should follow a logical sequence by what is documented on the chart. Experienced people can identify if the flow was usual an reasonable, or they're were errors and omissions.
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Hopefully, her mental status will improve as the antibiotic is doing its job. Yes, just as Jacfin stated-wishing you many more quality times with Ms. Theresa. I don't think it's uncommon to get a UTI with dehydration.
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Yes, thanks gals.... Judy only said she knew about the UTI yesterday.... And they probably did all the blood-work, and the tests in the Hospital, and before going to rehab... They wouldn't have done it Tuesday, because that's when she was admitted to rehab... She probably had been treated for it while in the hospital....
Steve... Theresa's Son, might know more than Judy does, because they seem to pass each other coming and going.... So in other words, I'll bet she HAS been treated for the UTI longer than just a few days...
I'm only her "friend".... Judy seems to be her advocate, nurse, doctor, attorney, AND her mouth-piece... Ha! She would just "chill" if anyone else mentioned something she hadn't thought of..... She takes care of Theresa, like she is her nuisance child.... very protective and domineering... She told Theresa "You feed yourself.... I know you can do it." And I know that Theresa loves to be waited on.... So they seem to be going on a path that is comfortable for all of them....
I told my DH that I'd rather go see her when she is back at Assisted Living, if she ever gets well enough to go back there.... I would rather wait until she at least knows me ..... it was really a shock to see her like this.... and maybe she WILL get better.... So right now I know she is in good hands.... and okay in her own mind.... even if she adds other people now and then.....
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Chevy, the same thing happened to my uncle, and once the UTI was cleared up, he was much better. Crossing fingers that this is the root of Miss Theresa's issue.
Been super busy, catch up with you guys later tonight!
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Hi Back in from dinner. A dear friend and I went to a place in the town north of me. Sat with two gals in the waiting patio. Then asked them to join us for dinner. They were way down on the list. We had a great visit had many people in common. The one gal would have never made her card game. She was so funny.
Hi Loverly and cubbie---and ALL. BBL
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More to come later. Happy Halloween
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