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Question about geriatric care and energy levels


Quill
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My MIL is living with us for a few months; she is 90. Her needs are not that extensive; she has some dementia, but nothing heart-stopping. Her blood pressure needs to be controlled and monitored and she has had one or more TIAs. Part of what we mean to do is get her some exercise every day, like going for a short walk. (And I do mean short.) She also gets some exercise in the fact that she has to go up the steps to take a shower. I spot her, but she walks them herself.

 

Her energy is so easily expended, though. It doesn't seem abnormal to me, but it is sort of disheartening in a sense. When she is finished her daily morning routine, she is exhausted. If we take her somewhere or have other excitement going on, she's wiped out for the rest of the day, or multiple days. This evening, DH was planning to have her walk outside with him and she begged off. She says she just cannot and does not have the energy. DH will not push this (me either), but it's a little disappointing. I want to be caring for her as expected by the other siblings (who have mostly all had at least one turn), but also, when I'm ninety, should I make it that long, I don't want anyone badgeing me to go take a walk.

 

Does this match your experience if you have assisted elderly parents? My own mother is much younger, but has Parkinson's disease and is more disabled than MIL. I think it is hard to accept because MIL was SOOO vivacious for so long; even when she was 80, she still planted a vegetable garden. But that has changed rather drastically just in the past five years.

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She might could use a B12 and/or iron supplement if she's not already taking one. Reasons for fatigue at 90, though, can be reasonable and individual. What would concern me is a sudden change in energy level more than generally low activity level, iykwim.

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We visit my dad and dh's parents for a week at a time so our sisters can take a break from caring for them. (We just got back home yesterday and spent a week at each home so it's fresh in my mind)  All of them are 'only' in their mid 80's and none take daily walks. Like your mil, they were quite active until the past few years but now they are slowing down. 

 

I'd probably encourage her to do a little more movement in the house during the day instead of pushing an outside walk.  Walking out to get the paper or the mail is about as far as my dad and fil walk but we do encourage more in the house stuff like helping to fold and put laundry away, or drying dishes. 

 

Does she have COPD or anything that might cause her to be short of breath? Or is arthritis bothering her? If it's something that will be improved by walking then maybe encourage her. But if not, gee, she's 90 and has earned the right to be less active. 

 

Are you thinking that the other siblings were able to keep her more active and you're feeling the pressure to do the same?  Or do you truly think she should be taking daily walks?

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I'm seeing this in my mother. She will be 87 soon, and her energy level has decreased considerably in the last couple of years. She has a lot more trouble getting around, and things are just generally more difficult for her, though she is in pretty good health for her age. 

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We visit my dad and dh's parents for a week at a time so our sisters can take a break from caring for them. (We just got back home yesterday and spent a week at each home so it's fresh in my mind) All of them are 'only' in their mid 80's and none take daily walks. Like your mil, they were quite active until the past few years but now they are slowing down.

 

I'd probably encourage her to do a little more movement in the house during the day instead of pushing an outside walk. Walking out to get the paper or the mail is about as far as my dad and fil walk but we do encourage more in the house stuff like helping to fold and put laundry away, or drying dishes.

 

Does she have COPD or anything that might cause her to be short of breath? Or is arthritis bothering her? If it's something that will be improved by walking then maybe encourage her. But if not, gee, she's 90 and has earned the right to be less active.

 

Are you thinking that the other siblings were able to keep her more active and you're feeling the pressure to do the same? Or do you truly think she should be taking daily walks?

She does not have COPD and she is a small woman; i.e., not overweight/obese. She does have Osteoporosis and it is very difficult for her to get up from a seated position. I think her hips are very weak.

 

As to your last line...I'm not sure. I don't think the other siblings have been much better at "making" her be active, but I do know the most recent sister she stayed with is a bit more militant about it. She had a little pedal exerciser and would "make" Mom pedal for 6 minutes a day. (dH does want to retrieve the pedal exerciser from her; maybe she'll do that much; I'm not sure. I know MIL wrote it in her journal that the sister makes her pedal on the exerciser, so I'm not sure she was happy about it.)

 

There is also one sibling who hasn't had her yet and some things she has said give me the impression that this SIL thinks *she* would have her walking a long way every day, and would be taking her to events every day, too. So that sort of bugs me because I feel she is judging from her position of ignorance and thinking we aren't doing enough with her. I overheard her on the phone, asking MIL if she had been out walking since the weather had been so nice. Also asking MIL if she had gone anywhere, to which MIl said, "No, not really." Which isn't correct, but she forgets. Actually, I felt a little guilty dragging her to my son's trampoline park day because once she was fed, showered, dressed and hair fixed, she sat down heavily and exhaled sharply. I felt like I was exhausting her over going to this unimportant play day thing.

 

I guess I'm just torn because I want her to have interesting days and not just stare at Fox News for ten hours, but taking her places takes hours of preparation and it seems to be so draining for her. We do interesting things at home; puzzles, nice meals, she reads library books, we talk about current events or the kids - but I guess I *am* feeling this worry that some of the siblings will think we aren't doing the most desirable things. The couple peole who are very extroverted don't see much value in those homey activities, I think, though MIL is also an introvert and has always liked domestic activities much more than "out on the town" things.

 

Maybe I just need someone to say, "You're doing a good job." There isn't an anxiety I have that can't be alleviated by words of appreciation. ðŸ˜

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I worked on a Geri floor for 4 years....definitely pretty common and to be expected.  My current client is around that age and just getting him out for a doctor appointment wears him out pretty quickly.  The extent of his daily activity is walking out to the front porch to bird watch and then back to his chair.

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I would not be pushing her to do exercises. Yes, there are some 90 year old people who are active.  They don't have dementia and probably didn't have mini strokes.  I think some people see the stories on tv about so and so who is still active and think their own parent should be too.  I think your siblings are totally unrealistic and I don't see any reason to be forcing her to cycle.  With dementia, I really would focus on what you see that she is enjoying and not worry about prolonging her life with exercise.  Not all dementias are the same and in some of them fatigue is one of the symptoms.  Mobility is one of the things destroyed early on in some of the dementias.  I really don't see why someone who has a fatal disease should be forced to do exercise or any other things to maintain health.  You want her to be free of pain and free of discomfort.  You want to make things pleasant for her.  What you are doing seems fine to me.

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And hey, you are doing a good job! All those "introverted" activities sound wonderful, actually. Have you asked her specifically what she might like to do, or places she might want to visit?

 

If she really would like to go places, and wouldn't mind a wheelchair, that might be an option, if she truly wants to get out and about. You might just have to be diplomatic in suggesting it.

Edited by Seasider
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Does this match your experience if you have assisted elderly parents? My own mother is much younger, but has Parkinson's disease and is more disabled than MIL. I think it is hard to accept because MIL was SOOO vivacious for so long; even when she was 80, she still planted a vegetable garden. But that has changed rather drastically just in the past five years.

 

 

Yes, that matches my experience with my parents. Low energy and limited stamina. As for the rapid change in health, this matches my experience as well. The way I put it was "Dad was healthy and then all of the sudden, he wasn't." My dad was in poor health for about three years before he passed away and Mom for less than a year. 

 

You are doing a good job - you are being a loving daughter in law. Remember to take care of yourself as much as you can (I know that's easier said than done).   :grouphug:

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You are doing a good job. Fatigue and low energy in a 90-yr-old is par for the course, ime. 

 

And, at 90, I think she should do as she pleases. I agree with Annie G that I would look more to minor indoor activity rather than set walks and so on. 

 

It sounds like you are doing a good job at keeping her days at home pleasant and interesting. Maybe start a running list of ideas for variety, and possibly do something a bit more elaborate once a week or so. By elaborate, I just mean something that requires a bit more planning, but is still way easier than taking her out. Like, is she the type who used to enjoy going to a nice tea room? Then create that at home for her, with fancy sandwiches and nice china. Did she enjoy listening to music and/or dancing? Big Band night at home. Whatever suits her interests, just one step up from 'just' making tea or 'just' listening to some music, kwim? 

 

As far as other relatives are concerned, keep updates simple and non-specific. Yes, we are encouraging her to walk. No, I'm not going to detail when and how much. 

Edited by katilac
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My mother is 89, and her energy level really changed quite suddenly this past winter.  We still don't know what all was/is behind it, and she won't have it checked out.  On the other hand, she still does quite well, and a slowing down is to be expected at that age, of course.  We were just surprised that it was all of a sudden.  She does still take walks a few days/week, with my father or myself or whoever, and can walk half a mile quite easily though very slowly.  Much slower than before.  Last year at this time, she probably walked a mile at a time, and at a faster (though certainly not brisk) pace.  

 

She has high blood pressure and checks it herself daily and knows what to do.  I do wonder if she had a mini-stroke this past winter.  She just does not seem as lively anymore.

 

She spends most of her days though sitting in a chair in the living room, usually reading, or on her iPad, or texting.  :)  She falls asleep a lot in her chair.  That's kind of new.  She does cook dinner for herself and my dad a few days a week, though it's become a lot simpler, and she no longer has the energy to clean up after dinner.  (My dad does the cleaning.)  She still drives herself to the grocery store which is a few blocks away, probably three times/week.  About once/week she drives to the mall (on back roads) and probably walks half mile there as she shops.

 

She probably walks up and down the stairs several times/day to their basement where the family room/laundry room is.  She still does their laundry.

 

She has quite severe osteoporosis.  I believe one fall will do her in.  It is scary to think.  

 

From what I've heard, aging is a slower process when "younger" elderly.  But once you approach your late 80's, changes can seem much more sudden.  I think that is normal.  I think at age 90, if they're happy doing what they're doing, then anything is fine.  

 

I think you're doing a great job!

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I've known some elderly people--and one in particular I'm thinking of had dementia--who very much enjoyed just going for a drive in the car. No destination, just riding around a bit and seeing the world. The one who had dementia was the mother of a friend. He took care of her on Saturdays so his dad could have a break. He'd load her in the car and they'd drive around for hours. She enjoyed it, it was different than sitting inside, she didn't have to do a lot of getting ready and it was easy on him.

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And hey, you are doing a good job! All those "introverted" activities sound wonderful, actually. Have you asked her specifically what she might like to do, or places she might want to visit?

 

If she really would like to go places, and wouldn't mind a wheelchair, that might be an option, if she truly wants to get out and about. You might just have to be diplomatic in suggesting it.

Thank you. She is a very agreeable person and does not claim to want anything in particular. She never was one for shopping, say, or really even eating out. The main things she used to like to do that were out of the house were going to church, volunteering at the elementary school, and singing in a chior. I have a notion to take her to visit her own church, but I will have to coordinate a few things because she will have to go to the latest service for it to even be feasible.

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You are doing a good job. Fatigue and low energy in a 90-yr-old is par for the course, ime.

 

And, at 90, I think she should do as she pleases. I agree with Annie G that I would look more to minor indoor activity rather than set walks and so on.

 

It sounds like you are doing a good job at keeping her days at home pleasant and interesting. Maybe start a running list of ideas for variety, and possibly do something a bit more elaborate once a week or so. By elaborate, I just mean something that requires a bit more planning, but is still way easier than taking her out. Like, is she the type who used to enjoy going to a nice tea room? Then create that at home for her, with fancy sandwiches and nice china. Did she enjoy listening to music and/or dancing? Big Band night at home. Whatever suits her interests, just one step up from 'just' making tea or 'just' listening to some music, kwim?

 

As far as other relatives are concerned, keep updates simple and non-specific. Yes, we are encouraging her to walk. No, I'm not going to detail when and how much.

That is a fantastic idea! She was a dance instructor years ago and loves big band music. It would be so awesome if we could do a dance/big band night here. Maybe some of the siblings could come. Maybe we could do this for Mother's Day weekend. Really, she would love this so much!

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I've known some elderly people--and one in particular I'm thinking of had dementia--who very much enjoyed just going for a drive in the car. No destination, just riding around a bit and seeing the world. The one who had dementia was the mother of a friend. He took care of her on Saturdays so his dad could have a break. He'd load her in the car and they'd drive around for hours. She enjoyed it, it was different than sitting inside, she didn't have to do a lot of getting ready and it was easy on him.

That's true. She would possibly enjoy this. I was just thinking, when we went to church for Easter, "She never even sees this part of town anymore. Like, she hasn't laid eyes on it." So, that would be a way of seeing what's going on without the anxieties and exhaustion of a goal end location.

 

But I have to chuckle because my parents have always liked "going for a drive." I have always thought it was the most pointless activity, lol!

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Yes, maybe a wheelchair to assist with outings? Do you have a porch or patio she could sit on to get some fresh air?

 

That's a great idea. It would give her more mobility and preserve her strength. She might look forward to getting out more as well if she didn't have to worry about her stamina giving out.

 

Quill, you're a good DIL. Tell yourself that every day. It sounds like you're doing your level best to care for her body and soul. If she's happy and engaged in those homey activities you mentioned, that's a win.

 

P.S. I seem to remember you weren't thrilled with the idea of shuffling MIL from home to home. You thought she'd feel better and deal with the dementia a bit better in her own familiar environment. (Not sure why I remember that, but do I have it right?) Depending on how often she has to switch homes, it could be that the adjustment to different surroundings, expectations, and routines is just hard for her.

Edited by Reluctant Homeschooler
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That's a great idea. It would give her more mobility and preserve her strength. She might look forward to getting out more as well if she didn't have to worry about her stamina giving out.

 

Quill, you're a good DIL. Tell yourself that every day. It sounds like you're doing your level best to care for her body and soul. If she's happy and engaged in those homey activities you mentioned, that's a win.

 

P.S. I seem to remember you weren't thrilled with the idea of shuffling MIL from home to home. You thought she'd feel better and deal with the dementia a bit better in her own familiar environment. (Not sure why I remember that, but do I have it right?) Depending on how often she has to switch homes, it could be that the adjustment to different surroundings, expectations, and routines is just hard for her.

Yes, that was me. DH and I were the pair who least liked her shuffling from home to home every few months. I also think it's sad that her home is sitting vacant and there is no intention of ever taking her there again. She just mentioned recently that she should be getting her garden started...that kinda broke DH's heart. It seems she doesn't really notice that she has been moving between siblings for almost two years now. :(

 

Having said that, I have come to appreciate the good it does her day-to-day to be living with one of us. I *do* think it is stressful whrn she moves to a new house, but overall, I think it is better. Her every meal is monitored, she has constant company, the kids are entertaining to her, there is nearly always someone to notice if she foes not appear well, etc. overall, it seems a lot better for her, but yes, I think the change-over is bound to be difficult because we are not all going to be the same or even very similar in our care.

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Quill, if it is any help, I noticed a BIG change at about 80 and then again about 90.  My mom was a tennis champion, for crying out loud, in her mid-40s.  Walked 10K's until she was 79.  Now, she putters around, age 94, taking an hour to get an egg for breakfast, and then she needs a nap.  For the first time ever, she sits and does NOTHING...no TV, no book, just sits.  She can go grocery shopping, drive (although that is happening less and less and I am glad for that), goes to church weekly, but then it is nap time.  Her daily exercise has been a walk to the apartment elevator and back--and I grant you that it is quite a distance!--and then doing the housework she can manage.

 

My MIL has always been sedentary, but at about 78 years, she put down the car keys and refused to drive anymore.  She has a container garden, and that is very engaging for her, but it is her only activity.  My dh does all her grocery shopping; she walks into and out of doctor appointments and that is about her most extended exercise.  

 

My dad was fairly ill, but about all he did after age 88 was sleep, get dressed, take his meds, eat, take a nap, watch the dogs playing outside his window, personal care, watch the kids playing outside his window, take his meds, eat, nap, personal care, meds, eat, watch tv for an hour, get undressed and go to bed.  That took all his energy.  I was impressed with his doggedness in taking good care of himself, but it took every ounce of energy he had.

 

Neither is depressed.

 

I have to say that while it bothers my mom in a way (she likes to feel useful), I have noticed that she in particular has recognized the changes in each stage of life and accepted them with grace.  And I'll even go farther than that.  She has explained to me that if she saw herself now with 45 year-old eyes, she would be depressed or worried.  But with age comes the grace to deal with the changes of age.

 

I see this in myself, and in my son's eyes on me.  He just doesn't understand whyyyyyy I am content to stick with email when I could be using SnapChat or whatever is the new technology this week.  And I remember feeling the same way about MY mom with the technology issues when I was his age.   :0) 

 

If your mom is content, I wouldn't be too concerned.  If she is depressed about her lack of energy, then take steps to figure it out, including the exercise.  

 

 

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Could you help her do some simple container gardening that would be productive during the time she's with you? I'm thinking lettuces? Or maybe if you can pick up some tomatoes seedlings already well set?

That is a good idea. I have herb boxes outside of the kitchen; I might be able to have her help me get them planted out. I would have to come up with a table or something, so they will not be down low. Maybe a cheapo table from Walmart/Target.

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Quill, if it is any help, I noticed a BIG change at about 80 and then again about 90. My mom was a tennis champion, for crying out loud, in her mid-40s. Walked 10K's until she was 79. Now, she putters around, age 94, taking an hour to get an egg for breakfast, and then she needs a nap. For the first time ever, she sits and does NOTHING...no TV, no book, just sits. She can go grocery shopping, drive (although that is happening less and less and I am glad for that), goes to church weekly, but then it is nap time. Her daily exercise has been a walk to the apartment elevator and back--and I grant you that it is quite a distance!--and then doing the housework she can manage.

 

That line, right there - that is exactly how it is. It takes an amazing amount of time just to do the normal routine each morning and then she is tired.

 

This morning she told me she had not slept well and barely slept all night. So then, that really affects her pep even more. She wasn't "ready" for the day until 11:10, and I had not fixed her hair yet. But she laid down on her bed "for a minute" and fell asleep, so I just left for work wothout waking her or fixing her hair. I was possibly going to take her to DS' LAX game today, but now I doubt it because she will probably be asleep.

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That line, right there - that is exactly how it is. It takes an amazing amount of time just to do the normal routine each morning and then she is tired.

 

snip

 

 

And the thing is, my mom KNOWS she is taking forever to make an egg, and it annoys her, but she doesn't seem to be able to do anything about it.  

 

I think she uses up more calories than she GETS, making breakfast.

 

:0)

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Totally normal--my grandfather is 90, and he was extremely active until the last couple of years. Most people I now that are 90 or more nap a lot, are always cold, and eat next to nothing. 

 

Would it help to bathe later in the day, and then just do a quick wash up in the AM so that if she does want to go somewhere, she's not starting with zero energy? Maybe the self-care in the evening would tire her out enough to sleep a little better/longer. I know eating and dressing would still be a bit of a struggle. Does her wardrobe make dressing super easy? Just some thoughts--they might not be practical.

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This sounds exactly like my mom.  She's 87 and lives sort of by herself in an independent living facility (she cares for her daily needs/laundry/ light cleaning (like dishes), but they clean her apartment, change her bedding, cook three meals a day in the dining room).  

 

She gets up and makes her own breakfast because she's a night owl and sleeps in sometimes. She eats breakfast, and then it's 10:30.  She rests for awhile, maybe does some paperwork, then goes downstairs for lunch.  They have live music at 2:00 on Wednesdays.  If she goes down for that, she may get up and dance one or two songs (she used to dance for 4 hours straight, not too long ago), then she goes up to her apartment and takes a 2 hour nap.  On the mornings that she has water aerobics (Tu, Th) at 10:30, she gets up earlier, eats cereal, and goes down for water aerobics, then gets her lunch "to-go" from the dining room, comes up and takes a bath, eats lunch, then takes a three hour nap!  She can generally only do one "thing" each day: either water aerobics, or dance, or go to a doctor appointment, or go out to eat.  She does like to go for rides around her old neighborhoods.  She doesn't like to eat out much because the portions are too large, and they turn off her appetite.  She has friends in her building who come visit her, or she visits them, or talks to them on the phone.  She has a recliner, and she spends a lot of time there.  She's only 84 lbs, and is frail, and has advanced osteoporosis, so falling is a constant concern.  She's good about using her cane or her walker, though, so that helps.

 

When I go see her, everything we do takes forever.  The simplest discussions or tasks take 3 hours (instead of 20 minutes, which is what would be "normal").  She loves company and attention, and she is a joy to be around, but we just have to be patient and plan accordingly.  

 

Everything you've described sounds totally normal to me.  There's very little wrong with my mom.  She only has one prescription (well, two, since they just added one for her dry eyes).  There's nothing wrong with her that can be fixed.  We cherish our time with her, and try not to be heartbroken to see her a fragment of what she used to be.  

 

I think I'll go call her.

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My mom has had fatigue issues since her 50s.  She was diagnosed with colon cancer at 60, so that could be part of it.  Then the chemo and radiation probably didn't help matters.

 

For years she's been unable to do much of anything other than go to the doctor.  Sometimes not even that.  At home, she has to go sit (reclining) or lie down after short activities such as eating a quick meal (that my dad cooks).

 

My mom is going on 73.

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I haven't read the other replies (sorry), but my grandmother will be 93 Friday, and I think she would say it's very normal. She has no dementia, but has had a few health issues. She can still do stuff, but it does wipe her out and she is very slow.

 

She enjoys doing jigsaw puzzles and adult coloring books. She watches sports and the news, and she still gets the paper. Those are things she can do to stay engaged without getting too worn out.

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My dad was very high energy, even into old age. But when dementia started to develop (even before we knew it was developing), his energy level plummeted - his legs tired and all he wanted to do was sleep. So the excessive tiredness, despite her energy at 80, may be due to progressing dementia, even if it's not bad yet.

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Totally normal--my grandfather is 90, and he was extremely active until the last couple of years. Most people I now that are 90 or more nap a lot, are always cold, and eat next to nothing.

 

Would it help to bathe later in the day, and then just do a quick wash up in the AM so that if she does want to go somewhere, she's not starting with zero energy? Maybe the self-care in the evening would tire her out enough to sleep a little better/longer. I know eating and dressing would still be a bit of a struggle. Does her wardrobe make dressing super easy? Just some thoughts--they might not be practical.

Her wardrobe is mostly very easy. She has a pair of knit pants (basically yoga pants with a flared leg opening) that my SIL bought her over her objections and I want to get her a couple more of those kinds of pants. She looks nice in them and I know they are much easier to wear than jeans or twill structured pants. I help her choose her clothing every day because if I don't, she will wear the same outfit over and over again. For Easter, I had some anxiety over her clothes because I didn't know if she would want to wear a dress out of a sense of propriety/tradition, or if she would happily just wear something ordinary that was clean. She opted for the clean and ordinary. I just offered a couple times that she could wear whatever she wished and nobody at our church would care whether she was dressed up or not. (It was kind of comical, though, because she changed out of Ordinary shirt #1, to put on Ordinary shirt #2, so it didn't make a difference, really. :D)

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A few things come to mind right away, heart failure or low hemoglobin/anemia. I would ask her PCP for an echo of her heart and basic lab work. I's easy and non-invasive. If she is in heart failure they could treat it with medications to help the heart pump more effectively.

She is due for an appointment to the cardiologist next week. I'm pretty sure they do an echo and I'm not sure what else.

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