Dad’s Medical Appointment

This week I had to take dad to his urologist for a medical checkup. He only needs to go annually to make sure everything is still OK following the prostate cancer he had many years ago. Because of my own tight schedule and the limited hours this specialist is in the office, I ended up making a 9 AM appointment for dad.

I left my house by 8 to be at dad’s ALF by 8:15, leaving us plenty of time to be early for his appointment. However, things never go as planned, and as I walked down the hall towards dad’s room I heard the aide say:”You HAVE to get up. Your daughter is going to be here any minute to take you to the doctor!”

Dad was still in bed wearing only his Depends and a t-shirt. The aide saw me walk in and said hello and she left pretty quickly. I think she was relieved not to be dealing with this unexpected problem. I was surprised she didn’t stay to help me as clearly this was not a usual morning.

Dad looked confused, even as I explained that he had an appointment with his doctor. I dressed him as I would a toddler, putting each arm into the sleeve and really having to work to get it in. Then I rummaged in his laundry basket to find a pair of sweats so he wouldn’t need a belt and his pants wouldn’t be falling if he refused to wear one.

Finally I had him dressed. Dad insisted that he was too dizzy and he couldn’t stand up. How would I get him to my car and then to the doctor’s office? Usually he uses his walker but this day he seemed unable to do so.

I ran down to the nurse and asked to borrow a wheelchair. I asked her to take his blood pressure as he was so dizzy but she refused because she “needed doctor’s orders” before she took blood pressure. I asked if he was usually this dizzy in the morning and she said yes, but I think that was stretching the truth a bit.

I sat dad in the wheelchair and got his warm coat from the closet. Then I realized he hadn’t eaten anything yet this day. I pushed him to the dining room and asked for a quick breakfast for him. I said he was in a hurry as he was now running late to make his medical appointment.

Dad ate his cold cereal and had some coffee. He seemed to revive a little, but not a lot. I pushed him in the wheelchair to my car and off we went. Now we certainly weren’t early for his appointment but if I hit all the lights just right, maybe we wouldn’t be very late.

We were lucky to get a parking space near the office door and I pushed dad into the waiting room. They gave me a clipboard with forms to fill out and checked on his insurance again (as they had already done this by phone 2 weeks ago). Since we were barely on time, I somehow expected to be escorted right in, but that never happens. We waited awhile and were then called in.

I mentioned that dad is dizzy today and I need to stay near him. They asked him to give a urine sample and then the medical aide wondered if he could do it by himself as he looked so unsteady. I said I thought he could, and luckily he did. I went in to check after he was done and moved the sample from on the sink to the little hole in the wall shelf where he was supposed to leave it. I noticed the urine looked a bit dark and asked about his kidney function. They said they only ordered the PSA test and not full blood tests, so they didn’t have that information.

Then I wheeled him to one of the examination rooms. The physician’s assistant tested his urine. She checked his vitals and at my request, also took his blood pressure. His blood pressure was a bit low and she suggested I have the nurse check it again that afternoon. I told her the nurse needed doctor’s orders before she would check the blood pressure!

The physician’s assistant told me she thought he had a UTI from the initial urine test she had run, but would need 2 days to run a culture. She asked who to call if he needs an antibiotic. I said to call his assisted living facility, but also to call me as I need to oversee his care. She said to make an appointment for next year for his next checkup. Apparently if it is a UTI, they expect the antibiotic to work without follow up.

When I took dad back to his ALF, I was already running late for my next appointment. I asked for the papers I should have been given before I took dad to the doctor. They specialist’s office wanted an official list of his current medications. Though I had an unofficial list on my iPad, they asked me to mail the up-to-date list from the ALF. I gave the wellness staff the appointment information and blood test referral for next year and they gave me the list of medications.

After I got home from all my tasks from the day, I sat down with the paperwork I had gotten for dad. Then I noticed it listed the results from the instant urinalysis the physician’s assistant had done. It says he had a large amount of blood in his urine, as well as protein (which I presume is from the blood). I suppose this is consistent with a UTI but it could indicate something else as well.

Three years ago when dad ended up in the hospital it was due to lots of blood in his urine. I think the problem he had at that time has been solved, but at first they thought the symptom was just due to the UTI he had at that time. This time I think we caught the UTI earlier, though just by good luck as we had set up an annual appointment.

I should get a call tomorrow after they check dad’s culture. I guess I am hoping it is positive as that would be easily treatable. Anything else could be a bigger problem. I worry about all sorts of things such as kidney disease, etc. I really don’t want dad to end up hospitalized or to need lots of medical treatments. Finding this UTI now may be the whole solution to his fatigue as well.

I don’t really know what happens next, except I will be checking on dad’s follow up. I want to be sure he doesn’t remain as dizzy as he could fall and break a bone. I called his ALF later in the day and was told he slept most of the day. The aide also said they had called his doctor’s office for “orders to take his blood pressure later that day” and I was glad for that. I suspect dad’s fatigue and dizziness are due to the infection and not “usual” as the nurse seemed to imply in the morning.

In the end, I was frustrated that the nurse didn’t show any more concern for dad than she did. It felt like she wasn’t willing to go out of her way for him. I will follow up with dad’s regular physician once I learn the results of dad’s urine culture.

About letstalkaboutfamily

I am a retired and was the primary caregiver for both my parents before they passed. I have children and grandchildren. This blog is an attempt to connect with other caregivers and share ideas and experiences. I hope you will let me know what worked for you if you had an experience similar to mine. The main issues I am going to talk about are elder care, death and dying, assisted living, family relationships and hoarders and hoarding. Other topics will come up as I address the issues and my relationship with other family members.
This entry was posted in Alzheimer's Disease, Assisted Living Facility, Caregiving, Dementia, Doctor, Elder Care, Eldercare and tagged , , , , , , , , . Bookmark the permalink.

10 Responses to Dad’s Medical Appointment

  1. digitalgranny says:

    Wow they needed Drs permission to tai egis blood pressure to see if that is what was making him dizzy.
    That is awful.
    Our caregivers take hubbys at will.
    I think they should have to do that on a regular basis without a drs orders.
    I can see why you are frustrated.
    Have a good rest of the week.

    • Thanks. I think it is just bull-headedness on the part of the nurse there. She doesn’t want residents families making such requests. I ran into this before and have asked his doctor to issue such orders several times. She can take a blood pressure if whe want to but I don’t think she wants to be responsible for making a decision if it isn’t normal!

      If dad weren’t so used to being at that ALF I would be tempted to move him. But it isn’t easy to make a change in dad’s routine so he stays there. I guess every ALF has it’s negativef aspects, so I try to live with her attitude.

  2. I have never in all my years of working in geriatrics (and trust me it’s many) heard of an AL needing a doctor’s order to take a blood pressure; that’s insane! And if they did need one wouldn’t you think that they’d make it a standard standing order for all of their residents. Ug it’s so frustrating what families have to go through. You’re a great advocate for your father…

    • Thanks. Neither dad nor mom needed such orders in their last ALF in the south. But that was a larger place and had several nurses on duty 24 hours a day. This place has one LPN 5 days a week for about 45 residents. She never looks that busy to me. It is just one of the frustrations of the life a a caregiver that we are subject to the whims of the staff!

  3. Janet Yano says:

    Wow…you had a lot to deal with for one doctor’s appointment. And, I agree with the previous comment…seems odd to need a doctor’s order for blood pressure reading. Good luck with everything.

  4. boomer98053 says:

    I can only guess that the reason for the doctor’s order for the BP reading is that with his “prescription” to check vitals, the facility is better able to add that to the care charges at the facility. Based on my experience working in AL and memory care, and being a long-term care ombudsman (advocate) after leaving the senior housing industry, that type of care service comes with a fee, depending upon what level of care for which your father is contracted.

    I hope all pans out well with his labs. Bless you.

    • Thanks, Irene. At this ALF, there is only one level of care. That is you pY to be there and not by the number of ADLs that the resident needs help with, etc. However, the idea they want to document what they are doing might still hold in their justification to the owners of the franchise, their requests for funding for staff and the nurse, etc.

      I will know more about dad’s culture tomorrow I think and I will visit there to see and ask questions for myself. I expect his urine culture just finished the end of the day and the nurse goes home by 4:30 so she wouldn’t be there if I called. I will call the urologist tomorrow also if I haven’t heard anything.

  5. liramay42 says:

    Yep, the ALF my mom was at until recently required a doctor’s orders to take blood pressure. I asked a caregiver to check it once when my mom was complaining about feeling dizzy, he refused, and I nearly lost my temper. It seems ridiculous to me, but it’s apparently not uncommon for these facilities. They wouldn’t monitor her oxygen levels either, even while she had a prescription for home oxygen. I am SO thankful to have moved her to a place where the staff are more sensible and helpful that they *offered* to monitor her oxygen levels without even being asked.

    • That sounds like you found a good solution. For now I leave things as they are, but I know the nursing staff is not sufficient for real health monitoring unless I request a home health nurse. Dad has had a home health nurse a few times for specific issues. Medicare pays for that but the need has to be specific, short term and limited. I am trying to fllow up more with dad’s physician and the NP who goes to his ALF.

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