Suzanne

May 292012
 

Elderly Parents and Their Doctor: How to have a more effective visit:

1. Leave your cell phone in your vehicle. You do not need it in the doctor’s office. The people in the waiting room do not want to hear your conversation. And please do not be one of those people who will answer their phone while the nurse is getting your blood pressure or the doctor is trying to talk with you and/or your parent.

2. Write down your question’s and concern’s ahead of time. Do not rely on your memory. Do not be afraid to ask your questions even if the doctor seems to be in a hurry. You might also ask the nurse some questions. If he or she can not answer them, they will tell you to ask the doctor but chances are they can answer some of them.

3. Tell the nurse and the doctor all the concerns you have at the start of the visit. (Again, write them down.) Different symptoms may be related or not. By knowing all your problems the doctor can prioritize.

4. If your doctor ask you how you are doing the proper response is not, “You tell me.” No one knows how you feel but you. It is up to you to tell the doctor how you feel. In the case of a parent who can’t communicate, it is up to you to tell the doctor how they are doing. You are with them every day, you notice any changes.

5. Describe your symptoms clearly using descriptive words even if you think it sounds weird. How long have you or your parent had this symptom? How severe is it? Does it interfere with your ability to eat, sleep, work, or perform any normal activities?

6. If you have expectations, state them up front also. Sometimes you may be right on target, other times you may need some education.

7. Tell the truth. If your elderly parent drinks two six-packs of beer every night, or uses illegal drugs, these are a few of the health risks their doctor needs to know about. If do not feel you can trust their doctor with this information, find a doctor you do trust.

8. Bring all medications and supplements, or a list of them, to each doctor visit. Bring the ones actually being taken and remember those that are only as needed (or prn in medspeak). If the doctor prescribed a medication and you stopped giving it, let him know. (Actually, you should have called him first to before stopping the medicine). For instance if you stopped taking potassium because it was burning your stomach, the doctor may need to change you blood pressure medication.

9. Make sure you doctor knows every doctor your parent is seeing. This enables them to share test results and treatment plans, prevents duplicate or conflicting medication prescriptions as well as duplicate tests.

10. Bring a record of your parent’s medical history and any medical records you may have such as test results or images from scans or x-rays. (I don’t get copies of all my mother’s labs and tests unless something is really weird. But if we are going to a specialist, even though her doctor’s office will fax the information, I get a copy.)

11. Don’t be afraid to disagree with your doctor. If they are recommending a medication and you do not want to take it, tell him and tell him why. If the medication is too expensive there maybe less expensive alternatives. If you think your parent needs to see a specialist, say so.

12. Do what the doctor tells you to do, take the medication he tells you to take! There is nothing more frustrating than the person who keeps coming to the doctor with numerous complaints but will not take their medication because they do not like to take pills. Why are you wasting their time and your money?

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May 282012
 

I sat on the front porch yesterday as the sun was going down and the trees cast long shadows on the ground. There was a breeze blowing the leaves creating a rustle as if someone were passing through. The birds were chirping, heralding the ending of the day as the crickets and frogs joined in.

There was contentment in moment as I felt you sitting beside me once again. We were back on that Georgia mountain you loved so well, sitting on the front porch watching the firefly’s come out as the Bob White’s called out and sad sound of the whip-poor-will answered back.

Your eyes were twinkling as you told a story as only you could, with your unique expressions that were always so descriptive. Memories of conversations and dulcimer playing arise, happier times, when life was simpler.

Memorial day is a day we set aside to remember those who have given their lives for our country. This year, I can not help but remember those who, like you, stayed home and made sure they had a country to come home to.

You raised two daughters while Grandaddy served in the Navy during WWII. Your stories of how you and your sister Sybil got by made it sound more like an adventure than a struggle. Then again, you almost always found a silver lining and turned it into gold.

Ever the lady, you got courtesy and respect wherever you went. Your warmth and genuine interest in people gained you many friends. Sadly you outlived all your siblings and friends, making your last few years lonelier than they should have been.

But you kept going, kept finding a reason to get up every morning. You always had something you wanted to do around the house or something new to make or a new recipe to try. You never gave up. Death had to sneak up on you in your sleep because that was the only way to catch you.

I thought it might get easier after the funeral, that the pain of loss would ease a bit. But at odd moments memories kept surfacing. I could get nothing done.

I gave up and went outside, called by memories I could not stop. I sat down in the rocking chair and within moments I knew you were there. You drew me down the path of memories then we returned to the present and I finally understood.

I could be with you again anytime, for you would be with me on any porch I ever sit on. And if I listen closely, I can hear you laughing as you tell another story.

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May 252012
 

“Nothing has any taste anymore. Not even ice cream, if you can believe that!” Granny is 92 years old and that is also what she weighs, which is not enough. My granny and I share a love of ice cream, especially Blue Bell Homemade Vanilla! So when she told me yesterday that not even ice cream had any taste, I knew things were serious!

Like many people as they age, my grandmother is losing her sense of taste. For some, the sense of smell also declines decreasing their ability to taste. Granny also has macular degeneration, which is slowly causing her to go blind, so she has a hard time even seeing her food. Living alone, she often feels like cooking is too much effort, especially a few weeks ago when she was temporarily using a walker.

Having given up driving over the last year, she still has not adjusted to having to ask others to take her to the store or go for her. Many of our elders also have dental problems that make eating difficult, dementia which causes them to forget to eat, and depression which can lower the appetite. I have had more than one elderly person tell me they could afford medications or food but not both.

What can a caregiver do when their parents are not eating enough?

Make sure they have food. Actually look in the pantry, refrigerator and freezer. Many elderly parents are too proud to tell their children they do not have enough money for food. Or they do not want to bother you, so if you do not ask them if they need anything from the store, they will just do without.

If they live alone, are they able to cook? There might be assistive devices that they can use to make cooking easier, such as a walker with a seat so they can sit down as needed. If cooking is still too hard for them, it might be time to look into Meals On Wheels in your community. Also, when you cook, make extra and take to them.

Socializing while eating is a large part of the American culture and many of our senior citizens are missing this interaction. They are eating meals in front of the television, the local news keeping them company for their meal. Call your elderly parent and ask them what they had for lunch or supper. It reinforces the need to eat without nagging, serves as a reminder to eat and anticipating you are asking when you call may actually motivate them to eat. So try to have a meal with them as often as you can.

Also, have a medical evaluation. There could be a medical reason your parent is not eating. It could be depression or a digestion problem. There are also medications available that help to stimulate the appetite.

Those are the easy problems to fix. The lack of taste is a bit harder. Here are a few suggestions:

Serving

Put less food on the plate. A large amount of food can be overwhelming to someone who already is not really hungry.

Serve only one or two foods. Fewer choices may be less intimidating.

Make the food as attractive as possible. Even when she is eating alone my granny puts out a placemat, cloth napkin and coaster on her dining room table. “There’s no sense in losing your civility,” she quipped when I teased her about it.

Serve small snacks between meals such as cheese and fruit, crackers and peanut butter, or half a sandwich on a small attractive plate.

If using replacement shakes put them in a glass rather than serve them from the bottle or can.

Specifically adapted utensils, plates, mats and cups may make self-feeding easier and promote greater intake.

Flavor

Add extra herbs and spices to enhance the flavor.

Ask them what foods that can taste. In the same conversation where she complained about not eating, granny mentioned that she hoped my aunt would bring her some desert from the church function she was at and mentioned making a pitcher of sweet tea. Ah, ha! She still tastes sugar. My grandma had more of a taste for salt. Using sweeteners such as Fructevia sprinkled lightly on foods might enhance the tastes. Instead of regular salt, try using small amounts of Sea Salt which tends to have a stronger taste.

Timing

Allow plenty of time to eat. Lingering at the table, talking and snacking may increase intake.

What is traditionally the time they eat the biggest meal? For my grandma it was lunch, with granny it is supper. Plan the main meal at their traditional time.

Have afternoon tea and a snack

Food

Let them eat what they want. Seriously. You have to start somewhere. Certainly if they have dietary restrictions you may have to limit some of their choices but you can talk with a dietician to help you. Or ask their doctor about bending the restrictions a little.

Serve their favorite foods

Nutritional shakes such as Boost, Ensure or Glucerna for diabetics can be used as meal replacement or between meal snacks.

Adding Nutrition to Shakes

If your elderly parent needs more calories and nutrition you can supplement commercial shakes by adding an extra scoop or two of protein powder and mixing it in the blender with ice cream and syrup or honey.

Add fruit and frozen yogurt to commercial shakes, along with protein powder.

Add different flavored extracts to enhance the taste.

Peanut butter or other nut butters can be added to shakes.

Powdered milk added to shakes will increase calories and protein without increasing fat.

For added carbohydrates add some Polycose Powder to shakes and foods such as mashed potatoes, cottage cheese, yogurt, oatmeal, cereals and soups. It is tasteless and odorless.

And finally, do not nag. Gentle reminders are okay but avoid making mealtimes into a fight-time.

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May 242012
 

Elderly are more susceptible to infections than most people and as a result often end up on antibiotics. While all medications have the potential to cause reactions, antibiotics seem to be the culprits more often than most.

The trouble is we do not know how you will react until you take the medication. While the list of possible side effects for all antibiotics are often long, there are five that are most commonly seen: nausea, vomiting, diarrhea, rash, and secondary yeast infection.

The problem for your elderly parents is they are more susceptible to yeast infections than younger people. Prevent the yeast infection by eating yogurt or drinking buttermilk every day or taking probiotics works sometimes. If that does not work, there are over the counter preparations ladies can try. Read the package instructions and follow them. If those do not work, have the doctor prescribe Diflucan. Usually, but not always, one pill will take care of the problem. So if you know that Sulfa gives mama a bad yeast infection go ahead and ask the doctor to order something for her. Or she may choose to order a different antibiotic.

But what about your father? He can get a yeast infection too. Yeast infections can occur in your mouth and are quite painful. When yeast infections occur in the mouth it usually called thrush. Thrush is associated with babies but people who wear dentures, are on long-term steroid therapy or have a weakened immune system have a harder time fighting it off. There are prescription medications available to relieve the discomfort and treat the yeast.

If your parent experiences any of the other common side effects, nausea, vomiting and diarrhea, depending on the severity and the antibiotic, the physician may decide to treat the symptoms and continue the antibiotic. Always check with your doctor before stopping a medication unless the reaction is severe.

If your parent has any trouble breathing or starts to swell, especially in the face, give them some Benadryl if they can swallow and call 911. They could be going into anaphylactic shock and every second counts.

While a reaction can occur at any time, usually the chances are greatest after the second dose of medication. Stay nearby for the first hour after giving a new medication for the first couple of doses.

Please do not ever give your elderly parent leftover antibiotics unless their doctor has given you instructions that it is okay because of a chronic, ongoing infection. Some medications and antibiotics do not play well together. Antibiotics are often specific to what classification or type of organism they treat. Cultures are done to determine what exactly will kill off the bacteria. Giving a person an antibiotic that is not strong enough to kill the infectious organism can lead to a more virulent drug-resistant strain.

Some antibiotics have to be monitored via blood work to ensure they are at therapeutic levels without being toxic. These types of antibiotics are usually given IV and can often be given at home. IV antibiotics get into the blood stream immediately and go to work faster. IV antibiotics are much stronger than those taken orally. They also have side effects and because of the speed with which those side effects can hit, make sure you know which ones to look for before the nurse hangs the antibiotic so that you know what to watch for.

Remember to check with the pharmacist about what to do if you miss a dose. This is more important with antibiotics than some other medications. And ensure your elderly parent takes all of the antibiotic until gone. Just because they feel better does not mean they are well. If you parent is started on an antibiotic and you do not see improvement within 48 hours, let you healthcare provider know.

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May 232012
 

If your elderly parent has a communicable disease whether it is a cold or HIV, there are standard precautions you should take to prevent the transmission of the illness to others, including yourself.

Caring for Someone with an Infection

It is also important to protect yourself from getting an infection from the person for whom you are providing care. Washing your hands is always the number one thing you can do but consider the following also:

Clean equipment by rinsing in cool water to remove any particles (warm water may cause particles to stick to the equipment). Then wash with hot, soapy water, rinse well, and dry thoroughly. If you are dealing with a very virulent infection, you may want to rinse with cool water, spray with a ten percent bleach-water solution and allow it to sit for a couple of minutes before washing in hot soapy water. Boiling for “sterilization” is usually unnecessary.

Urinary drainage bags a.k.a. catheter bags ideally should be left connected to the catheter to prevent contamination. However, during the day mobile people often switch to a smaller leg bag that can be hidden under a skirt or pants leg. Leg bags and the larger night bags can be cleansed with soap and water. Rinse with a tablespoon of vinegar in a cup of water to help keep down oder and infections. Allow to air dry.

Dispose of body wastes down the toilet being careful to avoid splashing. Wash linens and clothes soiled with body waste separate from other laundry.

If the parent you are caring for receives medications from a multi-dose syringe such as an insulin pen, it is best to have the person receiving the medication remove the needle from the pen if possible to protect yourself. With a standard syringe and needle, never remove, bend, break or recap the needle after use.

In healthcare settings sharp objects such as syringes with needles are disposed of in biohazard containers and the containers are incinerated according to strict guidelines. Small versions of these biohazard containers are available in most pharmacy’s but should never be thrown out with your home trash. If you elect to use these, you will need to find out where you can drop them off for disposal. Your pharmacist, physician, hospital or local home healthcare agency can direct you where to take them.

If you are caring for someone with an infection that can be transmitted by blood such as HIV or hepatitis B, consider having any used needles disposed of as a medical facility would.

For most homes people can use any rigid, puncture-proof receptacle with a small opening, such as a bleach bottle, will do and is acceptable practice. Place a small amount of bleach in the bottle, drop the syringe, with needle intact into the bottle. When full replace the cap and tape it well with a strong tape. I always reminded my patients that things fall off garbage trucks all the time and the last thing you want is a child getting into a bottle full of used needles. Never use bottles, glass or plastic, that can be returned to the store.

When someone in the home is receiving wound care the soiled bandages should be placed in a bag which is then tied up and placed in another bag for disposal. If the bandages are dripping wet, talk with your healthcare provider about using a more absorbent dressing. If there is a chance of a blood-born infection, soiled bandages might need to be burned. Discuss this with your healthcare provider.

Clothes and bedding should be laundered separately in hot, soapy water with a ten percent bleach solution added to the detergent.

Do not share thermometers, razors, razor blades, toothbrushes, douche or enema equipment.

Do not share eating and drinking utensils. Clean them after use with hot soapy water. Using a dishwasher is good.

When flushing a toilet germs are sprayed into the air, even with the lid down. Toothbrushes should be covered or placed in the medicine cabinet or in a drawer.

Faucets in bathrooms and kitchens should be cleaned daily with a disinfectant.

Obviously the best way to prevent infection is through cleanliness. The foundation of it all is good hand washing.

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