Another day, another Doctor: Pt. lll

Posted in August by

One of the benefits of having Dr G as Miss Cathy’s Geriatrician is that it’s like ‘one stop shopping’ when we go to see him.

Whenever there is a problem or question (and mom has many) we see Dr G first, and if he doesn’t have the answers he’ll know the appropriate specialist who does.

Case in point, we were back after about a month (it felt like longer) of schlepping around from one new doctor to the next, to discuss their various findings.

The good news was that (other than not remembering what day it is) mom is basically ‘fine’ (a very subjective word these days but considering the alternatives, we’ll go with ‘fine’).

Dr K, her new neurologists, added Namenda to her daily medications, Namenda is a dementia drug that is thought to work well in conjunction with Aricept (which she’s been taking since her diagnosis in 2010) to help sustain memory and issues of confusion.

One of the other specialists she saw was Dr M, a vascular surgeon. I took Miss Cathy to see him regarding the five ‘episodes’ of fainting that’s she’d had over the course of the last three years to get to the root (hopefully) of why they were happening; was it a stroke? Were they seizures? Up till now nobody could say for certain.

He determined that the problem was not the blood flow to her corrated artery (so the ‘why’ and ‘how’ of the episodes is still unresolved but luckily there haven’t been any recently).

After his examination the doctor did recommended Lipitor or it’s generic equivalent to help reduce the possibility of a stroke given her age and all she’s been through.

As we sat with Dr G in one of the (very small, very cramped) examination rooms, he went over all the notes from the other doctors, the things put in place and their recommendations moving forward.

There was a little debate (more between Dr G and himself than with either of us) as to whether or not to put mom on the cholesterol-lowering drug.

Dr G said that while Lipitor is a valid recommendation his concern was Miss Cathy’s various other health conditions; diabetes, Alzheimer’s, high blood pressure and anxiety. So he wanted to be careful that any new drug introduced into her system wouldn’t have either a negative effect or counteract the effectiveness of a current medication.

It seemed at first that he was considering adding the ‘statin’ to mom’s meds and said as much.

Miss Cathy’s response was, “I don’t want to take that. I’m taking too many pills as it is.”

I sat in a corner of the room on what looked like a banquette built for a child or as an afterthought next to a small sink and supply cabinet. There was barely enough room to contain my ever expanding ass and irritation as I eavesdropped on their tête-à-tête.

Dr G smiled and said, “Of course that’s what you say about every one of these pills that we give you to take, so lets just consider this for a minute.”

‘Points’ for Dr G! It may not sound like much but that was one of the rare time that he didn’t just acquiesce to her protestations…..we might just be getting somewhere today.

The Meds discussed in this Blog Post were:

Aricept: is used to treat confusion (dementia) related to Alzheimer’s disease. It does not cure Alzheimer’s disease, but it may improve memory, awareness, and the ability to function. This medication is an enzyme blocker that works by restoring the balance of natural substances (neurotransmitters) in the brain.

Namenda: is used to treat moderate to severe confusion (dementia) related to Alzheimer’s disease. It does not cure Alzheimer’s disease, but it may improve memory, awareness, and the ability to perform daily functions. This medication works by blocking the action of a certain natural substance in the brain (glutamate) that is believed to be linked to symptoms of Alzheimer’s disease.

Lipitor: is used along with a proper diet to help lower “bad” cholesterol and fats (such as LDL, triglycerides) and raise “good” cholesterol (HDL) in the blood. It belongs to a group of drugs known as “statins.” It works by reducing the amount of cholesterol made by the liver. Lowering “bad” cholesterol and triglycerides and raising “good” cholesterol decreases the risk of heart disease and helps prevent strokes and heart attacks.

Another day, another Doctor: Pt. ll

Posted in August by

It was evident long before we got to Dr G’s by the way Miss Cathy was acting that it was going to be an ‘off’ day (and I didn’t need to check the cutlery drawer, either).

The ride to his office wasn’t so bad, no rumpling through her purse or rambling about the weather (and thanks to a slight increase in her Lexapro) she’s not as jumpy during the car ride-but that’s probably due more to the fact hat she’s being chauffeured around while she sits in the back seat like her fictional movie contemporary ‘Miss Daisy”.

Anyway, I noticed when we arrived that she was slower than usual getting out of the car, which is hard to imagine since she’s usually moving about as a fast as a turtle and just as interesting to watch.

So, instead of hanging back to see her wrestle with unbuckling the seatbelt I walked ahead, went into the doctor’s office, dropped my ‘Cathy Clutch’ on a chair, signed in for her, then went back to the door to see where she was (or if she was a heap of little old lady bits piled on the pavement).

When I cracked the door open I spied her about fifty feet away from the steps to the entrance at a turn in the sidewalk. For whatever reason she chose to (try) to walk around a garage can (placed near the edge of the sidewalk) by going ‘nearer’ the outside edge of the sidewalk where the concrete was cracked and the slabs were starting to separate exposing some of the sand foundation instead of walking toward the center where it was smooth and unobstructed…that’s “my” Miss Cathy, give her a choice and chances are this is what you’ll get-the road less travelled (because it’s usually under construction).

From the look on her face I could tell she was determined to navigate the crack (as well as the turn) in the sidewalk, the last time I saw her concentrating this hard she was at the ‘Live Casino’ pulling on a slot machine.

She always has her cane with her whenever we’re out in public (never uses it at home) because she’s afraid she’s going to fall.

She was picking at the sidewalk with it as if it (the sidewalk) was moving or there was a snake that she was trying to spike.

At the same time she was engaged in a sort of time lapsed back and forth with her feet, slowly lifting one then the other, tentatively reaching out with her foot before putting it down and starting over with the other in her attempt to move forward, brow furrowed, like a runner trying to navigate a hurdle that’s suddenly been raised on the track.

You might be wondering ‘Why didn’t I just go help her?” or for that matter, why didn’t I help her get out of the car?

Well, the simple truth is that she exercises (her body and her mind) so little that I feel I’d be doing her a disservice by stepping in to help (especially if she’s in a position to help herself).

And I do so much for her already that I have to be careful to draw a line somewhere before total dependence.

Besides, I always check to make sure she’s physically not in danger.

I’m like a parent hiding somewhere that their child can’t see but are able to watch as the young one (‘old one’ in my case) walk out into the world alone (or so they think), I’m there (just out of site) watching to see that she gets to where she’s going (safely) and I’m always there to lend a hand if she needs one.

And more often than not Miss Cathy, left to her own devices, has that steely determination, just like that athlete during a track and field event, to jump her hurdle(s) or in her case, ‘step over a crack in the sidewalk’ and finally cross the finish line, which that day happened to be four steps up to the physician’s door.

Another day, another Doctor: Pt. l

Posted in August by

Today was a day not unlike a lot of other days around here; get up, strategically try to time my entrance into the kitchen so that I can make my morning coffee (in peace and quiet before the deluge of chatter dominate my day), meet Miss Cathy in the living room to take her daily blood stik (since she has type 2 diabetes) turn on the TV for her (only if it’s a bad day and she’s forgotten how to operate the remote), then back into the kitchen to start breakfast.

But looking at the calendar on the wall across from the stove I could see that it was also a ‘Doctor Day’ so preparations (in addition to her daily routine) had to be made to get Miss Cathy out of the door and to her respective physician on time.

I would have to make sure that she was bathed, dressed and be prepared to answer whatever questions she’d have (usually the same ones she’d already asked but obviously forgotten) depending on who we were seeing and why we were going.

After weeks and months of specialist after specialist we were off to see her “Geriatrician” (think ‘Pediatrician’ for old people) who just ‘happens’ to be her primary care physician, Dr G.

It makes sense; she’s been going to Dr G for more than thirty years so if anybody knows her inside and out (literally and figuratively) it would be him.

I asked Dr G to take on the additional role so there’d be one doctor (and someone she’s comfortable with and can trust) that is sort of the ‘ring master’ of the circus of care.

In addition to being a ‘Doctor Day’ it was(unfortunately) a ‘running late’ day, too. For some reason mom was still in her room watching TV when we should have been getting into the car.

It still amazes me that for someone who asks what day and time her appointments are over and over, when the day arrives it’s a 50/50 chance whether or not she’ll be ready on time, running late, forget all together or sitting on the sofa, purse and cane in hand ready to go hours before we have to leave….guess with all those variables I should use different odds, oh well…back to getting Miss Cathy outta her room.

TyTip: When possible, tell your loved one about appointments outside of the home a day or two (at most) in advance. The less lead time they have, the less time they will have to fret, worry and/or obsess over the upcoming event or appointment AND the less time they will have to ask you question after question (usually the same ones over and over) regarding said event or appointment.

Remember, changes in their routine (no matter how benign we may think) can be very stressful-even scary to a loved one with Alzheimer’s.

A Shadoobie by any other name: Pt. ll

Posted in August by

WARNING: READER DISCRECTION ADVISED

So, there I was, on my hands and knees scrubbing feces out of the beige colored carpet hoping there’d be no tell tale sign of Miss Cathy’s ‘accident’ after I’d finished laboring over the stain, wondering all the while, “How the hell did I get here?”

I’d gotten used to being “Hazel the housemaid” and “Nurse Ratched with the meds” but this….this was something I had no pop culture reference for.

I had to reach back to the seventeenth century and Lady Macbeth’s, “Out, Damn’d spot!” to find something (somewhat) apropos.

Hey, I accept that ‘things happen’ being a caregiver for someone with Alzheimer’s (and lord knows I’ve gotten used to quite a lot ‘happening’ since I’ve been here) but I couldn’t get over the ‘matter of fact’ way that mom talked about what happened.

I don’t know if I was more shocked by what she did or how blasé she was about it all.

Is alittle remorse, regret or (I don’t know) just some plain ole embarrassment a lot to ask (or expect) when something like this happens?

I pondered all this earlier as I gingerly watched my step walking down the hallway to get out of the front door so that I could go to the store for cleaning supplies.

After perusing the shelves I decided on the “Pet stain and odor remover for carpet”, boasting that it “cleans and freshens even the toughest pet stains”.

I figured if it was ‘guaranteed’ to make Fido’s mess vanish then cleaning up after Miss Cathy’s should be a breeze.

Still, I couldn’t get over mom’s straightforward delivery when she told me what had soiled the carpet.

“Oh, that…that’s shit”.

Since she was so calm and she seemed to have no shame or register any embarrassment in her voice I thought there was no reason for me to act surprised (or heaven forbid ‘shame’ her) so I took my cue from her as I continued my query in the best “everyday” tone I could muster.

“Um, how did that happen?”

She told me that she’d eaten too much of the watermelon I’d bought for her and she ‘felt something’ as she was walking down the hall. And that was that, no further explanation of why she didn’t make it to her bathroom.

The only real emotion she registered was being a bit perturbed (with herself I assume) when I told her that she’d made matters worse when she attempted to clean up the mess, that she’d only been successful in leaving a stain (which I was not sure I could remove once she told me she used Windex as a cleaner) and that she’d missed quite a few spots, and that there were still remnants of matter dotted down the hallway.

Thankfully, she passed the ‘smell test’ as I neared her person and I was somewhat relieved to know that she had the presence of mind to put the offending panties in the washing machine after rinsing them out.

So, back down on my hands and knees; spraying, waiting, gently dabbing, repeating the process (time and again), and amazed (and relieved) that the “odor and stain remover” carpet cleaner made good on its promise, I couldn’t help but wonder,” Did she think this was okay?” and “When did taking a shadoobie on the carpet become acceptable?”

I could only hope that this was the exception and not the new normal, but if it was a glimpse into the future, unlike Miss Cathy’s memory or cognitive issues (that I have no control over) then at least (in all matters poo related) I was armed with a super sized can to spray away stains from my memory.

A #Shadoobie by any other name: Pt. l

Posted in August by

WARNING: READER DISCRECTION ADVISED

A friend called me the other day while I was in my room so I went out to the balcony to chat.

I call the outdoor space my ‘summer living room’, a place where I can feel free to talk uncensored and without being heard (except, of course, for the neighbors if I talk too loudly).

It’s not that I have anything to hide or secrets to guard, it’s just that being a caregiver there is very little privacy, so I try to carve out what little space I can.

As I walked through the apartment I happened to look down and noticed that Miss Cathy had spilled something on the caret in the hallway right in front of the kitchen doorway.

Earlier I’d heard her in the kitchen rustling around with the kitchen garbage (something I’ve told her time and time again I would take care of because she’s famous for leaving the garbage bags ‘next’ to the can and never taking them out to the dumpster) so I thought it might be coffee grounds or maybe chocolate ice cream that had spilled.

But, I continued on, chatting away, I thought little of it, other than to make a mental note to go buy some caret cleaner later and joked to my friend, “I don’t know what that is, it could be poo for all I know” then I proceeded to the balcony where I spent the next hour or so talking about everything from the Project Runway season premier on Lifetime (television for women-and gay men) to the Anthony Weiner scandal (television for women-and gay men).

After clicking off my conversation I was ready to tackle the stain, which now looked as if an attempt had been made to clean it up but the result was less than successful.

Fearing permanent damage (because it looked like she really rubbed it in instead of lifting the stain out) I went to mom’s room in search of some answers.

She was already tucked in bed for the afternoon.

“I’m going to the store to get some carpet cleaner”, I said. “So I need to know what you spilled.”

“Oh, that”, she answered, as matter of fact as if I’d just asked the time.

“That’s shit.”

Calculating Cutlery: Pt. lll

Posted in August by

I’ve always thought that if Miss Cathy won’t do the things recommended (by doctors, specialists, social workers and mental-health care professionals) to keep her mentally challenged (things like crosswords puzzles, reading, exercising, socializing, or knitting) then she could at least be conscientious of keeping her surroundings organized and clean.

So, putting away the silverware and keeping the drawer organized seemed like a no-brainer to me when it came to keeping her brain stimulated.

One day I asked Miss Cathy to join me in the kitchen for a little tete a tete and quickly realized after watching her struggle that there was more at play then simple indifference to order.

She stood there trying her best to correctly place a spoon in it’s proper place in the drawer and to stand on her feet, laboring the entire time to do both.

After five minutes I simply couldn’t take it anymore and put an end to the task.

The fact that she has so much trouble standing is an unfortunate but direct result of her lack of exercise (the blame for which I lay at the feet she can’t support herself up on for very long) but that’s her choice and I learned long ago to pick my battles (after losing that one).

But her inability to distinguish what goes where and how to get it there in the cutlery drawer is something that she has little to no control over.

Miss Cathy’s brain isn’t firing off the neurons or whatever it is that fuels her ability to problem solve, and as we discovered after consulting several doctors, her brain is also playing tricks with her eyes.

And when she’s having one of those bad days it can affect everything from forgetting how to perform simple tasks, mood swings, to asking me the same question over and over again.

So, now that I know all of this I just remind her from time to time to be conscious of what she’s doing (whether it’s replacing the cutlery, her posture, hygiene or any number of little things) and she either responds or not.

Alzheimer’s is not only about keeping your loved one safe; it’s about learning to respect their limits and boundaries.

And it’s been important to learn that her mood swings, depression and confusion come and go, the same as her ability to put away the silverware.
I always thought that if Miss Cathy could stay ‘aware’ of the little things then one day the big things won’t be as daunting…or so I hope anyway.

As for the cutlery drawer, it’s become more than a place to retrieve eating utensils; it’s a Rochard test, a crystal ball, tea leaves at the bottom of an empty cup whose chaos or order is a glimmer into the mind of Miss Cathy.

Calculating Cutlery: Pt. ll

Posted in July by

I first noticed a correlation between Miss Cathy’s mood and the cutlery drawer around the same time that her vision started playing tricks on her way back in the early spring.

It seems her brain, diminishing by dementia, was telling her healthy eyes that they were weak, causing her to not recognize familiar objects like a knife or a fork and she couldn’t see clearly enough to read anything smaller than billboard sized type.

Her cognitive skills were affected too, making it next to impossible for her to learn new ways to compensate for her loss of vision and to adapt to her ever-changing circumstances and she seemed to complicate even the simplest of tasks.

Spring turned into summer and after many fits and starts, including the (sudden and unexplained) return of (some of) her vision, there was some improvement but putting the dishes and the silverware away could still be quite the challenge.

Her difficulties weren’t confined to the kitchen either; while sitting in the living room it wasn’t uncommon for her to turn the TV off by mistake or to switch the remote from cable to video mode (which completely throws her for a loop) and she’s not able to switch it back.

She would come get me most of the time when this happened, other times I might walk past the living room (and ‘not’ hearing) the familiar sounds of a courtroom, game, or talk show I’d just pick up the remote and correct the problem, and (sadly) there were those times when she’s just sit there, staring at a blank TV screen.

It’s heartbreaking to see her in those moments when she seems resigned to her fate, as if the disease is some sort of punishment for a past transgressed.

I’ll look at her, wondering what she’s thinking when she’s sitting in silence and wondering if I should step in and say something to break the spell.

Instead of just doing everything for her (automatically) whenever something goes awry, I’ve learned to take a moment, assess the situation and (if it’s pretty obvious that she’s not lit her hair on fire) I’ll help when I can and encourage her to do for herself whenever possible-if possible.

So, sometimes ‘I ask’, other times ‘I do’ and there are some occasions when I just ‘let her be’.

Calculating Cutlery: Pt l

Posted in July by

As any good caregiver will tell you, you quickly develop a second sense of your loved one’s state of mind after witnessing Alzheimer’s day in and day out.

You don’t have to be clairvoyant-just observant.

For example, I’ve learned that I can tell what sort of day I’m in for simply by looking into the cutlery drawer.

If, when I awake and go into the kitchen to make my coffee and look and see that the knives and forks are still in their respective slots in the tray (that I’ve returned them to the night before when I put away the dishes) then it’s probably going to be an easy day, a day where Miss Cathy is more or less self sufficient and not much is asked of me.

But, if I see that there is chaos and anarchy in the drawer; spoons and forks co-habitating and butter and steak knives fighting to occupy the same space then that’s a pretty good indicator that it’s going to be a long, long day.

At first I thought she was just ‘in a rush’ or ‘not paying attention’ and when I asked her about the mismatched cutlery she said she was “just being lazy” and would do better.

She was true to her word for a time but then she’d go back to making a mess.

This back and forth, with me playing “fork police” and Miss Cathy the “perp” went on for quite awhile. To the average person this may seem like ‘no big deal’ but caregivers get what I’m going on about.

It’s not the ‘mess’ (and no, I’m not comparing myself to Joan Crawford, as she was presented to the world by her victim-I mean ‘daughter’, Christina Crawford in the early 80’s biography and later cult classic “Mommie Dearest”, who happened to clean compulsively (usually three sheets to the wind) and clarify to her daughter after she’d dragged her out of bed in the middle of the night to help her clean that she wasn’t mad at ‘her’ (Christina) but that she was mad at the ‘dirt’).

No, this wasn’t about the mess, it was about trying to get a loved one with Alzheimer’s to try to ‘remember’ what they’d committed to doing and following through on a daily basis.

So, I try to use every little action or activity as a potential ‘teaching moment’ to help Miss Cathy learn to strengthen her memory muscle and challenge herself not to become mentally complacent.

good-day

bad-day

Happy Birthday: Pt. ll

Posted in July by

I decided on a ‘Sweet tooth’ theme for mom’s birthday.

I ordered rum balls from “Sweet Mama’s”, a tasty Tulsa, Oklahoma bakery that shipped in time for the big day. I placed them on a hand-blown glass cloche that was part of her ‘sweet tooth’ themed gift, it’s not only pretty, it’s perfect for the occasional apple pies and “sock it to me” pudding cakes that Miss Cathy likes (and I try to buy in moderation because of her diabetes).

I put a bow on the glass ball top of the cloche, walked Miss Cathy into the kitchen with her eyes closed and when she opened them-voila, a sweet birthday surprise!

A lady should never tell her age but I’m no lady so I’ll just put it out there that mom is seventy-five years old.

Seventy-five isn’t that old really, not these days, especially if you factor in that ‘sixty’ is the new ‘fifty’ (at least according to pop culture), people are working long past seventy (by choice or economic necessity) and doing all sorts of amazing things mentally and physically so by all accounts mom should still be a ‘vital’ person, and she would be, probably, if Alzheimer’s hadn’t stepped in to rob her of her ‘essence’.

Miss Cathy’s’ self-assurance has been replaced by a halting, questioning fragility and a begrudging reliance on me to help her with things that used to be second nature for her.

Life is becoming harder for her to navigate day to day and it’s becoming increasingly difficult for her to trust herself to either ‘remember’ or ‘to do’ the things she wants as Alzheimer’s continues to take a toll on her confidence and independence.

She still struggles to make peace with her diagnosis but as her condition becomes less subtle and more overt even she can’t deny that something is wrong.

With the help of her new neurologist she seems more accepting and she just might be ready to take some steps away from denial toward participating in her own care and maintenance, maybe….hopefully.

That is my birthday wish for her anyway.

She was touched by the gift and the gesture. She gave me a kiss and a hug then I was off to catch a train for New York where I’ve been teaching a summer program at LIM College this month and part of next.

I’m gone for most of the week and back at the weekend, my brother staying with mom while I’m away.

I can’t believe that another year has passed so quickly. The first week of August marks my third year as a caregiver.

So much has changed and there is still so much ahead that is unknown.

But, celebrating the day of her birth (however briefly) I could see that she was happy and present for the gifts she received and that’s enough, more than enough….. for today anyway.

Happy Birthday: Pt l

Posted in July by

It’s Miss Cathy’s birthday tomorrow.

What do you get for the woman who’s likely to forget what you’ve given her?

To be fair, I bought mom a gold watch to replace one that had been stolen years ago and rather than save it till now I gave it to her back in the Spring (I figured at her age why wait to make her happy).

She cherishes it and takes every opportunity to let people know that it was a gift from me.

But I also think its fun to have something to give on your loved one’s actual ‘Birth’ day, even if it’s just a little trifle, its a reminder that they’re loved and special.

I wish there was a way to give back her mind (the way it was five or ten years ago) when she was sharp as a razor and still on top of her game.

Oh, she still has the ability to cut you down to size (I’ve been verbally decapitated a few times myself in the past three years….that’s all blood under the bridge for now) but the Alz has tempered her temperament.

Those of us who are lucky enough to be healthy and whole take simple things (such as remembering the date that we were born and our age) for granted. So I’m reminded everyday of my blessings being healthy in body and mind.

Sometimes though I have a moment when I’m stopped cold by the thought that maybe the researchers are wrong.

What if Alzheimer’s is genetic? Am I’m witnessing my own future? Will there soon be a day when I’m searching the air to try to remember the year I was born, much the way Miss Cathy has been lately?

I’ve never professed to have a great memory so it’s been of little concern to me through the years that is until I became a caregiver.

Now I bear witness to the slow determination of a loved one’s mind and memory on a daily basis.

So it’s only natural (I think) to wonder, “is my mental state early signs of dementia or just the by-products of the stress that is so much a part of my life nowadays?”