July 10, 2009

It’s all about the Autonomic Nervous System

Posted by PeterT under Daily Challenges, Information on Parkinson's, Meaningful Caregiving, Practical Tools for Coping | Tags: , , , , , , , , , , , , , |
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Today was a little better, but not much.  So far, the decline is having more of a permanent than a temporary feel.  As always, tomorrow things may change.

It’s all about the Autonomic Nervous System (ANS).  I have just been looking at some online information about the ANS, the Parasympathetic Nervous System, a subset of the ANS, and Acetycholine, a basic Neurotransmitter that communicates messages to various parts of the body.

Sounds technical, but for me it has very practical implications.  The messages that are communicated from the ANS impact the movement of the iris/pupil in the eyes, the glands, sweating, the mucosa (nose running and drooling), the smooth muscles of the heart, the vascular system and its capacity to constrict and dilate blood vessels, the alimentary canal from top to bottom, food entering, begin digested and waste leaving, bladder function and urine production.

The list of actions under the control of the Autonomic Nervous System is a list of Mary Ann’s Problems.

We have gone to the Optometrist many times to try to get glasses that will fix her eyes ability to focus and make reading possible.  Her eyes and those of many with Parkinson’s will not cooperate.  Changes in glasses have no impact on the problem.  It is a combination of the ability to concentrate and the eyes inability to function normally.

There is hardly need to say again just how debilitating the daily sweats are when they come.  The fact the the ANS acetylcholine transmitter talks to the sweat glands and other glands in the body is very revealing.

Mary Ann’s nose has been running constantly for a decade.  We buy four ten packs of Kleenexes when we go to Sam’s Club.

The problems Mary Ann has with her heart may or may not have anything to do with the ANS, but certainly her life long problem with high blood pressure and now low blood pressure does.  The ability of the blood vessels to constrict when standing up is governed by the ANS as it connects with the smooth muscles around the blood vessels.  That ability is compromised by the disease and medications.

The workings of the alimentary canal are an obvious problem as Mary Ann has struggled with constipation for most of her life, now worsened by the Parkinson’s and meds as the smooth muscles around that canal slow.

The frequent urination and incontinence are on the list of bodily functions impacted by the Autonomic Nervous System.  Our lives are dominated by the actions of that canal.

I guess it doesn’t really make any difference that I can see the connection between Mary Ann’s many non-motor symptoms and the Autonomic Nervous system, but somehow it seems helpful to put some of the pieces together.  I don’t like it any better, but I understand it better.

One thing that is clearer to me is that there is not a whole lot we can do about the decline that is happening.  The Autonomic Nervous System governs involuntary actions.  We can’t decide to make it work better.  It has a mind of its own.

It is just confirmation of the obvious: we are not in control.  We can watch and react, we can whine and complain, but we can’t fix it.   We are left to live with it.  That is what we are doing.

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.

 

July 8, 2009

Changes: Are they Temporary or Permanent?

Posted by PeterT under Daily Challenges, Meaningful Caregiving, Practical Tools for Coping | Tags: , , , , , , , , , , , , , , , , , , , , , |
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This morning Mary Ann began the day feeling very weak and wobbly.  She had fainted more than once during the night at commode times.  She fainted more than once this morning.  She took her pills with juice and yogurt, but was not interested in the usual cereal afterward.  She just wanted to go back to bed.  She slept for a couple of hours. 

For the rest of the day, she has been able to walk only very short distances until she either fainted or couldn’t go any farther needing to sit down.  She did manage to get to the car so that we could, using the wheelchair as usual, head to Perkin’s for pancakes. 

While she was restless and in popping-up mode after that through suppertime, she still could not walk more than a few feet without having to sit down.  That, of course, meant I was also in popping up mode. 

Today has not been unlike many days in the last couple of weeks.  She did seem weaker even than prior days in that period.  The question is the one that is always at least in the wings but now has moved to center stage again.  Is this a temporary decline or a permanent one, a new plateau on the journey down the Parkinson’s Disease and Parkinson’s Disease Dementia path? 

I realize that worrying about whether it is permanent or temporary accomplishes nothing, but it just seems to be time for a little fretting on the matter.  What is especially of concern with this disease is the rate of decline.  We understand there is one direction this is going.  The rate at which it is traveling is at issue. 

The hallucinations are becoming stronger and more relentless, and the fainting is returning with a vengeance.  Moments of confusion seem to be more frequent.  All of those things are around all the time, so the challenge is to measure their intensity and frequency.   That is easier said than done since changes for the better and for the worse are incremental and seldom consistent.  

It is hard to know when the change is enough to warrant calling the Cardiologist or Neurologist.  If we do, what will either of them do that is not already being done?  We know the cost to be paid in destructive side effects if we raise levels of medication to control the problems as they worsen. 

There is no stopping the progression of this disease.  None of the medications currently available have the p0wer to slow the disease process, at least by the time the disease reaches this stage.  We have pretty well exhausted the options for controling the symptoms.  We are now left to the vagaries of the the daily and weekly and monthly ups and downs of the disease itself. 

There may be a change for the better coming, who knows, certainly not I.  We will continue to do as much as seems doable.  We have a major trip scheduled at the end of this month.  My hope is that the current apparent decline does not put that in jeopardy.   Maybe this time, what goes down will come up again on this roller coaster ride. 

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.

 

July 6, 2009

Caregiver: Reminded Why I Retired!

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The phone started ringing early (for us) on the Fourth of July.  The first call was from the Funeral Director to obtain the new Pastor’s phone number.  The second call was from the new Pastor on a much needed vacation with his family from whom he has been separated most of the time for the last five months.  He asked me if I would do the funeral.  Since I served the congregation for over twelve years until I retired almost exactly a year ago, I know the family well.  I agreed to do the service.

I have now been reminded how difficult it had come to be just to do the basics of the ministry before I retired.  Even with the Volunteers who have been so willing to stay with Mary Ann, scheduling appointments and meeting times on short notice is beyond complex.  

Just the phone calls are sometimes difficult to handle since Mary Ann’s need for help often comes with little warning, no matter what I am engaged in.  Completing a phone call, especially a long one, is sometimes virtually impossible due to a fall or a bathroom need. 

This family includes one of those who has Volunteered with Mary Ann in the past, so she suggested that the first planning meeting be at our house.   That eliminated the need for trying to get a Volunteer on the Fourth of July weekend with less than 24 hours notice.   The meeting was scheduled for 2pm.  The morning routine started fairly late in the morning.  The morning fainting spells began and a long nap meant that getting Mary Ann dressed came early in the afternoon.  I needed to make a meal.  The ingredients for a Quiche were in the house and ready to go. 

I started during her nap and moved sort of methodically completing each step before going on to the next.  I knew if I had hot pans cooking bacon and preheating oven and sauteeing onions and egg mixture and softening cream cheese all going at once, along with Mary Ann’s multiple requests, all needing to be done before the family arrived, the stress on this inexperienced and unskilled cook would be explosive.  The timing worked out so that the Quiche would not be done before they came.  Mary Ann needed something else to eat since she had not had anything to eat since pill time about an hour before the nap began.  I tried to postpone the meeting but could not get through to them. 

I managed to get my clothes changed for the meeting, the Quiche in the oven and scrambled eggs made from the leftover egg mixture, onions, bacon and cheese for Mary Ann to eat. 

When the family came, we met on the back deck while Mary Ann was eating and the Quiche was cooking.  I left the meeting periodically to check on Mary Ann, adjust the oven temperature, and take the Quiche out of the oven.

Understand, the meeting was with parents who had just lost their adult son.  One of their daughters, his sister, was with us.  Ministering to people in such painful circumstances demands full attention.  People deserve that kind attention when they are in such powerful grief.  The Son who died had lost a daughter at two and a half years of age many years ago.  The pain of losing that Granddaughter was still fresh after all the years.  Mom had lost her mother when she was just a little girl.  Those feelings remain intense. 

It is important to be there for people in times of such grief, in this case in multiple layers, listening intently and responding in ways that validate the pain and help provide a framework with which to handle it.  It is hard to do that while running back and forth to deal with another center of focus equally complex. 

Today reminded me why I made the decision to retire.  Doing a responsible job serving the people of the Congregation and being there for Mary Ann at a time of such need simply had moved beyond the limits of my ability. 

This week will include another very substantial meeting with the family to process feelings and gain information for the message at the funeral.  There is already a Volunteer scheduled at a time that was workable for the family.  There will be a number of hours after Mary Ann is in bed writing that message.  I have just completed the plan for how the service will be done, putting the pieces together so that a service folder can be prepared. 

For the funeral itself, Volunteers are simply not available (at least not so far) since some will be attending the funeral.  Mary Ann may be able to attend, but will need someone to help her during the time I am attending to the service and its preparations.  If she attends the service, that Volunteer is in place.  If she cannot go, I will need to arrange a paid agency person to serve as backup.  That may or may not work out. 

On Sunday afternoon I will be conducting the Ordination Service for a young man who has completed training and internship and will begin serving a congregation in Iowa the following week.  The plans for a companion for Mary Ann and an agency backup are now in place. 

The convergence of work needs and Caregiving needs is something that some who read this blog are experiencing.   To you I say, if you think what you are doing is impossible, you are right.  You are doing it and will continue to do it.  As I look back, I have no idea how I survived.  Those of you who are working full or part time and Caregiving also have no answer to give when someone who knows what you are doing asks, “How do you do it?”

I am being reminded this week why I retired.  I am grateful that I could, and glad that I did.  Mary Ann and I need every hour of every day just to deal with what the Parkinson’s and Parkinson’s Disease Dementia.  We are full time care partners.  It is what we are called to do. 

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.

 

July 4, 2009

Caregiver Reactions and Responses

Posted by PeterT under Daily Challenges, Meaningful Caregiving, Practical Tools for Coping, Relationship Issues, Therapeutic Activities | Tags: , , , , , , , , , , , , , , , , , , |
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It was a perfect time to be on the deck.  The temperature was in the high 70’s and there was a breeze blowing.  There were some hazy clouds occasionally filtering the bright sunshine.  The deck was partly in the shade and partly in the sun.  The sound of the splashing waterfall echoed providing accompaniment to the raucus squawking of Grackles and Blue Jays.  I read and thought and pondered and read and pondered some more.  It was a wonderful couple of hours.

I got Mary Ann’ s breakfast and pills done; then showered, shaved (yes, even though I wear a beard), and dressed.  The plan was to head to the grocery and then out to eat.  She stood up from the transfer chair for a moment and flopped down into it.  Whatever the switch is that turns off her ability to function, it switched her off.  The plan dissipated and a long nap ensued. 

Adapting quickly to a change in plans has never been easy for me.  If I got into my mind what we were going to do, frustration was my usual response to being derailed, a disabling frustration, leaving me grumpy and annoyed.   Today, video monitor in hand, I just headed out to the deck and had a great time.  In some ways I am learning to cope with the vagaries of the Parkinson’s Disease and Parkinson’s Disease Dementia.

When Mary Ann awakened from her nap, I got her dressed and ready to head out for lunch.  When we started the often endless task of picking a place to eat, she popped up with one we had not been to in years, Red Robin.  It seems to cater to the younger crowd, with a sort of boisterous atmosphere and very expensive burgers. 

I was happy that a decision came so quickly.  I mentioned the possibility of splitting a sandwich since they are large and costly.  I remember the first time we ate there.  It had just opened and there were lots of folks waiting for lunch.  Our name was on the list, but it seemed that others who had come after us were being seated.  I went in and asked why we had been waiting so long.  Somehow our name had been skipped.   As we were being seated, a manager came over and said that because of the long wait, lunch would be on them.  That was music to these frugal ears (big, but frugal).  Giddy with the thought of it, I decided to buy a beer, a Black and Tan (Guinness and Bass in the same glass).  As I was enjoying my beer, a bartender came by with a Black and Tan looking for the person who had ordered it.  He concluded that there had been some confusion, and I might as well have it.  While I just couldn’t manage to get two full beers down in one sitting (college days are over), it felt sort of luxurious to have them both sitting there for me to enjoy.  We had just had two full meals, a Coke for Mary Ann and a couple of imported draft beers for three dollars and change.  Yes, I did leave a tip based on the full price had we paid for the meals. 

This time we weren’t so lucky.  We got seated right away.  I had talked about our splitting a burger before we went in.  Then as we looked at the menu, both interested in the Salmon burger (made with a Salmon filet, not a salmon patty), I asked Mary Ann if we should go ahead and split the sandwich.  She always eats half and we take the other half home.  The burgers at Red Robin are between ten and eleven dollars each.   She said no.  It surprised me, since her normal response would have been yes.   I asked again just to be sure I hadn’t misunderstood.  She again said no. 

We ordered the two meals.  She finds it easiest to eat a sandwich if I cut it in half, and then cut the half in half again.  A quarter of a sandwich is about all she can manage to hold with her hands.  The fingers stiffen and lose dexterity when she is trying to hold on to something.  When she was working on the second quarter, she said, “I thought you were going to eat the other half.”  I am not sure exactly what happened that we miscommunicated so badly.  Red Robins are particularly noisy, and Mary Ann’s voice is very soft due to the Parkinson’s.  Most of the time I end up reading her lips when we are communicating in public, or in the car (can be challenging when driving).  It was annoying to think that we were paying eleven more dollars than we needed to, but I have come to be better at accepting and adapting.

One thing, however, that I cannot seem to accept, to which I struggle to adapt, is the messiness that goes with the dexterity problems.  I find it very hard to deal with my reaction to seeing the sandwich squeezed in her hand until most of it falls on the table her lap or the plate, sauce running through her fingers and down her arm.   Notice that what is hard to accept is not the messiness, but my reaction to it.  The reaction is internal.  My actions were attempts at helping her get the sandwich pieces back in her hand, suggesting she use the fork, then afterward cleaning her hands with napkins and a wipe from her purse.  I know she was uncomfortable with the cleaning I did, since it seemed that she was looking around to see if anyone was watching.

The messiness bothers me more than it does Mary Ann.  Part of it is that I happen to have grown up in a family with a Dad who was meticulous about eating habits.  Part of it is that Mary Ann doesn’t have the view that I have from across the table.  She is focused on getting the food into her mouth.  I see what doesn’t get there. 

Mary Ann did not choose to have limited dexterity.  All she wants to do is eat.  She does what is necessary to get that task accomplished.  My struggle is not with her messiness, it is with my inability to just take it in stride and ignore it.  I am self-conscious for her, when she is not.  I am embarrassed for her, when she is not.  It is hard to admit this, since she is the one living with the Parkinson’s and its impact on her ability to simply enjoy a meal.  I feel very petty.  In this regard, she is healthier than I am.   At least I have the sense not to allow my feelings to stop us from going out.  

Anyway, when we go out to eat, I don’t have to cook and clean up.  With that payoff, bring on the messiness! 

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.

 

July 3, 2009

What Lies Ahead?

Posted by PeterT under Daily Challenges, Information on Parkinson's, Meaningful Caregiving, Practical Tools for Coping | Tags: , , , , , , , , , , , , , , , , |
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Tonight we met a couple who have just received the diagnosis, Parkinson’s.  It was their first time at the Parkinson’s Disease Support Group.  I will speak only in general terms since I did not ask for permission to discuss their situation here.  As I listened to what they have been going through in incorporating the diagnosis into their lives, I couldn’t help but remember twenty-two years ago, when Mary Ann and I were in our early to mid-forties and the diagnosis came.

The couple tonight had been spending much time and energy trying to look forward, trying to determine what to do to prepare for what is to come.  There is so much information available now. I don’t know what the status of the Internet was twenty-two years ago, but, since we didn’t have a computer, its status is irrelevant to what we experienced then.

Information was hard to come by.  What was pretty unnerving was that the first Neurologists we saw didn’t seem to have much information either.  It isn’t that the disease had not been identified long before 1987.  The Neurologists we went to at first were not specialists in Parkinson’s.  Their staffs knew only the basics.  Since every presentation of Parkinson’s is different in each person, the basics seemed more harmful than helpful since they didn’t always fit Mary Ann’s experience of the disease.

During those early years, we did make occasional trips to Kansas City from Oklahoma City either to attend a Parkinson’s Symposium, or visit the Kansas University Medical Center’s Parkinson’s Clinic.  There we discovered a Neurologist and Staff who actually knew about Parkinson’s.  What was so frustrating to us as we went to the Neurologists in OKC was the discovery that we had come to know  more about Parkinson’s than the Neurologists and their staffs there.

Even at that, the knowledge of Parkinson’s in 1987 pales in comparison to what is known about it now, especially the non-motor symptoms.  I have talked about this before in other posts on this blog.  The question that has come to mind tonight is, what would we have done differently, how would our experience these twenty-two years have been different had we known then what we know now?

We talked tonight about the challenges that lie ahead for this couple.  They have worked very hard at anticipating and preparing.  They have searched the Internet and found lots of information, information that was not available when Mary Ann was diagnosed.  They have one of the best Neurologist’s around, one who specializes in Parkinson’s Disease.  Their situation is much more challenging than ours since both of them are dealing with physical problems.  The current Caregiver (now diagnosed with Parkinson’s) is likely to be needing care as time goes by. The one who has been receiving care is likely to need to become not only more independent but able to help the current Caregiver.

With the diagnosis only months old, it is hard for them to imagine how they will deal with what is to come.  When Mary Ann was diagnosed, we had no idea what we were getting into.  We did not have but a tiny fraction of the information these folks have.  The question wandering around in my head is what would we have done differently had we known what they already know, had we known what we now know.

The answer that first pops into my mind is, nothing, we would have done nothing differently had we known then what we know now.  Even with all the knowledge we have gathered over twenty-two years of listening and reading and learning, we still don’t know what lies ahead!

As we have lived out each day for all these years, we have used common sense based on the information available.  We found our way to a good doctor.  We paid attention and tuned in to the treatments and medications and reasons for them.  We went to the symposia and continued to read and learn.  When we moved we got a home that was fairly handicapped friendly and then increased that accessibility as soon as we could afford to do so.  At each step along the way, we made choices that accepted the most likely progression of the disease, choices that seemed to make sense.

We could not and cannot know what lies ahead.  We can simply create an environment friendly to our situation and trust that we will make good decisions as the days and weeks unfold.  We can only do what we have the knowledge and resources necessary to do them.  That is more than enough to do.  Yes, it means thinking about financial issues so that things are in place to the degree possible.  It means developing contingency plans within reason.  We cannot cover every potentiality.  We simply can’t.  We have had to accept that.  No one can know what lies ahead, nor is it possible to have every base covered.

The good news is that by acting responsibly, doing the best we can with the information and resources available to us as each day goes by, we have the best chance of dealing with whatever contingency may come.  There are no guarantees in life.  I am hardly the first one to come to that conclusion.  It is a truism.  By giving up the illusion that we can anticipate and prepare for every problem the diagnosis will produce in the future, we are free to live the day we are in with some peace and enough energy to deal with whatever that day brings.

The couple tonight had come to that conclusion after working very hard at assessing what the future will bring and preparing for it now. They will clearly make the best of a very difficult situation.

What lies ahead?  We have some clues, but only clues.  We won’t know what actually lies ahead until it happens.  Doing the best today with what we know, dealing responsibly now with what is actually happening, doing what we can today to position ourselves for what seems likely to come is not only a productive way to live, but it gives us the best chance of being able to deal with whatever it is that does lie ahead.

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.

 

July 1, 2009

Caregivers Need Eyes to See and Ears to Hear

Posted by PeterT under Daily Challenges, Meaningful Caregiving, Sources of Strength, Therapeutic Activities | Tags: , , , , , , , , , , , , , |
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It changed my whole perception of reality.  It only took thirty minutes to do it.  Nothing has looked the same since.  “A Time to See” is the name of the educational film made by Reinholdt Marxhausen and published in 1985. 

Reinholdt Marxhausen was extraordinarily gifted in the visual arts.  He saw things others could never have seen had he not pointed them out.  There were bottles on the window sill in his kitchen over the sink.  They were just bottles — not to Reinholdt Marxhausen.  They were an adventure in light and shadows and colors and darkness, changing character at different times during the day, different times during the year. 

Alzheimer’s Dementia has stolen from him his extraordinary gifts in the visual arts.  His impact has continued in many of his students and all who have known him.  I only know him through friends and that film that made such a lasting impression on me. 

What brought the film to mind was writing the sermon for the ordination of Karl into the ministry.  Karl has been a student where Marxhausen taught.  Karl was influenced by the legacy of Reinholdt Marxhausen when he was the the peak of his ability. 

For me, the center of the legacy is the recognition that what a person sees depends on his/her ability to look past the object to its relationship with what is around it.  The capacity to really see, allows the most ordinary found items to become extraordinary as shadows and colors and shapes and textures suggest something far more than ordinary. 

There is a commonality about the story line in the lives of Reinholdt and Karl and PeterT (author of this blog).   Reinholdt has seen his ability to make art diminish as Alzheimer’s has taken its toll.  Karl’s mother died at the age of fifty.  At one point she was diagnosed with Pick’s Disease, a form of Alzheimer’s.  Karl’s Grandmother died of what appeared to be a form of Alzheimer’s Dementia.  My wife, Mary Ann, has been diagnosed with Parkinson’s Disease Dementia. 

The objective realities in our lives hardly present beauty to the beholder, at least at first glance.  There is a painful ugliness in the world of Dementia whatever the specific diagnosis.  Karl and I have learned from Reinholdt that it is a time to see.  It is time to look at objective and sometimes very painful realities and see more than the obvious.  We need eyes to see what lies behind, above, below, and beside what we have experienced and are experiencing.  We need to see how what lies before us and around us looks from different angles.  We need to see the colors and shapes and textures, listen to the sounds of what we encounter.  We need to allow the possibility that there is more than meets the eye lurking what we have and are going through. 

There is beauty to be found, there is meaning to be found.  It can be seen if we have eyes to see.  It is often said that beauty is in the eye of the beholder.  I don’t suppose beauty really exists until we add the capacity to see it, to hear it.  If there will be beauty and meaning in our lives, especially those of us who deal with dementia, the beauty will come from within us as we look at what we are experiencing and see it for more than what first meets the eye.

My life has been enriched by taking time to really see what is around me.  Karl has seen what his Mother and Grandmother with through and has grown a gentle strength and wisdom beyond his years. 

Having said all of that, I am now struggling with finding the beauty in three hours of trips into the bedroom every few minutes to deal with one need or another, moments ago (1:30am) the need for some food, followed by the need for some water, after multiple turns in bed, trips to the commode, adjustments of the sheet and blanket and a few concerns with the wildlife in the bed.  Right now, I would find beauty in a wife finally getting to sleep!!

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.

 

June 30, 2009

Wildlife Moves from Deck to Bedroom!

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Why did I talk so much about the mother raccoon and her two babies that visited our deck the other night???  I should have known better.  For the last hour Mary Ann has been seeing a baby raccoon or two under the bed, on the side of the bed, in the bed all around her.  It may be a very long night.

Last night was not a good one.  It was very late before she finally settled.  It pretty much never fails that the day after a difficult night, the hallucinations ramp up in activity.

I feel pretty helpless when this happens.  There is nothing I can say to convince her that they aren’t there.  I know the rule is not to tell the person seeing the hallucinations that they aren’t real.  I have searched for them in the covers and under the bed and around her back as she lay in bed, assuring her that they are not there.  If I agree that they are there, there is no hope of her getting any sleep.  I am watching her on the monitor and will head in to reassure her whenever she appears to be bothered by the….whoops, there she goes.

When I got to the bedroom, she asked if the people (there were no people) had left yet, used the commode, while she holding the corner of the sheet she said she hated the fabric hanging there, she got back into bed and told me she was going to send the raccoons over to my bed.  I encouraged her to do so…back to the bedroom again.  This time a Tums was needed.

I have read hundreds of posts from those in the Lewy Body Dementia Spouses group.  It is pretty unsettling to read how many who have LBD (Mary Ann’s Parkinson’s Disease Dementia is a dementia with Lewy Bodies) have a much worse problem with hallucinations.  I don’t relish the time when her hallucinations become worse and more constant, assuming that happens.  Given recent experience, it appears likely that it will happen.

If these hallucinations don’t subside in a couple of days, I will phone the Neurologist to see about increasing the Seroquel.  There are some scary risks that come with Seroquel, but so far she has not had problems with it.

For tonight’s challenge, I am heading off to bed early to see if my presence will help. She has been quiet for a while.  Hopefully she will get a good night’s sleep.  Tomorrow is another day.  Maybe the raccoons will have left the bedroom and returned to the deck.

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.

 

June 29, 2009

Caregiver’s Have Memory Problems Too

Posted by PeterT under Daily Challenges, Practical Tools for Coping | Tags: , , , , , , , , , , , , , , |
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We were sitting on the deck with Don and Edie, who had called and offered to bring supper over — we accepted and invited them to stay and eat with us.  I was making a point about something, but I had one of those lapses, when I couldn’t think of the right word to complete my sentence.  Mary Ann finished my sentence by adding the word.  This is the same Mary Ann who has had Parkinson’s for twenty-two years, who has been diagnosed with Parkinson’s Disease Dementia and can hardly get an audible word out of her mouth.

Exactly who is it in this household who has memory problems? I certainly hope other Caregivers sometimes struggle with memory problems.  I would hate to think I am the only one.

A few weeks ago I was trying to remember the birthday of one of my brothers.  I knew it was sometime in the end of May and that my Sister-in-Law has a birthday near his.  I asked Mary Ann in one of those times when I was not anticipating an answer from her.  She said May 25th.  I assumed, since she has Dementia, I could not accept that as the final answer.  I called one of my Sisters.  Dick’s birthday is May 25th.

Why is it that sometimes Mary Ann’s memory is better than mine, and she is the one diagnosed with Dementia.  I wonder how many other Caregivers sometimes worry at just how often we forget stuff.  When the Caseworker comes by for the annual assessment visit, at a certain point he always gives her four words and asks her to remember them so that she can list them when he asks her again.  I am so grateful that he doesn’t ask me to repeat those words later in the conversation.  Of course I repeat the four words in my mind the entire time he is asking her other quesitons so that I can feel superior when I remember all four and she only gets two or three of them. If I had been forced to pay attention to the questions he was asking after listing the words I would not have had any hope of remembering the four words.

I recognize that stress can impact a person’s capacity to remember things.  I have used that rationalization a thousand times.  I understand that memory loss due to attention problems is a normal part of aging.  There is a unique character to the memory loss that is the result of Dementia, but I have forgotten what it is.

Actually, I just cheated and checked online to see if I could find something to help distinguish the normal memory loss due to aging and the memory loss that comes with dementia.  Forgetting how to do things that you have been doing for years is one.  Forgetting how to get someplace you have gone to often is another.  No longer being able to follow things that are done in steps, such as following a recipe is another.

One of the reasons that I have developed so many routines is that routines help me get things done that might be forgotten if the routine didn’t automatically lead me to do them.  I turn the medicine bottle upside down when I take my daily Synthroid so that I won’t take it a second time thinking I hadn’t yet done it.  I alway use the remote to lock the doors on the car rather than the button on the inside of the door.  That way I am far less likely to lock my keys in the car.  I have to have the fob in hand to lock them.  Of course, I keep a list of all the things I need to do.  If a new item comes to mind, I have to write it on the list immediately.

I guess I cannot know for sure if my memory loss is normal.  I think it is within a normal range.  I hope so!

I don’t think I am the only Caregiver who wonders sometimes if he/she is suffering from serious memory loss.  As Caregivers, we can see how devastating dementia can be.  When we can’t remember things, sometimes it scares us.  If we have a problem, who will care for our Loved One?

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.

 

June 28, 2009

Deck Retreat: Wildlife Population Grows

Posted by PeterT under Daily Challenges, Meaningful Caregiving, Practical Tools for Coping, Relationship Issues, Therapeutic Activities | Tags: , , , , , , , , , , |
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…and baby makes three!  Actually, it is Mom and two babies.  One raccoon is sort of a novelty.  Three raccoons is two over quota.  The young’uns are not all that well behaved either.  The banging at 3:30am turned out to be one of the babies knocking a ceramic pot holding an asparagus fern off the old wooden box it was sitting on.

After watching them for a while, I decided it was time to get them off the deck before the kids did any more damage.  I turned the deck light on and off a few times to scare them off.  Not one of them even flinched.  Mom and one of the youngsters kept eating what the squirrels had left in the pan of oil type sunflower seeds I provide to keep the squirrels attention away from the bird feeders.  The other youngster, I suspect, is the problem child.  He/she messed around some more and then finally left a while after the other two had headed off and under the deck.

The lights in the waterfall are now in, and as a result nighttime deck therapy is an  option.  Each of the four levels has a light at its base. The light is invisible until the timer turns it on.  Neighbors Tom and Amy and I sat on the deck for a while and talked, just enjoying the sound and sight of it.

What makes sitting on the deck possible is that the little seven inch screen on the A-V monitor keeps Mary Ann in view.  I can see when she starts moving and needs my help.  Without the monitor, I would need to head into the house every few minutes to be sure she didn’t need something.  This way I only have go when she actually needs me.  I have now ordered a second camera so that both the bedroom and living room can be seen by just moving the channel switch from A to B.  Again, the screen and audio-visual monitor is a Summer 2500 available at Babies R Us.

Mary Ann and I headed into Kansas City to spend time this afternoon with friends we have known since the early 1970’s.  The time there is always refreshing.  One couple in our crew, like us, is a caregiver/receiver couple.  Marlene has ALS. Charlie has retired (mostly) and is now a full-time Caregiver.  He is the one who sent me a beautifully written email when I first revealed my decision to retire and spend full time helping Mary Ann with her needs. In the email Charlie told me what an honor it is to be able to have the role of Caregiver.

As always, we enjoyed the time together.  There is no self-consciousness to distract from the relaxed friendship.  Whatever special needs Mary Ann has are just taken for granted.  Charlie and Marlene often have helpful suggestions.  There are ramps into the house and on to their deck.  The arrangement of furniture allows space for wheel chair movement.  Marlene uses a motorized wheelchair.

We returned home, and I have managed a few minutes on the deck with Mary Ann securely in bed.  Having just fallen asleep for a moment at the keyboard, i think it is time to post this draft and get to bed.

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.

 

June 26, 2009

Caregiver needs Deck Therapy

Posted by PeterT under Daily Challenges, Meaningful Caregiving, Practical Tools for Coping, Relationship Issues, Sources of Strength, Therapeutic Activities | Tags: , , , , , , , , , , , , , , , , , , , , , |
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Almost done!  The four level waterfall needs only the one watt light fixtures that produce twenty watts of light at the base of each of the four levels.  They will be installed tomorrow.  

The plants are now all in place.  Brad even brought some from his own yard to put in an area above the lined portion, his gift to us.  His Dad has Parkinson’s and we have come to know his parents at the Parkinson’s Support Group meetings.  Brad has put forth extra effort at every turn.  The end result is more than Mary Ann and I could have hoped for. 

The Mallards are now in duck heaven – our back yard.  They were hanging out there last evening and came today five minutes after Brad and his crew left. 

I also hung out on the deck last evening listening to the waterfall as rain and thunder and lightening came through.   While it was raining I sat on the portion of the deck that is covered with a section of the roof.  The wind cooled the air so that the experience was wonderful. 

Mary Ann and I spent some time this morning on the deck before the day heated up.  I got her out to a lawn chair to sit for a while.  Then she got up and walked to the rail to get a better look at the waterfall.  As she started to faint, I tried to pull a chair over behind her.  It didn’t work.  I let her down to the deck.  As she lay there, I went into the house and got the transfer chair so that I would eventually be able to get her into the house.  During the morning, before, and then out on the deck she had had some small fainting spells.  The one at the rail was a substantial one, one that turns into a sort of siezure.  As usual, there was some intestinal activity that followed.  Some time I intend to ask our Gastroenterologist for an explanation of that phenomenon. 

Last night, the third in a row, Mary Ann had trouble settling down and getting to sleep.  As expected, the hallucinations have been a little more active the past few days.

The reason I titled this post “Caregiver needs Deck Therapy” is that today was a pop up day.  Most of the times I went out to talk with Brad and the crew about something, I very specifically asked Mary Ann to stay seated while I was outside.  Of course I made sure that she had ice water, the television was tuned to something she liked, and that she didn’t need to get to the bathroom.  For the most part she did as I asked during those times. 

Other than that, Mary Ann popped up every few minutes.  When I answered the phone or made a phone call, she was up.  When I went into the kitchen to put things in the dishwasher she popped up.  When I tried to get food ready for her she popped up.  When I went to the bathroom she popped up.  It seemed that pretty much every time I sat down she popped up. 

As I have shared many times, falling is a major issue.  The fact that this was also a fainting day made it even more challenging.  Last I heard, aspirating food and falling are the two most likely events to end the life of someone with Parkinson’s.  People don’t die of Parkinson’s itself.   Mary Ann was falling generally more than once a day until the torn stitches a few weeks ago.  Since then she has fallen very seldom, at least by the pre-stitch-tearing measure. 

I realized today the reason the falls have diminished so much.  I am moving very quickly to be right there whenever she stands up to walk.  I offer my elbow for her to hold, thereby stabilizing herself while walking, or I put my hand gently on the gait belt she always wears so that I can help her regain her equilibrium if she gets off balance.  The A-V monitor helps me anticipate her getting up so that I can be there by the time she is up. 

The challenge is that I can’t keep her in view every moment.  The monitor has to be plugged in and within view for me to use it.  I can’t move it with me every time I walk into the other room, head down the hall just for a moment, or go to the bathroom.  At the first sound of movement, I move as fast as I can, sometimes even managing to get this sixty-six year old body to run, to get where she is before she falls. 

Today, I must have jumped and run thirty or forty times.  That is only a guess; it may have been a thousand times!  While as her Caregiver I should just take that in stride, if every day were like today, I am not sure I could do it.  Not long ago I used the metaphor of a marionette whose strings were being pulled by someone else as a  way to describe the feelings of being a full time Caregiver.  That was the sensation today.  She popped up and my arms and legs moved. 

I needed some time on the deck this evening.  The residual heat from the day made it much less bearable than last evening.  That respite and this post are my way of settling down and allowing the frustration to dissipate.  I understand that Mary Ann’s popping up is not a malicious attempt at making my life difficult.  In her mind it has nothing to do with me.  It is my problem that I come running when she gets up.  I suppose, if that is what she is thinking, she is right.  Nonetheless, the truth is, I need to keep her from falling to the degree it is possible not only to keep her safe but to keep my life from becoming more difficult.  If she hurts herself, it hurts both of us.  And, yes, while in my most rational moments I recognize that the disease is the cause of this annoying behavior, sometimes it feels as if she doesn’t care what impact her actions have on me. 

Today is done.  There have been many good moments along with the frustrating ones.  I celebrate the new retreat center behind our house.  I suspect that there will be need for some Deck Therapy tomorrow.  Then there will be lights!

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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