Pneumonia Free!!!

I was told yesterday that Rick’s chest xray showed he is clear of pneumonia. Praise the Lord! This bout of sickness, though, seems to have knocked him down a little. He isn’t eating as easily. He seems to forget to swallow at times. He is still on pureed food and nectar thickened liquids. He lost about 4 pounds during this time and hasn’t gained it back yet. It seems to be easy to lose the weight but difficult to gain it back. Too bad I don’t have that problem.  He is much more unstable on his feet. He gets his feet crossed and can’t figure out how to untangle them. He doesn’t pick his feet up very much and therefore trips on anything in the way. They found him on the floor in his room between the two beds. There is an elevated cushioned mat there that he tripped on. He wasn’t hurt, anyway, since it was cushioned. He isn’t controlling his bowels and bladder as well now. Of course, he wasn’t able to get himself to the bathroom before, but now it seems that he isn’t noticing when he needs to go. He has just gotten used to doing it in his pants. Sunday, I picked him up at the nursing home at 8:30 am to take him to church. He had just voided in the toilet, so I thought he was good to go. When we got to church we walked across the back of the sanctuary, thru the foyer, back to the Sunday School room. We were the first to get there. I was getting ready to sit him down in the chair. I smelled something. I felt the back of his pants and, sure enough, he had a big glob there. I took him to the bathroom and sat him down on the toilet. I said, "Rick, I don't even know where to start!" I tried hard to get his clothes off so not to get them dirty, but no such luck. It was a mess. All down his legs. I was thankful that Cheryl had not gotten to the church yet. I called her and asked her to go to the house to get clean clothes for him. Otherwise I didn’t have anything for him to put back on. She soon came with more clothes and wash cloth and towel. She stayed with me holding him up while I cleaned him up. What an ordeal. He has always been good about letting me know when he has to go. He would get squirmy or something. But he didn’t give me any indication this time. I think those days are leaving us fast. Between the pneumonia and the staff at the home not paying attention, he has just gotten used to going in his pants. Of course, he just completed 10 days of antibiotics and they always cause him to have very soft stools. From now on I will have a change of clothes in the car for him whenever he is out with me. I won’t be caught off guard again.

The Prayer of Faith

I came back after work to see Rick and feed him. He was eating with the speech therapist. He was doing well. He got a little fidgety and I wondered if he needed to go to the bathroom, so we left in the middle of eating. It was a pretty long walk back to his room to go to the bathroom. Then we went back and he finished all of his supper and 2 glasses of drink. He started holding it in his mouth and not swallowing. So we decided he had had enough. We went back to his room.

I helped Rick lay down on the bed to rest for a little while. I had asked Pastor on Sunday if the elders of the church could come pray for Rick according to James 5:14-15, “Is any sick among you? Let him call for the elders of the church and let them pray over him, anointing him with oil in the name of the Lord: And the prayer of faith shall save the sick, and the Lord shall raise him up; and if he have committed sins, they shall be forgiven him.” I wish you could have seen Rick’s face when he saw the men from the church come in to pray for him. He just lit up and smiled and chuckled. I felt he was almost ready to cry. You could tell he knew who they were, whether mentally or spiritually or both. The men prayed for him and he stood right there and let them. There was a word spoken from the Lord over Rick. “Rick, you are my son. I love you. I have not forgotten you. I am with you and will never leave you or forsake you. No one will take you out of my hand.” Jack Chandler said, “I knew it wasn’t meant to register in his mind but in his spirit.”

I am so appreciative of these men who took time to come pray with Rick and anoint him with oil. Pastor Byerly, Jeremy Fisher, Dan Alwine, Gerald Proctor, Ken Spencer, Patrick Glover, Jack Chandler. Seven – the perfect number, the number of completion and perfection. Thank you from the depths of my heart!

Day 5

Rick is improving! Praise the Lord! Yesterday morning, he ate his breakfast well. He was alert, no fever. Last evening when I got there he was restless in the bed. I got him up to the bathroom. He was already wet but also voided in the toilet. I had him stand up so that I could wash him up a little bit. He did well for that. He was rather unstable on his feet, so I put him back in the bed when we were through. He ate all of his supper and drank all of his liquids. Occasionally, he would choke a little on it, but on the whole he did very well. He was sleeping when I got there this morning. But he woke up alert. We went into the bathroom and I set him on the toilet. I went out to fix his bed and after a little while he got up of his own accord and walked out into the room. I washed him up and dressed him and walked him down the hall to the dining room to feed him his breakfast. He is still unsteady on his feet. He leans away from me while I’m holding him. So if I let go he would fall. He ate well while I was there. I felt he might do better if he was sitting up at the table instead of laying back in his bed. And I believe that was the case. I only had 15 minutes left to feed him after getting him washed and dressed, so the CNA had to finish him up. I plan to go back for supper tonight. I think he is on the uphill climb now. I am so thankful to God for his healing. The pastor and elders from our church are going to come over tonight to anoint him with oil and pray for him. Thank you all for your prayers!

Not so good today

Well, Rick doesn’t seem to be doing as well today. I went in to feed him for breakfast. He still needed to be reminded to swallow and sometimes would choke on it. I noticed that he would grimace some when swallowing, like maybe his throat hurt. I didn’t pay too much attention to it. Tonight when I was there for supper, he ate 75% of his pureed food, drank 8 oz of thickened orange juice and some of his thickened tea. But with each bite he grimaced when he swallowed. And sometimes he would grimace with the food being in his mouth. I had to remind him to swallow. He did better with the liquids. I couldn’t figure out why his throat was hurting him. Then I remembered that antibiotics can cause yeast infections. Candida, or thrush, is a yeast infection of the mouth that can be very painful. So when he finished eating I looked into his mouth. Sure enough, there was white stuff on his tongue. I shared this with the nurse, Elaine, who was on tonight. She just nodded her head and said she would check it again when she did his breathing treatment. Another thing… His skin felt hot again. I asked what his temperature was and they said it was normal. So I asked for a thermometer so I could take it. It was 99.9 axilary which is 100.9. I can’t figure out why his temperature would be back up. He was warm this morning too, but since they said his temperature was normal I didn’t go any further. I told Elaine about this too. She said that if he was still bad in the morning she would call the doctor. When I got home tonight, I saw my neighbor, Donna, out in her yard. I went over to talk to her. She is a registered nurse who works with this kind of thing regularly. She felt that the doctor should be notified right away about the thrush, and get it taken care of before it gets worse. So I called Heritage to talk with Elaine. She had already left. I asked to speak with the nurse who was on. It is Angelica. She gave the message back to me that she would call me back when she got through passing out medications. I felt a little put off by this. When she called me she said Rick was fine. I told her his temperature was elevated and that I thought he had thrush. She said this wasn’t reported to her at the change of shifts. And when they took Rick’s temperature it was normal. I told her that I felt something should be done about the thrush as soon as possible. She said she would evaluate him when she was giving his breathing treatment. I asked that she call me back when she completes the evaluation. She said she would. I’ve been saying that I have felt they have been taking good care of Rick during this illness. But I’m not too pleased with today’s responses. 9:30 pm Angelica called me back. She said she didn’t see any white on his tongue. She said he was sleeping well now and doing ok. So I guess we will wait until tomorrow to see if anything else needs to be done.

Improving

Praise the Lord! Rick was much improved when I went to see him this morning. He was awake and alert. He smiled at me when I spoke to him. Of course, the CNA was bathing him so that had him awake. But he ate a good part of his breakfast and drank some of his fluids. He is still getting the IV fluids. I was very glad to see him better. He still had to be reminded to swallow his food. I hope this will get back to normal as he continues to get better.

Secnod day of pneumonia. Much improved!

Eating breakfast. Still have to remind him to swallow.

I tried to get him to smile. This is the best he could come up with. :)

Pneumonia (cont)

I went to see Rick this morning. He really looked sick. I prayed with him and then decided to try to get him to eat a little bit. He was lying on his side in the bed and even when I rolled the head up it was still hard to get the food in his mouth and especially his liquids. So I asked for a feeding syringe. This really helped me get some fluids in him. He drank his prune juice and his Mighty Shake, 4 oz each. The nursing supervisor, Tracy, came in saying they decided to stop the Leviquin and put him on Rocephin 1 gram IM daily for 3 days, Augmentin 875 mg bid x 10 days. The Rocephin should kick in and start bringing down the infection. They are going to do a Depakote (seizure med) level today to be sure his seizures are being controlled. They are going to monitor his intake and output. Draw blood for a CBC and BMP tomorrow morning. She decided to put him on ‘honey thick’ liquids to help him swallow easier and get a speech therapy evaluation this afternoon. This will evaluate his swallowing. Rick’s temperature is 100.8 so Tracy gave him a Tylenol suppository. I was able to get some more liquids in him after she brought the thickened juice. I still used the syringe to put it in his mouth. But now he was sleeping more than he was awake and he wasn’t swallowing very well. I didn’t want him to aspirate more into his lungs. So I stopped. It was time for the quarterly care plan meeting that we had already had scheduled. Cheryl decided to come over for that. I was glad she was there. It was a little emotional for her because they spelled out the prognosis of Alzheimer ’s disease to her. It isn’t fun to hear and think about. After about an hour, we went back to see Rick. He was still sleeping. I tried to give him some more juice, but he wasn’t awake enough to swallow much. We finally left. Early afternoon, Tracy called me saying that Rick seemed more alert but his temperature is still 100.8. She was going to give him more Tylenol. The speech therapist, Valerie, had seen him and felt he wasn’t swallowing well at this time. So they suggested they put in an IV to be sure he remains hydrated. Or they could send him to the hospital. States his WBC is high and wants to be sure he is cared for. I decided I would like to give the antibiotics the rest of today and tomorrow morning, to see what they will do. If he isn’t better by then, then maybe he should go to the hospital. So that is the way we left it. I got a call from Valerie, the speech therapist. She said she was going to keep him on pureed foods and only increase the thickness of his liquids to nectar thick, not honey thick. She said she would be doing some ‘thermal stimulation’ in his mouth. This is using frozen lemon glycerin swabs to touch certain areas in his mouth to stimulate swallowing. She said she put down that she would work with him for 12 weeks. She didn’t think she would need to work with him that long, but just wanted to give the insurance companies a heads up. About 4 pm I got a call from Angelica, nurse at Heritage, saying that Rick is starting to come around. He pulled out the IV and bled all over his sheets. Oh, great! Now I have to try to get blood stain out of his sheets. And wouldn’t you know he had the light colored ones on!  She restarted the IV and really taped it up good so that he won’t be so apt to pull it out. She said he was smiling and trying to respond to questions. So Praise the Lord! The antibiotics and IV fluids seem to be helping. I’m planning to go over there tonight after I get off work at 8 pm to check on him. Then I will go back in the morning. Thank you, everyone, for your prayers! Prayer works!

Pneumonia

So I didn’t hear anything from either doctor all day today. During church tonight, I got a call from Jennifer, the nursing supervisor, saying the x-ray they did today showed Rick has right lower lobe pneumonia. She said they haven’t gotten the blood work results back yet. She asked Pascal how Rick did today. He said he ate less that 50% of his food, drank 500 cc of fluids and took his medications tonight. When the nursing home doctor got the x-ray results, she started him on Levoquin 500 mg qd x 10 day, Duonebs (a nebulizer) qid x 10 days, and Robitussin 15 ml qid x 10 days. Hopefully we caught this pneumonia early and started treatment quickly and he will get over it quickly. I spoke with Allison Ellis at church tonight. She is a nurse practitioner who works as a hospitalist at Cone in Greensboro. She said that an infection like pneumonia could cause seizures, or the seizure he had could have caused an aspiration causing the pneumonia. She also said that his weight gain (he has gained back the weight he initially lost when he moved into the nursing home) could have caused the seizure medications to not be effective and need adjusting, thus bringing on a seizure. This has helped me to understand a little better what is happening to Rick. We had just had prayer for Rick in church tonight because he wasn’t doing well. I am so thankful for my church family. I know their prayers are what is holding Rick and me up. What a blessing they are!

Medication Changes

Rick started his new liquid Depakote yesterday morning. He had it morning and evening. Last night I got a call from Pascal, nurse at Heritage, saying Rick was running a fever of 100.2. He gave him some Tylenol and the next time they took it, it was normal. This morning when I went to see him, he was still in the bed. He was drooling and looked bleary – eyed. He was very unstable on his feet. He had wet in the bed. I got him up, washed and dressed him. We took his temperature because his skin felt hot. It was 98.4 axillary, which means 99.4, a low grade fever. He was very unstable on his feet the whole time. He lost his balance once and almost fell. Then I took him to the dining room for breakfast. He kept his eyes closed a lot. I fed him a few bites but he wasn’t eating very well. He would hold the food in his mouth a long time before swallowing it. Then Angelica came in with his medicine. She gave him the liquid Depakote first. He didn’t swallow it and it drooled out of his mouth. She gave him his other meds crushed in pudding. He didn’t swallow it, either, and he let it run out of his mouth. It kept running out and running out. It seemed like more than we had put in. So he didn’t get either his Depakote or his Keppra this morning. I took him back to his room and put him to bed. I asked that they have the nursing home doctor look at him. I told them that I would be contacting Dr Boggs this morning. On my way home, I called and spoke with Jill, Dr. Boggs’ nurse. I told her all this that was happening. She will contact Dr Boggs and get back with me.

Seizures

Rick had a seizure last month, the Monday after Easter. I was in PA visiting Tamara and family. Cheryl went to be with him in the emergency room all day. I really appreciate her taking her time to sit with him. His Depakote blood levels were low so they gave him some IV. They found he had a UTI and put him on an antibiotic. They also increased his daily Depakote to 5 sprinkle caps twice a day (he had been on 4 bid). So we thought he should be free of seizures for awhile. Well, it wasn’t long before I started noticing him having what I call seizure like episodes in the morning. He would be very jerky, his knees giving way with him. We would have to sit him down and let him rest awhile. This probably happened 4-5 times. It is very disconcerting. Then yesterday afternoon he had another seizure. The nurse called me saying his pupils were unequal and he couldn’t get Rick to respond to him. He said he was sitting on the floor and sleeping heavily. I asked him if he was snoring deeply and he said he was. I told him that was a seizure. Before I could get back to the nursing home when they first called, they had sent him to the emergency room again. I need to get them to realize that he doesn’t need to go to the ER every time he has a seizure. Anyway, I left work at 4 pm yesterday to go be with him. By the time I got there he was pretty alert. Normally he is sleepy for 3-4 hrs after a seizure. The church was praying for him and I strongly believe that it was their prayers that helped him get over it so soon. We left the hospital about 7:30 pm and went over to the church. Everyone was glad to see that he was better. He smiled and enjoyed everyone talking to him. I decided to keep him home last night, because he had a regularly scheduled appointment with his neurologist today. He slept all night. I woke up about 4 am and decided to take him to the bathroom. Then he went back to sleep and slept until I got him up in the morning. I enjoyed having him home overnight. But he is having more and more trouble maneuvering the stairs. It wouldn’t be good to have him here all the time, since there is no way to get into my house except for stairs, and there are stairs from the main level up to the bedrooms. I forgot about his medications when I decided to keep him overnight. It wasn’t until breakfast this morning that I remembered them. I scrounged through my medicine cabinet and found some old Depakote that is not the sprinkles. It is the extended release and is not supposed to be chewed. So I gave him one of those. I believe he actually swallowed it instead of chewing it. That was a miracle. The doctor is going to try him on some liquid Depakote so that we can increase the dosage without it being so many capsules that have to be sprinkled on his food. But she said that the liquid can cause stomach irritation. So we are going to do a 7 day trial of it to see if he can tolerate it. I have to go pick it up from the pharmacy yet. Rick is still a pretty happy man. He smiles at everyone if they can get his attention. He stops to talk to everyone he walks by. He enjoys going to church where he can see all his friends. And they all love him. I am so blessed to have such an easy patient to care for. Thank you Lord!