April 6, 2017

My Hassle with the Hospital about my Parkinson's Meds

On January 20, I fell, fractured my hip, and knew I needed to go to the hospital. I remembered hearing stories from friends with Parkinson’s disease (PD) about complications they’d encountered getting their PD meds on time while they were hospitalized.

I didn’t want any of those troubles, so I packed a secret stash of my carbidopa/levodopa (Sinemet) pills before heading off to Sibley Hospital.

This National Parkinson's Foundation video describes this problem well:


The video offers some startling  stats:
  • People with PD are hospitalized 43 percent more often than others in their age group.
  • When they are hospitalized, 75 percent of people with PD don’t get their meds on time.
  • As a result, 61 percent of those patients develop serious complications. 

The video explains that patients with PD must be vocal and persistent with hospital staff about getting their meds on time. Many hospitals haven’t adopted the Parkinson’s Foundation’s training programs to increase awareness about the importance of maintaining timely medication schedules for people with PD.

As is typical for most Parkinsonians, my Sinemet dosage has increased through the years, and now I’ve reached the maximum dosage as far as my prior neurologist was concerned. These days, I normally take two pills every three hours: at 2am, 5am, 8am, 11am, 2pm, 5pm, 8pm, and 11pm.

March 30, 2017

My Walkers and My Falls since the Hip Replacement Operation

In my last post, I detailed why falls by the elderly are ominous. All too often, they put a once-healthy individual on an inexorable downhill slide.

I fractured my right hip on January 20, making that day (also #45's inauguration) doubly depressing. I had a hip replacement operation at Sibley Hospital here in Northwest Washington, followed by a week at Sibley's Renaissance rehab center. Since returning home, I've been working with an excellent physical therapist.

Much of my time in rehab was spent learning to use a walker. Before being released, I purchased a walker like the one I used there. I had another walker at home that I'd occasionally used during last spring's shingles attack.

I live in a split-level house. I spend almost all my time on either the ground floor (living room, dining room, kitchen, and screened-in back porch) or the upper level (master bedroom and bath, office, and guest bedroom and bath). I keep a small refrigerator and microwave in my office now, and the closet has become my  pantry, stocked with groceries, juice, and bottles of water.

The lower level and garage of my split-level house were converted into separate living quarters for my Kathmandu family -- Nimesh, Bhawana, and their daughter Nivah, who just celebrated her first birthday.

My Two Walkers
The Renaissance rehab walker is pretty basic, and not really suitable for use outdoors. It stays upstairs, where I use it to move between bedroom and office. Here it is:


We added the basket in the front and hung a tote bag from the side levers.

March 27, 2017

Falls and the Elderly and Me

My recent fall -- which fractured my hip and led to hip replacement surgery -- has become a major concern. Most of us have heard stories like this: an elderly person falls and breaks something -- a hip, a wrist, an arm. As a result, a once healthy, independent senior begins an inexorable downhill slide.

The statistics support my concern. Falls are the leading cause of injury-related death, and the third leading cause of poor health among persons aged 65 and older.

Nearly a third of older people experience functional decline after a fall, and many confront psychological difficulties directly related to the fall. Among these psychological consequences are fear of falling, activity avoidance, and loss of self-confidence. Together, these consequences have been labeled "post-fall syndrome."

Not surprisingly, seniors susceptible to falls also face higher rates of hospitalization and institutionalization. Hospital stays are almost twice as long in elderly patients who were admitted because they fell. Those same patients are at greater risk for subsequent institutionalization.

One in four elderly people who sustain a hip fracture die within six months of the injury. Over 50 percent of older patients who survive hip fractures are discharged to nursing homes, and nearly half of these patients are still there one year later. Hip fracture survivors experience a 10-15 percent decrease in life expectancy and a meaningful decline in overall quality of life.

March 18, 2017

This Aged Drama Queen Becomes a Coverboy for the First Time

I've often written posts about my love for my DC neighborhood, the Palisades. But some call it Kent. The Palisades and Kent have the same geographic boundaries with one exception. The southern boundary of the Palisades is the Potomac River, but Kent's southern boundary is MacArthur Boulevard. As a result, Kent excludes the "riffraff" living in the homes between MacArthur and the river, many of which are assessed at less than $1 million.

In 2015, The Kent Connection, a fairly fancy monthly, began appearing in our mailboxes. It's funded by advertisers eager to reach potential customers in our upscale 'hood. The magazine runs stories with photos about people, places, and happenings in Palisades/Kent.

Someone suggested to the editor that she run a story about me and my long connection with the neighborhood. I've always preferred calling it the Palisades and viewed the Kent label as a somewhat elitist designation popular with realtors and others interested in making us appear upscale and affluent.

Any concerns along those lines quickly disappeared during my first meeting with Sarah Taylor, the magazine's director. Nothing elitist about her. Her background includes a seven-year stint as VP/General Manager of a classic rock radio station in Washington.

I was surprised when a photo of me with my home family appeared on the cover of the magazine's March issue. Nimesh, much more computer savvy than I am, found a way to capture some of the photos and text, below:

March 17, 2017

Oh What A Beutiful Morning!

That song title from the musical Oklahoma kept coming to mind last Tuesday morning when, after Washington's first real snowstorm of the winter, my home family (also referred to on this blog as "my Kathmandu family") had a rare and welcome opportunity to spend some quality time together.

The overnight snowfall wasn't the blizzard the weather reporters had predicted, but it was enough to close most area schools and businesses (including the World Bank, where my housemates Nimesh and Bhawana are employed). When they go to work, their daughter Nivah -- who will celebrate her first birthday this coming week -- goes to the babysitter. So, on weekdays, I'm usually leaving "home alone."

Weekends, given the significant difference in our ages and backgrounds, we tend to go our separate ways. So the opportunity for a full morning of family time was most welcome!

Our first snowstorm called for our first fire in the fireplace. The four of us spent most of the morning enjoying the family time around the fireplace.

Nivah shows the happiness we all were feeling:

March 16, 2017

I'm Still Here but with a New Right Hip and a New Microphone for my Dragon

It's been over three weeks since my last blog post. I've started getting phone calls and emails from friends concerned that I might have had a setback after my hip replacement. Others hadn't even heard about the surgery.

Actually, my silence had nothing to do with the surgery or my health. I had decided to replace the microphone I'd been using with my Dragon voice recognition software with a wireless headset microphone from Sennheiser. You could not believe how difficult the new installation was for this 87-year-old man with Parkinson's. Fortunately Sennheiser's support staff was incredibly helpful and patient. I've been using the new microphone for several days, and I'm very happy with it. But this effort most definitely should not have been a self-help project!

Here's a quick update on my recent health happenings. It's been an interesting start to the new year.

The Hip Replacement
January 20th -- Inauguration Day -- was not a good day for me or for the nation. I fell at home and fractured my right hip.

This setback was just the start of a series of problems I encountered over the next few weeks, all because of prescribed drugs.

Are Your Prescriptions Killing You?
That's the title of a 2012 bestselling book by Armon B. Neel, a fifth-generation pharmacist. In 2010, the American Society of Consultant Pharmacists gave him its annual achievement award. As a consulting pharmacist, he visits hospitals and nursing homes daily and counsels patients on how their prescriptions could be interacting dangerously. Neel also suggests how people might be able to reduce the number of medications they take.

In his book, Neel describes the risks, dangers, and benefits of prescription drugs. He explains what factors must be taken into account when medical professionals prescribe meds for older patients, and he details the catastrophic consequences that can occur when those healthcare pros aren't vigilant.

Neel is a pioneer in the field of geriatric drug therapy. Enter his name in the search box above and you'll find links to several of my blog posts inspired by his book.

I thought about this book often during the events of the past couple of months.

February 17, 2017

Exercises that Support Recovery from Hip Replacement Surgery

I got a new hip three and a half weeks ago. Now I'm working with a very good physical therapist on exercises recommended for people recovering from the hip replacement operation.

Setting aside 15 or 30 minutes every day to exercise just doesn’t work for me. I do best when I can make exercise part of my normal activities.

For example, I've adapted some exercises recommended by my therapist so I can do them with my walker. One of the routines,for example, involves rising up on my toes; another  is a half  squat. Now I do those exercises when using the walker. This coming week will be devoted to the standing exercises for hip recovery.  I will talk with my trainer on whether any of those could be adapted to the walker.

When I wake up in the morning, I spend lots of time just lying in bed, contemplating the day ahead. During this time, I now do the most important "after hip-replacement" exercises for ankles, thighs and buttocks.

My daughter forwarded some links she found online with exercise videos specifically designed for people recovering from hip replacement.

The exercises are broken into short segments according to the activities you’d like to address, like getting into and out of cars, in and out of bed, going upstairs and down… You’ll see that this first video (like others) recommends leading with the good foot going upstairs, and leading with the operated side going downstairs. Up with the good, down with the bad.
She included several other links to hip exercise videos:

February 15, 2017

It Looks Like a Drug to Treat Incontinence (NOT My Parkinson's) Caused My Fall and Broken Hip...

Here's the sequence of events leading up to the fall that broke my hip:

1/17/17:  I’d been dealing for months with a strange incontinence that struck only in the late afternoon. Dr. U (my urologist) and I had been reluctant to use any of the incontinence meds because each   has potential side effects that could be particularly difficult for me. But the problem got worse and worse, so I asked Dr. U to prescribe one of the meds. He chose tolterodine, which I began taking on this day.

1/19/17:  I went to the office of Dr. BP (my blood pressure doctor) for some blood work in advance of my appointment with him following week.

1/20/17:  Two major disasters. At about 10:30am, I got up from my desk chair, immediately fell to the floor, and ended up with a broken hip. The other disaster occurred at 12 noon at the U.S. Capitol.

1/23/23:  I underwent hip replacement surgery at Sibley Hospital.

What Caused the Fall?
One might assume that Parkinson’s disease caused my fall. But Dr. BP and I have concluded that the loss of balance that precipitated my fall was likely caused by the tolterodine I’d started taking for incontinence.

My 1/19 blood work showed surprisingly low sodium (129). Normal is 140.

At Sibley Hospital, my hip replacement surgery had been delayed because of concern about my low sodium (On admission, my sodium was 121. It rose to 124 and then fell back down to 121.)

February 8, 2017

Home Sweet Home


I was discharged from Sibley Hospital's rehab center on Sunday morning, in time to watch that incredible Super Bowl game at home on Sunday night.

I was even happier to be reunited with my girlfriend Nivah!

Doctors usually urge their patients who’ve undergone hip replacement surgery to have someone else on hand during their first week at home. I got lucky.

I’ve talked before about my good friend Joey, my on-call chauffeur, gardener, shopper, and all-around helper. As fate would have it, Joey’s wife Georgelyn is a nurse in the intensive care unit at Sibley Hospital.

Nurses typically work 12-hour shifts three days a week. Since Georgelyn usually works weekends, she’s been available to take care of me during the day through this first week at home. She leaves shortly before my housemates return from work. So, my serendipity strikes again.

Joey and Georgelyn are natives of the Philippines. Over these past few years, I’ve often seen Filipinos in caregiving roles. Many of the Sibley nurses are from the Philippines. About half of my Parkinson's support group members have Filipino caregivers. My own experience – and comments I’ve heard – suggest that Filipinos have a natural gift for this work.

Unfortunately, Joey and Georgelyn can't do my exercises for me. I need to step up my game here. Tomorrow, I start working with a physical therapist.

But for now, all is well.



February 4, 2017

T Minus ONE... and Counting


No, I don't mean the Super Bowl. Not exactly.

During my "care planning" meeting on Thursday, the hospital team agreed to my request -- that they release me on Sunday, in time for me to get home to watch the Super Bowl.

Progress.

More soon.

January 31, 2017

My Fall, Hip, Operation, Rehab, and Schedule



With my friend David. His shirt reads “LIFEGUARD,” which -- 
as far as this narrative is concerned -- is just about right.

It’s been an interesting week and a half. Here’s a recap of events:

Friday, January 20
In the morning, I fell hard in my upstairs home office. I crawled over to get my cell phone on the desk and called my friend David, who arrived quickly. He wanted to call 911 and get me to Sibley Hospital’s emergency room, but I wanted to stay at home.

That night, wondering how I’d get into bed and manage to sleep, I finally relented and asked David to call 911. We arrived at the emergency room around 11pm. The medical team there decided to wait until morning to complete the necessary tests.

Saturday, January 21
No surprise -- the tests revealed a fractured hip. There were other issues, too. It looked like surgery would happen the next day.

Sunday, January 22
The schedule of surgeries was already full, and I was a late addition. By 3pm, the hospital team advised me that there was no way they could operate that day. The surgery would happen tomorrow.

Monday, January 23
It was another busy day of surgeries at Sibley. I was relieved when the pre-op unit team began the prep process around 3pm. I didn’t want to wait yet another day.

January 24, 2017

A Brand New Hip


Yesterday's hip replacement went just fine. Here I'm enjoying some homemade coconut cookies from Nancy, one of my terrific nurses. Now, bring on the rehab, and get me HOME!



January 22, 2017

A Fractured Hip


Here I am in Sibley Hospital's emergency room, after falling and fracturing my right hip on Friday. Surgery tomorrow. Then I'll be here in rehab for up to two weeks. I'll keep you posted on the recovery.



January 20, 2017

THANK YOU, MR. PRESIDENT!

It's 9:13am, January 20, 2017. Inauguration Day.

Like many others who have lived in Washington for a long time, I remember being a bit player in past events.

I just watched President-elect Trump being greeted at the doors of St. John's Church by its rector, the Rev. Luis Leon. Every President-elect traditionally attends a brief prayer service at St. John's -- "the church of the presidents," directly across Lafayette Square from the While House -- on Inauguration Day morning.

I was in the balcony at St. John's for the prayer service on the morning of Ronald Reagan's first inauguration. I had mixed feelings when I looked down at the congregation and spotted Frank Sinatra and other movie stars.

I also remember being on the vestry of St. John's when we chose Luis Leon as the church's new rector, replacing my treasured friend John Harper who had retired from that position after 30 years.

Enough "me stuff." What I need to do today is "accentuate the positive, eliminate the negative." So here are a few favorite videos from the Obama years.

The Obama's Were the Greatest First Family of Modern Times.



President Obama Is a World-Class Writer and Speaker, but He also Has a Nice Voice. 



But When it Comes to Singing, Michelle Could Win any "American Idol" Competition.



January 19, 2017

Diagnosing my Parkinson's: Then and Now

A neurologist diagnosed my Parkinson's disease (PD) in the fall of 2009. I should have been diagnosed several years earlier, but I didn't -- and still don't -- have the typical tremor that makes PD easier to detect. About 35% of all Parkinsonians don't have the tremor.

My former internist gave me a physical every year. During our 2005 session, I mentioned I had lost my sense of smell. He said, “Don’t worry about it. That happens to a lot of people as they age.”

In 2006, I told him my kids thought my right arm had an unusually limited swing when I walked. Again, he said the symptom was common. No big deal.

In 2007, I told him I was having balance issues, and he referred me to a physical therapist. This PT was very good, and I met with him every week for nearly a year. He kept asking, "Have you told Dr. X about your right arm not swinging?"

In retrospect, I realize he had diagnosed my PD but didn't feel comfortable questioning my doctor.

My kids were becoming increasingly concerned and recommended I see a neurologist. 

The neurologist told me that no specific test exists to diagnose PD. But he did order some tests -- including blood tests -- to rule out other disorders that might be causing my symptoms. He also conducted a thorough neurological and physical examination.

Finally, he gave me a trial prescription for levodopa-carbidopa, the gold-standard medicine for PD. After a week or two on this med, I noticed that several symptoms had improved. Bingo! I had Parkinson's.

January 17, 2017

Where Did the Story of My Parkinson’s Begin? Probably in this House


The photo shows 215-217 Prospect Street in Ithaca, NY, where I lived from age 7 to 25. We rented the right half of the house. The Slattery family owned the house and lived in the other half.

The house sits on Ithaca's South Hill. My dad walked up that hill to his job at the Morse Chain Company plant.

My brother Roger still lives in Ithaca. After visiting him several years ago, I realized I didn’t really know what the company did. Something about auto chains, I thought. So I Googled it.

To my surprise, most of the hits described a longtime controversy: a chemical the company used to clean greasy auto chains had apparently contaminated much of the soil on South Hill. Residents have brought class-action lawsuits, claiming that serious health problems have resulted from that contamination.

The toxic chemical has been identified as trichloroethylene (TCE), typically used to decrease metal parts. Googling TCE, I found a 2011 study that made a startling conclusion: people exposed to TCE are six times more likely to develop Parkinson's.

Although the research focused on workplace exposure to TCE (and perchloroethylene, or PERC, another de-greasing agent), most people experience low-level exposure to these solvents. Millions of pounds of the chemicals – which can be detected as contaminants in blood, breast milk, water and food -- are released into the environment each year. 

January 14, 2017

The Heimlich Maneuver and Parkinson’s

Dr. Henry J. Heimlich, the thoracic surgeon best known for developing and popularizing his lifesaving anti-choking technique the "Heimlich maneuver," died last month at age 96.

I hadn’t thought about the Heimlich maneuver in years. But it might just save my life one day, since I'm now struggling with swallowing problems stemming from my Parkinson's disease (PD).

It seems like I've known about the Heimlich maneuver forever. But I wasn't sure any longer how it worked, and wanted to check if friends who might be around -- should I have a choking incident – knew how to perform the maneuver. 

Older friends were like me; they knew about it but weren't certain how to perform it. Younger friends had never heard of it.

So I’ll be sending this video to my nearest and dearest:

January 13, 2017

Parkinson's 101

I regret starting the new year of blog posts with one about politics. Last year, I did a pretty good job keeping the blog free of political issues, though I slipped a couple times.

This blog concerns aging and Parkinson's and me. That's how it began… and where the focus will remain.

Today's post is a good example. My daughter sent me the link to the January 9, 2017 edition of the "Michigan Health" newsletter, produced by the University of Michigan. Its author is Kara J. Wynant, M.D., a movement disorder specialist.

The article offers an excellent primer on Parkinson’s and its non-motor symptoms. I’ve been dealing with a variety of these symptoms, and found the summaries very helpful.

The article also is a reminder for me that "concise is nice."  I wonder if I could get that to pop up every time I start a blog post.

Here's the article. Recommended reading.

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Parkinson’s disease is a chronic, progressive illness, meaning over time people with Parkinson’s will develop new symptoms.

That is why recognizing symptoms — and communicating them to a Parkinson’s care team — can help patients find relief as symptoms change. Here’s what patients, in many stages of the disease, should look for.

PARKINSON’S 101

First, the basics: Parkinson’s disease is primarily caused by low and falling dopamine levels. Only 10 to 15 percent of Parkinson’s cases run in families. We don’t know what causes the vast majority of cases. We think Parkinson’s is caused by a combination of people being predisposed to it by their DNA and coming into contact with some kind of environmental factor, such as an infection or a toxin. A lot of research is going into this area.

January 11, 2017

"Yes We Can!" But How? Here's a Plan to Answer our President's Eloquent Plea for Less Chat, More Action.

I had wanted to use this first blog post of 2017 to share my ideas for refocusing the blog this year. After listening to President Obama's farewell address last night, I junked that plan.

He concluded his eloquent and moving address with a plea for us to believe "not in my ability to bring about change -- but in yours." Watching the Obamas and Bidens work their way through the crowd as they exited, I wondered what I could do to respond to the president’s call to action.

The Facebook Bubble
My first thought? Post something on Facebook. But President Obama had mentioned how easy it was for us "to retreat into our own bubbles, whether in our neighborhoods, or on college campuses, or places of worship, or especially our social media feeds, surrounded by people who look like us and share the same political outlook and never challenge our assumptions."

Fortunately, earlier in the day I’d seen an excellent, specific plan of action from yesterday's post on my favorite senior blog, “Time Goes By.” Written by the remarkable Ronni Bennett, "the mother superior of elderblogging,” the blog has been called "the quintessential seniors' blog" by The Washington Post.

GOP Confirmation Blitz
Ronni’s post was prompted by Republican attempts to confuse and distract us today by scheduling simultaneous confirmation hearings for President-elect Trump's nominees for attorney general, secretary of state, CIA director, and the secretaries of transportation and education. On top of that, Trump also scheduled his first open press conference since last July on the same day!

When I watch the TV news tonight, I'm sure the press conference will be the lead story, while the confirmation hearings will receive short shrift.

Constituents' Phone Calls Pay Off
Ronni reminds her readers that the thousands of phone calls from constituents forced House Republicans to reverse their decision to scrap the Office of  Congressional Ethics. Many news outlets attributed the reversal to the president-elect's tweet. But most members of Congress agree it was the deluge of phone calls that forced them to backtrack.
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