Merry Christmas from the Coburns 2012

 Merry Christmas from the Coburns 2012

MOST

Cheryl and I went to a care planning meeting about Rick at the nursing home this morning. It was mainly to complete the advanced care directive called MOST (Medical Orders for Scope of Treatment). It is just a more detailed ‘Do Not Resuscitate’ form. The following are the directives we chose.

• ·       Comfort Measures” Keep clean, warm and dry. Use medication by any rout, positioning, wound care and other measures to relieve pain and suffering. Use oxygen, suction and manual treatment of airway obstruction as needed for comfort. Do not transfer to hospital unless comfort needs cannot be met in current location.
• ·       Determine use or limitation of antibiotics when infection occurs.
• ·       IV fluids for a defined trial period
• ·       No feeding tube

They said that his disease is progressing and each time he gets sick, like with pneumonia, he more than likely will not return to his pre-sick condition. Just like with his last bout of pneumonia. They said that it is not ‘if’ he gets pneumonia again, it is ‘when’.

They did a swallow test this morning at High Point Regional Hospital. It showed that he is having ‘silent aspiration’ when he drinks thin liquids. They recommend he be on nectar thick liquids, pureed meats and mechanically soft sides. If we want to give him regular foods, we have to sign a form saying that we know the recommendations and are refusing to cooperate and adhere to the diet and take responsibility for any adverse affects that might happen.

Then they recommended he be referred to Hospice. I asked if they thought he was ready for that now and, without hesitation, they said yes. So we will be hearing from Hospice shortly to get him enrolled. 

I just got a call from United Hospice and our initial visit is Thursday morning, July 12. 

Update continued

This morning when I went to see Rick, Leslie already had him up on the toilet and he had peed. He ate all of his food. They haven’t had any thickened juice so I’ve had to go ask for regular juice for him the last 2 days. He drank all of his prune juice and orange juice. I tried to give him the thickened milk (or whatever it was – maybe Mighty Shake) and he didn’t swallow it. He would hold it in his mouth. He walked well this morning from the bedroom to the dining room without any difficulty. Standing up straight and looking at people in passing.

The sore on his right arm is a hard knot today. I’m not sure what it is. While we were eating the lab tech came in saying she had to draw his blood for a CBC and blood cultures. I spoke to Angelica, who said that she noticed the knot yesterday and told the doctor about it. The doctor ordered the culture. It seems that I’m the last one to know what is happening, when I should be the first one to know. But then I’m glad they are checking into it.  (Angelica said “I’m glad you are here. Otherwise I was going to have to call you today to tell you about this.”)

Update

Rick is no longer in the merry walker. He has fallen in it twice. The first time was the CNA’s fault. She was pushing him in it like a wheelchair and the seat broke and he fell. The second time, 062112, he was leaning over the front of it and his weight was too much for the walker and it tipped over. He fell and knocked out his right front tooth, root and all. I took him to the dentist, who said we have to wait until the gum heals up before we can do anything to fix it. So Rick is now snaggle – toothed. We have an app’t to get it fixed on 071212. 

The night shift is supposed to be getting Rick up before they leave to bath and dress him. It doesn’t seem to be working very well. Some mornings he is in the bed with a hospital gown on, sometimes with his clothes on, sometimes dry, sometimes wet. Most of the time I have to wash him again and redress him.

This morning when I went in, he was in the bed, lying on the sheet with a protector under him. He had a hospital gown on and a diaper. The diaper was dry but the hospital gown was wet. When I went back to the bed to see what was going on, the protector was laying on top of a wet spot. The problem being that it wasn’t covering the entire wet spot and Rick had been laying in it long enough to soak the hospital gown. It wasn’t that he had wet the bed after he was washed up. They put him back in the wet bed and he laid in it. Therefore I had to wash him again and dress him. 

It worked much better when day shift was getting him up. 

Today, he has a sore on his right arm on the inside of his elbow. I took a picture of it.

Merry Walker

Rick continues to have a low grade fever from time to time. Saturday, 060212, I noticed a sore on his lower abdomen just above the hairline. It is about the size of my little finger pad and has a hard core. I have asked the doctor to look at it, and they said it was an ingrown hair. I’m not sure about that. But they are going to start him on Onmicef 300 mg qid x 7 days today. But I got to wondering if it could be MRSA. So they are going to check for that before starting the antibiotic.

He is up and down with his awareness. When he has a fever it is worse. They have put him in the merry walker, which seems to be good for him. It keeps him from falling as much. He does get his feet tangled up a lot.

  He is forgetting to swallow a lot. He gets food in his mouth and just holds it there, especially if he gets too much in there. Then he can’t figure out how to swallow. This has been worse ever since his pneumonia.

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!