Tag Archives: walk

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Pathos

Beloved, what is my path?

I remember. You are gone and dead
I lie on my side, close my eyes
I feel your body behind mine
your arm tucked under me
your breath on my hair
your body warmth against me
your arm lying across my side
thighs and knees relaxed against mine
you are not gone and dead
as long as I can remember

Beloved, what is my path?

I remember. A path alone
so that I can see
so that I can hear
so that I can feel
so that I can write
Beloved, you set the path before me
a brief elaboration of a tube
Beloved, sometimes I want
Beloved, sometimes I say why
Beloved, sometimes I forget

And then I remember

_______________________________

For the Ragtag Daily Prompt: March.

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What to check before bringing your elder home from the hospital

I get a call from the hospital (this is over a year ago). They say, “Your friend is ready for discharge. What time can you pick her up?”

I reply, “Can she walk?”

“What?”

“She has three steps up into her house. Can she walk, because otherwise I can’t get her into her home.”

“Oh, uh, we will check.”

They call me back. “She can’t walk. She’ll have to stay another day.”

I knew that she couldn’t walk before they called. She could barely walk before the surgery and after anesthesia, surgery and a night in the hospital, her walking was worse. She had been falling 1-5 times at home and the surgeon knew that. He did not take it into account. The staff would have delivered her to my car in a wheelchair and then it would have been my problem.

She was confused by that afternoon, which is not uncommon in older people after anesthesia. She stayed in the hospital for six days and then went to rehab, because she still couldn’t walk safely.

Recently I have a patient, an elder, that I send to the emergency room for possible admission. He is admitted and discharged after two and a half days. Unfortunately he can barely walk and his wife is sick as well. The medicare rules say that he needs 72 hours in the hospital before he qualifies for rehab. We scramble in clinic to get them Home Health services, with a nurse check and physical therapy and occupational therapy, and I ask for Meals on Wheels. It turns out that Meals on Wheels will be able to deliver in two months.

The wife refuses to go to the emergency room. I tell her that if she does get sicker, that they both need to check in. The husband can barely walk and is not safe home alone. If one gets hospitalized, they both need it.

If you have a frail elder, be careful when you are called about discharge. Go look at them yourself, make sure that you see that they can get out of bed, get to the bathroom, walk up and down the hall. Can they eat? Do you have steps into your house or theirs and can they go up the steps? I got away with saying please check that my friend could walk because I am a physician, because I knew she couldn’t and because there was no one else to pick her up. Do NOT ask your elder. They may want nothing more than to go home and they may well exaggerate what they can do or be firmly in denial. You want them to be safe at home, to not fall, to not break a hip and to not be bedridden.

For an already frail elder, even two and a half days in bed contributes to weakness. And being sick makes them weaker. If they are barely walking when they are admitted, it may be worse even after just 2-3 days. I used to write for physical therapy evaluation and exercise when elder patients were admitted, to help them for discharge. Once I got a polite query from physical therapy saying, “This patient is on a ventilator. Do you still want a consult?” I reply, “Yes, please do passive range of motion, thank you!”

Your elder does not have to be doing rumbustious dancing before they go home, but they need to be able to manage stairs, manage the bathroom, manage walking so that they can get stronger. Otherwise a stay in a nursing home or rehabilitation facility may be much safer for everyone.

For the Ragtag Daily Prompt: rumbustious.


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A tale of no tail

Yesterday on our early morning walk, Sol Duc rushed up a driveway, all fierce hunter, and attacked the pile beside a garage. Not our garage. I wondered if it was a mouse? Nope. She lost interest once she’d flushed the prey. The tailless prey was quite relieved.

For the Ragtag Daily Prompt: tail.

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Sol Duc and the farm

This morning is quiet, quiet and Sol Duc and I took a late walk for us. We could hear bugs and a train, across the valley. We went over to the fence where the farm starts. Barbed wire and an electrified fence, so we did not trespass. Sol Duc is wearing red, but get her in the weeds and she’s darn difficult to see.

Have a wonderful day and drive carefully.

For the Ragtag Daily Prompt: barbed wire.

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Morning ablutions

I took this with my Panasonic F150, zooming in, walking part of the Blue Heron loop along the Colorado River. Wow! Not truly ragged, but think if instead of combing our hair, we had to clean and arrange all of these fantastic feathers! The heron demonstrated many spectacular neck positions and can fan out the feathers in amazing ways. I tried not to disturb her too much.

Done for now.

For the Ragtag Daily Prompt: ragged.

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Driving Lily

I was driven yesterday. I have an ill friend. She is currently in a “rehab”, aka “nursing home”, in Sequim. I drive 40 minutes to be with her at an hour appointment. Afterwards we check in at the nursing home and then I drive her back to her house, 40 minutes again. That is where Lily is. Lily is her cat. My friend was in the hospital for six days and now the “rehab” for two weeks. My friend wants to go home. Lily is miserable. She misses her person and hisses and swipes at me. I was driven to take my friend to see her cat.

Lily let me pet her yesterday because I brought her person home. However, the whole thing was a near disaster. My friend has been trying to get stronger, but she is not stronger. She is weaker. She has three steps into her house. We were there for about three hours. She sat to wash the cat’s bowl in the kitchen sink and Lily was very very happy to be near her. My friend was then tired enough that we had real difficulty getting her out of the house and back in the car. I used a bath stool to let her stop and sit about every four feet. She was using a walker, but could barely walk. She sat in the doorway of the house and talked about crawling. However, those muscles in your upper legs? Those are some of the biggest muscles in the body, and if you can barely walk, scooting or crawling is not feasible either.

We made it to the car without having to call an ambulance. I’m pretty strong for my age and size, but I’m not strong enough to carry her alone.

Poor Lily. I don’t think I dare try to get her in a cat carrier and she’d probably cry all the way driving and anyhow, the nursing home would need a shot record.

Lily will have to put up with my care for now.

For the Ragtag Daily Prompt: driven.

I am not my friend’s doctor, I am just a friend.

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Elder care: stairs

Most of us do NOT live in homes practical for aging. My house has four steps in the front and five in the back to get in and out. The main floor has almost everything needed if I cannot climb a flight of stairs: only the laundry is in the basement.

I am helping a friend in her 80s. The issue, from my practical and pragmatic Family Medicine standpoint, is that she is falling. She told me that she was falling, five times in a day, in November. I got involved right away, because she had a surgery canceled because of it. She has three specialists and a primary. I called them all and took her to the emergency room first and then to her primary.

We asked her primary for disabled parking and for home health services. In Washington State, if you can’t leave your house except to the store or the doctor, you qualify for home health. I also fussed about her blood pressure, but her primary thought she was fine.

The thing is, we should not always have a blood pressure goal of 130 or less systolic once we hit 75 or 80. With weight loss, people can drop a blood pressure point for each 2 pounds lost. The blood pressure range that is safer at age 75 or 80 is to keep it around 140-150, unless the person has heart disease or congestive heart failure. Over 150 is getting too high. The brain must get good oxygen by blood flow and if it doesn’t, there are sensors in our neck that make us faint. That can be a full on loss of consciousness, or just a decrease and drop to the floor. There are some instances where the blood pressure still needs to be kept down at 125-130 systolic: bad coronary artery disease and congestive heart failure especially. But being able to stand up and walk is rather important to elder health.

The distraction for my friend’s physicians is that she has had cancer for three years. We are told that she needs an MRI of her head to rule out brain tumors, metastases from her cancer. Yes, brain tumors can cause falls, so that does need to be ruled out. My friend only falls when standing, sometimes at the counter, gets lightheaded and once has had a full on syncope. No chest pain or heart racing.

It took two months to get the brain MRI, which is negative. We saw her oncologist this week and I pushed for her cardiologist to see her sooner than June. He saw her yesterday. She is on medicine for a heart arrhythmia, but it doesn’t sound like her arrhythmia is acting up. He’s still checking: a monitor and heart ultrasound, but meanwhile he says, “I don’t tell many people this, but you need to drink more fluid and eat more salt.”

“They told me low salt. I stopped salt when I cook.”

“Start salt again and more fluid and return in 3 weeks.” She has been falling 1-5 times a day in her home. She lives alone. She is stubbornly resisting leaving her home and I am ok with that. But, it would be most helpful for her health if she was not falling. That is the priority here. She will not live forever, but she wants to stay in her home. Let’s help with that.

I am NOT saying that everyone over 75 should increase salt. If a person has bad hypertension, or heart disease, or congestive heart failure, they should not increase salt unless their doctor has a specific reason. And heart is the number one killer, so there are lots of people who should continue to eat a low salt diet. But falling and breaking a hip is also a killer.

My friend has three steps to get out of her house. The first day last week that I took her to get labs, she fell three times. “But Jim, I’m a doctor, not a nurse!” Ok, I am not a good nurse. However, we got her back inside after labs and getting the CT scan contrast for her to drink. She has not fallen when I have gotten her in or out since. I’ve had to enlist help twice, since she’s taller than me. Going down the steps is worse than going up. Home health is doing physical therapy and she has a raised seat on her commode. That is good, except those are the muscles that help us go up and down stairs. She has a walker too. She is still falling, because to cook, one has to let go of the walker, right?

So if someone wants to stay at home, think about the home. Are there steps? How strong is the person? Do they have the resources to pay for around the clock care if they become bedridden? I am practicing getting down on the floor and back up every single day, because I want to be strong. I have an upstairs and a basement, and I am going to continue with stairs for as long as possible. If I break my leg, those four front stairs are going to be an issue, but I am thinking about it. Perhaps I should design a decorative ramp, or a sloping earth entry.

Will the house accomodate a wheelchair? Is there a bathroom and a bedroom, as well as the kitchen, on the main floor? Is there clutter? I know I am supposed to keep the floors clear to reduce fall risk. I had one person who kept falling at night because he wouldn’t turn on a light. “It would wake my wife and disturb her,” he said. “It will disturb her more if you break your hip.” I said. “Turn on a light or a flashlight or something.”

Harvard Medicine agrees: https://www.health.harvard.edu/staying-healthy/master-the-stairs

Be careful out there. Or maybe in there.

For the Ragtag Daily Prompt: Elder care can’t be laissez-faire.

The photograph is not my friend. This is Tessie Temple, my maternal grandfather’s mother. I do not have a date nor who took the photograph. Another photograph is stamped on the back: Battle Creek. She must have gone to one of the famous sanatoriums, like Kellogg’s, for rest or the cures.