Dad is taking a nap but in a few minutes I will wake him up and take him to the rheumatologist, Dr. A (not his real initial). Dad’s arthritis was under control on a daily dose of 2.5 milligrams of prednisone, but prednisone has side effects, like reducing bone density, which concerned the doctor because Dad is 93 and a fall could kill him. I take this seriously because a fall led to my mother’s death in 2006.
However, every time we have tried to go below 2.5 mg of prednisone, Dad has had a flare-up of arthritis, usually in his left hand. So Dr. A and I went several rounds over tapering the dose — I argued against any reduction and pointed to the one-to-one ratio of tapering below 2.5 mg. to a flare-up and having to drastically increase the dose for a few days afterwards. But Dr. A was very concerned over the results of a bone density test — he proposed reducing the dose to 2.0 mg. Finally I agreed.
Disaster followed in about 48 hours. Only this time, the arthritis flared up in both hips and his spine. So a man who could walk comfortably upright was suddenly in agony and stooped over his cane, barely able to walk or get in and out of bed — AND this pain enormously increased his chances of falling.
I already have impressed my dissatisfaction with this turn of events on the nurse practitioner. But, since the increased dose of prednisone has not resolved Dad’s pain, I have snagged a cancellation appointment today with Dr. A.
If you are caring for someone who is elderly and/or dying, here’s are the takeaways: I should have negotiated with the doctor that this would be absolutely the last attempt to taper Dad’s prednisone if the bad result I feared manifested. Also — neither the doctor nor I foresaw that the arthritis could flare up and strike directly at Dad’s ability to walk. We both should have seen that one coming. I want the doctor to see the result of his insistence that we taper Dad’s prednisone so he will know why I will stand my ground to the death in the future.
Speaking of death, when you are making end-of-life care decisions — and that is what this is because Dad is 93 and has other health problems — here’s the thing: you are going to die of something. At the end of life, the choices you make do not determine WHETHER you will live as much as they determine WHAT WILL KILL YOU. I am going to impress on Dr. A that the gradual bone loss due to prednisone that could result in death from a fall is very much preferable to the nearly 100 percent certainty of falling that attends an arthritis flare-up (even one that only affects his left hand, since he has to push up from chairs to get out of them these days).
I am heartbroken that religious totalitarianism prevailed in Maine by telling lies about homosexual marriage equality. Think I’m exaggerating? I’ll explain another time.
The bright side of NY-23 is that Newt Gingrich showed his true colors and God willing, this has ended his bid for the Republican presidential nomination in its infancy.
And I am joyful about the victories in Virginia and New Jersey.