A tale from a nursing home

[Russell Williams]

Originally Posted by Webmaster

All my best to Louise, Russell. It is awful that she has to go through all this.

I hope that some who do not know Louise will be more prepared for what they may face in nursing homes.

[Russell Williams]

The bad news is that she now officially has C diff. However we both expected that to happen. Louise has now been told that while staff is not allowed to use Clorox in the bathroom supervisors are allowed to use Clorox in the bathroom. The reason given is that Clorox will ruin the tile. Louise actually convinced them that in the past Flagyl did not work and so Louise has been started on vancomycin. The problem with vancomycin is, at four pills a day, a month supply cost $3000. Fortunately, so far the insurance covers it. If the insurance stops covering it we are in deep do do. I need to call the insurance company up and find out if there is a lifetime limit on payments to the patient and their doctors.

I explained previously about Louise not getting her IV antibiotics until 3 AM and being told that in the future she would have to get them at 3 AM every morning. Tonight the person on duty explained that since the computer said that Louise was supposed to get her antibiotics at eight o'clock she would have to get them according to the computer schedule and so she got them at nine o'clock.

I refuse to get upset about the food because I consider it not a major problem. Louise however does get upset when a dietitian comes in and she and Louise carefully discuss what she will be having for her three meals each day and the dietitian carefully writes it down and then the food that actually shows up bares little or no resemblance to what was discussed and written down.

[moore2me]

Dear Russell,

What you have described happen in Louise's room is deplorable infection control practice. Louise should not be made a culprit of passing C diff to her room-mate. C diff can be a death sentence to some folks - especially the infirmed in a nursing home. If you are in the state of Maryland, the health authorities should be notified about the danger to other residents. As usual, I am copying some links and info from Maryland's regs. Also, since the nursng home receives money from Medicaid/Medicare - federal regs also apply. If the home wants to keep getting federal reimbursement, it has to follow federal requirements. If you or Louise does not want to file a complaint, you can complain anonymously to your state elderly resource person - called an Ombudsman.




http://www.ltlmagazine.com/news-item...ted-infections

Rates of Clostridium difficile, which kills 14,000 Americans each year and adds an estimated $1 billion in extra costs to the healthcare system, remain historically high, HHS said.

A separate recent CDC report showed that 75 percent of C. difficile infections now begin in medical settings outside hospitals, such as nursing homes and outpatient clinics.

An announcement of the request for public comments on the National Action Plan will be published in the Federal Register the week of April 23, HHS said.
Report from CDC. (Russell, you and Louise should submit commits to this bunch. It will help people in the future who are facing the same fight you are in. You may even get to testify to a Congressional committee.)

Making Health Care Safer Stopping C. difficile Infections
http://www.cdc.gov/vitalsigns/HAI/index.html
C. difficile germs move with patients from one health care facility to another, infecting other patients.

• Half of all hospital patients with C. difficile infections have the infection when admitted and may spread it within the facility.
• The most dangerous source of spread to others is patients with diarrhea.


Doctors and Nurses Can:
• Prescribe antibiotics carefully (see http://www.cdc.gov/getsmart/specific...hcp/index.html). Once culture results are available, check whether the prescribed antibiotics are correct and necessary.

• Order a C. difficile test (preferably a nucleic acid test) if the patient has had 3 or more unformed stools within 24 hours.

• Be aware of infection rates in your facility or practice, and follow infection control recommendations with every patient. This includes isolating patients who test positive for C. difficile infection and wearing gloves and gowns to treat them.

Patients Can:
• Take antibiotics only as prescribed by your doctor. Antibiotics can be lifesaving medicines.
• Tell your doctor if you have been on antibiotics and get diarrhea within a few months.
• Wash your hands after using the bathroom.
• Try to use a separate bathroom if you have diarrhea, or be sure the bathroom is cleaned well if someone with diarrhea has used it.
What Can Be Done

Federal Government Is:
• Tracking and reporting national progress toward preventing C. difficile infections in many types of health care facilities. These programs help track the size of the problem, antibiotics used, and people at risk.
• Promoting C. difficile prevention programs and providing gold-standard patient safety recommendations
(see http://www.cdc.gov/HAI/organisms/cdi...ff_infect.html.

Maryland Nursing Home requirements (below)
http://dhmh.maryland.gov/SitePages/Home.aspx
http://dhmh.maryland.gov/ohcq/SitePa...gulations.aspx

Making a complaint in a Maryland Nursing home (links below)
http://voicesforqualitycare.org/MDOmbMan.pdf
http://www.voicesforqualitycare.org/id176.htm
http://www.voicesforqualitycare.org/id77.htm

http://www.cdc.gov/hai/pdfs/toolkits...kit2-29-12.pdf Cleaning Rooms with C Diff

[moore2me]

Originally Posted by Russell Williams

The bad news is that she now officially has C diff. However we both expected that to happen. Louise has now been told that while staff is not allowed to use Clorox in the bathroom supervisors are allowed to use Clorox in the bathroom. The reason given is that Clorox will ruin the tile.

I am shocked that the nursing home values the cost of their precious bathroom tile more than they do the lives of the other patients using the communal restroom. Since the cleaner go home at 8 PM - there is plenty of time to expose others to C diff. Louise is just trying to save some lives.

Louise actually convinced them that in the past Flagyl did not work and so Louise has been started on vancomycin. The problem with vancomycin is, at four pills a day, a month supply cost $3000. Fortunately, so far the insurance covers it. If the insurance stops covering it we are in deep do do. I need to call the insurance company up and find out if there is a lifetime limit on payments to the patient and their doctors.

Why are you guys having to pay out of your pocket for an infection Louise caught in a hospital? I would think the place she contracted this infection from should be paying the lion's share of the bill. Is there a record when she caught this stuff? Can you lawyer help you with this?

I explained previously about Louise not getting her IV antibiotics until 3 AM and being told that in the future she would have to get them at 3 AM every morning. Tonight the person on duty explained that since the computer said that Louise was supposed to get her antibiotics at eight o'clock she would have to get them according to the computer schedule and so she got them at nine o'clock.

I refuse to get upset about the food because I consider it not a major problem. Louise however does get upset when a dietitian comes in and she and Louise carefully discuss what she will be having for her three meals each day and the dietitian carefully writes it down and then the food that actually shows up bares little or no resemblance to what was discussed and written down.

I think in this tragic Greek comedy of errors that the food deal is hilarious. I think Louise should ask who is getting her pre-ordered food. Someone in the nursing home probably ordered what Louise is eating. Also, since C diff is transmitted ususally by a fecal/oral route - the authorities should not be so casual about what happens to Louise's meals.

(Is the nursing home run by Moe, Larry, and Curly or by Simon Legree?)

[CastingPearls]

I'm horrified by how this nursing home is treating Louise and doubtless many other patients. God help those who have no insurance at all.

EDT: Russell, please consider a consult with an attorney. First consult is normally free. I think you need one. Immediately. Because we're not talking about quality of life at this point. We're talking negligence to the degree of 'quantity' of life.

[Russell Williams]

And I've been copying these posts to him.

[Russell Williams]

Louise entered the nursing home last Friday. Since then she has been pushing to get a sponge bath. Today, Thursday, they took her to the shower room and gave her a sponge bath. Because Louise is taking fluid pills again she gives off a lot of fluid and her bedclothes were pretty well soaked. Before she left for the shower room she took all of her wet bedclothes and put them in a ball in the center of the bed and took down one quarter of the fitted sheet to indicate that it was time for fresh sheets to be put on the bed. When she got back from the shower room she saw that the bed had been very neatly made with all the pads and sheets properly placed in the bed. As she started to get into bed she found out that the bed had been remade using the urine soaked sheets. Louise refused to get into the bed until it was changed and fresh clean and dry sheets put on it.

Because of some of Louise's special needs due to the type of wounds she has, in her closet, a bag of specialized supplies including sterile gauze dressings and the special type of tape that her skin needs for the sterile gauze dressings to be attached to her. Louise had been wearing a T-shirt which also become urine soaked while she was laying in bed. The urine soaked T-shirt had been put in the bag and on top of the specialized sterile dressings and other supplies.

[moore2me]

Russell,
I can barely read your posts without getting so mad I could bite myself. If you give me the name of the home, I will turn them in using my name.

[Russell Williams]

Last night when I talked to Louise. I told her that on the dimensions board I was being encouraged to talk to the state and federal authorities and being provided with addresses to send information to. Louise told me that she wished that I would not do such a thing. I am not yet ready to do something that Louise is explicitly told me she does not want me to do.

What is going on?

From what I observe, Louise is very willing to stand up for the rights of others especially if they are fat people being discriminated against. She is less willing to stand up for her own rights. She has mentioned that she is afraid that she will be banned from all the nursing homes in this County. Because of her size she is already banned from most of the nursing homes in this County.

I have told Louise that I would like to make copies of all the posts I've made about events in this nursing home. I would then like to take copies of these posts and show them to the administrators of this nursing home.. I plan to explain to them that I have been not only posting this on the dimensions board. I have also been sending copies of them to the leaders of my church and to the local equivalent of the Council of churches where many ministers will be able to read them. I would then tell the administrators that there is a very good chance that one of the ministers in the Council of churches or the church leaders of my church will ask me which nursing home Louise is in. I will then ask the administrator, "When they ask me that question what should I say?" I hope to do that today.

Louise told me that last night, at some point, it was mentioned that she had had her bedtime snacks to eat. She told the staff member that she had not gotten a snack. An investigation was done and Louise was told that, while the snacks had been brought to the floor, the previous shift had not done their job and passed them out. On the whole floor Louise was the only one who had mentioned the lack of snacks. I do not consider this to be a major problem but rather indicative of the whole situation.

Yesterday, with a walker, Louise walked about 200 feet. She also walked up and down a flight of low steps the top of which was 4 feet above the floor. The wound surgeon looked at Louise's two wounds and says that neither seems to be a cause of concern. The wound over her hip replacement has no redness nor heat. In 24 hours it did leak about two thimbles full of clear fluid. The wound on her lower leg was cut into and is currently about half the size of a dime and perhaps three dimes deep. The Dr. said that the wound no longer needs to be packed but only to have the dressing changed twice a day. I watched one of the hospital staff change the dressing on Louise's leg. I trust my ability to maintain sterility more than I trust what I saw. The plan is to stop the IV antibiotics on Tuesday. At that point Louise wants to go home even if it is against medical advice. She has started vancomycin and the C diff has not gotten worse. Louise tells me that her roommate, who also had a hip replacement had a redness and swelling all along the line of the surgery. An appointment was set up for the roommate to go to be seen by a Dr. No arrangement was made to transport her there although her son was apparently told the transportation would be provided. The woman, with recent hip surgery, was transported to the doctor's appointment in her sons(I believe it was) Corvette. The Dr. looked at the wound and sent the woman straight to the hospital.

I thank all of those people who have taken the time to provide advice and links to Louise and I as we work our way through this situation. So many different things have happened to Louise in the last three years I becoming desperately afraid that one of these times she will not recover.

[Russell Williams]

Louise just called with an update.

Louise told me that the director of nursing came in to see her and told Louise that she did not wish to discuss anything that happened before yesterday. Louise said that when she described some of the events of yesterday the director of nursing told Louise that each of those problems had been fixed.

Louise then proceeded to tell me about a whole bunch of things that were happening to her and her environment. The following is a very partial list: In the bathroom, for three days there was a feeding bowl and spoon apparently used with one of the men on the other side. Somebody opened up a box of something and left the box top on the sink. After three days Louise was the one that put it in the trashcan right under the sink. Louise was using the soap dispenser and somehow knocked it loose and it fell to the sink counter. It is still there. After she uses the toilet she frequently experiences great difficulty in getting someone to wipe and clean her. She often winds up doing it herself.


I decided to post the name, address, and phone number of the nursing home. I realize that this will anger Louise but I decided that for the sake of everybody else in that nursing home I need to do at least that much. This particular nursing home is not listed in the three different phone book Yellow Pages that I looked at. Because of my trouble with names I do not remember the name although I will recognize that once I see it.

I will see Louise tonight and hope to collect the information at that time.

Louise said that the motto of the places something to the effect of, "We treat you like they do at home." Louise commented to me that if I treated her like that we would have been separated and divorced by now.

I think I have to risk the wrath of Louise. Louise cannot be the only one in the nursing home that is being given this kind of treatment and many of them are not as smart or as verbal as Louise is. I cannot continue to sit and cursed the darkness. I must somehow try to light a candle.

[Russell Williams]

In light of Louise's desires I provide this information in case any of you are looking for a nursing home for yourself or for family or friends of yours.

http://juliamanor.org/

Our focus is on providing excellent skilled nursing care, outstanding rehabilitation services and attention to detail in everything we do. Julia Manor’s professional staff works diligently to accommodate you whether the length of stay is anticipated to be many years or just a few weeks.
To arrange for a personal tour of our facility and a free consultation "click here" or call 301-665-8700.
Everything is running smoothly
in house keeping, laundry and our floor
technician department for the past three
months.
In housekeeping, we have two
housekeepers on the third floor, three on
the second floor and one on the first floor.
Part-time evening housekeepers will be
hired, to help clean dining rooms after
evening meals. They will also help on the
nights that we have Candlelight Dinners.
The laundry department has had no
change in employees and continue to do
an excellent job of inspecting residents’
personal items for wear and tear.
- Rochelle Shawyer, Housekeeping

Greetings friends, families, co-workers and most importantly our family of residents.
During the last few months, I have really enjoyed meeting all of you. It has been a
pleasure being able to provide quality professional care and services to each of you. Our
focus is on providing excellent skilled nursing care, outstanding rehabilitation services and
attention to detail in everything we do. This could not be possible without our professional,
dedicated, and hardworking staff who works diligently to accommodate all your needs.
I would also like to take this opportunity to remind everyone about the monthly
candlelight dinners. Please come out and enjoy some good food and socialization with your
loved one. I look forward to seeing you there!
- Nola Blowe LNHA, Administrator

[cinnamitch]

Julia Manor only received a 2 star rating from Medicare, not good at all. I would definitely report them to state and to Medicare. They have been cited for not having adequate nurse staffing. Sounds like it needs a surprise inspection.

[Russell Williams]

Greetings friends, families, co-workers and most importantly our family of residents.
During the last few months, I have really enjoyed meeting all of you. It has been a
pleasure being able to provide quality professional care and services to each of you. Our
focus is on providing excellent skilled nursing care, outstanding rehabilitation services and
attention to detail in everything we do. This could not be possible without our professional,
dedicated, and hardworking staff who works diligently to accommodate all your needs.
- Nola Blowe LNHA, Administrator[/quote]

Louise provided me with the following information. This morning a man who can only use the bathroom with assistance used the bathroom that Louise uses. After he and the assistant left Louise went in and found poop on the seat and on the floor around the toilet. Eventually that was cleaned up. Later on the same man went into the bathroom, with assistance, and the toilet was not flushed. Louise talked with one of the aides who, when called, comes when Louise's uses the bathroom and who cleans up behind Louise. The aide said that no one had ever told her anything about using bleach. Someone came in to give Louise her insulin. The man insisted that he had to give it to her on the sliding scale because that's with the rules said. Louise said no there were rules that said that Louise got to tell them how much to give. The man went and looked and found out that yes they were rules that said Louise was to tell them how much insulin to give her. Apparently the man was also planning to give her IV treatment at about one o'clock instead of the 8 PM when she is supposed to receive it.

[Russell Williams]

Conrad, I hope that you do not require that the threat be deleted. As the situation gets worse and worse and Louise comes closer and closer to deciding that she's going to talk to the authorities about it (please do not tell her that I have already sent some e-mails to some of the addresses given to me) it is at least possible that I will be asked to describe exactly when did these various things happen and the posts I have made here are a running record. I never expected it to get this far, this complicated, and this (I'm not sure what a good adjective might be – appalling – disgusting - outrageous – something like that

The following is not crucial but it is at least interesting – tonight at dinner my spinach smelled sort of like cigarette ash and so did Louise's. I was afraid to eat it because I do not know what spoiled spinach smells like. Perhaps it smells like cigarette ash. I commented to one of the food workers that the spinach smelled like cigarette ash. She said she did not know and that she does not eat the food. Later, when no one else was in the dining room I believe it was the same worker who quietly said to me, all of the spinach I served tonight smells like cigarettes.

I've already mentioned about the shared toilet being covered with poop. After Louise uses the toilet now she rings the call bell and people respond very quickly and she is told that it will be cleaned. She then places a piece of toilet paper on the toilet seat to see whether or not it is still there the next time she uses the toilet. This evening, Friday, June 15, 2012, a man from the other room used the toilet. When he uses the toilet he is always accompanied by staff. When Louise went in she found that presumably the toilet user had left some sort of clear body fluid on the seat that was sticky enough to hang down from the seat toward the water. Louise turned on the call light and somebody came quickly and Louise said "Does this toilet look usable to you?" The person used regular body soap and a paper towel to clean the top of the seat and wiped it off with a hospital gown. He did not clean off the side of the toilet seat, the bottom of the toilet seat nor anything else in the room. The person explained that after the custodian staff went home at eight o'clock the people still on duty had no access to regular cleaning supplies. Louise took the bleach wipes that I made for her and went to the first floor to the public toilet. She used it, she used the bleach wipes to wipe down everything that she had touched, and then, since it was a place where staff members who cleaned the public toilet were supposed to put their names and the time they cleaned it Louise added her name to the list and put down her room number.

Louise took a blank copy of their cleaning record and taped it to the door of her bathroom. She plans to tell people to sign it after they cleaned the toilet.


• Note –The above has been read to Louise and she has made the appropriate corrections and says that it is now correct. – Louisa said that she is not so sure whether I am her Boswell or her Watson. For obvious reasons I did not read Louise the sentence between the parenthesis.

[Russell Williams]

These events are occurring at Julia Manor, the one behind Bester Elementary School. The events I have described are, to the best of my ability an accurate rendition of what Louise has told me. A few of them have been read back to Louise before I e-mailed them. If others have different memories and interpretations I would not want it to be automatically assumed that my memories and interpretations were correct. I'm trying to simply describe the activities without value judging them.

8:53 AM June 16, 2012 Louise calls to report the following:

About three o'clock in the morning Louise pulled the call button and an aide came. Louise asked the aide what they used to clean the bathroom with. The aide went out and pretty soon the nursing supervisor came in. The nursing supervisor explained that at eight o'clock the cleaning staff on home and they lock the cabinet so in the evening no one can get access to the cleaning supplies. Louise pointed out that she had a special situation and the bathroom needed to be cleaned with bleach. The nursing supervisor went out and after while came out with a bottle of bleach that she found supposedly in a shower somewhere. The nursing supervisor explained that there was no need for the cleaning supplies to be available at night because "This is not normally a problem". (The above was read to Louise Wolfe and she said that, to the best of her knowledge and belief, it was correct)

Research question: Some of the people reading this take care of people who are in hospitals or nursing homes. Have you ever had a situation in which a patient used the bathroom in the middle of the night? Have you ever had a situation in which the bathroom should be cleaned up after the patient used the bathroom?

[Diana_Prince245]

What I've seen in cases of C-Diff in facilities is that the person is placed in isolation -- private room, private bath, staff and visitors gown and glove up before entering the room, hands must be washed with soap before leaving the room (ie. hand sanitizer doesn't kill C-Diff). I have not noticed the bathroom being cleaned after each use, but that doesn't mean the aides aren't doing it. There are usually cleaning supplies in the bathroom, which isn't normally the case.

[Russell Williams]

Originally Posted by Diana_Prince245

What I've seen in cases of C-Diff in facilities is that the person is placed in isolation -- private room, private bath, staff and visitors gown and glove up before entering the room, hands must be washed with soap before leaving the room (ie. hand sanitizer doesn't kill C-Diff). I have not noticed the bathroom being cleaned after each use, but that doesn't mean the aides aren't doing it. There are usually cleaning supplies in the bathroom, which isn't normally the case.

In this case Louise shares the bathroom with someone in another room. Louise has not mentioned any cleaning supplies in the bathroom except for hand soap and the bar of Dial soap that we brought in. Louise has been leaving a piece of toilet paper on the toilet seat after she uses the toilet. One time, after the person the other room, with the help of an aide, had used the toilet and left some clear sticky fluid on the toilet seat the piece of toilet paper was still there. Louise did not understand how that could have happened. I suggested that perhaps the person was simply coughing up a lot of clear phlegm and hit the toilet seat instead of the toilet.

[Russell Williams]

Originally Posted by Diana_Prince245

What I've seen in cases of C-Diff in facilities is that the person is placed in isolation -- private room, private bath, staff and visitors gown and glove up before entering the room, hands must be washed with soap before leaving the room (ie. hand sanitizer doesn't kill C-Diff). I have not noticed the bathroom being cleaned after each use, but that doesn't mean the aides aren't doing it. There are usually cleaning supplies in the bathroom, which isn't normally the case.

actually, when Louise was in the hospital with C diff the gowns and gloves and handwashing were what were used. Here there are no gowns, no gloves, and no instructions on handwashing before leaving the room. Louise eats in the main dining room with other residents. As best I remember the people who picked up her tray when she is finished eating in the dining room do not wear gloves. I know that they do not wear a mask or a gown

[Diana_Prince245]

Originally Posted by Russell Williams

actually, when Louise was in the hospital with C diff the gowns and gloves and handwashing were what were used. Here there are no gowns, no gloves, and no instructions on handwashing before leaving the room. Louise eats in the main dining room with other residents. As best I remember the people who picked up her tray when she is finished eating in the dining room do not wear gloves. I know that they do not wear a mask or a gown

Russell, you or Louise should ask to see the facility's policies for dealing with diseases such as C-Diff, MRSA, and VRE. I can't fathom that isolation isn't required for all three anywhere. The facility may not be following their own rules, and they are placing everyone in the facility at risk for C-Diff by doing so.

[Russell Williams]

Originally Posted by Diana_Prince245

Russell, you or Louise should ask to see the facility's policies for dealing with diseases such as C-Diff, MRSA, and VRE. I can't fathom that isolation isn't required for all three anywhere. The facility may not be following their own rules, and they are placing everyone in the facility at risk for C-Diff by doing so.

Your experience has been gowns, and handwashing, and gloves. In this nursing home the medical professionals have told Louise, who has a nagging cough and has been diagnosed with C diff, that today she can go out and spend four hours at a free poker tournament playing cards.

[Diana_Prince245]

Originally Posted by Russell Williams

Your experience has been gowns, and handwashing, and gloves. In this nursing home the medical professionals have told Louise, who has a nagging cough and has been diagnosed with C diff, that today she can go out and spend four hours at a free poker tournament playing cards.

Yes, gowns, gloves, and handwashing until the course of vanco is complete and there are three days of negative stool samples in a row.

[moore2me]

Originally Posted by Russell Williams

(snipped)

8:53 AM June 16, 2012 Louise calls to report the following:

About three o'clock in the morning Louise pulled the call button and an aide came. Louise asked the aide what they used to clean the bathroom with. The aide went out and pretty soon the nursing supervisor came in. The nursing supervisor explained that at eight o'clock the cleaning staff on home and they lock the cabinet so in the evening no one can get access to the cleaning supplies. Louise pointed out that she had a special situation and the bathroom needed to be cleaned with bleach. The nursing supervisor went out and after while came out with a bottle of bleach that she found supposedly in a shower somewhere. The nursing supervisor explained that there was no need for the cleaning supplies to be available at night because "This is not normally a problem". (The above was read to Louise Wolfe and she said that, to the best of her knowledge and belief, it was correct)

Research question: Some of the people reading this take care of people who are in hospitals or nursing homes. Have you ever had a situation in which a patient used the bathroom in the middle of the night? Have you ever had a situation in which the bathroom should be cleaned up after the patient used the bathroom?

In answer to your bathroom use question, of course people have to go to the toilet in the middle of the night. (One thing that might decrease the amount of toilet trips in a nursing home is that many of the residents wear adult diapers and due to their weakened physical state cannot get up and use the toilet without assistance.) It would be interesting to get a % of the Manor's residents that use the toilet unaided. You would also have to calculate the number that use adult diapers.

As to our own personal experience, I spent a week in a hospital once with a bad skin problem. The hospital classified me as infectious and labeled my room as an hazardous area, posted the door with biohazard signs, and required personnel to wear protective equipment. And yes, the staff was required to clean the restroom with solution to disinfect surfaces of hazardous waste. (I obviously had a private room with a private bathroom.) It is ridiculous and perhaps negligent or even criminal to let other unaware sick patients to be exposed to C diff. Of course, many nursing home patients are confused, or have dementia, or other mental problems that would prevent them from understanding the necessary precautions. This would require the home notifying the person with their family who is in charge of okaying the patient's care and the patient's progress.

[moore2me]

Originally Posted by Russell Williams

Your experience has been gowns, and handwashing, and gloves. In this nursing home the medical professionals have told Louise, who has a nagging cough and has been diagnosed with C diff, that today she can go out and spend four hours at a free poker tournament playing cards.

Russell, Do not let Louise sit in one place for 4 hours without walking and moving around. Sitting too long will most likely damage her hip and reduce the necessary circulation to her hip structures. Most back doctors do not even want a patient to sit for an hour without getting up and moving around.

[Russell Williams]

Originally Posted by moore2me

Russell, Do not let Louise sit in one place for 4 hours without walking and moving around. Sitting too long will most likely damage her hip and reduce the necessary circulation to her hip structures. Most back doctors do not even want a patient to sit for an hour without getting up and moving around.

thank you for the helpful advice. Louise has agreed to get up and use the bathroom every two hours, at least when she is awake. In physical therapy, which only occurs during weekdays, using her Walker, she has been able to walk about 200 feet each day. She is now been able to go up and down, twice, in one day, a of steps that is about 4 feet high. I have suggested to her that when she comes back to the house she may no longer need to use her her scooter in the house.

On a totally irrelevant note Louise loves to play Texas hold 'em poker and so we play in a free poker Texas hold 'em tournament once a week we go to one bar and once a week we go to another bar. I play in the bars because Louise goes to church with me. Louise goes to church with me because I play in the bars with her.

In each bar it is possible to qualify for the regional finals. The spring finals wrapped up yesterday. Louise was not happy with having to both battle with her treatment at the nursing home and with the unpleasant knowledge that I had qualified it both bars and she had not qualified at either bar. The tournament director at one bar said would be acceptable for me to give my place at that bar in the regional finals to Louise. I gladly did. If it would have made Louise happier I would have gladly given both of my places to her.

While I would need much more data before making a decision if I were to find that I had a place in heaven and she did not I would seriously consider giving her my place in heaven.

[Yakatori]

Russ,

If we post stuff here, will you tell Louise about it?

Do you have a laptop that you can bring to the nursing home, to watch DVDs on and such?

Do they have Wi-fi that you can post from there?