March 9, 2010

Cherish?? Maybe not Every Moment

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“I am cherishing every moment we have together.”  That is what I said in last night’s post after the challenge of feeding Mary Ann.  I lied!  As terrible as it sounds, I don’t cherish every moment.  At 4:15am after having been aroused for one thing or another multiple times an hour (the last one only five minutes before) Mary Ann insisted on getting up.  I did not cherish that moment with her.  I got her up and out in front of the television in the living room and went back to bed for an hour.  Then she was ready to lie down, at least for a while.

I guess I am a terrible Husband and Caregiver to admit to not cherishing at all times my sick wife on the last leg of her journey from here.  Yes, I do feel guilty about it.  I sound so sweet and loyal and loving when I say I cherish every moment with her.  I am not all those things!  I am just an ordinary selfish somebody trying to live out my life and my relationship with Mary Ann with a degree of honor, expressing my love for her.  I do cherish most of the time with her, extending even into waste management.  I just get grumpy when I don’t get my beauty sleep.  (Who is going to be the first smart-aleck to suggest just how clear it is that I am seriously sleep-deprived?)

Is it the Amantidine that we resumed that is making the hallucinations and restlessness so intense, or, since she had slept four days, were we just due for the usual return of that behavior?  God only knows, and He ain’t telliin’.  How about the idea of somehow trying to get God a wireless router so that he could just email responses to prayers and cries for help??  How getting on that, Steve, Bill?

When Daughter, Lisa was here last week, her Mom slept all but about four hours of Lisa’s visit.  “Lisa, I would gladly have traded last night for one of the sleep days or nights you had when I was gone.”  Yes I am grateful that Mary Ann is napping now.  I gave her the morning dose of Amantidine, still hoping that she will regain the use of her hands and the ability to assist with her leg muscles when being transferred from her chair to the bed or toilet stool or dining room chair or car, should we be able to get her out again.  This almost 67 year old body is beginning to show its age (the mind is still 25 years old, except for the memory which is pushing 90).

At one point last night Mary Ann was convinced that she was not in her bed, but another bed like hers.  She was convinced this morning that the dining room table was not our our dining room table.  In fact when I first tried to transfer her to the dining room chair for breakfast, she refused since she didn’t want to sit next to the bride.  At least when I checked with her, the bride wasn’t Lulu (the woman I married after divorcing her in one of her dream/hallucinations).  She didn’t know who the bride was.  When I asked if she wanted me to turn on the television she said it was “his” television, not ours.

She has been napping for about three hours now.  Yes, I am grateful for the break.  I just don’t want her to sleep too long.  She had a good breakfast, but she has not yet had lunch.  It is after 2pm.  Our Daughter-in-Law Becky relayed an email from a close friend who works for a Hospice.  In that email, she said that people come to need less nourishment at this time in life, suggesting that I can relax if a meal is missed.  Mary Ann always “ate like a bird” — one reason she has never gotten overweight (very annoying) in all our years together.  Other than ice cream, she usually eats what would be the equivalent of a child’s portion (a pre-teen child).

This morning Bath Aide Zandra brought a helper with her since Mary Ann had fainted so many times the last time she did her shower.  Zandra was concerned that Mary Ann had hit her head because she couldn’t get into the right position soon enough to stop her from falling off the shower chair.  She asked about the possibility of getting a secure three sided shower chair so that Zandra could stand in front and be sure she wouldn’t fall to the side.  We had a tubular metal rolling shower chair that we obtained a few years ago.  It turned out to be unsafe because of the reinforcing bar across the front, making safe entry and exit from the chair virtually impossible.

Zandra was a bit distressed to see how much Mary Ann had declined since her visit last Wednesday.  Today Mary Ann could not assist at all in getting from the transfer chair to the shower chair and back.  Mary Ann’s hands were fine last Wednesday but swollen and clubbed (nor sure that is the right word for describing the claw-like form) today.

I just called our Hospice Nurse, Emily, who listened carefully to what we needed for the shower.  She said she would try to find it for us.  In fact, she said that if we didn’t hear from her, one would be delivered tomorrow afternoon.  Holy Mackerel!! That is an unbelievably fast response.  I have seen PVC pipe chairs that looked sturdier, but the last time I searched a couple of years ago, I didn’t see one without a bar in front.  I hope the supplier Hospice uses has something workable.

Mary Ann had an appointment with the Dental hygienist for her much needed quarterly cleaning scheduled this afternoon.  I did try to get her up in time to go, but she declined.  That was at about 1pm.  It is now 2:45pm and she is still sleeping.  Again, she didn’t want to go to bed until after 11pm last night and spent much of the night, especially from 2am or 3am on, up and down.

She slept until some time after 5pm. She ate a good supper, sat in front of the televsion for a while, then headed back to bed about 7:30pm.  At about 8pm she was hungry and wanted a bowl of ice cream again.  After taking some Ibuporfen for back pain and then later taking her night time meds, she is now lying down.  I am not expecting her to settle in without lots of restlessness tonight.  We will see.

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.

 

March 8, 2010

Mary Ann is Now in Hospice Care

Posted by PeterT under Daily Challenges, Family, Help from Others, Information on Parkinson's, Meaningful Caregiving, Practical Tools for Coping, Relationship Issues, Therapeutic Activities, Uncategorized | Tags: , , , , , , , , , , , , , , , , , , |
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What that means is that we have someone to call whatever comes up.  A Hospice Nurse will stop by a couple of times a week.  We have added one day a week of having an Aide to help with shower and hair.  Mary Ann loves current Bath Aide Zandra, so we will continue to use that paid service.  All the Hospice costs are covered by Medicare.

The Hospice Nurse who enrolled Mary Ann today was already helpful.  Mary Ann declined so much in the last few days since we took her off one med (Amantadine), that I thought we should start it again.  Because these are powerful meds, I didn’t want to do it without professional advice.  This is Sunday.  Nurse Jennifer contacted the Hospice Pharmacist and confirmed that it was all right to restart the med.  The most obvious change was the clubbing of Mary Ann’s hands, rendering them useless — in four days.  We are all hoping that her hands will return to functionality when the med reaches the therapeutic level in her bloodstream.  There are no guarantees that she will regain what she lost.

Mary Ann was a little more responsive this afternoon.  She was up while the Hospice Nurse was here, and she responded appropriately a few times.  She has been sleeping much of the day, but up for breakfast and to get dressed, as well as an hour or two after the Hospice Nurse left.  She was actually lying with her head down and her eyes closed, but at least she was out of the bedroom.  She ate lunch, the usual half sandwich, chips and a Pepsi, followed by a good-sized bowl of Buttered Pecan ice cream.  As hard as it is to hold her head up and feed her at the same time, I am cherishing every moment we have together.

She has not yet eaten supper.  I have been going in to talk with her every half hour or so to see if she is hungry or wants to use the bathroom.  She finally got up to eat at about 8pm.  She ate a substantial supper capped off with a small Boost and ice cream shake.  The Boost should help assure adequate nouishment.

As the evening has worn on, it is beginning to appear that the Amantidine is a very problematic medication.  She is now very alert, unable to sleep, doing some hallucinating, and when she was in bed complaining that she couldn’t move.  She is up and in the living room watching television, sitting up and it is 11:15pm.  There is no sign she is slowing down — I take that back.  She just decided to lie down in bed.  I don’t know how long that will last, but she has been sleeping most of the time for almost five days, so I guess it would be no surprise if she is up many times tonight.

It is tiring be be jerked around so much of the time by medications that wreak havoc with her functionality.  Sometimes they work, sometimes they don’t.  Sometimes they do exactly the opposite of what they are supposed to do.  Then in an hour or a day or a week, they start doing what they are supposed to do — or not.  I will wait to see if her hands open and resume usefulness.  If they don’t, I will talk with the doctor again about the possibility of removing it.  When looking at side effects, Amantidine’s list contains very many of Mary Ann’s problems.  Stopping it seemed to result in the clawed hands and weakness that does not allow her even to assist in a transfer, let alone walk, even with assistance.  Today after restarting the Amantadine this afternoon, it has seemed to produce more strength and alertness, sort of bringing her back to life.  Of course I can’t be sure the medicine is causing all the changes.  It is just that the changes seem to associate directly with the times we stopped and then started again the Amantadine.

Even the professionals, Doctors and Pharmacists can’t help very much since people don’t always react in the same way to the same medication.

On the positive side of taking the Amantadine, if it helps with her alertness and ability to communicate, that will be a very good thing in the next few weeks.  Some of Mary Ann’s friends and family intend to come and visit.  They would appreciate being able to interact meaningfully with her.

Some readers have asked about the time at the Retreat Center — how it went.  I have already written about the two evenings.  The day Friday was wonderful.  It was 70 degrees and full sun all day long.  Thursday night, when heading out to watch the sun set, I was spotted by a deer, who headed over to be with ten more deer.  I watched them for a long time.

During the day on Friday, I walked at a leisurely pace along the path that wanders back and forth through a large wooded area.  The moss on the path was in its new spring shade of green.  The trees were budded out ready to burst open with flowers for leaves.  There were birds to be enjoyed. There were some I couldn’t identify (not unusual).  Even though they are common, the Red-Bellied Woodpecker that doesn’t have a red belly, and the Yellow-Rumped Warbler, that does have a yellow rump are just fun to call by name.

I did see something out of the ordinary.  It is what one of the staff there has dubbed the Mutant Armadillo.  It is certainly an Armadillo, but the largest one I have ever seen, dead or alive.  I suspect it would take five or more of the ones that are routinely spotted on the side of the road with their feet in the ari to match the weight and size of the monster I saw.

I sat for a long time on the three legged stool in the fartthest corner of the property I could reach.  I read Psalm 104, a great description of the creation and all that’s in it.  Then I read the a few chapters in the book probing the implications of physics in regard to the presence of God.  It was a good grounding for me as we ride the roller coaster we are on here at home. I did take a moment to phone home from that place.  I have done that on the last few retreats.  It helps me keep the world of prayer and meditation connected to the day to day reality.

I continue to be overwhelmed by the words of support through the electronic media.  There is no chance to feel isolated and alone when so many are thinking of us and praying for us.  Thank you all for that.

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.

 

March 7, 2010

Decision is Made

Posted by PeterT under Daily Challenges, Family, Help from Others, Information on Parkinson's, Meaningful Caregiving, Relationship Issues, Sources of Strength, Therapeutic Activities | Tags: , , , , , , , , , , , , , , |
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I am phoning the Hospice folks tomorrow (Sunday) to begin the application process for Hospice.  When we asked in a way that she could respond yes or no, Mary Ann said yes.  The kids both agree wholeheartedly.  I have grieved my way through to agreeing.

It seems none too soon.  I can’t believe how much Mary Ann appears to have declined in just the last three or four days.  She slept through the entire time I was gone, either in bed or in her chair with her head down.  She had been sleeping like that before I left.  She is seldom responsive, but can on occasion be lucid for a while. All of a sudden in the last three days, her hands have swollen and are stuck in a clench, which could become hand contractures, something our daughter saw often in the nursing home context.

Mary Ann was at the table with us during the entire conversation about Hospice, and the decision about the possibility of a Do Not Resuscitate order.  She had her head down but her eyes open.  The kids were sitting closest to her and I was across from her.  We worked hard to get responses from her at various times.  I explained that acceptance by Hospice would imply that we are on about a six month trajectory.  I added that if she was doing better she could “graduate” from Hospice for a time.  She responded in a way that seemed to indicate she was tracking with what I was saying.  She said a distinct yes, for all three of us to hear.

What is most comforting to me and, I am sure, to Mary Ann is that should she qualify for Hospice Care, she will be able to stay at home to the very end.  We both dread hospital stays so much; that alone was enough to seal the deal.  Of course, there still could be need for hospital care, but since Hospice can administer IV’s at home, it is far less likely there will be any need to do so.

I talked about the DNR option.  After explaining it and the reasoning for it, I asked her first thoughts on it.  Again she said, yes.  I told her that I would check back with her another time to be sure.

Since, a decade or two ago, Mary Ann already had tearfully wished she had gotten something she could die from rather than the long protracted decline of a disease like Parkinson’s, the DNR did not bring resistance but agreement.

Speaking of tears!  I have encouraged people, men and women alike, to celebrate the ability to cry as a powerful gift from God.  I have told people that it is a sign of strength and not of weakness.  At the same time I was proud of myself that in my adult life I could count on one hand the times I had cried out loud, sort of denying my own counsel.  Well, I am now, a few weeks short of my 67th birthday, giving up counting.

Last night in the cabin at the retreat center in Oklahoma, I could no longer hold it in.  I have ministered to people for forty years.  I have watched die and done funerals for people that I genuinely cared about.  I refused to become clinical and treat funerals and the people grieving at them as just a part of a job.  I risked becoming vulnerable enough to care about them.  I buried babies, and teenagers and young adults, parent of young children, people of all ages and circumstance.  I felt the pain and cared about how they were feeling.  I ministered to people and preached at the funerals and never broke down (except once in an inconspicuous moment after preaching at the funeral of one of my best friends).  I cannot describe to you just how different it is to think about watching Mary Ann go through what I have seen far too many times in these forty years.

I want this process to stop right now.  I am not willing to lose her — but I can’t do a damn thing about it!  There is no where to which to run to get away from it.  I have a very ugly and very loud cry.  I guess not having practiced it more, I never really learned how to do it well.  I warned the kids tonight and asked them to explain to their children that they might see their Grandpa crying out loud, but not to be afraid.  I wanted them to know that it is all right, even healthy to cry, to let their emotions show.

I spent the evening the night before last talking with friend John.  I just spewed it all out, the good, the bad and the ugly.  I can trust John with the worst of it.  He can listen without judgment and never give advice.  He had gone through a shorter version of this when his wife died of Cancer — shorter, but no less devastating.  He had some very tough challenges as a single parent immediately after Sherrie’s death.  I shared a struggle with anger toward someone in Mary Ann’s closest circle who hurt her deeply.  That evening, that person and that deed’s power to turn me into someone I don’t like was lifted from my shoulders, better said, my gut.

So much is happening so fast.  This is all I will write for now.  More will follow.

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.

 

March 4, 2010

Hospice Report — Lisa’s Here — Construction Begins

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We met with two folks from a local Hospice program for about an hour and a half this afternoon.  The construction has begun on the sunroom.  Lisa has arrived.  Three of the anticipated events have been (are being) realized. 

Lisa came in late in the evening.  Mary Ann was in bed but awake enough to get to see her and talk for a moment.  It will be interesting to see which Mary Ann will be present with Lisa during these three days, sleeping Mary Ann, hallucinating Mary Ann or lucid Mary Ann.  It could be all three who appear.  This form of dementia is so odd and unpredictable in how it presents itself. 

The folks from Hospice were, of course, very pleasant and engaging.  The one who took the lead was Nurse Lisa (same first name as our Daughter – lest you be confused).  She had managed to get information from the doctors, at least the Cardiologist.   She had read it over carefully and was fully aware of Mary Ann’s situation, at least to the extent of what was covered by the information she had received. 

They asked lots of questions, and listened carefully to the account of Mary Ann’s current situation and recent history.  There is a doctor in Kansas City who is charged with determining if Mary Ann’s problems rise to the level required for enrollment in Hospice.  The three general problems that will be evaluated are her heart issues, her late stage Parkinson’s and her dementia.  It is one of those three that must be at a certain level.   

One understandable but mildly disappointing observation made by Nurse Lisa was that Mary Ann’s dementia was certainly not bad enough to qualify her.  Understand, I would be happy to hear that she isn’t yet far enough along to require Hospice care.  Nurse Lisa made that comment after Mary Ann got up from a nap and I brought her to the table with us.  Mary Ann was alert enough to present herself well. 

Parkinson’s Disease Dementia [PDD]  is a Dementia with Lewy Bodies [LBD].  It is different from Senile Dementia or Alzheimer’s Dementia.   PDD/LBD does not move in a steady decline but erratically jumps between severe dementia, especially hallucinations, to lucidity, or sleep.  All of the LBD Spouses in the online group I am in know about “showtime.”  People with this disease can present themselves in a way that looks and sounds as if they are functioning very well.  Later this evening Mary Ann was hallucinating almost constantly, just as she had early in the day.

One of the challenges with this disease is finding people who understand it, or educating them so that they do.  We will find out by Friday what the doctor says about the assessment of her problems and their implications for enrolling in Hospice.  Since I will be out of town on retreat, they will call our Daughter Lisa.  By the way, our Daughter Lisa worked in a Hospice program in South Carolina for a few years.  She said that there and in the Hospice programs she has checked on the Internet, a problem called “Failure to Thrive” has often been used.  That is used when there are multiple problems, including weight loss.  Mary Ann’s height/weight ratio fits well within the range of those who qualify for other hospice programs. 

Nurse Lisa and the other Hospice rep named Chris mentioned that 20% of those who enroll in Hospice, eventually graduate.  That means they get better and no longer fit the criteria for enrollment.   If Mary Ann is enrolled, we will set graduation as a goal.  While the resources and support provided by Hospice appear to be wonderful, we have a pretty effective system already and would like to extend our quality time together.  Bythe way, a recent study is suggesting that those enrolled in Hospice generally live longer than those who are not enrolled in hospice.  The LBD Caregiving Spouses online group posted that information this morning, well before this afternoon’s meeting with Hospice. 

This morning we experienced the classic frustration of conflicting medical problems and treatments.  When Bath Aide Zandra was doing the morning shower, hair washing, dressing routine, Mary Ann fainted two or three times — once she bumped her head since Zandra had her hands full with soap and hand held shower sprayer and could not catch her in time.   I suggested to Zandra that maybe I could give her the Midodrine that helps raise her blood pressure before Zandra comes to see if it will help.  Then when Parish Nurse Margaret was here later in the morning to spend a couple of hours with Mary Ann so that I could have a break, her blood pressure measured 204/100.   There seems to be no way to keep her from experiencing a low blood pressure syncope (fainting) without raising her blood pressure dangerously high.  Imagine how high it would have been if I had given her a Midodrine this morning before Zandra came.

The jury is still out on whether eliminating the Amantidine is more good than bad (see last night’s post). 

After the meeting with Hospice, we managed to get to a Lenten Worship Service at church and the meal following.  At the meal, she was willing to let me feed her.  She ate a good quantity of food.  She usually resists letting me feed her in public.  It may be that there are so many church folks there who have been very accepting and very helpful to us, that Mary Ann simply feels secure enough not to be so concerned about what they think of her as she is being fed. 

The very noisy construction crew have been doing demolition and then preparation for putting in the subfloor of the new sun room.  It will be hard to put that project out of my mind so that I can relax for the three days I will be on retreat.    The time is set for John to come to the center and spend time talking tomorrow evening (see last night’s post)

It seems like such an important transitional time for us.  It will not be clear how important it is or is not until weeks or months later as this journey unfolds.  The Spiritual Formation Group’s conversation this morning centered on the matter of  looking for past times that ended up serving as teaching moments for God to shape who we are becoming. 

I guess it is still energizing and exciting to realize that even as Geezers we are growing and  becoming more than we have been and less than we will be.  It is sort of like Adolescence without the pimples!  (Constipation instead.)

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.

 

March 3, 2010

Anticipation

Posted by PeterT under Daily Challenges, Family, Help from Others, Information on Parkinson's, Meaningful Caregiving, Practical Tools for Coping, Relationship Issues, Sources of Strength, Therapeutic Activities | Tags: , , , , , , , , , , , , , , , , , , |
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Connecting the posts on this blog to Facebook has brought a wonderful new dimension to this experience.  It is hard to describe how meaningful it is to be noticed by so many of the folks we have known and cared about over more than six decades.  It is easy to feel very isolated when spending most of every 24 hours inside a small townhome.  It is hard to feel isolated when reading comments of so many who wish us well.

It struck me today that it is a time of anticipation.  So many things are converging on the next few days.

  • The Neurologist okayed the removal of one of Mary Ann’s long time meds.  It is called Amantadine.  Its purpose is to reduce the dyskinetic movements produced by years of taking the main Parkinson’s med, Sinamet.  Dyskinesias are the wavy  movements that are apparent when Michael J. Fox is on television.  Those movements are not caused by the Parkinson’s but by the medication that gives basic mobility.  The Amantadine can trigger hallucinations and fainting spells (Orthostatic Hypotension).  Both are major problems for Mary Ann.  We will see if the trade-off is worth it.  We have stopped the Amantadine and we are waiting to see how Mary Ann will fare.
  • We are anxiously awaiting our Daughter Lisa’s arrival late tomorrow evening.  We both love having our children with us.  Lisa lives a ten hour drive away.  On that account it is a special treat.  It will be good for both Mary Ann and Lisa to have a couple of days of one on one time.
  • I am anticipating almost three days of solitude at St. Francis of the Woods Spiritual Renewal Center in North Central Oklahoma.  I will hike and read and pray and sleep and listen to music and look for birds and varmints of all sorts.  I will walk for hours and let the endorphens wash over my brain.  I will think about where we are in our lives and how to better deal with it all.  The reading will include devotional material, the Scriptures, a couple of books that deal with Quantum Physics and Theology. I will do each thing if and when I choose.  For a few hours the locus of control will shift from external demands to internal needs.
  • I am anticipating, assuming it works out, time talking with as good a friend as a person could have.  Many years ago John and I spent hours talking as he was going through the loss of his wife to Cancer and I was trying to come to terms with Mary Ann’s Parkinson’s.
  • I am anticipating a visit at our house tomorrow afternoon from a couple of people on the Staff of a local Hospice program.  They now have access to all of Mary Ann’s doctors, and whatever information they can gather from them.  I will, of course, have many questions.  There are certain criteria that must be met to be served by Hospice.  Actually, I would like very much to be told that Mary Ann is not yet eligible for Hospice.  This is a time we would love not to measure up.
  • I am anticipating the delivery of materials tomorrow and the beginning of the construction on our new sun room, which will become interior space in the house.  When it is done, we will be able to see from the inside of the house the waterfall project that was done six months ago in our back yard.  Since we are here pretty much 24/7, we want the best and most nurturing environment possible.  I am bummed that the project will begin while I am gone.  The weather here forced the later beginning time.
  • I am anticipating sitting with Mary Ann (depending on how she is doing) and Daughter Lisa and Son Micah this Saturday evening to talk about Hospice, especially the prospect of putting in place a Do Not Resuscitate (DNR) order.  This has been a tough journey for the kids.  Gratefully, they are committed to whatever seems best for both Mary Ann and me.

The day went pretty well today — better than I expected since she is in the hallucination cycle.  She went to her Tuesday morning group and tracked well there according to Mary, who sits next to her.  There was some intestinal activity, but since a number of the ladies in the group have served as Volunteers with Mary Ann, Eva and Mary managed to deal with the situation. While Mary Ann was meeting with hergroup, I enjoyed some time talking over coffee (PT’s of course) with the Pastor who is now in the position of Senior Pastor from which I retired.  It was a good time together.

Mary Ann wanted to go to McFarland’s, the restaurant at which we were eating when I decided that it was time to retire and be with Mary Ann full time.  I thought again how grateful I am to God that the decision was so crystal clear.  It took approximately 13 seconds to finalize that decision as I watched Mary Ann struggling to eat.  Today she struggled again.  She got nothing in her mouth until she finally agreed to allow me to feed the hamburger to her.  I had long since finished my meal.  With my help she was able to consume two quarters of the hamburger.  She had some left over Baskin & Robbins ice cream from the freezer when we got home.

Later we managed to get out to the grocery and buy lots of food, especially ingredients for Lisa to use to make some things for our home freezer that I can thaw and just pop into the oven.  That is a tremendous help to us, since I am well-known for my lack of skill in the kitchen.

Supper was another challenge, but she did get some food down.  She then ate the new two scoop B&R treat that we had brought home this afternoon.  Are we bad or what!

Tonight the dreams and hallucinations are active.  She called me to come in and said, “I am awake, but I don’t know how to get up.”  She thought it was daytime.  She had one of the dreams that she cannot differentiate from reality.  I was taking a Call (another position at a church somewhere), and we had to get ready to leave.  There was a hug and a kiss when I told her I am not going anywhere, I am for her and her only.

Well, there is no telling what tonight and tomorrow will bring, but whatever it is, we will make the best of it, grateful for the time together.

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.

 

March 1, 2010

A Great Day!

Posted by PeterT under Daily Challenges, Help from Others, Meaningful Caregiving, Practical Tools for Coping, Sources of Strength, Therapeutic Activities | Tags: , , , , , , , , , , , , , , , , , , , |
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What a ride!  Mary Ann was ready to get up at 7:15am today.  This time I did not ask her to stay in bed until the alarm was due to go off at 7:45am.  She had been sleeping for 36hours straight.  I decided I did not want to risk her falling asleep again for a number of hours.

I got her dressed right away; then washed her hair. She took pills and ate a good breakfast.  She let me feed her.  She did not seem to be hallucinating at all.  She was very lucid.  There was a some fainting, so after checking her blood pressure, I gave her a half tablet of Midodrine to help keep her blood pressure up.

Volunteer Elaine came to stay with Mary Ann this morning while I had my usual Sunday morning quiet time at the lake.  Elaine engaged her in conversation.  At some point while I was gone, she began reading to her, which Elaine was doing when I returned.  Mary Ann was leaning forward some, but Elaine just moved her back up regularly.  As a result, Mary Ann was awake all morning.

Mary Ann picked scrambled eggs and bacon from the options I gave her for lunch.  She ate every speck of it on her own.  By the time she was done with the small amount of Baskin & Robbins ice cream that was left from a few days ago, Volunteer Jan arrived.

This is the first of the monthly Beginning Birders’ field trips I have been able to make.  While I did not get a detailed report from Jan about how things went, Mary Ann was awake when I left and awake when I returned.  As far as I know they had some good quality time.

Jan brought food to heat for supper.  Since Mary Ann had been up all day, we decided to stay home rather than go to the Evening Service.  That way I was able to prepare what Jan had brought.  Again tonight, Mary Ann let me feed her supper.  She ate a full serving and followed it with one of two scoops of Baskin & Robbins ice cream that I had gotten for her two days ago.

You can do the math.  She ate three full meals today.  She also had part of an apple as a snack when Jan was here, and a snack of some coffee cake with Elaine just after I left for the lake.  Her body must be in shock from all the food!

If a person only had today as a reference point for Mary Ann’s health, they might wonder what all the fuss is about.  My gut has been yanked from one extreme to the other in a matter of hours.  I guess that is nothing new.  I felt good today also, knowing she was doing well.

There is a certain level at which there is frustration that today seems to make yesterday’s grieving a meaningless waste of time.   I remain convinced that feeling the feelings when they come is better than burying them, in case things might change.  In our situation, they will change.  The grieving I did yesterday still counts.  I know where this is going.  I probably know too much having read emails written by folks in the throes of the worst this dementia has to offer.  I know too much from forty years of ministering to people going through terrible times of pain and loss.

Yesterday provided some preparation that needed to be done.  There will be more that needs to be done as we move to new and still more difficult stages of the disease process.  Having gone through the reality therapy yesterday, having grieved more the anticipated losses, today is all the sweeter.  She got to have today.  I got to have today.

This morning’s time at the lake offered great entertainment in all the displays by the birds.  I read a very meaningful devotional piece in the Spirituality Journal called Weavings.  The sky was crystal clear and the air crisp.  All of it combined to lift my spirits.

There were American Bald Eagles to watch again.  I saw a drama unfold, as a juvenile Eagle spotted a Canada Goose with a broken wing, walking across a road less than a hundred feet from me.  The drama happened about 150 feet away.  The Canada Goose managed to ward off the Eagle as he tried to make lunch of the goose.  While the goose did not have the weapons the eagle had (talons and powerful beak) the goose was bigger and heavier.  Later I watched from fairly close range two Red-Tailed hawks fighting over a kill.

Then there were the White Pelicans.  They are huge and have a magnificent wing span.  Their wingspan can exceed nine feet, much larger than an eagle.  One Pelican circled around and around until it was almost overhead.  They are blindingly white (especially in this morning’s sun) with contrasting black on part of their wings.  It was quite a sight. There were a variety of waterfowl coming an going.  It was quite a treat.

This afternoon, the time with the birders at a different lake was another treat.  I learned more about identifying a few birds and enjoyed talking with other folks with like interests.  We spotted an eagle, some Mergansers, Redheads, Ring-necks and Golden Eye water birds – along with the ubiquitous Canada Geese, American Coots, Mallards and Ring-Billed gulls.

After such a good day, I must add that I just went in to check on Mary Ann.  The hallucinations have started again.  She agreed to manage a treasury of come sort and was afraid she had messed it up.  So much of the time there is nothing I can think of that even remotely connects with the hallucination or dream.  Then she fainted two or three times as we tried to get to and from the commode.  I will take her blood pressure in the morning to see if some Midodrine seems warranted.

I think I am going to get whiplash!

Tomorrow is the appointment with the Neurologist.  The report will be in tomorrow night’s post.  I am anxious to see how the appointment goes.

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.

 

February 28, 2010

Sleeping, Thinking About Hospice

Posted by PeterT under Daily Challenges, Family, Meaningful Caregiving, Practical Tools for Coping, Relationship Issues, Sources of Strength, Therapeutic Activities | Tags: , , , , , , , , , , , , , , , , , |
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She is sleeping; I am thinking about Hospice.

She has been sleeping for 24hours other than about an hour doing food and pills this morning (about 11:30am) and one trip to the bathroom this afternoon.  I wake her enough to give her the 1/2 Sinamet every two hours.  That pill is for keeping mobility.  While she hardly needs mobility when sleeping, without the Sinamet, she stiffens up and becomes very uncomfortable.

I have now found something that I can cook for Mary Ann that she seems to like very much.  I do a very skillful job, and the result, I must admit is very tasty.  I get a slice of bread out of the package, toast it to perfection, butter the toast from corner to corner, slather on some super-chunk chunky peanut butter and top it with some of Maureen’s homemade preserves.  I cut it into quarters and hope I don’t get my fingers bitten as I help her eat it.

She had juice, a container of yogurt, the PBJ on toast, and that is all in the last 24 hours.   So far I have not been able to get her to get up even for a commode trip, let alone some supper.  It may happen yet.  It is 8pm at the moment.

It just popped into my mind that this is sort of like riding some sort of tilt-a-whirl.  I almost go crazy with the hallucinations, praying that she will take a nap, and my heart sinks when she sleeps so long, fearing that she is not going to get up.  We have been on this ride long enough, that I don’t lose my bearings as we swing one way and then the other, but I have to tell you it sure isn’t as much fun as riding the tilt-a-whirl (not that I can remember riding one — I probably would have thrown up — I was mostly a roller coaster guy in my younger years).

While she has been sleeping, I have been thinking, or maybe it would be more accurate to say, feeling.  So many times in my ministry I have tried to help people deal with hearing the word “Cancer” in a diagnosis.  Minds immediately fly to the worst case scenerio for how things will go.  While that may be the way things go, the word “Cancer” spoken as a diagnosis does not determine an outcome.  It has implications for outcomes, but ask any Cancer survivor about some of those possible outcomes.

Well, the word “Hospice” carries with it for me the weght of many visits to people in our local Hospice House, whose stay most often varies from hours to days, and then they are gone.  I have ministered to people for forty years with most of those entering a hospice program reaching the end of their lives not long thereafter.  While I realize intellectually that there are folks who have been enrolled in hospice programs for years, my gut has no clue about that.

In addition to the gut reaction, there is the harsh reality that Mary Ann has been declining at what seems like breakneck speed.  She has bounced back from so many medical problems that would have taken someone with less strength of will, part of me is just waiting for her to rally, as usual.

This time she seems to be moving past the point of being able to return to the level of functionality we enjoyed just a few months ago.  I will happily eat those words if a week from now she is her old feisty self.

Today, as I had time to immerse myself in the implications of “Hospice,” I did what I usually do, what I think should be done, I felt the feelings that come with the potential loss.  I grieved.  I have been down this road before, more than once.  The memory that surfaced today was the memory of sitting in an empty emergency room about four years ago at a hospital in Tucson, Arizona, while Mary Ann was somewhere else in the hospital receiving a test of some sort.

We had flown to Tucson to attend a gathering of Lutheran Seniors at a large retreat center there.  On the plane trip down, Mary Ann began having some congestion, I am convinced due to the poor air quality in the airplane.  As the days went by, it got worse until we decided to call an ambulance.  I remember looking back from the passenger seat of the ambulance to see the one EMT in the back trying to deal with Mary Ann’s arms and legs flying this way and that, because of the dyskinetic movements produced by the Parkinson’s meds.

As I sat in that empty emergency room, a thousand miles away from anyone I knew, any family, the doctor and nurse had just left.  The doctor told me that the X-ray had shown her lungs to be completely white.  She would most likely be on a ventilator by morning.  I asked if it was time to phone the kids to get them to come, implying, of course that otherwise they would not see her before she died.  The answer was, of course, yes.  I called them.  They each got on a plane and came, Lisa bringing a little one with her.

I had what seems like an eternity in that room, sitting by myself.  The feelings were powerful, the moment surreal.  Today, I remembered what it felt like to think about losing Mary Ann.  I have written at least one post almost a year ago that included a desrciption of some time thinking about her eventual departure.  While a few hours from now Mary Ann may be irritating the Hell out of me getting up and down and up and down (which at this point I think I would celebrate), it seems very possible that we are approaching the beginning of the end.

I need to tell you that my heart is aching as I am writing those words.  I don’t mean to sound dramatic.  I will be fine.  I am just describing feelings as I am experiencing them.  This is what it means to be alive!  Mary Ann is still alive and may be for a long time.  If she is not, if I am not, it is still all right.  We are secure beyond our time here.

She just got up to use the bathroom and get a drink of water.  She was not hungry and is in bed again.  It is about 9pm.  She was lucid and did not seem to be hallucinating.

After a while, I put on the CD by Lisa Kelly, one of the Celtic Woman group.  As I listened to it again, most of what is on it is relevant for someone thinking about a life’s partner, as well as the need to let go and the challenges associated with doing so.  In the song “May It Be” there is a refrain, “a promise lives within you now.”  As I listened to music that resonated with my feelings, I thought about how trite and shallow and sentimental music can be when it seeks to manipulate the feelings of listeners.  I realized that what makes such music meaningful is only real life, lived with all the struggles and mundane tasks adding depth to what could be shallow and meaningless.

Let me say it this way.  With all my self-doubt and lack of confidence, painful flaws and weaknesses, guilt feelings about all that I have not done that I should, especially in showing Mary Ann and my Children how much I love them — with all of that said, I am keeping my promise to Mary Ann.  That promise lives within me now and it is not just a feeling. It is being lived hour by hour and day by day.  I hope at some level Mary Ann feels secure in that promise.

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.

 

February 25, 2010

Fax to Neurologist

Posted by PeterT under Daily Challenges, Help from Others, Information on Parkinson's, Meaningful Caregiving, Practical Tools for Coping, Therapeutic Activities | Tags: , , , , , , , , , , , , , , , , , , , , |
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It is done.  I sent two pages of recent events and current symptoms to the Neurologist in the Parkinson’s Clinic at the University of Kansas Medical Center in Kansas City.  Dr. Pahwa is one of the best in the nation, especially in the area of the Parkinson’s meds.  I am not sure to what extent he specializes in the dementia that is unique to Parkinson’s, but he certainly has a large enough patient base to have lots of experience on which to draw.

I think anyone who has complex medical problems ought to consider the approach of putting the information in writing and the questions in writing.  It seems logical to me that getting it to the doctor in advance of the appointment, even if he/she only sees it a few minutes before entering the examination room on the day of the appointment, will help create a better communication and exchange of information.

My impression is that the doctor focuses full attention on a particular patient by reading the chart carefully to reclaim the recent medical history.  Maybe it is a little like cramming for a test.  No doctor can keep a full and current awareness of every patients’ symptoms and their history of treatment.  Reading the chart fills the doctor’s mind at that moment with whatever is immediately available to him/her.

The fax contains recent history that I might not have remembered in detail in the heat of the moment in the exam room.  The written material gives the doctor a window into Mary Ann’s situation beyond what he will see in the ten minutes we are with him.  She may be lucid at that moment (the online LBD Spouses group calls that showtime).  He will conclude that what he sees is how she is.  Dr. Pahwa listens well and asks good questions, but he can’t help but be influenced most powerfully by what he sees in that room.  The fax gives him a history of all that I have seen in the past few weeks as well as what he is seeing.

I included in the material faxed to the Neurologist a third page, a full and current list of all the medicines that Mary Ann is taking, dosages, time of day the pills are taken.  Especially when there are a couple of specialists (Cardiologist and Neurologist) and a Primary Care Physician doing prescribing, it is necessary to have absolutely accurate information available to each one that includes all the meds.

Mary Ann has a regularly scheduled appointment with Dr. Pahwa this Monday afternoon.  I am going into the appointment willing to accept the possibility that this is the best we will get and no changes in medication are likely to help.  I am hopeful that there are some changes that can be made with the possible result of a better quality of life.  I am also fully aware that the risk is high that any change in meds might make things worse, causing a further decline, a potentially irreversible decline.  Mary Ann always goes in with the hope that she will be able to take fewer pills or find the magic pill that will make everything okay again.

Last night was not a good one.  Mary Ann was up a number of times, ready to get up for the day beginning around 3:45am.  She got up at 6:30am, when I got up to prepare for the Spiritual Formation Group that meets here at the house.  It is always distressing to me when she is up at that time, since I have a short time to get things ready for the group and no time to spend helping Mary Ann.  Before this decline, she almost always remained asleep during my prep time and part or all of the time until Bath Aide Zandra arrived.

She was in that intense mode that his hard for me to deal with, lucid, but on the edge of the dementia.  Gratefully, Volunteer Maureen arrived at 7:30am, just as I finished giving Mary Ann her pills and feeding her the daily yogurt (need those live cultures).  I was able to get to the group meeting downstairs.

It was a busy Wednesday.  Zandra came to do Mary Ann’s shower and hair.  She said Mary Ann was doing a lot of leaning over, seeming to be tired — understandably since the night was a very restless one.

Kristie came to do the monthly house cleaning. Since Mary Ann had gotten up so early that she ate lunch at 10:30am.  Volunteer Rebecca came from 11:30am to 2pm.  I was able to get away for a while.

I returned with Baskin & Robbins ice cream treats, as promised.  Mary Ann, surprisingly, declined hers and instead, asked to have supper.  She ate supper (the other half of the sandwich she had for lunch) at 2:30pm.

Not long after eating, she lay down for a nap.  She had been sitting with her head in her lap for a while.  Later in the afternoon, she got up and ate the ice cream treat.  The hallucinations began firing up as the afternoon wore on.

She got up again and had a little to eat, some pear sauce.  That is like applesauce, but made with pears.  Maureen had brought that, along with a large jar of frozen chili for future use, cinnamon rolls, and a dozen or so cookies.

Mary Ann headed to bed around 7:15pm.  I fully expect the vivid dreams and hallucinations to dominate the night, since that would fit the pattern of the last few weeks.

I guess I was right.  She just called my name.  When I went in, she was sitting on the side of the bed.  I knelt down in front of her and asked what she was seeing.  She was distressed that the people were beating on me.  She had her eyes closed and was continuing to see that happening.  She started crying for a bit.  I kept saying that I was all right and no one was hurting me, but she couldn’t open her eyes and let go of the hallucination.  Finally she calmed and was willing to lie down.  It is only 10:20pm, and it has already reached this level of intensity — does not bode well for either of us getting a lot of sleep tonight.

On the positive side, there were two very helpful times for my personal/spiritual health.  In the Spiritual Formation Group this morning, we each picked a favorite Psalm.  We applied three question to the Psalms: what is particularly meaningful to us in the Psalm, how can something of its message be incorporated to the ordinary stuff of our days, and is there a present day metaphor that might be used to communicate the message of the Psalm in contemporary terms.  The discussion that followed was very stimulating and thought provoking and meaningful.

The time away this afternoon was spent at a coffee shop (not PT’s but serves PT’s coffee) for lunch and some reading.  I know and enjoy the young family who own the shop.  After a while a former parishioner happened by.  Donny is a very pleasant fellow. He and his family are also folks I cherish.

After a conversation about a variety of things. Donny asked what I was reading.  As I described the book, it became clear that he also is intrigued by scientific inquiry and its relationship with faith.  I think he was a little surprised at my interest in Quantum Physics and things like String Theory.  I am not so much conversant in either subject as I am intrigued by them and fascinated by their potential implications for people of faith and theological conversation.  It was a very enjoyable mental respite from the daily struggles at home.

It is time to head back to the bedroom and see if my presence and familiar voice might help calm some of the distress the dreams/hallucinations/delusions produce.

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.

 

February 23, 2010

Awake, Lucid and Fainting

Posted by PeterT under Daily Challenges, Help from Others, Meaningful Caregiving, Practical Tools for Coping, Sources of Strength, Therapeutic Activities | Tags: , , , , , , , , , , , , , , , , , , , , , , |
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Sitting in the transfer chair in front of the television, she just fainted.  I took her blood pressure as soon as I could get the cuff on her arm, the stethoscope in my ears and the cuff inflated.  It measured 80/50.  About five minutes later I took it again.  Then it measured 90/60.  Remember the three weeks it measured 220/120 when I took it first thing in the morning?  Check a few posts back.

I started her on a half of a Midodrine pill three times a day.  I got in two doses today.  And so the roller coaster goes up and it goes down.  Today is the best day in the last four (if I am counting correctly) in terms of Mary Ann being awake and lucid.

She got up in time to eat and take pills before Bath Aide Zandra came this morning. While I needed to help her with all that she ate, she had a good quantity of food. She did faint more than once for Zandra as she was trying to give her a shower.

She sat up in the chair for the rest of the morning.  It was the longest she has sat up in the chair in many days.  There has been no evidence of hallucinations today.  She ate reasonably well at lunch, having a big bowl of ice cream for dessert.

After lunch she sat for a while and began slumping over some.  Soon she got up to go in and take a nap.  She slept until supper.  She ate reasonably well (I actually cooked) and had a lemon bar for dessert.

Since Volunteer Twila came for the evening, I was able to get out for a while and bring back for her a couple of scoops of Baskin & Robbins.  She ate that treat right away.  It was not long after that that Twila left and she went to bed.  She has been down for a couple of hours, either watching television or sleeping.

I have finished the fax to the KU Med Center Parkinson’s Clinic Neurologist and intend to send it tomorrow.  As I finished it, I could describe what has become a pattern for the last three weeks: two days and two or three nights with streaming hallucinations any time she is awake;  then two days and two or three nights of sleeping all the time (day and night); then a couple of days and nights in which she sleeps at night and is awake and lucid about half of each of the days.  Then the cycle begins again.  This is the closest we have come to a pattern in a long time.  It is not a wonderful and pleasing pattern, but at least it provides something coherent to communicate to the doctor other than constantly unpredictable changes.

Last night instead of getting to bed early as I had planned, I checked out some of the Taizé music on YouTube.  I followed it with some Russian Orhodox Liturgical Chant, also on YouTube.  That hour or so was very nurturing spiritually.  Since the snow and Mary Ann’s sleeping through the entire day precluded getting to corporate worship, I needed the sabbath rest more than the physical rest.  Tonight for part of the time I found a spot with enough light at PT’s coffee shop and read the book on science and religion called The Mind of God by Paul Davies.  I mentioned it in a prior post on this blog.  The author does not believe in God as do I, but his approach certainly makes it clear that he does not rule out that possibility.  He seems to be arguing for belief, based on the science, even though he does not claim belief.  My faith is nurtured rather than challenged by what I read.

As I have repeated far too many times, this is a particularly difficult time in our journey.  The Spiritual nurture is a key element in sustaining me during this time.  I am grateful for Mary Ann’s strong faith as we journey together.

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.

 

February 18, 2010

Hallucination/Delusion Elaborated

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It started with the comment, “last week was really terrible.”  I asked her if she meant the hallucinations. I listed a number of them that I remembered.  When I mentioned the one about my asking for a divorce, she elaborated.  She wanted to know if it was real.  Again, I assured her that divorce was not an option, and she would not get rid of me that easily.

When she elaborated, it was clear that this was a vivid and detailed experience for her that impacted her emotionally.  There were watering eyes and a quivering lower lip as it came out.

She said I had better call my sister Gayle.  Apparently, in her mind not only did she talk with Gayle about it, but Gayle and my Brother Dave and Sister-in-Law Velda were with her at the wedding when I married someone else. She remembered her name, “Lulu.”  At one point, we both laughed at the name.  I asked her to at least fine me someone with a different name than Lulu (no offense to any reader who may be named Lulu).

She also asked if our kids were divorced.  I asked which couple, she said both.  Somewhere in the jumble of hallucinations/delusions/dreams the kids had divorced.  That is when her eyes began to drip a bit.

Now I understand better why she asked me that one night if I shouldn’t be with my wife.  She must have been referring to the one I had married after divorcing her.

I am grateful that we  have had a couple of good days and nights so that there was enough clarity to be able to process what she experienced.

She slept well (as did I) last night again.  She seemed not to be hallucinating very much today.  There were still some of the threads and tiny gold chains she picks up, tries to get off her fingers and into the waste basket.  That is almost a constant presence.

Bath Aide Zandra came and did her shower and hair.  Zandra voiced concern for Mary Ann’s weight loss and her rapid decline.  She wondered about the increased size of the Exelon patch, whether or not meds were adjusted for her lower body weight.  It is generally true that older and more frail patients often need lower doses of medication due to changes in weight and how medicines are metabolized — more to add to the fax to the Neurologist.

After she was dressed and ready to start the day, I needed to help her eat at breakfast.  She did pretty well at lunch on her own.  She was in her chair much of the day, sitting up some, other times in the sitting with her head in her lap mode.

Volunteer Clarene was here for part of the afternoon, so I was able to do some errands and spend a little time walking the path at Cedarcrest.

I had talked with Mary Ann a number of times about going to the 5pm Ash Wednesday worship service.  The brisket and cheesy potato dinner following the service was a plus for her.  When I returned from the errands, I changed for church and we managed to get to to the service.

It was good to sit in church and look around at the people who had been such an important part of my life for so many years.  Mary Ann did reasonably well in the service, just struggled with sitting up in the pew.  I had to gently pull her into the sitting position and hold her there some of the time.

After the service, we headed down to the meal.  One of the Youth helped get our tray to the table.  When we sat down it was apparent that Mary Ann would not be able to handle the meal.  She was shut down — a term used when the Parkinson’s medication is not providing mobility.  It was a little hard to see her sitting there with her head down, immobile while the young family (really nice folks) at the table with us was unsure how to react to her.

She wanted to try to feed herself, but she couldn’t get her hands working.  She agreed to let me help her eat.  Gratefully, most folks know us well enough that they didn’t seem to give a second thought to my feeding Mary Ann.  She liked the food and ate quite a bit.  She accepted someone’s offer to bring her one of the apple desserts.  By that time another young couple, Don and Edie’s Son, Daughter-in-Law and, more importantly, their new little baby joined us. They know us well enough to be very matter of fact about our situation.

Yes, there was a stop on the way home to pick up some Baskin and Robbins.  Mary Ann is now in bed.  I have the uncomfortable feeling that she is having some trouble settling down.  We may be heading into a troublesome time.  There is no telling where the ride will take us tomorrow.  We are both grateful for a couple of good nights and days.

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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