Cat Trouble

So add to all the stress that I've been going through, Zenith, our seven year old Siamese cat, has decided to NOT use the litter box....

And, I tell you, I have been at my wit's end about this.

I've tried everything: from getting another litter box, then yet another litter box. To making sure the boxes (now three!) are all spotless clean. To even bringing a litter box into (yuck) the kitchen (where she has been using the rug instead of the litter box).

And nothing has worked.

Zenith (asleep & innocent!)

My thought was that this new behavior was a "behavioral" problem. My fear was that there was something medically wrong with her. Especially since it is so very hard for me to get out of the house these days, I couldn't imagine finding the time/opportunity to get the cat to the vet. Even with Chris coming over once a week or so, these trips are always spent rushing around getting Bob's meds and other supplies and trying to get back in time for Chris to get home in time to watch her great-grandkids after school.

Not to mention: how on earth to afford a (probably very big) vet bill?? (One vet I called quoted me $248.00 for a visit + tests. yikes)

Add to all of that, Zenith is Bob's favorite kitty and I surely didn't want anything to happen to her, as he'd be devastated. Not to mention, I love her too!

Pre-stroke: Bob & Zenith were constant companions...

That was my dilemma, until this past week, when I found a veterinarian who makes house calls! And doesn't charge an arm and a leg. And, extra added bonus, this particular vet actually accepts PayPal!

The doctor came on Wednesday. She was absolutely terrific. She wasn't sure if Zenith's behavior is from an infection or from stress, but thought we should just try some antibiotics and see if that works, before running Zenith through a bunch of expensive tests.  She actually, for no extra charge, stopped at a pharmacy and picked up antibiotics for Zenith before she arrived as I had told her how hard it was for me to get out of the house. She was here for nearly an hour and she even gave Boomer a free check-up, to boot! And her charge was only $70.00!

She also asked if anything had happened recently that could be causing Zenith to be stressed out. But other than me, being far more stressed out than usual with all this crazy-making lawsuit business, really nothing has changed. She told me, however, my stress level could certainly be affecting the cat.

Anyway, we are trying 20 days of antibiotics to see if that clears up the problem. She also suggested that I get a "Feliway" diffuser for the house, which is a plug-in device that diffuses cat pheromones and this may help to calm her down. I am currently scoping out e-bay to see what I can find....

I am praying that all this will work, and Zenith will get back to normal. That we don't need more tests, etc. Or I'm going to need to find a human "pheromone" diffuser to calm me down!

And I do want to say: THANK YOU!!, from Bob and me and Zenith, to all my blog readers who have sent donations through my PayPal "donate" button. Those donations always come in handy, to buy little things like latex gloves and bath wipes and pressure sore creams and an occasional guilty treat, like a pair of slippers -- but this month I had enough to pay a vet bill and that has been a real life saver! I greatly, sincerely appreciate it. And don't know what I'd have done without that help. Thanks again!

Armed & Dangerous

And that was me. When we headed back to the urologist.

You might remember, the last time I took Bob to the urologist, he had a bladder scan which indicated he was retaining urine. At that time, his PVR (postvoid residual urine volume) had measured 370 ml. The doctor flipped out at that number, said it was supposed to be 250 ml or less and gave me three options for Bob, which were an indwelling catheter, or a surgically implanted bladder stimulator or 3 times intermittent catheterizing daily. None of which sounded appetizing, to say the least.

Since then, I've done my research and have learned a lot about PVR (including the term PVR!), so I printed off some literature, got out my highlighter and, thus, armed, I was ready for battle.

Among my weapons were these highlighted tidbits:

From AHRQ (Agency for Healthcare Research and Quality), a paper entitled Evidence Based Practice Center Systematic Review Protocol, Chronic Urinary Retention (CUR) Treatment:

There appears to be little standardization in the duration or PVR volume necessary for CUR diagnosis and treatment . Research studies often use PVR volume greater than 300 ml to diagnose CUR; others have used 100 ml, 400 ml, and 500 ml.

From the National Center for Biotechnology Information (NCBI):

There is no agreement on which is the threshold value to define a significant PVR and different society produced guidelines with different thresholds range from 300 ml to 1000 ml... Most studies seem to describe the condition as either a PVR of greater than 300 ml in men who are voiding, or greater than 1000 ml in men who are unable to void.

And from the UK National Institute for Health and Clinical Excellence:

Guidelines define CUR as a postvoid residual urine volume of greater than 1000 ml.

 Now I know, 1000 ml sounds like a lot of urine, but I wanted to point out to this speedy urologist that there are different opinions out there and his "magic number" of 250 ml, is not necessarily an agreed upon standard. Also, I planned to argue that since Bob can't pee on command, he really doesn't have a true "post-void" urine volume.

Also, I had documented Bob's urine output after the scan at his last appointment as:

2:00 p.m. scan showing 370 ml PVR

3:00 p.m. emptied 100 ml 

4:00 p.m. emptied 200 ml

And I also remembered that six months prior, Bob's PVR was 250 ml, exactly.

So, thus armed, I prepared for battle and we went to see the urologist.  Before we left, I had urged (begged!) Bob to try to pee as much as possible. Also, I made sure I didn't give him too much water when I administered his noon meds.

And I tell you, I was nervous. I do not like confronting doctors. Especially ones that think they know everything. My Plan B, if I couldn't convince this doctor to "go lightly" on Bob, was to get a second opinion from another urologist.

So it was a great relief when the scan was done and it showed only 218 ml still in Bob's bladder! AND, directly after the scan he peed out another 30 ml.

And the urologist gave us a reprieve.  Until June.

So all that research/preparation, and I didn't even need it.


Though, believe me, I will save these documents and all my notes and arrive ready for another battle, next time....

It's A Conspiracy

Sometimes, I swear, there's a conspiracy out there to drive me nuts.

Monday was my Errand Running Day. When you are the only caregiver for a man who cannot walk/talk/eat and is pretty much confined to a hospital bed at home, Errand Running Day has to be planned to a T. Because it's my only day to get out of the house and get things done while I have a sitter for Bob.

Chris came by around 10:30 a.m. to sit with Bob and I had my list of things to do. First I needed to get Bob's two different pain patch prescriptions filled, then groceries, and, that very morning, Bob's digital watch stopped working so I needed to get him a new battery and I need a couple things from Walgreens.

Now lately, Errand Day is very stressful because of Bubba's dire warning that The Green Machine may give up the ghost anytime. I actually started keeping the phone # of a towing company in my purse and, in order limit the amount of times I have to shut off and start the car, I plan my trip carefully.

Add to that stress, it's pain patch run day, which can be a headache. Last month, when I went to get Bob's patches refilled, the pharmacy only had one of the two prescriptions on hand and had to order the other, which really ticked me off because that pharmacist had promised to keep them in stock and which also meant I had to make another trip to that store later in the week and, because Chris was not available, had to leave Bob home alone while I made the run. And I hate doing that. Because what if something happens to him, while I'm gone? Or what if something happens to me? Or the car breaks down? And there is no one with Bob, who can't even dial 911 if he needs to....

So, this month, I thought I'd be smart and call the pharmacy the week before I picked up his patches to make sure they had them in stock. And that's what did. On Thursday. And the pharmacist assured me that she had them in stock and when I asked how soon I could pick them up, she told me the insurance wouldn't pay for them until Monday. I told her I would be by on Monday to get them. And I thought everything was all set up to go smoothly.

Back to Monday, I leave the house and stop first at the grocery store pharmacy with Bob's two prescriptions. I make a point to make this my first stop, because, if they don't have the patches in stock, I can take the prescription to Walgreens and have it filled there. And my next stop is going to be jewelry repair which is right across the street from Walgreens.  So! I go to the pharmacy and I hand the prescriptions over to the gal behind the counter and she says she will "check to make sure they have them" and then she returns and tells me they do and they will be ready in 30 minutes.

I leave the pharmacy and run to the jewelry repair shop for a new battery for Bob's digital watch. I park The Green Machine in the Walgreens parking lot, go into Walgreens to get a few items, walk across the street (because I don't want to keep starting up The Green Machine, as I'm worried about the potential starting problem), get a new battery installed in Bob's watch, walk back across the street, start up The Green Machine and then head back to the grocery pharmacy to pick up the patches and grocery shop which will be my last stop before going home.

When I get to the pharmacy, the pharmacist tells me she only has one of the patches in stock and she'll have to order the other one. What?!

I tell you, I am dumbfounded.

Then she says, "Can you come back on Thursday, or do you want to take the prescription to Walgreens?"

I say, "I was just at Walgreens!"

And I say, "You said you had them, just 30 minutes ago! What happened? And I even called last Thursday to make sure you had them!"

She says, "I know. We had them on Thursday and I thought I still had them, I should have looked in the drawer when you came in, but I guess someone came in since Thursday with the same prescription and we gave them to them."

I say, "But you ordered them specifically for my husband! And you just gave them to someone else?"

She says, "We can't reserve prescriptions, we have to refill the prescriptions that come in first. You should have got here earlier."

I say, "But you told me I couldn't pick them up until today!"

That's when I break down crying.

Because this means I will either have to run back to Walgreens (another iffy start and stop for The Green Machine) and will that pharmacy even have them? or wait until Thursday, when I have no sitter for Bob and worry that the car will break down leaving me stuck somewhere and Bob back home with no one to help him.... GA!

There I am, in the middle of a grocery store pharmacy, crying like a baby. But I figure I'd better take the script to Walgreens as today I have Chris with Bob and maybe, just maybe, they will have that prescription in stock. And Bob really needs this pain patch because he's going to run out by Saturday.

So I do some quick grocery shopping (the pharmacy is in the grocery store) and I load up the car and I get behind the wheel of The Green Machine and I can't get the key in the ignition.

Yes, you read that right. I can't get the FREAKING key in the ignition!!! I mean, it just won't fit. It won't go in. It's like it's suddenly the wrong key! And this has got to be, by far, the stupidest car problem I've ever had!!!

Of course, I check to see if it's the right key. It is. I make sure I don't have it upside down or something. I don't. I try again and again, and finally the key slips into the ignition.

OK. Off I go, back to Walgreens, where I have to wait 45 minutes to fill the prescription, but at least they have it. Then, I get back into The Green Machine, and, once again, THE KEY DOESN'T FIT THE IGNITION!!!!!

GAAA!

I try it again. And again, and again, and again. By the sixth or seventh time, I am in tears. Again. Second time that day.

But I make it home. Park The Green Machine in the driveway. And just for giggles, try to put the key back into the ignition and it won't go in.....

So I call Bubba and he thinks the problem is a "metal shaving" jamming the lock tumbler and, on Friday, Chris can sit with Bob so I'll be taking the car up to him to replace the tumbler. That is, if I can get the freaking key into the ignition and start the car....

Oh, and if anyone is wondering why I just don't get Bob's patches at Walgreens, it's because Walgreens no longer stocks Bob's oral pain medication (because of DEA problems last year) and I am told that I MUST get all Bob's narcotic meds at the same pharmacy. It's the law....

Why I Hate Aphasia...

This, just one example from last week:


Bob: Too low.

Me: You need a boost? (meaning, to be pulled up in bed)

Bob: No. Too low.

Me: If you're too low, I can boost you up a bit. Not much, but a bit.

Bob: Nooo. It's too low.

Me: What's too low?

Bob: Too low!

Me: What is too low, sweetheart? I don't understand.

Bob: (making a gesture with his hand, holding it first up higher and then down lower) Too low!

Me: I know what "too low" means. What is too low?

Bob: (getting frustrated) TOO LOW!

Me: (also frustrated) WHAT IS TOO LOW?! I DON'T UNDERSTAND!

Bob: (smacks the towels, neatly arranged, on his bed) TOO LOW!

Me: The towels? The towels are too low? You want more towels?

Bob: (smacking the towels, again) NO! TOO LOW!

Me: Do you want more towels? I can get you more towels.

Bob: NO! Towels! (smacks the towels again)

Me: What's wrong with the towels?

Bob: TOO LOW!

Me: GA!

Bob: TOO LOW! TOO LOW!

Me: I DON'T UNDERSTAND! WHAT'S WRONG WITH THE TOWELS? I DON'T UNDERSTAND!!!!

Bob: TOO LOW! TOO LOW!

Me: I want to help you. I do. I just don't understand!

Bob: (smacking the towels again) SEE? TOO! LOW!

Me: I DON'T KNOW WHAT YOU WANT! I DON'T UNDERSTAND! WHAT'S WRONG WITH THE TOWELS?? THEY ARE THE SAME TOWELS! EVERY SINGLE DAY, I WASH THOSE TOWELS FOR YOU, I DRY TOWELS FOR YOU, I FOLD THEM UP JUST LIKE YOU LIKE THEM, I EVEN SORT THEM BY COLOR AND SIZE, JUST LIKE YOU LIKE THEM, AND YOU DON'T EVEN APPRECIATE IT!!!!

Bob: I appreciate it.

Me: GA! Why can you sometimes speak so clearly and other times MAKE NO SENSE AT ALL???

Bob: I don't know.

Me: Aaargh!

Bob: Forgive me?

Me: I'm not mad at you. It's just so frustrating, so damn frustrating when I don't understand you.

Bob: I know.


I tell you, it's enough to drive a person insane...

Stress, stress and more stress...

The other day, I find myself, tears rolling down my cheeks, on my knees, in the bathroom, mopping up water. This because, when the washing machine (in the laundry room) drained, the water backed up the sewer pipe and poured out the base of the toilet and flooded the bathroom. And I really did not need this...

This was also the second plumbing problem in February. The first being the kitchen faucet which would no longer shut off. I knew it just needed new washers, but the kitchen sink does not have a shut off valve and the water would need to be turned off at the meter on the boulevard and I knew you need a special tool to do this. Which I don't have. So I called a plumber, figuring, how much could a couple of washers and 30 minutes of labor cost? And I nearly fell over dead when the plumber tried to charge me $291.00! But, after 20 minutes of arguing with this guy, I got the price down to $171.00 -- but still, jeepers!

And now I was dealing with a new plumbing problem, which appeared much more severe.

I tell you, they say money can't buy happiness, and it can't buy love, but it certainly can buy the services of plumber.  Which can make a person, if not happy, at least less stressed out.

And what do you do when you just don't have the cash? or the credit?

Well, you find yourself crying on the bathroom floor and wondering if it's possible to somehow run the hose from the washing machine out the window so that it drains out onto the lawn... or you call your mom and dad and ask for help. Which is what I did. And, lord almightly, I hate doing that.

So the plumber arrives and gives me a bid of $4600 to replace the sewer line, or I can just have it roto-rootered out for around $450, but that will only temporarily solve the problem (which is roots in the sewer line that are bound to grow back) but the price includes re-seating the toilet. So, I go the cheaper route, because what can I do?

It's been a stressful couple of months here. Because add to plumbing problems, there's been Green Machine problems. When I finally got the car back from Bubba, he told me that he was pretty sure that he DID NOT completely fix the problem. He thinks it's some mysterious intermittent electrical short that he's been unable to pinpoint. And told me to be prepared to have starting problems and ultimately getting stranded again, somewhere, with a car that will not start. And he advised me to sign up for AAA. Which I checked into, but for the cost of the membership, it didn't seem like a great deal. And besides, I can't afford it at the minute.

Money can't buy love, but it certainly can buy a AAA membership. Or a new car.

And, now I'm scared shitless to drive The Green Machine anywhere....

And add to this, there's some screw-up with Bob's health insurance and, for some reason, EVERY SINGLE CLAIM for this year has so far been DENIED. So, add to the stress factor, hours on the phone trying to straighten this out. Plus a mailbox full of bills and trying to run interference with those medical providers.

Then add, the neurologist's bright idea to refer Bob for admission to an inpatient rehab hospital to "jump start" his therapy. This without my knowledge. And this instead of referring him to Outpatient Rehab or for more home therapy, which is what I asked for. I mean, I just get a call from this hospital, out of the blue,  telling me they have a referral. Which is news to me. This hospital sends PT and OT and ST therapists to our house to do a "pre-admission evaluation" and also orders a whole bunch of blood work and a nursing evaluation. Which we do. Then add the PT who tells me that Bob's room (the living room) is "set up wrong" for his disabilities and I should totally rearrange it into an impossible configuration because, really, it's a small room with 3 windows, four doorways, a fireplace and built-in bookcase and when I point this out him, he tells me to "find a way" to "remodel" it and if I don't do this, I am, in fact, responsible for making Bob "worse".... ga!

Then, after all of that, I find out that the rehab hospital needs a $1675.00 co-pay from  us...  So nix that idea.

Money may not buy happiness, but it certainly could pay for a fancy rehab hospital.... or a home renovation...

And I tell you, seems everytime I turn around, someone wants money from us. Or just wants to waste my time. Like the pharmacist, who promised to have Bob's pain meds in stock, and then doesn't. So that I have to run around (in a car that may not start up again) making multiple trips to multiple pharmacies. Or the doctors who are charging us $250.00 or more just to be interviewed by our lawyer. And our lawyer has to interview them because the defense is calling in nearly every single doctor who has ever laid eyes on Bob in the past 10 years for depositions.  Or the mortgage payment that just went up because the house insurance just went up. Or the property tax exemption that we will lose this year because Bob's student loan was granted a "disability discharge" and the tax assessor considers that "income".

And I won't even mention Boomer, who is getting old and his arthritis is really acting up and I am so worried about that, or the one cat who seems to be vomiting a lot more than usual, or the recent GA! flea infestation (finally under control) or, geezus, I think we've got termites in this house! and believe me, there's more, I could go on and on and on...  And add all that on top of my usual caregiving duties, which, of course, includes being up at 3:00 a.m. cleaning up poop and pee...

All I can say is thank God we have this lawsuit as a light at the end of the tunnel, because if not for that I think I'd have cracked into a million pieces by now.

But, right now, Dear God, just stop the world and let me off....