22 November 2025
A few notable things happened this week but I didn't have time to write about them until now.
TUESDAY
As I get Joyce up, Julian the Transport Guy comes by to see if we got our booster shots yesterday. I ask him about Lauren the Social Worker, since she didn't respond to my text yesterday asking for clarification about the Medicare reset after Joyce's hospitalization, among other things.
She just got married, he said, and she broke her ankle, so she hasn't been around lately.
As we look for the suckerfish in the tank, a nurse comes over to tell me a Blake the Nurse Practitioner saw Joyce today and discontinued the thiamine (for B1) and Buspar (buspirone). I don't catch the names but as I think about it, wasn't the Buspar what Dr. Khanna prescribed a month ago?
I check with Peter the RN who says to check with the desk RN who says Dr. Dimaano said Joyce didn't need it. But Dr. Dimaano didn't prescribe it, I point out. We were to reevaluate it after four weeks. She'll have Dimaano call me, she says.
When I get home, I send a message to Dr. Khanna at the Memory Clinic asking her what's up with the Buspar. She's the one who had prescribed it to address my concerns about Joyce's anxiety when standing.
I don't think Blake or Dr. Dimaano actually observed that.
WEDNESDAY
I do talk to Dr. Dimaano in the morning. She apologizes for not keeping me in the loop. Blake comes around every three months and evaluated her yesterday, she says. And recommended stopping the Buspar to limit her medications.
I pointed out the the Memory Clinic doctor had prescribed it on Oct. 23 to address Joyce's anxiety when walking. And that we'd evaluate the low dosage after four weeks. Which is hasn't quite yet been. But if there's no improvement, the dosage would be increased, not eliminated.
So she agreed that we should continue the Buspar for two more weeks before making a decision.
She also says the anxiety could be caused by peripheral neuropathy and it may be time for an MRI.
Meanwhile Dr. Khanna replied to my email that she was deferring to the staff that see her more frequently. Although I'm the only one who sees her every day. So I tell her, I'd prefer she make the decisions about the dementia medications rather than a nurse practitioner who rarely sees her.
And that's the end of that.
I'm helping Joyce to the bathroom and to get dressed when Lauren drops by to say she'll be in her office. We're going to the scale anyway, I say, so we'll chat then.
I give Joyce a neuropathy test similar to what the physical therapist gave my father long ago. I brush the bottom of her foot with a nail brush and she can feel that. She also plays the piano with her fingers. So peripheral neuropathy is not likely to be the issues.
Joyce lost weight again. I take her to the Pacific room and get her a chair during the social lunch break. Then I knock on Lauren's door and she comes over on her scooter.
We talk about her wedding at a winery in Livermore on a rainy day. And yes, her ankle was in a boot. She shows us the photo in the vineyards. One white high heel, one big black boot.
Then we talk business. It's remarkably confusing.
Joyce has to pay a share-of-cost. Period. Kaiser did not cover the entire bill (although she seems to suggest the bill was even more than they list on the statement I brought that suggested they paid the whole bill and Joyce paid her share, too).
And Joyce won't qualify for the $0/month Kaiser plan because she's in a nursing facility. Or something like that.
She said to use the state bar site for a recommendation for an attorney to deal with the Medi-Cal change on Jan. 1 that allows only $130K in assets. The SF elder law group, I had discussed this with, is notoriously slow, she said.
And once again she says she'll find out about the weird charge on the Golden Heights bill they keep carrying over. There's been a $1K mysterious add-on.
She asks how I'm doing. I tell her about the fall in August and stitches and hospitalization. She asks about Andy, who she remembers from his visit, so I tell her about his son who wants to move to San Francisco for the playgrounds (and college). She wants to move to San Francisco too.
She does mention if Joyce went home, Medicare would restart her benefits at the SNF for 100 days (they restarted for therapy for 100 days but that's all because she's a resident). So I tell her about the Dec. 29 surgery (which she knew about) and recovery in January and maybe coming home in February.
Cassie the Physical Therapist chased us down in the meantime so we walk back to the gym with her behind us pushing the wheelchair. She tells me Joyce's balance is really quite good. But she hasn't seen her when she falls backwards.
I ask her if she has any peripheral neuropathy tests. Nope but the nurses might, she says. I tell her that I did run a nail brush against Joyce's foot today and she said she could feel it.
She has a new exercise for Joyce. Stepping up on the blue foam platform and then back down. And Joyce does it with Cassie and I holding her. Then she stands on it and marches.
Finally she bends over, with just Cassie holding her, to pick up some cones and hand them to me. She does all that with no problem although little grace.
Then she does the SciFit sets, which dissipates her nervous energy.
THURSDAY
I get over there by noon, after finally replacing our Cesca chair seats, and help her to the bathroom where she has a bowel movement. Then she dresses and we walk to the scale. She's up three pounds today at 117. Odd.
Jayce and Leonie meet us to work with her. It's her last day of physical therapy, Leonie announces. She'll go back to RNAs after today.
I walk her back to the gym and she sits in a chair at her insistence before they roll her in her wheelchair, which I retrieved, to the basketball game. She doesn't want to do it but does.
She can't reach the hoop sitting but refuses to stand up. When she does stand up, she makes quite a few, some on the bounce off one of the two hoops.
Then she does the SciFit for three sets before I take her back to the hallway to have lunch.
FRIDAY
I get Joyce to the bathroom but her Mepilex is coming off. So when she finishes getting dressed, we walk to the desk where Raquel the RN has returned. I ask her where she's been. Her mother had heart surgery, she says. But everything's OK. She's going back to the hospital after work. Meanwhile Binita is not there, so there's no wound nurse today. Ask the cart RN, who is Princess (and overwhelmed), she suggests.
Princess hadn't done the dressing change yet, which is why it is falling off, so she makes time. I get Joyce on the bed, remove the dressing and we talk about the wound. The peri skin is improved but still has spots of irritation from the poor wound care on the weekend. She has a skin prep she uses on it. When she's done, we walk to the scale. And then back to the chair. It's already time for lunch.
I set her up in the hallway and then she brushes her teeth before Sheik brings her more mouthwash.
Then we go to the gym to do her three sets on the SciFit.
So that's why you didn't hear from me all week. I felt like I was arguing for Joyce to prevent some backsliding more than I was helping her progress. But the Buspar fiasco is a good example of why every patient needs an advocate.
Even the doctors confused the issue, one yielding to the staff, the staff delegating to a superficial exam, all of which would erase an attempt to find out why she's afraid when walking.