It finally happened this morning. I went to the kitchen just for a moment. Then came the usual thump. She was down. The last time she fell, we had to go back to the Dermatologist to re-sew a two inch row of stitches, actually two rows, one deep in the wound and one pulling the surface of the skin together. She had fallen directly on the wound and had broken the stitches. The Plavix thinned blood ran freely.
It was just the other day that it dawned on me that we were then almost three weeks out from that drama, and there had not yet been another fall. To appreciate the significance of that record, you need to know that Mary Ann has fallen multiple times a day, up to a dozen, in the recent past. Up to that last disastrous fall, the pattern had been that falls came daily, sometimes two or three times. On occasion there would be a day or two without a fall, but that was rare.
Mary Ann falls for a variety of reasons. One of them is a symptom of Parkinson’s. In fact it was one of the central symptoms that took her to the doctor when we first suspected that there was something wrong late in 1986. She had pain and tight muscles in her left shoulder. She had pain and stiffness in her left hand. She would on occasion lose her balance and roll to the ground. Maybe five years before that, we went on a couple of three day long church ski trips with other famiilies. Mary Ann struggled especially with getting off the lift. She always fell and had very much trouble getting up. Finally, she just chose to stay in the lodge while we skiied. Little did we know that a few years later the diagnosis of Parkinson’s would come.
That particular symptom of Parkinson’s cannot be corrected with a pill. Physical therapy can help, but other than that there is no medicine that restores the balance.
A central symptom of the particular expression of Parkinson’s with which Mary Ann has been diagnosed is called bradykinesia. Wikipedia has a good definition of bradykinesia: “Slowed ability to start and continue movements, and impaired ability to adjust the body’s position.” When Mary Ann tries to start moving, the top part of her body may move forward while her feet refuse to move. Of course, when that happens, she falls unless there is an arm or a walker supporting her.
She seldom tries to use a walker any more. She doesn’t have the physical strength to move it ahead of her. When she did use it, she would often lean forward, body moving and feet cemented to the floor, leaving her in a very precarious position, hanging on to the walker for dear life.
With bradykinesia, a soft carpet may as well be wet cement. Her feet just won’t move. We have replaced all the carpet in the house with a short-knapped berber that is firm enough that she can move her feet (and we can roll the transfer chair), but soft enough to cushion her falls. Most falls still leave a rug burn or a bruise or both.
When Mary Ann gets out of her transfer chair and tries to turn to walk around it, falls often happen. When she tries to pick up something from the floor (now it may be something that is not actually there) she is, of course, vulnerable to falling over.
Since her stroke and the addition of the Parkinson’s Disease Dementia, a Lewy Body Dementia, Mary Ann has had some spatial perception problems. Getting the utensil where she intends it to be when eating is a problem now. When she is walking, sometimes she just does not perceive accurately where things are so that she can move her feet around them rather than trip over them.
In the last few years the Orthostatic Hypotension has been added to the mix. That is a term that refers to the body’s inability to constrict the blood vessels fast enough to raise a person’s blood pressure to counteract gravity when standing up. An adequate supply of blood is not pumped to the brain. The result is called syncope, a fancy word for fainting. It is not hard to figure out what happens next. When people faint, they fall.
The time not so long ago when Mary Ann was falling up to a dozen times a day, it was the fainting that caused the increase. She now takes medicine (Midodrine) to raise her blood pressure. The medicine has helped some, but it has not eliminated the problem. In fact the high blood pressure is taking a toll on her heart and her kidneys. There are often trade-offs that need to be made to maintain a reasonable quality of life.
Maybe now you can understand just why it was such a monumental accomplishment to make it twenty-two days without falling. I am not completely certain why we managed to avoid falling for so long, but there are some things that seem to have potential for helping reduce the falls.
One thing is that Mary Ann’s last fall was pretty traumatic. She has fallen hundreds of times and rarely done much damage to herself. This time there was damage. The return trip to the Dermatologist to be sewn up again was no picnic. Mary Ann’s automatic pilot may have been reset to reduce her inclination to put herself at risk for falling.
Another thing has been my increased commitment to getting to her before she has a chance to fall. I now spend less time in another room unable to see her. I move more quickly when I suspect she might be on the move.
Since that last major fall, I have obtained the audio-visual monitor that allows me to see as well as hear her when she is lying in bed or sitting in her chair and I am at the computer. I am now able to anticipate her getting up and heading out. I can see her shifting or leaning forward, about to get up. I am able to be there and help her before she falls rather than waiting for the thump and running to pick her up.
One recent change that may be having some sort of subtle impact on her stability is the new medication she is taking, the Exelon Patch. It is intended to help with memory and alertness. To my knowledge it is not supposed to have any impact on the motor symptoms. While I can’t put my finger on any identifiable dramatic change since she has been using it, she does seem to be doing better in most areas of functionality. Since we live on a roller coaster of symptoms that come and go, sometimes very quickly, most of the time there is no clear reason for declines or improvements in Mary Ann’s ability to function well. There is no telling for sure how much, if any, impact the patch is having.
In the matter of this morning’s fall, Mary Ann, as is usually the case, did not hurt herself. I still contend she could lead workshops on how to fall without hurting yourself. I was upset that it happened, but no one can prevent the falls completely. As a full time Caregiver, I have to accept that. Most of all, I am still celebrating twenty-two days without a fall. Of course any decent celebration requires ice cream. Two Pecan Cluster Blizzards from Dairy Queen beats a champagne toast any day.
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The Caregiver Calling 