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The Twilight Years Are Here

The Twilight Years Are Here

Sunday, March 21, 2010

Dealing With Dementia Jan. - March

Jan. 8, 2010

Dad tries so hard to be helpful but it really has a tendency to backfire at times. Last night, he decided to rid the fireplace of ashes just before he went to bed. He scooped everything, including the burning coals into a 10 gallon plastic bucket. When I went upstairs to secure the house for the night, I found a small electric fan on (blowing into the fireplace itself). I bent down and was assaulted by the smell of burning plastic and wood. I picked up the bucket to place it on the hearth and was shocked to watch the entire bottom of it come off.
In a split second my brain processed what was happening. 3 pitchers of water later, I felt secure enough to run downstairs and beckon Richard to help me. A major crisis was averted. But I am now more aware of the dangers that a demented mind can create.
When I explained what had happened to Dad, I expected denial (which is usually the case). Instead his response was curiosity. "That was really stupid. Why would I leave it on the floor? I should have put it on the hearth." He is fully aware that it could have been much worse. He is also determined to clean up the mess.
I guess the only thing we can do at this point is buy him a metal ash bucket. Oh yeah, and keep praying for strength and guidance. There is no doubt in my mind that, had it not been for divine intervention, what was a minor crisis could have been a major tragedy.

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Feb. 27th, 2010

You know it's coming...the day a doctor will use the words you have been dreading to hear. But when you see it in black & white, it still takes your breath away and makes you numb inside. This past week, we finally reached that point. Dad has been officially diagnosed with Alzheimer's Disease. The funny thing is... he was diagnosed by his previous doctor, we just didn't know it.
So, what exactly does that mean? Well, for starters he has become very combative and the forgetfulness has gotten progressively worse. The slightest change in routine can send him into an absolute tailspin. And he is convinced he is losing his mind. He has been known to double up on meds because he didn't remember taking them (they are now hidden from them). And he constantly argues while stating he doesn't want to argue. Dad is a classic example as he has hearing loss, and no sense of smell or taste left. On the 10 point scale for determining Alzheimer's, he is 10 for 10. Next step, we go for a full Neurological work up.

What is Alzheimer's... It is a progressive and fatal brain disease. As many as 5.3 million Americans are living with Alzheimer’s disease. Alzheimer's destroys brain cells, causing memory loss and problems with thinking and behavior severe enough to affect work, lifelong hobbies or social life. Alzheimer’s gets worse over time, and it is fatal. Today it is the seventh-leading cause of death in the United States. It is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer’s disease accounts for 50 to 80 percent of dementia cases. Other types of dementia include vascular dementia, mixed dementia, dementia with Lewy bodies and frontotemporal dementia. There is NO CURE yet!
Just like the rest of our bodies, our brains change as we age. Most of us notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work are not a normal part of aging. They may be a sign that brain cells are failing.
The brain has 100 billion nerve cells (neurons). Each nerve cell communicates with many others to form networks. Nerve cell networks have special jobs. Some are involved in thinking, learning and remembering. Others help us see, hear, taste and smell. Still others tell our muscles when to move. In Alzheimer’s disease, as in other types of dementia, increasing numbers of brain cells deteriorate and die.

As a caretaker, it can be very difficult dealing with a loved one (or patient) who is impossible to reason with. While they may be upset or antagonistic one moment, they may completely forget an altercation the next. You simply have to learn to cherish the rare moments of clarity when they occur. And deal with the rest with patience and love. Remember, they are unaware of their own behaviors so there is no accountability for their actions. Your frustration is minor compared to what they must be feeling. You have control...they DO NOT!
We have begun a new phase in life here. It is often painful, exasperating, frustrating, aggravating, and heartbreaking. But on the rare occasions when it is none of the above, it is loving, rewarding, and special. I am blessed to be here sharing the end of their lives with them. And these notes will ensure that, should I someday be on the same path that they are, I will never forget how it was for them. Each day brings a new opportunity to learn and grow for me as they continue on their journey of forgetfulness.

March 5, 2010

Tonight in the ER, Dad told me he needed to talk to me. There was something he'd been thinking about a lot lately. I was then asked to make a promise that I know I will never honor. Dad insisted I promise that if Mom should die first I would see to it he could join her as soon as possible because he is only staying alive to take care of her. He said, "She is my breath. She is my soul. And I CANNOT have a life without her." I believe him.
But I will not do anything to hasten another persons departure from this world!
I truly believe he would die without her. I have seen it happen a couple of times in my life. Where a mate dies and the remaining mate simply gives up and dies within a very short time. In each case, an undying devotion was present in the relationship. I think that's why it happens. The connection is, quite simply, too strong. I believe it is likely he will simply slip away quite soon after she does. And he will be eternally content and happy to live his afterlife loving her.
I watch him tell her of his love (sometimes 20 or 30 times in a day). I watch how he hovers over her. Trying to help but constantly in her way. How he asks her over and over again, "Do you need anything, Sweetheart?" She considers it the height of rudeness to talk through a bathroom door but Dad will start knocking in 5 min, banging at 7 min and yelling at 9 min, "Sweetheart, can I get you anything?" Her tears break my heart. He smothers her with attention and suffocates her with love.

Without a doubt, she loves him, too. But she gets so tired sometimes. She is of frail mind and body. Far frailer than he. Her soul longs for a little peace and quiet.
She too thinks she is losing her mind. At this point she is still in touch with reality enough to understand, when I remind her, "It's just that touch of Dementia" she has. Her heart breaks as she watches Dad's mind deteriorate. And she is the most frequent recipient of his extensive, demented tirades. Though, I can say I am easily #2 on that list.

Our days are hard. Our days are incredibly complex. There are days I wish I were anywhere but here. There are days when I can't stop the tears of frustration, anger, and heartache. There are days when I feel too tired to lift my head in the morning. But I always do. My duties are numerous and my responsibilities are heavy. But they are mine because I choose it.
A friend of mine recently made me admit that I knew before I got here that it would be really tough. I did. But I could not have, in my wildest dreams, imagined how tough it would really be. You really have to walk this walk to even begin to understand.
I get it now in a way I didn't before. I came here to help them get their last wishes. They want to die at home. They want a modicum of dignity. They want a little bit of privacy. They want a semblance of independence. They want to go back to younger, better days. They want to share their memories and they want to, in some way, influence the the lives of the children in our house. The children are something they look forward to every day.
I am committed to helping them die. I am here to take care of them. I am here to help keep them alive for as long as possible. I am here to do all I can humanly do for them. But most importantly, I am here to try to understand them. I am here to listen to them. I am here to LOVE them.

I will not honor this promise. I made it because I was dealing with a need to put a demented mind at rest. I was buying us all, most importantly Dad, a little peace of mind. I hope.

This morning we went to the Neurologist for some tests. At the end of the visit Dad made a joke about being sent there because somebody thought he was going crazy. I asked the doctor, very softly, if he could please assure him he is not going crazy and explain to him what was going on. The doctor turned to Dad and said, "Mr. Felker, You are not even a little bit crazy. You have Alzheimer's Disease. Do you know what that is?" Dad explained it fairly well. The doctor pointed out to me quietly that Dad had been told at some point and either was in denial or possibly forgot. Dad sat there processing the information and thanked the doctor politely for telling him.


As of 3:17 a.m. he has so far gotten it but it is a long time til morning and he is currently asleep. That's a lot of hours to forget. If he does, we will start over again. And I will always be in awe of his love for her! And I will always be here to love them both and help them through this, the end of their lives.

March 10, 2010

Ok, Mom's list of illnesses is rather long (especially when you're 87). She has CHF (Congestive Heart Failure) and a leaky valve, COPD (Chronic Obstructive Pulmonary Disease), severe Manic Depression (Bipolar Disorder), OCD (Obsessive Compulsive Disorder), Carotid Artery Stenosis (at 60%), Chronic Asthma (with frequent bouts of Severe Acute Asthma), Debilitating Arthritis in her back and Dementia. She is confined to a wheelchair 99% of the time for 2 different reasons, the exertion of walking puts a terrible strain on her heart and the Stenosis causes her to feel light-headed and dizzy when she stands. She is on 24 hour oxygen (which she hates with a passion and calls her leash). She is frustrated with the quality of her life but at least she is alive (which I frequently point out to her).
Mom is currently in a Manic episode and it isn't hard to figure out the catalysts this time. Since Feb. 16th we have had to make 3 different 911 calls (all of which resulted in someone going to the hospital, one resulted in hospitalization) and 2 trips to the ER by car (one of which resulted in hospitalization as well). Dad was also diagnosed officially with Alzheimer's Disease and this time the doctor told him so. And, as if that weren't enough, their caregiver of over 3 years is getting ready to stand trial for criminal neglect to the elderly (most specifically my in-laws). It would be enough to drive anyone crazy. At times, I am almost glad she has an escape.
There is never a way of knowing how long an episode may last. Sometimes it is only a day or 2, others it can last a week or more. I have heard it likened to a shot of adrenaline that consumes one with boundless energy. She is unable to stay focused on any one task for more than a few moments at a time. She may have 8 or 10 projects going at the same time. When it is over, she will be exhausted for days. Together we will battle the overwhelming depression that sinks in once the euphoria has faded.
It is a vicious cycle that has claimed many great minds of our time Sir Winston Churchill, Abraham Lincoln, Theodore Roosevelt, Lord Byron, Victor Hugo, T.S. Eliot, Rudyard Kipling, Ernest Hemingway, Leo Tolstoy, Mark Twain, Virginia Wolff, Charles Dickens, Charlotte Bronte, Tennessee Williams, Hans Christian Anderson, Robert Louis Stevenson, Christopher Columbus, Bach, Beethoven, Tschaikovsky, Chopin, Mozart, Schumann, Handel, Rachmaninoff, Cole Porter, Irving Berlin, Noel Coward, F. Scott Fitzgerald, Albert Einstein, Sir Isaac Newton, Charles Darwin, Florence Nightingale, Vivien Leigh Butler, St. Francis Of Assissi, Martin Luther, Thomas Edison, and Robert E. Lee just to name a few.
Genetic factors contribute substantially to the likelihood of developing bipolar disorder. There is a history here of Manic Depression (even though the term is rather new). Mom's mother may have had it, as well as two or more of her siblings (they had the symptoms just not the diagnoses). All 3 of her daughters (one is no longer with us) have it. One of my own daughters has it, as do a couple of the other grandchildren.
The diagnosis of bipolar disorder can be complicated by coexisting psychiatric conditions such as obsessive-compulsive disorder. In the elderly, recognition and treatment of bipolar disorder may be complicated by the presence of dementia or the side effects of medications being taken for other conditions.As yet there is very little evidence-based research to guide management of bipolar in the elderly as opposed to adults in general. Mood stabilizers may significantly reduce psychotic episodes but they can not eliminate them. To date, there is no cure for this insidious mental illness. There are only treatments to help keep it in check.
As a caregiver who deals with mental illness on a daily basis I strongly advise anyone who thinks they may have Manic Depression or knows someone that may be suffering from it, to seek professional help. Mental illness is just that, an illness. There is help available (with proper diagnosis and treatment) that can improve the quality of your life and help you deal better with the illness that torments you.

March 11, 2010

I heard something so sweet today it made my heart ache and my eyes swim with tears...

I was getting the boys ready for school when Dad wandered into the kitchen. He came straight to me and gave me a big hug. "Shari, is it morning or night?" I assured him it was early morning and I was getting ready to take the boys to the bus stop. I suggested he go back to bed. With a squeeze of my arm, he turned and shuffled off in the direction of the bedroom.
As I headed for the stairs, I heard him talking to Mom. "Del, Shari says we can go back to bed. I think that's a good idea. Don't you? Let's go back to bed, Sweetheart, and cuddle for a while." For once, she didn't ask him to repeat himself.

Sometime after my return, I went upstairs to check on them. My fingers itched to take a photo as I peeked in their doorway. Sitting propped up in bed, side by side, their bodies inclined toward one another, they were sipping cups of hot coffee and obviously quite content.
I ducked back with tears in my eyes (for the second time today) and went to the kitchen. The poignancy of the moment was demolished as I turned the corner. I giggled as I took in the sight that greeted me. The freezer and microwave doors both stood wide open. The Half & Half stood next to the instant Community Coffee on the counter (hers) the top of the sugar bowl was MIA. The generic coffee was across the room with the Equal sitting next to it (his) also missing the top to its bowl. When I opened the refrigerator to put the cream away, the mystery of the missing tops was solved... Both tops were upside down in the egg holders. I picked 2 Mardi Gras cups out of the trash can and got them washed, dried and hidden. Dad repeatedly throws them away though I have explained over and over again that they are the kid's cups.
I still haven't found the measuring cup I left out to dry last night. I heard somewhere once that a little mystery in your life can be good for you. In our house they crop up daily. I can't count how frequently I hear that things around here "just move themselves". But I have a few theories on that...

March 17, 2010

Dad's doctor prescribed a cream that has to be put on his arms twice a day. When we sat down tonight to do his arms, I was quite pleased at how well it was going and felt him relax. Suddenly, he leaned forward and in a low voice, he said, "I've been having some problems with my penis, and I figured you are who I should tell about it."
I see his point, I am the one that schedules the appts and sees to it the get there. I administer their meds, I cook them their meals and I take care of them in every aspect of their lives. So, of course, he would tell me if he had a problem. He would expect me to have a solution for him. But these aren't exactly words you think you will ever hear from your father-in-law.
I continued to rub the cream into his arm as he watched my hand moving on his scaly skin. "That's it!", he exclaimed. "Can I put this on my penis? I think it just needs a little lubrication!"
To say I was speechless, is a gross understatement. I announced we were finished, told him I wasn't sure that was a good idea and assured him I would call the doctor tomorrow to see what he would suggest. Then I made a beeline for the door.
Can't wait to see what tomorrow will bring...

March 20, 2010

Ayla is 3 years old. She has connected in a way with her great-grandparents that is very unique. Though Mom (Muner) is legally deaf, she can hear Ayla quite well. More importantly, she can understand what she says. Ayla has taken it upon herself to "help" with Muner and Pop. In the mornings, she helps Mom get out of bed and into the wheelchair. She gathers a robe, lipstick, an inhaler (which she always shakes up before handing it to her), hairbrush and Mom's orthopedic socks. As soon as Mom has her socks on Ayla brings her a pair of slippers and slides them on her feet. Next thing you know, here comes Mom being pushed by Ayla straight to the scales.
There isn't much on earth more touching than watching a 3 year old try to hold the very shaky hand of an 87 year old while she steps on the scales. When Mom is back in her chair, Ayla hops on the scale so Mom can see what her weight is today. Ayla immediately pushes her to the table while I gather the blood pressure machine. Ayla pushes the buttons as soon as I have it in place and has her own notebook that she pretends to jot the numbers in. When we are done, she announces that Muner needs her memicine and breakfast. And then proceeds to hand Mom her oxygen tube and stands at the ready until it's in place. The instant it is, she turns the machine on.
If you ask Ayla what she wants to be when she grows up, she replies, "Me's gonna be Princess/Doctor." Because of her intense interest, Mom wanted to take her to a doctor's appointment.
So yesterday was the big day. We arrived at the office and Ayla insisted on opening all the doors. When we got settled in the waiting room, she sat quietly looking at several magazines until they called us back. When we got into the room, she became a whirlwind of activity. I have never seen a child so interested in EVERYTHING in a doctor's examining room. She was completely fascinated by the "other- one-kind" of blood pressure machine and asked the nurse several questions about things in the room.
It was an adventure for her and our doctor was delightful about it. Especially as he was trying to examine Mom and answer all Ayla's questions at the same time. I doubt I will do it again any time soon but it was a learning experience for us all.

Ayla knows when Dad is having bad Alzheimer's moments and will warn others that "Pop sick today". She will cuddle up to him more during these times and if he yells at her, she will simply walk away. She understands that he can't help it. On good days, he will tell anybody that listens that she is the cutest little girl he has ever seen. It really ticks Mom off when he points out that includes his own kids. Ayla is allowed to sit in his chair any time she wants to and has even been known to crawl into bed with them in the wee hours of the morning.

Mom is enchanted with Tyler and spends so much time watching him at the dinner table that she forgets to eat. She allows and encourages behaviors we are constantly having to correct. One of her favorite games at the table is to send wind-up toys across the table to Tyler while we are eating. Throwing food can cause her to burst out laughing. Running in the house is often considered a "cheerful" sound. Playing with things a child shouldn't can easily be a case of "Isn't that precious?" and can easily be a case of "Don't touch that" the next time.

Dealing with Dementia in the elderly while chasing 4 active children at the same time can be very trying. It can also be amazingly rewarding. It can be frustrating while it is fulfilling. It can be heart wrenching while it is heart warming.

And when all else fails, I call in the 3 year old cavalry. She can get the grownups to do most of the things they give me static about doing. All it takes is a little tilt of her head and an adorable smile... usually they become putty in her hands...



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