New Medication Schedule

Mom's transfusion on Thursday went well. I learned more about the process because a new nurse was being trained to work in the ATC (Ambulatory Treatment Center). All vital signs are taken prior to the patient being prepped for the transfusion. If everything is normal, the transfusion proceeds. Since Mom has a heart condition the new blood can't be given too quickly or else it will put a strain on her heart, the rate for her is 3 hours per unit. Mom's blood pressure was not continually monitored but dissolved oxygen in her blood was. Since she was getting 2 units of red blood cells plus saline, at the end of the 1st unit they check her blood pressure and administer furosemide if it is too high. (It was, they did.) During the 2nd unit they monitored her blood pressure every 15 minutes. Then at the end of the transfusion they again take all vital signs. We were there for 7 & 1/2 hours.

Mom's appointment on Friday with Dr. Pham also went well. Based on the blood pressure data I provided, Dr. Pham decided to keep Mom off the lisinopril as long as her blood pressure is not constantly 140 or higher. She also said to only give Mom the furosemide if she gains weight rapidly. So I will be monitoring Mom's blood pressure a couple times a day and weighing her each morning. Dr. Pham wished Mom lots of luck in Las Vegas! We see Dr. Chan (Mom's oncologist) next Tuesday.

Here's this evening's sunset as seen from my bedroom window. I have the hottest room in the house - its in the southwest corner. I can't stay in it after about 12 noon because it gets too hot for me. And I have a fan on all night so it cools down enough that I can sleep comfortably. Needless to say, my fibromyalgia is loving the lack of cold!


Here's Chibi enjoying the bean bag chair. She's also trying to cool off. All the cat's have their special places to sleep to keep cool. Most of the time they are on the linoleum portions of the floor.


Happy Birthday to Marcie, Vener, and Andrew! Happy Belated Birthday to Claudia! Happy Belated Anniversary to Joan & Gary, Monava & Bruce, and Pierce Sensei & Mrs. Pierce!

Prepping for the Next Transfusion

Took Mom in for the cross-matching in preparation for the transfusion tomorrow. Both the phlebotomist and I stressed the importance of the yellow wristband. I also reminded Mom that the last time when she took it off before the transfusion it added 3 hours to her stay in the ATC! I reminded her after lunch and when she went to take her shower that she needed to keep it on. (I later found where she put the other one that she removed.) She is also concerned over how much it will cost for the transfusion. We have discovered that the biggest cost for her treatments is the parking fee; since we have a parking sticker book it will cost $10 for tomorrow's visit.

We also visited one of her financial advisors today. Keoki explained about Roth IRAs and possible future strategies. It looks like Mom will leave her Roth IRA intact and pass it on to Dad, then at that time Dad will likely withdraw money from it to consolidate it into a savings account so he has less people to deal with for financial items.

After leaving Keoki's we headed over to pick up lunch at Don Quijote via the side streets. And almost literally ran in to the SPAM food truck! We saw a piece on the news last night about it. And there it was, right in front of us! The driver apparently cut the turn to close and was having issues getting around the corner of the intersection. People on the street we were on started turning around and going back the way we had come from. People on the other street were not as lucky, they were on a one way street. It did not make it on the news again, so they must have got it unstuck. Apparently they started their 12 city cross-country tour in April and people kept telling them they needed to come to Hawai'i which was not on their original itinerary - you would think that SPAM knows where its biggest fans are!


Since Mom's blood pressure was not making sense to me, I called Dr. Pham. She said since Mom's diastolic is fairly consistently low (79% of 53 measurements over 8 days) and her systolic is either normal (40%) or prehypertension (49%), to hold off on giving her the lisinopril. And since Mom's weight is steady, also continue keeping her off the furosemide. Dr. Pham said to keep track of how Mom responds to the transfusion tomorrow. If possible, Dr. Pham would like to reduce the number of medications Mom is on. We will check with her in-person on Friday.

Mom was very concerned about whether the sheets in the northeast bedroom had been washed. I reminded her that they had been washed twice since David and Kai left. (I did them as soon as they left, folded them and set them at the foot of the bed. But I was not fast enough on putting them back on the beds. Mom came along and washed them again!) We had the same conversation about them being washed 4 times tonight! I think she is finally remembering that they are washed and ready for the next visitors.

Happy Birthday to Leno, Charlene, & Grey!

Happy Birthday, Sue!

Today is my sister Susan's birthday. I took Mom to Punchbowl to put flowers at her niche. Just after we placed the flowers, it started to drizzle. Mom said it was Sue's tears of happiness. We discovered renovations that are being done in the portion of the columbarium where she is has been improved. There is now a sidewalk that leads to the court that she is located in. Previously we would have to walk through the graves in the lawn. It made it a lot easier for Mom to get around.

Earlier I took Mom to the luncheon for retirees from Liholiho School where Mom worked as an educational assistant. She had a great time seeing a bunch of people that she no longer sees except at this luncheon. Here are a few photos of some of the people she saw today.

Miss Kasahara (Sue's kindergarten teacher) and Mom

Mrs. Yabusaki (Curt's kindergarten teacher) & Mom

Mom with Sandy & Jeanne, 2 of the mahjong players

Mom with Mitzie (another mahjong player) & June

The luncheon was at the Waialae Country Club; I had never been there before. On the way back from the luncheon I missed my turn so we took a different route. Here are a couple of other views of Leahi.

Leahi #16 from Kahala Drive

Leahi #17 from Diamond Head Road

Before we went to the luncheon, I took Mom for her blood test. Since Monday was a holiday we weren't able to do it yesterday; today was quite busy because of it. Later Dr. Chan's office called; Mom is now scheduled for a transfusion on Thursday. I kind of guessed she would be because of all her complaints of being tired.

Happy Birthday also to Lem & Rosario!

Kohala House Is Done!

... for now. There is more repair and renovation work needed on the garage. And solar panels to be added. And a remodel for an addition on the north side of the house. But this initial part, to make the house accessible and safe, is done! Here are some photos sent by the contractor. I will be making a trip later in September to clean things up and unpack boxes. Later I will take Mom over for a visit but I don't want her there while I am unpacking because she will want to help and that will tire her out too much.

Accessible bathroom doorway with walk-in shower and raised basin to allow wheelchair access.

Kitchen with new floor, stove, and door.

Mom's blood pressure is still low. I think. According to the Internet, a blood pressure of less than 90/60 mmHg is considered hypotension. Both measurements do not need to be below those thresholds, if either the systolic (90 mmHg) or the diastolic (60 mmHg) is low, then you have hypotension. Of the 47 measurements I have taken since this started, 39 of the diastolic (83%) are below 60 mmHg and 2 of the systolic (4%) were below 90 mmHg. The low systolic were on the day she got very dizzy and had trouble walking. Twenty-seven of the systolic (57%) were higher than 120 mmHg (prehypertension) with 3 higher than 140 mmHg (6%, hypertension) over the last 2 days. Yes, I know, this paragraph sounds like one of those reports I used to write for the State and Federal agencies! I think the thing that concerns me the most is that 21 of the measurements (45%) have a systolic that is 120 mmHg or higher with a diastolic lower than 60 mmHg. Which would mean meds to lower her blood pressure would tend to push her diastolic measurement even lower! One other thing, on 2 occasions Mom's pulse shot up to 95 for walking around.

Happy Birthday to Tim, Denise, Uncanny Injury Guy, Rikayla, Kerry, & Andre! Happy Belated Birthday to Michael & Jeremiah!

Lester Losing Speed

Hurricane Lester has diminished to a Tropical Storm and has also moved to a path further north of the islands. All the hurricane watches have been cancelled. There was no extra wind today, in fact Lester is blocking the tradewinds so it has been still and muggy. Yuck!

Channel 2 had updates on Lester every hour, starting at 6 am. Mom was very focused on the updates. I think it helped make her less anxious as they talked about it moving farther away and losing speed. (She stopped asking me whether we had enough food and water!) Not sure how she would have handled it if Lester maintained the previous predicted path or veered towards O'ahu.

Mom is still having problems with her blood pressure. I put all the measurements I have taken in to a chart and color coded it to get a clearer idea of what's happening. I made 9 blood pressure measurements today. All except one diastolic measurement was still low; 5 systolic were prehypertension and each of those had a hypotension diastolic measurement. Not sure what it means when the systolic is prehypertension and the diastolic is hypotension, but she had no dizzy spells like yesterday.

Shiro doesn't like to be bothered when he's sleeping!

BP Still Low

Mom's blood pressure is still low. I only took 7 measurements today but they were similar to yesterday's measurements. Though there were more systolic measurements that are normal or on the slightly higher side, nearly all the diastolic measurements were low. She still doesn't like that I am making her spend most of her time lying down with her legs elevated. I told her that we need to get it under control or she won't be able to go to Las Vegas. I think if we can keep her systolic up to normal and her diastolic does not go below 50 mm Hg she will not have any more dizzy spells. Right now the diastolic is hovering mainly around the mid-to high 40's. By the way, Mom is glad I made her get the bench in the shower! She has been very good about sitting down while she showers so she does not fall when she gets dizzy.

Mom is glad that her buddy Xander is back. He had a good night with two good bowel movements. He has been very good about taking the cisapride. Though he doesn't have much choice since I squirt it into his mouth, but he doesn't fight when I open his mouth. I have been told I do it so fast that the cats don't know what's happening until its over! The i/d diet came in today so I picked up a bag and started mixing it in with the Nature's Variety food they have been eating. The vet said Nature's Variety is a good quality food but Xander is needing something specifically to improve his digestion and stool quality. Dr. Sylvester said it wouldn't hurt for Chibi to be on it either since she will be a geriatric kitty next March.

The bulbuls in the front yard are gone, it has been quiet for the last 2 days. I think all of the fledglings are now able to fly so they left. The spotted doves and zebra doves are now back in the yard. I also saw a red-headed cardinal today.

Yesterday there was a red-vented bulbul in the cat run. It apparently came in through the chain link fence. It was frantically searching for a way to get out because Shiro was in the cat run. Fortunately for the bulbul, Shiro was more interested in sleeping in the sun than catching birds; it finally found its way back out. Today there was a brown anole on the netting. The anoles frequently go running along  the cat run walls.

Anolis sagrei

Hurricane Lester is now a Category 2 with winds in the center at 80 to 90 mph. It is predicted to pass nearest to O'ahu sometime tomorrow evening. On its current predicted path it will not make landfall but will bring winds of 30 to 40 mph and lots of rain. I moved the garbage, green waste, and recycle bins in to the front of the garage. I started moving other things in and realized there's not enough storage space to put everything under cover so I just consolidated things and am hoping for the best. 

Mom is still concerned about whether we have enough food (we do). She also keeps asking if we have a lantern for light, she has forgotten about the solar lights that I have. Perhaps I should keep them visible tomorrow so that she is more comfortable that we do have something available. I think if the lights start flickering I might even turn them on and give her one to keep with her.

Happy Birthday to Dean and Steve!

Mom's Blood Pressure Still Low

And she is not pleased that I am making her lie down and elevate her feet. Today I talked with Dr. Pham, her primary care physician, who wants Mom to remain prone until her blood pressure comes back up to normal; Mom keeps asking why she needs to lie down all the time. We are also having her drink more water and not giving her the lisinopril or furosemide until after Mom sees Dr. Pham next Friday. I need to have Mom weigh herself every day; if she begins to gain weight I need to give her half a furosemide. If Mom's blood pressure gets so low that she passes out, she needs to go to the ER.

I took 14 blood pressure readings over the course of the day. (I'm glad its all automatic now!) All of the systolic readings were above 90 mm Hg, with 8 of them in the normal range (90-120 mm Hg); the rest were over 120 mm Hg but none over 130 mm Hg. Only one of the diastolic readings was within the normal range (60-80 mm Hg); the rest were between 46 and 58 mm Hg.

Aunty Judy came for a visit today; she helped keep Mom from getting too bored with having to lie down and keep her feet elevated. (Aunty Judy originally went to school to be a nurse so she understood exactly what was going on when I told her about the low blood pressure.) Aunty Judy also brought bento for us. We had a great visit!

Xander is back! He is still constipated but there has been a little movement. They gave him subcutaneous fluids so he would be well hydrated, meds to keep him  from vomiting, and meds to stimulate his intestinal mobility. They sent cisapride and mirtazapine back with him. I need to monitor the litterbox and track what he passes (~3" so far). He also has a special I/D diet dry cat food that is supposed to help with good digestive health. He is spending the night in the utility room with the Cat Genie, which is turned off so I can see what he deposits overnight; Shiro & Chibi will have to use the litterbox in the cat run.

The wind is picking up, not sure if it is the leading edge of Hurricane Lester, which has increased to Category 3. Hawai'i County, Maui County, and O'ahu are all under Hurricane Watch, which means hurricane level winds are expected within 48 hours. Currently the predicted path of the center of Hurricane Lester is just north of the islands with Lester now about 600 miles east of the Big Island. Since hurricane level winds (>74 mph) extend 35 miles from the center and tropical storm level winds (39 to 73 mph) extend up to 150 miles from the center, we will likely get some high winds. I will check the cat run tomorrow to reinforce the connections.


Here are the solar lights that I have; I showed them to Mom and Dad last night, they liked them. I leave them in the west-facing window in my room so they get charged every day. The two on the left are the Solar Puff, the one on the right is the Solar Helix; I like the puffs better than the helix. I got them as part of a Kickstarter that I supported to provide solar lights to people in Haiti and Nepal. They are supposed to last 8-10 hours on a full charge, can be stored flat when not in use, and float! They have 3 light settings; low, high, and flashing. I think they will come in very handy in rural areas with frequent power outages. (Although it doesn't look like it below, they really lit up my room while I was taking the photo!) 

Happy Birthday to Aunty Jeanne and Troy! Happy 43rd Anniversary Mike & Marilyn!