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There Go the Apples!

The life of a caregiver and their “caree” is always in such a delicate balance that I think of that old saying, “don’t tip over the apple cart.”  When I hear that analogy, I have a vision of a small cart piled high with apples, holding its own until someone puts one too many apples on the pile, and then the whole stack comes tumbling down…or maybe it’s similar to a house of cards?  Not sure which but I do know that it doesn’t take much to upset the balance.
In our world, balance is the secret to having a good day.  There needs to be a balance of sleep versus awake time; my work and his routine; his needs and my available time.  There also has to be an emotional balance.  We can cope with the routine aches, pains, fatigue, and malaise but throw in more pain, fatigue, frustration, or sleep deprivation than usual then the balance is gone and we have to work toward establishing equilibrium again….whatever that is on that particular day.
What threw us off this week was Lynn’s powerchair.  We’ve known for some time now that the motor was sounding as if it was going to go out at any time.  When we checked with our “chair repair man” however, we found out that insurance would not pay to have it replaced until it actually went bad. I know that motors are expensive (over $1400) so I understand that the insurance company doesn’t want to replace one unless they know it’s essential, but obviously, they have never had to survive a broken wheelchair!
Lynn’s powerchair is the Cadillac version.  It has three speeds, the legs elevate, and the chair tilts, among other things.  He uses the leg lift and the tilt function off and on all day to achieve comfort. When his legs get stiff, he elevates them to different positions.  When he scoots forward after a while and ends up sitting too far forward, he tilts back and gravity helps him slide back so I don’t have to lift him. These are just two of the maneuvers he does with it all day but there are many more.  Suddenly on Wednesday, he goes to tilt back to adjust his position and there is no response!  Fortunately, he was not tilted back like he was being launched into space; he was on the ground; but the impact of losing “tilt” was enormous for his quality of life. 
Since he could no longer tilt, he could no longer help me in shifting his position himself so I had to lift him more; therefore, my back is more sore.  He could not position his chair in the slight tilt needed to keep his knees from hitting the keyboard on his computer when he worked. It interfered with his comfort in sleeping (he sleeps in the chair), his exercising, his moving from place to place with his legs dangling, and so much more…but the worst was that it keep him from being able to shift his weight as he sat for hours.  By not being able to shift slightly ever so many hours, he experienced “butt fatigue” so he could not get comfortable.  His buttock skin stayed compressed longer so it is redder and he now has a couple of top layer skin tears.  There was even more impact than this but that’s enough for now. Let me just say that it was traumatic….for us both.
In our house, “if Lynn ain’t happy, nobody’s happy.”  When he’s uncomfortable, he looks to me to find a way to make him comfortable which means constant interruptions.  At times he gets angry and frustrated but that blows over.  What is worse is the sadness and worry in his eyes.  He wonders how long he will have to suffer and what the impact will be…because when the balance is off in an MS patient, bad things often happen.
Fortunately for us, it didn’t this time.  I cheered with joy today when the doorbell rang and it was the repair man with a new motor. We were both very grateful for his ability and house call.  The chair is now fixed; Lynn is comfortable again; and I should be able to get his poor butt back to health without too much trouble.
So once again, balance is restored.  We both prayed for God to help us during those hours of waiting for the repair man…and he did.  We worked together to make Lynn more comfortable and to reduce the discomfort as much as possible. … and where we could, we joked, or made light of the problem.  Using humor, seems to lighten the load so we try that out when we can.  Sometimes it works and sometimes it falls short, but most of the time we have at least a few minutes of respite to forget the seriousness.
So anyway, watch the apples you put on the chart.  Try to keep a balance.  When the focus shifts to the front, then try to lighten the back and get back the balance.  It helps to make the waiting time go much faster.

Too many changes in too short a time

I’ve always disliked change.  I like things to be predictable and I like feeling in control.  I want to know what I’m responsible for, be able to plan my immediate future with some degree of probability, and I like to finish jobs and cross them off my list. Change doesn’t come easy for me but I eventually adapt.
This week has brought a lot of change. Ever since Lynn was originally diagnosed with MS, he has participated in a study whose purpose was to determine if taking Copaxone along with Avonex would reduce occurrences of exacerbations.  There were three groups; one got Copaxone and a placebo; one got Avonex and a placebo; and the other got both drugs.  We found out that Lynn was in the group that took only Copaxone.  Now that the study is over, he has to decide what he wants to take as a medication.  His doctor feels he did not do well on Copaxone because his condition declined rather quickly in those five years. Tough to say if it was the MS or the long hospitalizations but he certainly has a lot less function now than five years ago. 
Now he has three medication options to consider–Rebif, Betaseron  or Tysabri.  None are good choices for someone with probably progressive disease rather than relapsing/remitting so it’s a matter of which will do the least harm.  Betaseron can cause liver disease, thyroid disease, seizures, bleeding disorders, anemia and depression.  Rebif can cause liver disease, seizures, congestive heart failure, thyroid disease, and depression.  Pretty much the same as the other one but there is the risk of heart failure instead of anemia and you take it three times a week instead of every other day. Tysabri on the other hand can kill you.  It may cause a serious viral infection of the brain that leads to further disability and death. Supposedly there’s a test that will help determine who is susceptible to the viral condition but it’s no guarantee. Therefore, he’s not inclined to take that one.  Unfortunately, that’s the one I think his doctor wants him to try. I believe he thinks it might work better for him. It’s Lynn’s decision but as I write out the side effects, I’m not thrilled about any of them but I, too, lean more toward the Tysabri.  I am sure Lynn will not consider it at this time; however, so Rebif will probably be the one he chooses.
Rebif makes you feel like you have the flu for about 8 hours after you take it according to the literature.  So three days a week he’s going to feel lousy…oh, joy.  Not only that, I’m waiting to find out just how much the insurance will cover.  It costs around $30,000 per year I understand without insurance. Who has that kind of money?  I know the drug companies offer assistance but I’m expecting big dollar signs in our future.  I sure hope my insurance will cover the majority of it!
The other change I found out today was that we are no longer approved for home health visits.  We have 90 visits per year.  Lynn tried spreading them out so they would last till July when the number increases again.  Instead, because he was not using them as much, they got cut off completely.  Now I’ll have to call and try to persuade them to reinstate the number that was left.  Just one more challenge to face.  If they don’t allow us to get them back, then I guess we’ll see if he can do outpatient physical and occupational therapy.  That means three days a week driving an hour each way to therapy, paying $5 to park each day, and taking, at a minimum, three hours out of our day…actually more since there’s all the preparation time and then “re-settling” time afterwards.  I just don’t see how I’ll be able to keep up with work with all those trips. I’ll just have to find a way, I guess.
Speaking of work….I’m busier at work.  I go in only one day a week for about three hours but on that day, I get nothing done due to the travel and the fact that everyone wants to talk to me while I’m there so it takes me more hours to stay caught up.  I’m working seven days a week to keep up. If we have to start going in for therapy…well do the math.  On the other hand there is more therapy equipment there and maybe he’ll do better and get stronger faster.  We can always hope.
I admit I’m overwhelmed right now with all the change to be considered.  I know we’ll adapt and it will be become our new normal but it sure would be nice to just coast for a while.

The world still doesn't understand disabilities

 

Would you believe I still don’t have the loan settled for our van?  I know God will provide and this van will be ours but it has been so very frustrating dealing with the loan company this week.  Here’s the issue:
The seller is asking about $7000 more than the blue book value for a 2005 Uplander.  The loan company’s policy is that they will not loan more than 125% of the blue book value.  Can you figure out why there’s a difference in price?  Of course!  It’s a wheelchair converted van! Duh!  It’s not a regular van that is equivalent to the basic 2005 Uplander blue book value.  It’s a van that has had $20,000+ of work done to it so that someone in a wheelchair can use it. Therefore, an additional $7000 is extremely reasonable as an additional cost above the blue book value.  However, the fact that this is a specialized van does not seem to figure into the equation.  The loan officer is very sympathetic.  She was once a nurse and understands the need for the van and the fact that they are very expensive but rules are rules–there has to be a way to determine a “reasonable” value for the van and that’s the blue book value.  I’ve suggested that she contact companies that actually do conversion van work so hopefully she will but today was Veteran’s Day and they were closed so I’m not sure what is going on with the loan.  It’s just so frustrating that rules get in the way that do not take into consideration the needs of the disabled.
If dealing with the loan company was not enough this week, I’m also struggling with the insurance company regarding a patient lift I want to buy. When Lynn was in the hospital, I learned to use a device called a Maximove.  It was so easy to manage.  It has electronic controls and allows you to be at the patient’s side as you adjust him from lying to sitting and then slowly adjust his position as he’s placed into a chair or location.  It’s easy to use, very stable, and much safer than the hydrolytic lifts the insurance companies want you to use.  Hydrolytic, manual lifts require that you stand near the pump and/or release value as you use the

patientlyft i aluminium
Image via Wikipedia

device.  Although that’s not that far from the patient, it doesn’t allow you to be right there with them.  It’s also difficult to get the patient adjusted because you can’t change their position while they are in the sling.  I’ve tried the one we have now that has been approved and I never can get Lynn comfortably settled into his wheelchair. Usually he ends up on his spine or twisted. It looks like the insurance company would realize that if it’s not as easy and as safe to use, the caregiver is not going to use it and eventually the wear and tear on their body will cause the insurance company to have two people submitting claims instead of one.  Go figure…
I wonder if the people making the rules for insurance and loans would implement as many barriers to caregivers if they became one themselves.  Maybe it would help if they “walked a mile in my shoes.”