Lasix - Don't leave the Nursing Home With it!!

I called the VA home yesterday afternoon and reminded them that I was coming and not to give Bill his Lasix. They give him Lasix to keep his leg swelling down, but it makes him pee all the time. So, when I go up, I ask them to delay giving it to him until after we have been out. 

Apparently, the person who took the message didn't get it to the medication nurse. She had already given it to Bill when I got there. I decided to go ahead and take him out because he LOVES to go for car rides. 

I decided to take him to a new-for-us, Tex-Mex restaurant in downtown Houston called, Ninfa's. His joints weren't working real well, but we managed to get him in my RAV4 and off we went. 

Bill enjoyed the cityscape. We were talking about how big Houston is when he said he thought he saw the Twin Towers. "The Twin Towers are gone," I said. He looked at me in disbelief. He has no memory of that. I guess that is a good thing. 

We lucked out with parking and got a spot right in the front. It is a beautiful restaurant in a nice area. 

We ordered chicken and shrimp fajitas for our meal. They came out steaming hot! The chicken and shrimp were both cooked to perfection. Sides included salsa, rice, beans, sour cream, avocado, and pico de Gallo. 

It was delicious! But before we got too far into our meal, the Lasix kicked into high gear. Bill had to go to the bathroom. I took him to the men's room and turned on my timer for 15 minutes - the usual amount of time it takes him to finish. Some nice guest in the restaurant brought him back in ten minutes! 

He ate one of the fajitas and then he had to go again! So, back he went for another 15 minutes. This time our server helped him back out to the table.

He finished up his fajita just in time for key lime pie. He ate his pie and then, you guessed it, he had to go again! So back he went for another 15 minutes.

I paid the bill and, this time, I went in the bathroom myself and rescued him. I had barely gotten him in the car when he said he had to go again! He started shaking his arms and banging the car door. I told him to go ahead and go in his underwear (he has depends on). That seemed to do it. After that he settled down and enjoyed the ride home. The nurse later told me he doesn't go that often when he's at the VA. I'd never seen him go that much either. So who knows, but I will make sure that next time he gets no Lasix on the days I go if I have to call two or three times ahead! 

We had a good time in spite of the Lasix. He enjoyed the ride and the food. When he got back to the VA, the aide put him in the shower and I left. A fairly good day. 

DNR Decision, Part 2

I went to Houston today and took Bill out for lunch. I had all intentions of talking to him about the DNR; but I quickly realized, that only when I’m at home do I think he is capable of making such a decision. He has the cognitive skills of a 6-year-old. How can I ask him to make a decision like that - I can’t. So I didn’t.

I had done more research on the internet and, in the process, discovered the low outcomes post DNR, especially with people who have dementia. 

"Even if a patient does survive the initial resuscitation, their long-term quality of life can be significantly impacted. For patients with dementia, the quality of life post-resuscitation is often diminished due to the additional neurological impairments that may occur during cardiac arrest. Studies show that many survivors experience worsened cognitive function and physical disabilities. In some cases, these patients may not regain their previous level of independence, and the overall prognosis for returning to a meaningful quality of life is generally poor.

Additionally, the chances of long-term survival are slim, with significant mortality within the first year after discharge. For older patients, particularly those over 70, survival rates drop even further, with only a small percentage surviving beyond one year."

Really not much positive about it. I didn’t realize (or it didn’t register) that it would probably decrease his brain function even more, among other things, making his quality of life even worse. I can't do that to him.

I’ve decided to sign a DNR. It’s the right thing to do. I guess I didn’t want to face it. But face it, I must. 

The Social Worker will email me the form and I must sign it in front of two witnesses, so that is my job this week. Damn, this is hard.

The good thing is that Bill is in fair physical condition, other than high blood pressure and arthritis. So we shouldn't need the DNR for quite some time. In the meantime, I'll continue to take him out for his rides around Houston; the one thing he looks forward to each week. At least we have that.

DNR - How do I make this decision?

I'm a bit weepy today. I went to see Bill at the VA Memory Care. It was a ______ visit. I'm trying to fill in the blank with an adjective, but I don't have one. It was not pleasant. It was not fun. It was not happy. Bill only wants to get out and ride around. Unfortunately, I hurt my shoulder and did not want to lift the wheelchair or worry about catching him if he falls. So we sat in his room and "talked." 

He doesn't talk. He asks questions. The same ones over and over. How are the kids? How are you? Then, he says, "I want to take you out to lunch." I explain, again, that I can't today. He says that he'll drive. I remind him he has no license. Then he sits and stares until the session starts all over again. And again. And again. 

After I got home, I began to think about the question that the VA asks me every month. Do you want a DNR on Bill? I always say no. But, am I doing the right thing? I don't know. This afternoon, I searched the internet for information on when to put a DNR on a loved one. Here are the answers I got: 

Deciding when to place a Do Not Resuscitate (DNR) order on a loved one with Alzheimer's Dementia is a deeply personal and challenging decision. It involves considering their current health status, quality of life, and their previously expressed wishes if they were able to make their preferences known.

Here are some factors that might help guide your decision:

### 1. **Stage of the Disease**

   - **Early to Mid-Stage:** If your husband is still able to engage in life meaningfully and has some level of independence, you might feel that resuscitation would be appropriate if it could extend his life with a decent quality.

   - **Advanced Stage:** In the advanced stages of Alzheimer's, when the ability to communicate, recognize loved ones, or perform basic functions is significantly impaired, many people consider a DNR. At this point, resuscitation might prolong life without improving the quality of that life.

### 2. **Overall Health**

   - If your husband has other significant health issues, such as heart disease or chronic conditions that could lead to sudden cardiac or respiratory arrest, it’s worth considering how these conditions might interact with his dementia. Sometimes, the presence of severe comorbidities makes the decision clearer.

### 3. **Quality of Life**

   - Consider what your husband’s quality of life is like now and what it might be in the future. If resuscitation were to occur, would it lead to a meaningful recovery, or would it likely result in more suffering? For example, if he were to be resuscitated, but with diminished capacity afterward, would this be what he would want?

### 4. **His Wishes**

   - If your husband ever expressed his wishes regarding life-sustaining treatments before his diagnosis or in the early stages, those wishes should guide your decision. If he has an advance directive, living will, or had conversations about his preferences, they should be honored.

### 5. **Family Input**

   - It can be helpful to talk to your children or other close family members about their thoughts and feelings. They may offer insights or support that can make the decision less burdensome.

### 6. **Medical Advice**

   - Consult with his doctors. They can provide insights into his prognosis and help you understand what resuscitation might entail for someone in his condition. Palliative care specialists can also offer guidance focused on comfort and quality of life.

### 7. **Emotional Readiness**

   - Are you emotionally prepared to make this decision? It’s okay to seek support from friends, family, or a counselor. It's a heavy burden, and you don't have to carry it alone.

### 8. **Ethical and Spiritual Considerations**

   - Reflect on your ethical and spiritual beliefs, and how they align with the idea of a DNR. Your faith community or spiritual advisor might provide valuable guidance.

There's no single "right" time, as every situation is unique. It’s about finding the right balance between honoring your husband's dignity, respecting his wishes, and considering the emotional and physical toll on both him and you.

After reading this, I could only cry. . . 

Oreo - the Vegetarian!

My most beloved pet, Oreo, is now a vegetarian! Yes, you heard it right! 

Here's the scoop: 

From the time she was born, Oreo's had food issues. At a year of age, she had bladder surgery to remove bladder stones. The vet showed me the stones they pulled out: they were the size of peas and filled a 3/4 cup measure! At that point, she was on a Rx diet and has been since then.

For the next eleven years, her digestive system got worse, until, by this spring, she was having nausea and diarrhea at least once or twice a week. I was at my wits end, and so was my vet. Even the strict Rx diet for gastronomical issues was not working. Finally, in July, my vet suggested a vegetarian diet. He had been doing some research and found studies that suggested this type of diet may help dogs like Oreo. So, six weeks ago, I started the transition to Royal Canin Vegetarian diet. The protein in it is soy, so she is still getting protein. 

She has been completely on the vegetarian diet for the past four and one-half weeks. And guess what? No more stomach issues or diarrhea! She's happier, more energetic, and looks the best she has in years. In fact, it makes me wonder if I should become vegetarian! 

UPDATE: I've added green bean "candles" to her vegetarian dinner! 

Caregiver Stress - Yes, It's real

I was looking through my photo album this week and it finally registered how much stress I had been under while caring for my husband at home.

These are actual photos of me before caregiving began (2010), during my twelve years of caregiving at home (2012-2022), and today, after placing my husband in a Memory Care unit almost two years ago (2022-2024). 

 

As the saying goes, A picture is worth a thousand words. I had no idea what caregiving was doing to me. Thankfully, my kids intervened and finally convinced me to (1) see a therapist and (2) place my husband in memory care. They could see the stress I was in and the toll it was taking on my own health, even if I couldn't. I will always be grateful to them for the intervention.

If you know someone going through caregiving stress, please be their intervention. They will thank you later.

Additional reading on the topic of caregiver stress:

• Effects of Caregiving 
• Symptoms of Caregiver Stress 
• Top Stressors for Caregivers 
• Tips to Avoid Caregiver Burnout