Kathleen A. Gagne

Kathie Gagne died 4,704 days ago.

May 7th, 2012 @ 10:27 am

My sister sent me this email:

Hi, David.

I have been talking to Jann at Coastal Rehab. She suggested I pay them $2000 up front to cover physical therapy for a couple months. This would spend down the money enough so that Mom will qualify for Medicaid which would then cover the other expenses at Coastal because they pay retroactively. Coastal also has a psychologist and psychiatrist that would be working with Mom.

I am waiting to talk to Dr. Buck to find out more about why Mom may not be urinating properly.

I spoke with Victoria at the Volusia County Courthouse who said I could basically fax a doctor’s note to them stating why Mom would not be in court tomorrow. Susan, Mom’s Case Manager at Halifax, and Dr. Moore have both written notes which will be faxed today.

I have to go to the Social Security office to pick up a form showing that the disability process has been started and still need to meet with the Chamberlin Edmonds rep at the hospital to finish the Medicaid application today.

Tomorrow I will go to Grace Manor with the same Dr note which will release us from having to give them a 30 day notice. It basically shows that Mom needs skilled nursing care beyond what Grace Manor offers at this time.

I am glad that the last 2 days, Mom has seemed a little better. Nothing amazing, but I will rejoice in the little things. I was told that they had her up and walking the hallway holding onto the railing this morning (with the wheelchair following right behind her). She is also eating much better and not crying quite as much.

Let me know what other questions you have or what your plans are for when you get here.

Love you.

[name redacted]

Update

May 2nd, 2012 @ 6:20 pm

An update from my little sister, sent from Halifax:

Hey, David.

[…] Dr. Buck said that medically speaking, Mom’s physical condition is not critical enough that it warrants continuing to be in the hospital. Mom will need to go to a nursing home next. My thoughts are that I can get things in place for that, and then when you get here you can reassess. Meanwhile, we should look into if it would be possible to get her to Shands or a similar facility. I like the idea of Shands because I know of at least a few people that may visit her, compared to if she ended up in Jacksonville or elsewheres. As she is now, she is not a probable return to Grace Manor. I have been to The Health Center of Daytona Beach (near Halifax), and it seemed ok. Dr. Buck had his mom there and thinks it would be a good choice, as did the Social Director from Grace. Dr. Buck is going to have the social worker at Halifax that I have been talking to setup a meeting. We are also going to see if Coastal Health and Rehab Center could be a potential as well. Hoping that whatever funding is needed can be used to pay down her funds to get closer to Medicaid.

Dr. Buck was also talking about decreasing her Ativan, and giving her an a.m. Seroquel. She has a busy day with the physical therapists this morning. They put her in a wheelchair and had her scooting down the hallway using her feet, as well as getting up and down a few times. She was asleep when I got here this afternoon and agitated pretty much the entire time she was awake. It is like watching someone in a nightmare they cannot wake up from. The only way I have been able to describe it. Yesterday she was better. Seemed calmer. Clapped along to “Eh Cumpari”. Almost looked like she was going to smile when we watched “Golden Girls”. I hope for more days like yesterday.

Since Mom is 90% not going back to Grace at this time, you need to let me know if I should put the tv in storage or if you want to do something else with it.

I am sure there is more I need to say, but my head hurts, and it’s time for me to leave the hospital.

To consider…

April 28th, 2012 @ 12:46 pm

Here’s an email I just received from my sister:

I think I told you that they took Mom off of the Cymbalta the other night. I have not heard from Jan yet, but I think she may have already visited Mom today. I can’t imagine that if she saw Mom as she has been since I have been here today, that she would think Mom would do well to go back to Grace right now. I visited 1 rehab/nursing home today that Lynn suggested, the Health Center of Daytona. The 2 that the Social Worker on this floor recommended Lynn said were dumps. And I don’t think a rehab/nursing home is going to help Mom at this point. Maybe we need to see what can be done to get her into Shands.

http://psychiatry.ufl.edu/Patient-Care-Services/Adult-Psychiatry/index.shtml

http://www.shands.org/hospitals/vista/services/inpatient/default.asp

Also, we need to spend down her money, but I don’t want to pay Grace Manor for May if she is not going there. I will try to get a hold of Jan asap. But even if she says Mom can go back there, I am not so sure that will help. There are a few other big bills – $600ish for her neurologist seeing her in the psych ward, plus her bill from the Deland hospital $1000ish – that I can pay. The money needs to be moved so we can reapply for Medicaid. What do you think?

If you want to see how Mom has been the last few days, I can record her, but it is up to you.

Love you.

This Is Madness

April 27th, 2012 @ 3:19 pm

My sister just sent me this very disturbing email:

I told Dr Moore no Haldol. He is taking Mom off Cymbalta. Her behavior has been off the chain the last couple of days-constant crying, starting some hallucination type comments, and a slew of the other side effects the Cymbalta ads say "notify your Dr right away if". They just stopped it this afternoon. I don't know what she needs to be on. Pam, a social worker for the hospital, has contacted a couple of nursing homes she wants me to check out to be prepared if Mom cannot go back to Grace Manor right away. Jan, Grace Manor RN, should be coming by tomorrow to see how Mom is. 

Not happy so far with any nursing home I googled, but I will go visit them early tomorrow. (Manor on the Green and Daytona Beach Health & Rehab Center are the 2 she gave me pamphlets for.) 

This is madness right now. 

Any word from [name redacted]?

Stuck in the 1960s

April 27th, 2012 @ 2:58 pm

Here is the email I just sent to my sister:

[name redacted],

Under no circumstances should mom be administered ECT. She shouldn’t be taking Haldol, either. Is Halifax hospital stuck in the 1960s or something? This is ridiculous.

Wikipedia says, “[haldol] is by far more active against ‘positive’ psychotic symptoms (delusions, hallucinations, etc.) than against ‘negative’ symptoms (social withdrawal, etc.).”

Mom didn’t start HAVING any delusions or hallucinations (as far as we know) until AFTER they started pumping her full of all these antipsychotic drugs, some of which the doctors admitted have no proven benefits. She DID show “social withdrawal” prior to all this. If anything, haldol seems like the exact OPPOSITE of what she should be taking.

I know you’re frustrated. I’m frustrated, too. I don’t know what to tell you.

I wouldn’t freak out too much about the Ford thing. Nobody is going to put mom in jail for not paying her car loan payments from years ago; I don’t care if there are a dozen warrants out for her arrest. She’s been in a state-run hospital and / or mental ward for the last five months. If “the law” wanted her in jail so badly, they would have done it. Hell, she would probably get better (free!) medical care if she WAS in prison. We can deal with stupid stuff like that later.

If you want to look into getting one of those $20 “power of attorney” packages from Office Depot or whatever, that’s okay with me. I’d still want to let [name redacted]’s dad review it first before we actually file anything anywhere. (He’s a lawyer.) I’ll try to look into that more, too.

David Vincent Gagne

Update

April 27th, 2012 @ 7:34 am

My sister just sent me this email:

I received a call Wednesday night around 11:30pm from Crystal, the nurse on duty. She called to tell me that Mom’s bed alarm went off and that when they got to her room , Mom was on her knees on the floor. She did not appear to have received any physical injuries, so they placed her back in bed and called Dr. Buck. Mom was very anxious and upset and crying nonstop. I came in to try and calm her down and stayed the night. Mom was very agitated when I arrived. Cheryl, the CNA on duty, was sitting outside her door and had been coming in to sit with Mom periodically but nothing seemed to soother her. I suggested they reposition Mom because it sometimes seems to help calm her down. She finally settled down, maybe sometime between 1 and 2am, and she seemed to sleep pretty deeply then. This morning I do not see any outward signs from the fall, no major bruising on her knees. There does seem to be a little red spot on her left knee that I will keep an eye on, but overall, I did not see any bruising or anything to indicate she fell hard.

The Physical Therapist came in at 8:30am and had to wake Mom up. (The Physical Therapists who were here yesterday – 2 of them – sat Mom up and helped her to her feet a couple of times, doing most of the lifting for her.) The PT today was alone and stretched out Mom’s legs and got her to sit up in bed. She had Mom kick out her legs a few times, as well. When I returned from the bathroom, the PT had Mom sitting in a chair. Mom was starting to get weepy. The PT left her in her chair, and I helped her with breakfast. She ate decently, feeding herself some and I fed her some. The nurse, Kylie, and I moved Mom’s chair by the window. She couldn’t relax and tried standing up a few times. She periodically was able to answer a couple of questions about what she was looking at outside, but she continued to be restless and upset.

Shawnta (CNA) got her back into bed, and it took her awhile to settle down. She ate some of her lunch on her own but continued to be weepy and anxious when awake.

Dr. Moore came to see her today. Because she has been so highly agitated, he has increased her Ativan from .25mg 2x/day and .5mg at night to 1mg 3x/day. (David, Dr. Moore does have an outside practice, but he says it is very small and getting smaller as his inpatient work takes up so much time.) Dr. Moore asked me what I thought. I talked about wanting to just snap her out of it, wondering if she just needed a zap to the head. Dr. Moore said that he and Dr. Buck had spoken about Electroconvulsive therapy (ECT) based on the curiousness of Mom’s condition. He said that ECT has shown to be useful with psychotic depression with side effects of some short-term memory loss, but she would need to go to Shands, Jacksonville, or Orlando. He said that if it is dementia, ECT could make it worse, but if it is a psychotic depression, then it could be helpful. He seemed to think that a teaching hospital might be more accommodating because Mom’s case is so perplexing. Dr. Moore also asked Pam, a Psych nurse from the hospital who worked with Mom while she was here previously, to come and observe Mom. Pam came and saw that Mom was much more anxious and upset than she had been. Mom received 1mg of Ativan around lunch time. When she was sleeping, she was sleeping pretty good, but when she wakes up, she has a minute of peace and goes straight to anxiety.

Dr. Moore was saying that maybe Mom needed to go back down to the Psychiatric unit for a bit, and I told him that I would take her home before letting back in there. He did agree that it did not seem as if they had been able to help her down there previously. He said that we should see how the increase in Ativan goes.

Dr. Buck came in around 7:30pm. Dr. Buck said that the Zyprexa had been increased, as well, to 15mg/day (if I recall correctly). Dr. Buck said that he and Dr. Moore had spoken briefly about ECT, but that it could be difficult to even consider due to the costs. He said that because Mom’s original admission need had been met, that we need to start considering her discharge and whether she can go back to Grace Manor in her current condition or if she will need a nursing home/rehabilitation home. Jan, will you be coming to do an assessment? She will continue to need Physical Therapy, but I do not see any reason why she won’t be walking again soon. Part of wanting to know about Mom’s return to Grace Manor is because if that is a go, I can pay May’s rent early, depleting her funds enough to be able to apply for Medicaid May 1st. Dr. Buck said that we will need to see how the next couple of days go with the Ativan increase.

When I arrived around 1pm yesterday, Mom was sleeping. When she woke up, I gave her some of her favorite Starbucks coffee. She had both eyes open and almost looked like she was going to smile. She did not stay awake for very long though. The nurse said that she had been weepy in the morning, but not as bad as her previous shift. When Mom woke up again, I helped her with dinner. She ate some of it on her own. Her overall mood seemed better, but she was not awake for very long while I was there. I am hoping to see some more improvement when I get there today.

Update on Mom

April 19th, 2012 @ 1:58 pm

My sister sent this email to me and copied Janis Stovall and Janice Day at Grace Manor

Hi, All.

Dr. Moore, psychiatrist at Halifax, came to visit Mom around 1pm yesterday. When I asked him what he thought, he said he thinks she has a combination of some dementia/confusion/paranoia with possible severe depression. She was sleeping at the time, and he asked if she had been sedated. I said no, but explained that when she is awake she seems to be suffering, and it is only when she is asleep that she seems to have any peace, but that we don’t want to just have her knocked out all the time. He suggested Haldol again, and I told him no. I explained to him my concerns for her depression override my concerns about dementia. He said that he was going to take her off the Celexia (Citalopram) and start her on Cymbalta. He says that it is somewhat related to Citalopram, but that it can also help with any pains. She started Cymbalta last night.

Dr. Hatten, an Orthopedic physician, came in to see Mom around 5:30pm. The CT-Scan she received Saturday night showed that she has 2 fractures in her pelvis that occurred within the last couple of weeks. Dr. Hatten said the position of the bones is good and should be fully healed within 2-3 months. He said her treatment would be conservative, needing to do some walking with a Physical Therapist and using a walker for a bit.

A PT came to assess Mom this afternoon, did some range of motion with her, and got her to sit upright and then stand briefly a couple of times. Mom was stiff from being in bed for so many days and was in pain, but she did manage to stand.

Janis, do you have any reports of Mom having fallen the week of Easter? To the best of my recollection, it was that previous Sunday that Mom was walking as good as I can recall. I was also wondering when she began sitting on the floor.

Mom was then moved from the Bill France Tower to the old building and is now in room 711. (They needed the rooms in the other building for some post-ops.)

Dr. Buck came to see her around 7:30pm. He agreed with putting Mom on the Cymbalta, saying that it is an antidepressant without the sedation and should help with any discomfort. He thinks that the physical therapy will also help because it will stimulate her mind and get her off of the monotonous humdrum thinking she has been doing.
He says he cannot make a full commitment to it, but does feel that much of her condition can be explained by a severe major depression with some kind of breakdown. He is not 100% sure a full-fledge dementia has been proven but recognizes that he did not see her for that time when she was at Act and Halifax through the winter. He feels that Namenda does do some people some good, but he does not necessarily feel that it has to be on board. We can try her off of it if we want. He is not seeing any side effects from it.
Dr. Buck says Mom is on the 3 blood pressure medicines because it tends to be better to balance things out by adding another one than increasing what she has. He said that when you increase a BP med, you tend to see more of the side effects. His only concern was the HCTZ because of its effect on her potassium level.

Dr. Buck’s next concern is how long she will be in Halifax and will she be able to return to Grace Manor or will she need to go someplace else for rehabilitation. He says we will need to see how the next couple of days go.

She will continue to need physical therapy for awhile, and he said it can be done as an outpatient. Janis and Jan, maybe you could give us an idea of what you think regarding how much care she can get or what it would look like to have a pt go to Grace Manor.

Her mood has been better overall, but she has seemed a little “stoned” at times. I am optimistic to see her watching tv as if she is focusing on it, and also, to see her left eye open more. She is a little slow to respond to questions but when you get her attention she does respond, albeit quietly.

Thank you all for your support.

Please let me know what other questions I need to be asking or if I missed anything.

Drugs and drugs and drugs

April 16th, 2012 @ 9:25 pm

I replied to my sister’s email and copied Janis Stovall and Janice Day at Grace Manor:

[name redacted],

I can get you the details about Elder Source tomorrow when I get to my office. The assessment was definitely done; I will get you the date and the name of the person that did it as soon as I can. I know for certain it was completed because -- as usual -- every government agency involved with that process made every mistake possible before I was able to get it done correctly.

As for the drugs:

I don't understand why she is still on Namenda. I thought we'd been told by several people that it has no proven beneficial effects at all and a plethora of negative side effects.

I know that Ativan is an anti-depressant. And I see that, according to Google, Celexa (not Celexia) is also an anti-depressent. (This is a new drug for her as far as I know. Did Dr. Buck start her on this?)

Lopressor, Prinivil, and Lozar are all used to treat high blood pressure. (I am guessing you meant Lozar and not Zozar.) Can you try to get someone to explain why she is being treated with three separate prescriptions for high blood pressure? I thought you said there was some question as to whether she even had high blood pressure in the first place.

In your last message you indicated that Dr. Buck was trying to minimize the number of drugs in her system, so it seems odd to me that she'd be getting three separate drugs to treat high blood pressure, two separate anti-anxiety drugs, and one drug that nobody seems to think does anything valuable.

Thanks for the update, [name redacted].

David Vincent Gagne

Update: Part 2

April 16th, 2012 @ 8:20 pm

My sister just sent me the following email. She copied Janis Stovall and Janice Day at Grace Manor Port Orange:

Dr. Moore, one of the psychiatrists from Halifax, came to see Mom around noon. Mom was pretty sleepy at the time. Dr. Moore asked me some questions regarding Mom’s history. He also tried to ask Mom a few questions, but she was fairly unresponsive. Dr. Moore did not say much to me at the time, but he did say that her condition did not seem as much like dementia as catatonic.

Dr. Buck returned later in the day to check on Mom. He is going to have the catheter removed (I assume Tuesday) to see how she does, and he is going to have a physical therapist come in to work with Mom to get her walking again. He said that she seemed to be having a “major depressive syndrome” which would put her in a catatonic state. (Mom has not been very animated since she has been here, other than occasionally pulling herself up to a sitting position as if she wants to get out of bed and her aggressive behaviors towards me.) Dr. Buck said that as far as he can tell, it seems as if she has a fairly healthy brain for someone her age. Dr. Buck went over some of Mom’s older records and seems to be pretty adamant about getting to the root of things.

She is now on Celexia ¹, Zozar ², Namenda, Lopressor, Prinivil, and Ativan.

Lee, from Chamberlin Edmonds, is going to help me through the Social Security Disability process which should quicken the Medicaid process. She said that if Mom was on the Diversion Wait List, someone from Elder Source would have visited Mom and done an assessment. Can anyone verify if that has happened?

Thanks.

¹ The correct spelling is Celexa.
² I couldn’t find any drug by this name and have no idea what it was.

Easter Sunday

April 15th, 2012 @ 9:52 pm

My sister just sent me the following email. She copied Janis Stovall and Janice Day at Grace Manor Port Orange:

Mom was brought to the Halifax emergency room, Saturday, April 14th, at approximately 7pm, after conferring with Jeanne and Hannah regarding Mom’s inability to urinate in almost 24 hours and claims of abdominal pain. Mom was catheterized and blood was drawn. She had a CT-Scan which showed an older fracture to her pelvis, possibly an injury that occurred within the last few months. The lab work showed Mom to have hypokalemia (?), very low potassium levels, possibly due to the HCTZ. (Dr. Buck said that signs usually appear when someone’s levels were down in the 3s and that Mom had dropped to the 2s.) They started her on a saline-potassium drip and admitted her to the hospital around 3am. Mom did not get her 8pm meds. She received Ativan around 11pm. When she was moved to the 7th floor, her blood pressure had risen and she was going to receive a one-time dose of a med (I do not recall the name), but she did not because her blood pressure stabilized before it could be administered.

Dr. Buck came in around 5pm, Sunday, April 15th. Dr. Buck said that Mom will be in the hospital for at least a couple of days, as he wants to go over all her meds and lab work thoroughly, while also running some other tests.

As of this evening, he has taken her off of the HCTZ and Haldol and wants to reassess. He says he would like to take her off of everything she does not absolutely need and go from there. He has also requested that Dr. Moore, Psychiatrist from Halifax, come in to observe Mom with a fresh set of eyes.

Since she has been here, she has been fairly mild tempered, with the usual “help”, “please”, and “I don’t want to be here”. She has been sleeping quite a bit otherwise, has had a few moments where she was speaking clear enough to express her desire to “not be a burden”, and had a short bit of aggression squeezing/digging nails into my hand and grabbing my hair once. She did not eat very much of her lunch or dinner and seemed to almost be too tired to chew.

I will keep you all updated as best as I can and will try to get more thorough details as well.

Thanks.

PS Janis, FYI, your staff, overall, is pretty awesome and has been a tremendous support. I am very grateful for them and the love they (and you) have shown towards Mom during this trying and confusing time for all of us. Thanks!