Pop’s morning blood work did show that his calcium level was respectably near its target; near enough for him to be released today. So back to Piedmont Place and his own bed he went.
I briefed various PP staff on the current situation. (I’ve come to understand that my primary job is to facilitate effective communication between all levels of caregivers.) When I returned to Pop’s room, I found the Nurse Practitioner waiting for me. She had already consumed much of the paperwork I’d brought back from the hospital.
We had a lively discussion about hospital processes, and about what had been accomplished over the past three days. (I will write about processes separately, perhaps in a letter to the hospital’s administrator.) My confidence in Piedmont Place’s medical staff was strengthened further by the Nurse Practitioner’s full comprehension of the hospital’s recommendations and her resistance to blind acceptance of them. A reconciliation will now take place and I’m sure the best course of action will be taken.
So what we have here is two medical problems: 1) C.diff, and 2) elevated calcium levels. Pop’s cognitive disconnectedness may only be a symptom of either or both of these conditions. It may not be, of itself, a problem requiring medical treatment.
Regular readers of ElderBlog know that C.diff is an infection requiring a course of treatment with two antibiotics and one probiotic over a six-week period for each active occurrence of the infection. Pop has now experienced several bouts of active C.diff over the past few months. The NP, having consulted with the staff doctor and an infectious diseases specialist downtown, has decided on a new strategy where a lower dose of the antibiotics and probiotic will be in Pop’s system at all times. This I knew already last week.
The hospital nephrologist (kidney specialist) is recommending a new medication, Sensipar, already introduced to Pop’s system in intravenous form, to be continued now in pill form at PP in treatment of the elevated calcium levels.
The NP’s big-picture question is: should both of these problems be treated at once? Or would it increase the probability of success if C.diff were deemed to be well-managed first and then followed by treatment of the calcium problem? These are questions for the medical heads, not me. But I really like the push/pull of medical decision-making. I may not learn how this plays out for another couple of days yet.
In the meantime, Pop’s cognition challenges are not harming him. C.diff and calcium are.
Perhaps the second most important job I have is that of advocate. Mom and Pop are technically classified as “vulnerable adults.” This means, among other things, that they are easily redirected by others. While the others may indeed be well-meaning, it’s my job to ensure that the interests of my parents are being served. So, for example, when a hospital doctor asserts something that I know to be incomplete or untrue, I can cause reconsideration given the introduction (or re-introduction) of information. This occurred three times during triage that first twelve hours, and again once on Saturday. Doctors are way smarter than I am, but they tend to see only the evidence relevant to their specialties. My job is to stretch their perspectives wider.
I met briefly with the PP Nutritionist this afternoon. She told me that Mom’s weight is up to 119.5 now. This is very good news and is something they watch continually. The credit goes to a slightly higher fat diet being fed to Mom, and to the three-a-day offering of strawberry-flavored Glucerna. This is sort of like Ensure, but (according to Mom) is much better tasting. Pop’s getting it, too. Now that I’m aware of it, I’m spotting Glucerna in stores all over the place. Neither Lisa nor I need it, however… we need Anti-Glucerna. I’m nearly 200lbs now, the most I’ve ever weighed. It’s tough lugging all this stuff around.