It finally happened this morning.  I went to the kitchen just for a moment.  Then came the usual thump.  She was down.  The last time she fell, we had to go back to the Dermatologist to re-sew a two inch row of stitches, actually two rows, one deep in the wound and one pulling the surface of the skin together.  She had fallen directly on the wound and had broken the stitches.  The Plavix thinned blood ran freely.

It was just the other day that it dawned on me that we were then almost three weeks out from that drama, and there had not yet been another fall.  To appreciate the significance of that record, you need to know that Mary Ann has fallen multiple times a day, up to a dozen, in the recent past.  Up to that last disastrous fall, the pattern had been that falls came daily, sometimes two or three times.  On occasion there would be a day or two without a fall, but that was rare.

Mary Ann falls for a variety of reasons.  One of them is a symptom of Parkinson’s.  In fact it was one of the central symptoms that took her to the doctor when we first suspected that there was something wrong late in 1986.  She had pain and tight muscles in her left shoulder.  She had pain and stiffness in her left hand.  She would on occasion lose her balance and roll to the ground.  Maybe five years before that, we went on a couple of three day long church ski trips with other famiilies.  Mary Ann struggled especially with getting off the lift.  She always fell and had very much trouble getting up.  Finally, she just chose to stay in the lodge while we skiied.  Little did we know that a few years later the diagnosis of Parkinson’s would come.

That particular symptom of Parkinson’s cannot be corrected with a pill.  Physical therapy can help, but other than that there is no medicine that restores the balance.

A central symptom of the particular expression of Parkinson’s with which Mary Ann has been diagnosed is called bradykinesia.  Wikipedia has a good definition of bradykinesia: “Slowed ability to start and continue movements, and impaired ability to adjust the body’s position.”  When Mary Ann tries to start moving, the top part of her body may move forward while her feet refuse to move. Of course, when that happens, she falls unless there is an arm or a walker supporting her.

She seldom tries to use a walker any more.  She doesn’t have the physical strength to move it ahead of her.  When she did use it, she would often lean forward, body moving and feet cemented to the floor, leaving her in a very precarious position, hanging on to the walker for dear life.

With bradykinesia, a soft carpet may as well be wet cement.  Her feet just won’t move.  We have replaced all the carpet in the house with a short-knapped berber that is firm enough that she can move her feet (and we can roll the transfer chair), but soft enough to cushion her falls.  Most falls still leave a rug burn or a bruise or both.

When Mary Ann gets out of her transfer chair and tries to turn to walk around it, falls often happen.  When she tries to pick up something from the floor (now it may be something that is not actually there) she is, of course, vulnerable to falling over.

Since her stroke and the addition of the Parkinson’s Disease Dementia, a Lewy Body Dementia, Mary Ann has had some spatial perception problems.  Getting the utensil where she intends it to be when eating is a problem now.  When she is walking, sometimes she just does not perceive accurately where things are so that she can move her feet around them rather than trip over them.

In the last few years the Orthostatic Hypotension has been added to the mix.  That is a term that refers to the body’s inability to constrict the blood vessels fast enough to raise a person’s blood pressure to counteract gravity when standing up.  An adequate supply of blood is not pumped to the brain.  The result is called syncope, a fancy word for fainting.  It is not hard to figure out what happens next.  When people faint, they fall.

The time not so long ago when Mary Ann was falling up to a dozen times a day, it was the fainting that caused the increase.  She now takes medicine (Midodrine) to raise her blood pressure.  The medicine has helped some, but it has not eliminated the problem.  In fact the high blood pressure is taking a toll on her heart and her kidneys. There are often trade-offs that need to be made to maintain a reasonable quality of life.

Maybe now you can understand just why it was such a monumental accomplishment to make it twenty-two days without falling.  I am not completely certain why we managed to avoid falling for so long, but there are some things that seem to have potential for helping reduce the falls.

One thing is that Mary Ann’s last fall was pretty traumatic.  She has fallen hundreds of times and rarely done much damage to herself.  This time there was damage.  The return trip to the Dermatologist to be sewn up again was no picnic.  Mary Ann’s automatic pilot may have been reset to reduce her inclination to put herself at risk for falling.

Another thing has been my increased commitment to getting to her before she has a chance to fall.  I now spend less time in another room unable to see her.  I move more quickly when I suspect she might be on the move.

Since that last major fall, I have obtained the audio-visual monitor that allows me to see as well as hear her when she is lying in bed or sitting in her chair and I am at the computer.  I am now able to anticipate her getting up and heading out.  I can see her shifting or leaning forward, about to get up.  I am able to be there and help her before she falls rather than waiting for the thump and running to pick her up.

One recent change that may be having some sort of subtle impact on her stability is the new medication she is taking, the Exelon Patch.  It is intended to help with memory and alertness. To my knowledge it is not supposed to have any impact on the motor symptoms.  While I can’t put my finger on any identifiable dramatic change since she has been using it, she does seem to be doing better in most areas of functionality.  Since we live on a roller coaster of symptoms that come and go, sometimes very quickly, most of the time there is no clear reason for declines or improvements in Mary Ann’s ability to function well. There is no telling for sure how much, if any, impact the patch is having.

In the matter of this morning’s fall, Mary Ann, as is usually the case, did not hurt herself.  I still contend she could lead workshops on how to fall without hurting yourself.  I was upset that it happened, but no one can prevent the falls completely. As a full time Caregiver, I have to accept that. Most of all, I am still celebrating twenty-two days without a fall. Of course any decent celebration requires ice cream.  Two Pecan Cluster Blizzards from Dairy Queen beats a champagne toast any day.

If you want to write a comment about this or any of the posts on this blog, look to the column on the right side of this page, titled “Recent Posts,”  click on the name of a post and you will find a box at the end of that article in which you can write a comment.  Clicking on the title of the post you are reading will accomplish the same thing.  Comments are appreciated.

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As I sit here at my computer writing this post, Mary Ann is in bed and secure.  Even though the door is closed and the bedroom is in another part of our small townhome, I can see her in bed.  Sometimes electronics actually help!

This afternoon we made a stop at Babies R Us.  I ran in and purchased an A-V monitor set.  It includes a camera, video display unit and a portable audio-only unit that can be clipped to a belt.  What is especially important for me is the size of the video unit.  it has a seven inch screen.  For me that means that as I look at the computer screen, out of my peripheral vision I can see her movements.

After ending up back at the Dermatologist’s office to sew up again a large incision that had broken open completely when Mary Ann fell directly on the stitched area, I decided that I needed to either be joined to her at the hip or find some way to see when she gets up from the chair even if I am not in the room.

I called the manufacturer before I bought this set to determine how to obtain a second camera.  That way I can have one in the bedroom aimed at the bed and one in the living room aimed at her chair.  On Monday, I am going to check on whether or not I could buy another kit (the cheaper one without the audio-only unit) and have two screens as well as two cameras.  I would like to be able to have one in a spot in the kitchen that will allow me to see her from there or from the dining room table, providing even more security. After she was in bed this evening, I was at the dining room table and barely heard her calling.  She had tried to turn over in bed and ended up on her knees on the floor next to the bed.

It just worked!  As I was typing the previous sentence, I saw her moving around.  I checked on her and found her trying to turn over to face the opposite direction.  I was able to help her.  Her Parkinson’s has taken from her the ability to move freely in bed.  I would rather help her when she begins the task of moving than wait until there is a problem that might result in damage.

This new monitor will replace the audio-only baby monitor that we have been using.  One problem for us with audio only is that her voice has gotten so low in volume that it is very difficult to hear her calling over the sound of the television in the bedroom.  The television is Mary Ann’s version of a night light.  While having the television on in the bedroom is not recommended by those who study sleep patterns, it is an important part of Mary Ann’s world.

The security that the A-V monitor provides is not just Mary Ann’s security.  The prime goal is to protect Mary Ann from harm.  Not far behind that goal is the goal of my freedom and peace of mind.  When she is out of sight, I am always aware of her potential for getting hurt, mostly from popping up out the chair and ending up on the floor.  I can feel the stress relief that comes with having her in view when she is in another room.

One of the heaviest burdens of Caregiving is the loss of freedom to move about at will.  When she fell, I had just gone into the kitchen to get something for her.  To lose the freedom to move about the house would be intolerable.  One of my primary distractions when trapped at home is the computer.  I need the freedom to head down the hall, away from the television and concentrate on what I am doing at this desk.  This monitor, as long as it continues to work, gives me that freedom without sacrificing her safety.

There is no way to guarantee that Mary Ann will not fall and be hurt.  What this does is simply add to the practical tools for creating as safe an environment as I can within the limits of available resources.  While we cannot control what happens, we do have some control.  This is another way to use what power I have to help create a safe environment for someone no longer able to keep herself safe.

The monitor I chose is a Summer Day and Night Color Flat Screen Video Monitoring System.  The model number is 02500.  It is available at Toys R Us, or Babies R Us.   If you want to check it out, the web site of the manufacturer is, http://www.summerinfant.com. There was also a monitor I checked on that has a smaller screen but has optional software that allows the monitor to be checked online.  That one is called a MOBI Bundle Monitoring System and Internet Kit.  The website at which I found it was http://www.ActiveForever.com.

If you want to write a comment about this or any of the posts on this blog, look to the column on the right side of this page, titled “Recent Posts,”  click on the name of a post and you will find a box at the end of that article in which you can write a comment.  Clicking on the title of the post you are reading will accomplish the same thing.  Comments are appreciated.