Dr. O made a house-call to mom’s apartment on the 26th. If I haven’t expressed my appreciation adequately for Dr. O, let me take a moment… This is palliative care practitioner who kept my mama as a patient when our university hospital defunded his in-place program. He now works mainly in the hospital, and keeps certain Fridays for clinical visits. He had to cancel our clinic visit due to illness, and made a house call rather than ask me to bring mom to him, even though that’s not part of his practice protocol any longer. Bringing mom to Dr. O would have been a nightmare for both me and her. I am SOOOOO thankful for Dr. O’s care and consideration.
When I arrived at mom’s apartment, she was busy at an activity. I scooped the cat box, again, and then went to collect her. She, as predicted, had forgotten our conversation the night before about her appointment. S’ok. I almost giggled when she said, “I must not have written it down. That’s not like me!” We made our way to her apartment, and within a couple of minutes Dr. O arrived.
He asked her how things were going, to which she answered, “Just fine.” He went down the list of usual questions, and when she answered that she hadn’t had any falls, I filled him in on the two falls I knew about, including the one where EMS was called. Her illness has gotten to a point where she’s not combative about me correcting reality to another person. In part it’s because from 10-feet away, she can’t hear/understand me, but it’s also because she’s sort of zoning out. Dr. O’s chart notes made reference to mom being completely unable to participate in her own care, and that I had to answer all questions.
Mom dozed off in the middle of her appointment. I was looking outside, when Dr. O caught my attention, and pointed to mom snoozing while sitting upright on the couch. He found this notable, and it gave us a moment to ‘pass notes’ on my phone. This is how I told him about the tremor, and used her sudden inability to care for Elvis’ litter box as a marker to her sharp and rapid decrease in stability and mobility. He said there was every possibility the mobility issue was global (caused by her Alzheimer’s), and that, “Thing are generally OK until they’re not.” So very logical, and so hard to take in.
The possible causes of mom’s current problems are:
- The tremor could be caused by low thyroid. Her last test in July showed normal, but at the very low end of the normal scale. She has gained weight since. The chart notes also said Parkinson’s could not be ruled out.
- Lower extremity swelling may be caused by heart issues though her heart sounded good.
- Dr. O wasn’t terribly worried about the swelling in mom’s forearms, wrists and fingers. And, it’s somewhat diminished from what it was.
- Mobility has been hampered by her right knee for a while, and it’s hard to say why there’s been such a precipitous drop in her ability to ambulate. I take her to the sports medicine clinic on Friday to assess whether cortisone injections might help.
Mom’s blood pressure was lower than Dr. O wants it, 112/67, especially given that she’s fallen a couple of times. He’s taking her off of one of her BP meds. The community will take her BP each morning for the next week to make sure it’s stable.
Someone will come to do a blood draw and take a chest x-ray in the next week. The x-ray will let Dr. O know if there’s fluid accumulation around mom’s heart or enlargement of the heart. Labs will let us know about all sorts of things, thyroid in particular, which would be an easy solution for the tremor.
Each step down the path is expected and dreaded all at the same time. I am never ready for the longer hops and leaps mom takes now and then.
This is palliative care for a person who already has a life-limiting disease. We won’t go digging too deep for answers or cures for scarier diagnoses. That doesn’t equal quality of life for my mama.