Just Breathe

My dad has been on O2 and a nebulizer for about a year now. It's one of the side effects of having been a 4-pack-a-day man and living to be (now) 96. His quitting smoking is a whole story in itself, which I may do later, but today I want to write about his treatment.

My brother and I had just commented over the phone on how much clearer his mind has been working lately, at least most of the time. There are fewer periods of confusion, better thought processes, more of his sense of humor resurfacing. He's still complete crap on remembering names, but you can't have everything.

So I was a little puzzled the other morning when he announced upon rising that "your gal" had told him he no longer needed his oxygen. "Your gal" is his way of referring to his home health aids, since he can't remember names, and I'm the one who set them up for him. They bathe him, clean up the house, change his bedding, and do some continuation on his physical therapy now that Medicare quit covering it. We are going through our county now, and as a result the county nurse also stops by regularly to monitor him and supervise any changes in his care. I knew she had stopped by the day before since she'd left some paperwork on the table.

I just couldn't figure out what she had to do with his taking his O2, since his doctor was the one who prescribed it for him, and had just renewed it and the nebulizer for another year a few weeks before. So I decided to call her and let her explain whatever it was she had really told him. Meanwhile we got his tubing on him for the day as usual, and I promised I would report back to him that evening on what was going on.

When she returned my call, she confirmed that he wasn't completely confused. She had been monitoring his blood O2 levels on her visits, and last week, without O2 and just sitting in his chair, they were at 96. With O2, they rose to 98. For perspective, when they drop to 88 or 89 is when folks start to worry and add O2. That was his sitting level at the doctor's office when it first got prescribed, and it dropped to 86 after walking. These new results were excellent, and an indication of very real progress in his health, not something one would suspect at his age and given his history. So she had, in fact, told him he didn't need the O2 24 hours a day.

That garnered a discussion of when he actually used it, since it was only while sitting in his chair, or using portable tanks while in the car. He didn't use it while eating, or going to the bathroom, or out on his scooter rides, or overnight. The doctor originally told him to use it whenever he was active. He'd started with it as often as possible, but that required long coils of plastic tubing stretching throughout the house, in itself a tripping/falling hazard with potentially much worse outcomes than time away from enriched air, particularly given his vision. So we compromised on his taking it while sitting in his recliner, where he spends most of his day. Then he's "stocked up" for those periods of activity, and "recharged" afterward.

His set-up is a machine back in the corner behind his chair which condenses the O2 from regular air and pushes it through the tubing to the two little prongs which sit in his nostrils. On top of that is a 2nd machine which does the same thing for filling his 2 little portable tanks. Finally, there's a big monster tank in his bedroom in a stand in the corner for emergency use, like when the power goes out. It's supposed to last two days. There's also a no-smoking warning sign about O2 use in the front door, and of course I informed the local fire department when we moved him in. His tubing comes from behind and beside his chair, long enough he can move slightly but not long enough to trip him.

I asked the nurse about his improvement, which was not just his rising O2 levels, but her now being able to hear breath sounds all the way to the bottom of his lungs, something he'd not been able to produce when she first visited him several months ago. Was it the nebulizer? She asked me what kind of meds he was on, and I told her, generic for DuoNeb. After sharing a laugh over not remembering the exact generic name for the ipr...(insert lots of letters here)... bromide, she informed me that the albuterol was a "right now" kind of bronchio-dialator, and the unpronounceable one was longer acting, and that the pair likely had made the difference.

Did the improvement mean he didn't need to take the nebulizer any more? That would be the best kind of news for my dad, since he hates taking the stuff and will "forget" any time he can get away with it. It really brings out the child in him. No, he still needs to take that. Three times a day ideally, twice if we can't force it. So, I'll continue nagging and reminding and bribing. Tonite, for example, it was a dish of ice cream as soon as he finished.

At least he did.