February 26, 2010

Difficult Day

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This was one of the difficult days in the cycle we are in.  As much as I want her to be present with me, I was grateful when she took a couple of naps.  I don’t really know how to explain how difficult it is when Mary Ann is weaving hallucinations/delusions/dreams with moments that seem lucid, at least on the surface.

This mode demands full and constant attention.  Since she can’t differentiate what is real from what is not real, I am expected to deal with things that are not there.  Every task demanding my participation is multiplied exponentially in difficulty.

Of course she started trying to get up between 5am and 6am.  Then she was in the intense sort of mode that has a bit of an adversarial tone.  On days like today, she may be mobile on her own one minute and then weak and confused with her eyes shut the next moment.  When she is in that mode she often can’t connect with the simplest things.  If I ask her to sit down to put her pants on, she may stand up.  She may think we are in the bathroom when we are in the bedroom.

Eating is a nightmare.  When she will allow me to help, she often moves her hands in the way of the food as if she has food in her hands, or put her head down in a way that won’t allow me to put the food in.  She tried to drink the chips from the little pyrex dish, then she tried using a fork on the chips.

In this mode she will often not answer a question or say a word that doesn’t fit, then get angry with me for asking her again.  Sometimes she will say no to a food, but eat it when I put it to her mouth.

It is almost impossible to find out what she wants or where she wants to be.  At one point, she wanted to write a thank you note to a fiance’ from fifty years ago whom she decided had come by to visit.  Another time she just said she wanted her chip autographed.  I said back to her those words, and she confirmed that is what she said.  I, of course, have no idea what that was about.

It was a difficult day also because I find it physically very taxing to lift, move, twist her into the transfer chair or the chair at table when her eyes are closed and she has no spatial awareness to help.  Constantly getting her into and out of bed, turning her from facing one side to facing the other, demands physical strength that is right at my limit.  So much of the time in days like today, she is minimally helpful in that moving.

I tried to nap this morning during her first nap, but it was a restless one for her, so I needed to be up, helping.  Very soon she was up again.  Finally, this afternoon, I was able to rest in bed for about an hour while she was napping more soundly.

She has been incontinent in bowel activity and having bouts of mild diarrhea.  The tasks that are associated with that problem have been increasing and were included in today’s struggles.

I am disappointed in myself that it takes so little time when she is in this sort of mode for me to feel as if I am at the limit of my capacity to cope.  It would seem as if I should recoup when she has the sleeping days or a good day, and then be able to keep things in perspective, dealing with great patience on the bad days.

What seems to happen instead is that as soon as there are even signs that one of these especially frustrating times is coming, the dread emerges.  When the day comes, of course, it is after a challenging night.  With the difficult day comes the awareness that this is what is likely to be the norm more and more as the days and weeks and months and years go by.  As much of a struggle as today has been, it is only a taste of what is likely to be in store, judging from the experience of others.

I understand that the difficulties today are just for today.  Tomorrow may be better or worse, but that will be for tomorrow.  Were I perfectly rational and dispassionate, I would be able to take each moment as it comes without feeling the weight of past struggles and ones yet to come.  I am not perfectly rational and dispassionate.  I am alive, able to feel the frustration and helplessness and sadness to the core of my being.  With that comes the capacity to experience the full range of what it means to be alive, feelings of joy and exhilaration.  I guess the trick is to retain the capacity to experience fully the extremes that come with truly being alive without getting lost in one or the other.

Mary Ann’s friend, Jeanne, phoned today and will come tomorrow for part of the day to be with Mary Ann.  She came a few days ago to spend time with Mary Ann while I met with a friend, but Mary Ann slept the entire time Jeanne was here. Tomorrow’s visit will give me a chance to get the van serviced.  I was having difficulty figuring out how to get that work done given Mary Ann’s current condition.

Needless to say I am hoping for a better night and a better day tomorrow.  I can hope.

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 13, 2010

Hopelessly Confused — Me, Not Her

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I need to find some synonym for “confused.”  I wonder how many of the posts I have written over this almost year now of writing that have the phrase “hopelessly confused” in them.  Again today I am hopelessly confused.

Mary Ann settled last night after a few signs of restlessness. Oddly, in one of those restless moments, I came in because she had been moving around in bed, seeming to be ready to hop up (as seen on the monitor while I was at the computer).  She asked me something about where I was going to go.  I don’t remember the exact words.  I told her I wasn’t going anywhere and asked what brought her to ask that question.  She said that she had been thinking (or dreaming) that I was going to divorce her.

I told her that she was not getting rid of me that easily, and that it was not even a remote option.  I wondered from where the thought had come.  Even in my most frustrating moments, when my words were far from sweet, that was never a word used or even implied.  As different as we are in some ways and as many times as we were not pleased with one another in our 44 years of marriage, that was never a realistic option.  I make no judgments on those whose circumstances became so difficult that divorce was the best option in a bad situation.  Our conflicts and frustrations never reached the level of raising that as an option.

What causes me to be hopelessly confused at the moment is that, after working on the sheet to fax to the Neurologist about changing meds to control the bouts of hyperactivity and streaming hallucinations, Mary Ann has been subdued and sleeping a lot.

After our conversation eliminating divorce as an option, she settled in for the night, and the morning and into the afternoon!  She has gotten up seldom to use the commode.  She slept until almost 10am (okay with me!).  I helped her to the commode and got her dressed.  As soon as she was dressed (while we were finishing) she started trying to lie down again.  I took her blood pressure (210/120), and then she just lay back down in the bed.

At about 1:15pm, she was moving a bit, so I asked if she wanted to sit up.  She half-heartedly agreed that she did.  I got her to the bathroom and out to the dining room for pills and yogurt.  As soon as she was done with the yogurt, I asked if she wanted cereal or lunch food next.  Then I asked if she was still hungry at all.  She said that she was tired.  She wanted to lie down in bed again.

It is now 2pm and she is resting peacefully.

It is now 3:30pm.  I sat her up to take her mid-morning (I know!) pills, take her to the bathroom, change her pad (disposable underwear), and get her jeans on again.  I asked if she was hungry.  She said no.  I asked if she would like to come out into the living room and watch some television.  She said she wanted to go back to bed.  That is where she is.

It is now 8:30pm.  I got Mary Ann up (she was reluctant) at about 5:30pm.  She was not hungry, but after sitting up for a while, she agreed to eat some supper.  I cooked and sliced up a bratwurst for her.  She likes them and they are easy to eat in that form.  She managed to spear them with the fork and get them to her mouth on her own.  She had a chip or two and some Pepsi.  Then she ate a dish of ice cream from the freezer with very minimal help from me.  She had some fairly normal intestinal activity.  She then sat in the chair in front of the television, but after a short time of sitting up, began leaning forward on her lap again.  At about 8pm she decided it was time to go to bed.  I cannot imagine that she will sleep the night after sleeping most of two full days and nights.

I now have no idea what I would write on the sheet to fax to the Neurologist.  What I wrote Wednesday does not reflect what is going on now.  If meds are changed to calm her down, she hardly needs that.  If meds are changed to perk her up, the wild hallucinations and hyperactivity might return with a vengeance.

By the way, I expect the hallucinations and hyperactivity to cycle back in at some point. I dread that time.

She hasn’t been fainting but seems likely to do so again judging from the past.

Everything she is experiencing, including the vacillations from one extreme to the other are talked about frequently by those in the online group of Lewy Body Disease Spouses.  That does not prove that Mary Ann’s current vacillations don’t have to do with medications, but it does suggest that all this is just part of the deal. It also helps take the pressure off, suggesting that what I do or do not do as problems arise probably does not have all that much power to change things either for the better or for the worse.  This is outside my power to fix.

For someone who has been a planner who struggles with changing quickly from workable patterns, this is madness on steroids!  At the moment, as long as I accept that things may change in a heartbeat, Mary Ann sleeping a lot and remaining fairly subdued when awake makes caregiving doable.  I lament the loss of having more time that she is alert and communicative, but I am grateful for being able to continue to care for her here without going crazy.  If/when the hyperactivity and streaming hallucinations return, it will take about fifteen minutes for me to conclude again that I am in over my head.  What a 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.

 

February 6, 2010

Sometimes No News is Good News

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I will log today as a good day.  It was uneventful, gratefully so.  There were no dramatic hallucinations.  Last night provided a decent amount of sleep.   The times up during the night were not too many.  We slept late enough to compensate for the sleep lost during the commode trips and shifts in bed. 

The morning was spectacularly beautiful since we had 3.3 inches of fluffy snow.  The branches and twigs were so full of snow that it was falliing steadily in large clumps for part of the morning.  The Homes Association cleared the streets and sidewalks.  Our job was just to enjoy it.

Mary Ann ate her normal breakfast with the morning pills.  She watched some television and looked through her new Martha Stewart magazine (a newly received gift subscription).  I read emails from the Kansas Birders and the Lewy Body Dementia Spouses group.  There was some interesting material, an article on Seroquel and halluciantions — helpful information. 

After a sandwich, chips and Pepsi, Mary Ann was content to return to the magazine and the television, while I shoveled the deck to make room for more seed for the birds, cleaned out the birdbath, filled a feeder, spread birdseed and picked up the mail. 

I actually made supper, ham steak smothered in homemade green tomato relish, baked sweet potatoes with butter and brown sugar and some canned corn.  Mary Ann ate fairly well, especially after she relented and allowed me to help get the food in her mouth.

I offered get some Baskin & Robbins ice cream, and she accepted.  Of course, out of the goodness of my heart I got some for me to eat also just to keep her company.  She was struggling some to get manage eating the ice cream, but she would not allow me to help.  She did finally finish all of it. 

The ice cream that late in the day pushed bedtime an hour or so later than usual.  It is probably too much to hope for, but it would be nice to have another uneventful night. 

I did cut her second dose of Midodrine in half, in hopes that her blood pressure might move a little lower.  I haven’t checked it today. 

 I will accept today as a good no news day.   As for tonight and tomorrow,  they are mysteries yet to unfold. 

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 5, 2010

Change is the Only Constant

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Hallucinations ruled until about 1am or so last night.  Then she slept through with only one or two commode trips until around 11:15am this morning.  I didn’t get up unitl 9:30am.  Nothing ever stays the same.  Yesterday that was not a good thing.  Today it was a good thing.  She gave very little indication of having hallucinations.  She was awake most of the day until she went to bed tonight at about 8pm.  I will not presume to guess what tonight will have to offer.

After Mary Ann got up and took pills with some yogurt, we began talking about lunch already.  I suggested the possibility of going out, listing a few of her favorite spots.  She did not really seem interested.  I am wondering if the need for me to help her eat is beginning to diminish her interest in eating in public.  Some point at which she seems especially sharp, I will ask her about that issue.

I offered to make scrambled eggs and bacon.  She took me up on that offer.  As I was getting the eggs out, I noticed the untouched left over baked potato from a couple of days ago. I realized that would make great fried potatoes.  About a thousand dirty pans, dishes, pieces of silverware, cooking utensils, and bowls later, I delivered Mary Ann, two scrambled eggs, seasoned with parsley flakes, garlic and onion powder, salt and pepper, covered with shredded cheese that had melted on top, home made bread (Maureen’s) toasted and buttered, fried potatoes and onions, two slices of thick bacon, all served on a warm plate.

Have I gone crazy???  It all started with sighting that potato.  Then I fried some eggs for myself, which I covered with the wonderful Peach Salsa that I order by the case from Texas.  From the time I started cooking to the end of cleaning the thousand dirty items or putting them into the dishwasher, wiping off the stove and counter, must have been close to two hours.  This cooking business with all the accompanying cleaning up duties remains on the outer edge of my domestic capabilities.

Gratefully, Maureen had brought for the freezer some very tasty vegetable beef soup to go with the home made bread.  That was supper.  Mary Ann needed help with that, as well as some help with the two scoops of ice cream from B&R that we had picked up from there on the way home from the late afternoon doctor’s appointment.

While our visits are usually with the Cardiologisit himself, today we met with Advanced Registered Nurse Practitioner [ARNP] Angela .  She had seen Mary Ann once when she was in the hospital last fall.  She knows her case well. It was especially comforting to hear from her that they (she and the Cardiologist) often talk about our situation.  They appreciate that we are traveling a very narrow road of functionality, playing meds that do opposite things against one another to get a result that allows us to survive.

It was scary today when three blood pressure readings at different times in the appointment all were in the mid-200’s over the low 100’s, even when she was standing.  Because of her Orthostatic Hypotension (low BP when standing up), normally the standing reading is much lower. Not so today.  The fear, of course, is a massive stroke, as well as long term damage to her heart and kidneys.  We all know that.  At home the readings have been in the 160 to 180 over 90 to 100.  If we reduce the Midodrine that Mary Ann takes to raise her BP, she starts fainting.

I am going to reduce the dosage of Midodrine a little (cut the noon pill in half) to see if we can do so without resuming the fainting.  One irony is that the Seroquel we have been raising to reduce the hallucinations, has the side effect of increasing the likelihood of fainting. Another irony is that Mary Ann is taking a heart medication after her heart attacks a few years ago.  That medicine’s purpose is to reduce heart pain by lowering blood pressure.  Another of Mary Ann’s Parkinson’s meds (to reduce the dyskinetic movements caused by another Parkinson’s med, the main one) can cause hallucinations and fainting.  The main Parkinson’s med can cause hallucinations, fainting as well as the dyskinetic movements.  Without that med, Mary Ann cannot move at all.

As the primary Caregiver, it is my job to observe and help inform the doctors prescribing these medicines, since I am with her 24/7.  I have been given permission to adjust the Midodrine and the Sinamet (the main Parkinson’s med) within certain limits as seems appropriate.

The doctors have no clear insight into how much of the problem with hallucinations is caused by medicine and how much by the disease process (Lewy Bodies on brain cells).  They don’t know how much of the fainting problem is the disease process and how much the meds. Both the disease process and the medications produce the constipation, as well as other non-motor symptoms.

My head starts to swim when I try to think through the effects of all the meds with the goal of suggesting a workable balance of all of them.  The truth is, the doctors and pharmacists are no better equipped to find that balance, since they don’t see the effects on a day to day, hour to hour basis.  When we have raised or lowered dosages of meds, Mary Ann has not always reacted the same way in adapting to the change.  Sometimes, as with the Seroquel, the change comes, and then leaves quickly, leaving no clue as to how to proceed.

For whatever reasons, the last part of last night and this morning have included sleep; today Mary Ann was lucid and did not seem to have strong hallucinations; she ate tolerably well and has been sleeping fairly calmly for the last couple of hours.  I have no idea what will come between now and the morning, nor can I even begin to guess what tomorrow will bring.

There is one note I would like to add.  It may change tomorrow.  It is likely to change soon.  Since Sunday morning’s powerful experience, I have not felt angry with Mary Ann at behaviors that frustrated me in the past.  I have been far more accepting of the challenges in caring for her.  The feelings of irritation may return soon, but for the moment, caring for her has been less draining emotionally since I haven’t spent so much time feeling angry and frustrated.

That observation makes me wonder how much of the irritability emerged from simple grief over what the disese has been taking from her and from us for twenty-three years.  Again, there is no predicting how I will feel tomorrow or the next day about behaviors that have been frustrating to me in the past.  For the moment, there is a peace and a calm that has been missing for a long time.

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 3, 2010

Dinner and a Show

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Well, lunch and a movie.  The day began with Mary Ann’s Bible study group at church.  She got up early enough to make it, and the report was that she was alert and engaged and communicative during the class. As we were about to leave, she wondered if she should stay home, since she might have one of her attacks.  She was referring to the times of intense hallucinations.  I said I thought we should not give that experience the power to decide for us what we should do.  I checked with her to confirm that she truly has not been having hallucinations in the last couple of days.

After the class we went out to eat a place called called New City Cafe.  They have great food, done in a catering style.  The customer orders at a long case with the plates of food already prepared.  Mary Ann loves the Seafood Tortellini.  It is also easier for her to eat than most foods.  She was not moving well and, to my surprise, was willing to let me feed it to her.  She has done it with ice cream but very rarely in a regular restaurant. We were in a very exposed location.

After eating, we drove over to the theater and found a feature of Avatar that was about to begin.  She reluctantly agreed to that movie.  I have wanted to see it in a theater on a large screen since the PR on it suggested that the visuals are impressive.  That certainly was so.  The music and colors of the fantasy world breathtaking, especially with the 3-D glasses.  Mary Ann tried the glasses, but did not like them. She watched it without them.  When I took them off the image was not clear, but she seemed okay with it.

Her opinion of it was that it was a glorified Star Trek (which for me is a good thing)..  She was decidedly unimpressed.  I found it very entertaining.  The story line was the same as every other action movie.  There are very good guys and very bad guys.  The bad guys hurt the good guys and then — you had better go see the movie to find out.  It was just a very imaginative use of technology to create a powerful visual experience.  It was fun to imagine riding on the backs of those odd pterodactyl-like creatures as they flew among floating mountains.

After the movie we came home.  At that point the day was the best we have had in weeks.  The good news is that Mary Ann seems to be adjusting to the increased dosage of Seroquel.  The bad news is that Mary Ann seems to be adjusting to the increased dosage of Seroquel.

She was able to get up earlier today without struggling to awaken.  She was alert, no hint of sedation.  That was an improvement.  She insisted that she needed to do something with the turkey (small whole turkey, I think) she had in the fridge.  There was, of course, no turkey.  She has had that in her mind before a couple of times when it was not so.  I can’t remember ever other than Thanksgiving or Christmas having a turkey in the fridge or freezer.

Then she asked me about her trip to Wyoming. It was real wasn’t it?  That was one of her hallucination/delusions last week.  She asked about the word from Allen, was that real.  Her memory of that information was more than the simple relaying of well-wishes via a third party email.  I asked about some of the other hallucinations she had had.  She did not remember them (jail, Alaska).  She did remember some of the hallucinations about her Grandma, talking almost as if she believed her Grandma was still alive. The hallucinations seem to lie just on the edge of her reality.  I hope the medication helps keep them on the other side of that edge.

Tonight, she took her night time meds about three hours ago.  She has been needed my help three or four times, and seems to be having difficulty settling down.  I hope she continues to sleep well.  When she does not, the hallucinations fire up.

During the first half of the day I was exhilirated by how well she was doing. It seemed as if I had her back. I hoped that we would continue to have good quality time for a long time to come.  This afternoon deflated any illusion that we now had the problems at bay.  While reality has made itself known, hope has not left.  Sunday morning seemed to reset my understanding of what is happening here.  I remain determined to get the best quality out of each day and at the same time I am fully aware of the inevitable.  We choose not to let the inevitable become a reality any sooner than absolutely necessary.  We choose to give it no more power than it actually has.

 

February 2, 2010

Two Nights of Sleep!

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Again last night she slept from around 8pm to 9am this morning.  She was very sleepy, but she got up for pills and food before Bath Aide Zandra arrived.  Zandra chuckled that she seemed to sleep through the shower, hairwash and dressing time.

While Mary Ann was with Zandra, a friend from our Kansas City crew of friends of some 35 years called just to check in and provide some words of concern and support.  It helps to know there are people who are aware and concerned.  There are so many who are in difficult times, many worse than ours by far.  A word of support to someone you know can make a difference.

After her time with Zandra, Mary Ann sat in her chair, head down, dozing more until I got her to the table for lunch at about 1pm. She ate reasonably well at lunch.  When she eats on her own with no help, it takes her almost an hour to eat a meal.  Then she watched television for an hour before we took a trip out that we have been waiting at least a year and a half or two years to take.  The nearby Baskin & Robbins that closed then, has been remodeled and enlarged. It opened today!!!

Mary Ann had two scoops in a cup, Gold Medal Ribbon and Peanut Butter and Chocolate.  I ordered what I have been planning for weeks to have the first day it opened, a Hot Fudge Sundae made with Nutty Coconut ice Cream.   Yes it was as good as always.  Mary Ann allowed me to feed her the ice cream even though we were in public.  Ice Cream trumps pride.

I assured the owners that I would be one of their best marketing people.  I had met the owners when we were forced to drive to the other side of town to get our Baskin & Robbins fix when the one close to us closed.  They now own both franchises.  Owner Steve mentioned that the day or so before, he had been outside the new store when someone drove by, opened her window and yelled out that her old Pastor was excited about them opening.  That would be me!  Maybe, if I play my cards right, there will be a free dishes of ice cream for Mary Ann and me some time.  I am not counting on it.  They are likely to need every penny they can find to make this work.  I seem to remember hearing that ice cream places have generally fared well during the downturn in the economy.  I may be wrong about that, but it would not surprise me.

After we returned home, Mary Ann sat in her chair and moved back into dozing position.  She did grab a large stuffed frog that Becky and Chloe had brought for her Saturday night.  Our Daughter, Lisa, who supervised the building of a state of the art dementia building at a large CCRC (multi-layer of care facility for the older population) she helped administer, mentioned to them that sometimes it helped residents with dementia to hold a stuffed animal on their lap.  It helped keep them from trying to get up and it gave them something to hold on to.  Mary Ann hung on to the frog and it ended up serving as a place on which to rest her head.

Mary Ann ate supper by herself, another bowl of the meatball, sauerkraut, and veggie soup.  She went in to get changed for bed shortly after eating.  She has now had her meds and seems to be sleeping soundly.

The last two days have been easier caregiving days for me.  I still would like for her to be more active during the day so that we could get out and do some things.  I get out some when Volunteers are here, but that does not get her out and active.

I am still sort of reeling from last weeks craziness, and certainly do not want to risk repeating it.  At the same time, I want her to have the best quality of life possible at each point in her trip with this disease as a passenger. I will give this medication time for her body to adjust, then look at the possibility of reducing the dosage some to see if she can be more alert without triggering the hyperactivity and hallucinations.

My motives are at one level selfish.  I have a need to feel good about myself, to have purpose and fulfill that purpose successfully.  For those selfish needs to be met, I need to provide Mary Ann the best possible experience.  What is good for her fulfills my selfish need.  I also do love her very much, and it hurts my insides when she is not okay.  In addition I was raised in a family that holds honor and honesty in high regard.  Our last name can be traced back centuries, Norman originally, settling in Cornwall England. I have a great, great…Grandfather who was a hero of the Revolutionary War. We pass his sword from oldest son to oldest son. It is in my oldest brother’s closet.  Our ancestral Coat of Arms has written on it “Honor and Honesty.”  All that is to say, I keep my promises.  Mary Ann and I meant our marriage vows.

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.

 

January 26, 2010

It Was Only Water

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It was only a cup of water, but it was 3:48am, and it ended up all over Mary Ann, and the bed and the floor between our beds.  The bed spread, bottom sheet and mattress pad were soaked in places. Everything needed a clean and dry replacement.

Those who are in the Caregiving Spouses of those with some form of Lewy Body Disease Yahoo Group would recognize this to be tiny on the scale of messes they have to deal with routinely.  It is just that it was one of those nights with rampant hallucinations, lots of times in need of my help throughout the night.  I had asked again and again for her just to stay in bed, since otherwise there would be no hope of sleep.  She decided to get up and get the water for herself from the bed stand.

I won’t deny feeling pretty annoyed, but I got things changed and put her back in bed.  There were additional needs increasing as we got closer to morning.  She was up early, in need of food and pills.  Needless to say, it is midday; she is napping; and I am, as usual, wide awake and sitting here at the computer (after having fed the birds, of course).

Before the troublesome night, I had thought today might be the day we could take in a movie.  It is almost 3pm and Mary Ann is still sleeping.  I asked her about the possibility of getting up when I gave her the last round of pills.  I hung around for a while talking with her about getting up, but she wasn’t ready to do so.  I am grateful to have most of last evening’s PT’s coffee refill left this morning, so I am avoiding the ugly caffeine withdrawal headache.

She finally got up around 4pm, ate lunch and began watching some television.  The hallucinations continue.  I had hoped that she would sleep them off with the long nap.  Just moments ago she fell in the bedroom but did not hurt herself.  As I was getting her up, I could see in her eyes that she was seeing someone.  She whispered that there is a man in the living room.  She insisted that I hide the coin jar on her dresser.  When I got her back into bed, she asked me to tell him to go to bed.  This morning, at one point she told me that there was someone in his bed, correcting herself quickly that is was my bde the person was in.  I wondered if it was another fleeting moment of the Capgras Delusion, thinking that I was a substitute.  By the way, that delusion was the basis for the Body Snatcher movies.

I just saw on the monitor that she was getting up.  I rushed in and she said she had something to tell Pete.  I told her that I am Pete.  I asked her if sometimes she thought I was an imposter.  She didn’t answer that clearly.  Then she talked about the people again.  She said, “Now they are eating here.”  She told me that the children were standing at the rail around the opening to the stairs to the basement.  That spot was about ten or twelve feet from the bed where we were standing.  She said the dad was in the kitchen making food.  I asked if there was a Mom, a wife.  She said that of course there was.  She did not say whether or not at that moment she could see her.  It is no wonder she has a hard time sleeping with all those people around.

Volunteer Patrice came over for a couple of hours this evening giving me a chance to run a couple of errands and begin a much needed clean up of my office.

It seems likely that we are in for another night with lots of interruptions.  I am now thinking about going over to the Hospice House Administrative office to check on the option of Mary Ann staying a night there.  They have an Adult daycare program in one building and offer rooms in the Hospice House for occasional night time care (having nothing to do with the Hospice program itself) at a reasonable (I think) cost.  If there are too many sleepless nights in a row, I will need to have an option for getting some sleep.  I will take Mary Ann along so that she can see what the rooms are like.  It is a beautiful place in a lovely setting.  As pleasant as the setting is, it may not be a workable option.  If she is not comfortable with the situation, I will not be able to sleep at home knowing she is distressed.  That would then defeat the purpose.

For now I am just hoping for a decent night’s sleep some time soon.

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.

 

January 25, 2010

Acrobatic Eagles Entertain

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I am not sure how many there were sitting on the ice at the lake, but certainly fifteen or more.  It is a huge lake, so I could barely see some of them.  There were adults and juveniles in many stages of development.  They sat on the lake waiting for frozen fish to work their way close enough to the surface of the ice that they could get to them.

Many of them flew from one place to another.  At one point a beautiful black and white adult American Eagle flew right overhead, low enough so that I could practically count the feathers without using the binoculars.  Later a juvenile did the same thing.  The mottled brown and cream were bright and beautiful in the sunshine.

The Eagles interacted with one another.  They would land near each other.  At one point there were a cluster of four, two adults and two juveniles hopping toward each other, then flying a few feet away.  A while later there were two standing on the ice so close to one another that they were touching.  One was a juvenile and one an adult.  It looked like a parent and child (same size as parent) leaning on one another, both looking straight ahead in the same direction.  I suppose it could have been a May-December thing.  I don’t know enough about eagles’ behavior to be able to make an intelligent guess.

The most spectacular sight was of two eagles flying into each other, almost grasping talons in mid-air.  At one point one of them did a complete sideways somersault, a roll. “Contrary to traditional belief, eagles don’t copulate in the air but rather on a branch near their nest or on the ground.”  That is a quotation from a website named Birdhouses101.

It took a while for me to settle after the excitement of what I was seeing.  Once settled, I spent some time reading an article from Weavings, the Spirituality Journal that I read.  It was the second reading of the same article.  Many of the articles in the journal are a little like fruit juice concentrate.  They need some time thinking, some contemplation, to get the best and most satisfying flavor from them.

The third week in the online Ignatian Retreat I have been doing has provided Scripture passages and articles on a theme that has been reinforced by the online Prayers and exercises provided by Fr. Ed Hayes (through the National Catholic Reporter website).  The theme is appreciating God’s imprint on and activity in all dimensions of life, especially the natural environment, a little like the movie Avatar, but without crossing into Pantheism.  I haven’t yet seen the movie, but would like to see it on the big screen rather than waiting for the DVD to come out.

The time at the lake provided the perfect setting for contemplation of God’s presence.  It is a theme that provides respite and strength for the day to day demands.

Mary Ann had a reasonably good day.  Elaine spent time this morning with her while I headed to the lake.  Elaine always reads more pages in the book they have been working on for months.  When Elaine reads, she immerses herself completely in the story and the characters come to life.

Lunch was a grilled sandwich, none too exciting, but then the football playoffs were on television today. Mary Ann enjoys watching professional football.  When we went to our first Chief’s game in Kansas City, she wondered what the ten yard business was about.  Not too many years later she reached the point that she knew the names of most of the quarterbacks on the various teams.  She would yell out loud when the games were on.  She has become much more subdued, but sitll enjoys watching the games.

There have been some mild hallucinations today.  She only had a short nap on the couch today.  I prefer that she nap in her bed, since it is outfitted to deal with disposables leaking.  I put a chux on the couch for her to lie on just in case.

She is in bed now, but I don’t know how the night will go — whether or not it will be filled with raccoons and people and any other unwanted guests remains to be seen. Actually, I went in to see what her movements were about.  There were children again.  Then she looked over my shoulder as I was helping her to the commode and said, “What am I going to do with all those sponges?”  That is a new one.  I checked again and she was checking the children who she said had found their spots.  She asked for some tapioca.  As i was feeding the last of it to her, she jumped because the raccoon was nibbling her foot.  Then the bedding was moving.  I saw no movement.  I am anxious for the new order of Seroquel to come so that I can titrate from 100mg to 150mg per day.  Then we will see if there is any reduction in the hallucinations.

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.

 

January 24, 2010

Couch Potato Day

Posted by PeterT under Daily Challenges, Meaningful Caregiving, Practical Tools for Coping, Relationship Issues, Therapeutic Activities, Uncategorized | Tags: , , , , , , , , , , , , , , , , , , , , , , |
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“Let’s do something special today,” Mary Ann said when we were out doing her breakfast and pills.  I asked what she had in mind.  She had no more words available or, I suppose, specific thoughts behind them. 

I agreed that we ought to do something to get out.  Let me jump ahead.  She is now in bed for the night (I hope), and we have gone nowhere and done nothing. 

Why?  Why is it fourteen hours after saying that, and we have not set foot out of the house?  Let me correct that.  I did set foot outside a few times.  When she decided to nap this afternoon, I went out and stood in front of the house as patches of sunlight came through.  In fact, I got a folding chair out and did some reading in a Spirituality Quarterly called Weavings. 

While she was napping, Don and Edie stopped by for a while with some freshly baked blueberry muffins in hand.  We spent a while talking inside then headed out to the deck for a while, watching a few confused geese head by.  In the course of that conversation, I think we have come up with a possible name for the waterfall and surrounding wetland/raingarden.  Don referred to it as a “bog” at one point — a name that did not strike my fancy.  Then he mentioned a couple of names that included the word “peat.”  It is not a peat bog, but it is Pete’s Bog.  To say that Don and Edie have quirky style of humor would be to understate the truth of the matter dramatically. 

One of the things that allowed the day to drift away is the cluster of tasks associated with getting us both up and going, bathroom needs met, Exelon patch put on, hair washed and dried, Miralax mixed in juice of her choice, yogurt and cereal of choice provided, pills taken, other pills put in the timers, clothes put on, my shower taken, morning household chores done.  Understand, there is no time at which we can both be doing working, one doing one thing and the other doing something else.  All the tasks are done in succession rather than concurrently.  Eating and pill taking are long, drawn out activities.  During pill taking and eating I do have a chance to do a couple of things in the bedroom, clean the commode, make one of the beds, move the lift from the front door entry to the bedroom.  The time I have to do other things depends on how Mary Ann’s spatial problems are impacting her eating and how much help she needs.  Straightening up the kitchen and cleaning off the counters, putting things in the dishwasher and others in recycling is part of my need for having some semblance of order in the household.  My office is a shambles, as is the garage and the storage area downstairs.  I just need some areas clear to provide some sense of control in our chaotic world. 

Reruns of the Closer and Law and Order, tended to draw us into them just enough that if one was nearing the end, I sat down and see if it would come out the same way it did the last eight times we saw that episode.  I concede there is not a shred of rationality in that behavior.  

We were up shortly after 8am, but Mary Ann was hungry by the time we were both ready, and all the chores were done.  I suspect it would appear to someone seeing the morning activities at our house  as if it was all happening in slow motion.  I have usually eaten my bowl of cereal toward the end of all the morning chores, so when she is ready to eat lunch, I am still full from breakfast. 

After getting her some lunch, a movie was on television.  Since it had been going on for a while, it was distracting us from doing anything else.  I went back and forth to the computer attending to emails (eats much time), while watching enough of the movie to be engaged in its strange plot.  It turned out to be a depressing movie — just what we needed as a break from Law and Order episodes. 

In the morning, when Mary Ann first mentioned that we ought to do something special today, I mentioned the idea of heading to Kansas City to visit a close friend in rehab for a broken kneecap.  Marlene has ALS and needs a fully equiped unit to keep mobility as it heals.  Surgery is not an option.  Then I mentioned that we could drop off a couple of items at our kids’ home in the KC area.  After the movie, I mentioned that option again.

It was then that she said she wanted to lie down for a while.  That was around 2pm or 2:30pm.  I tried once, around 3:30pm to get her up, but she wanted to sleep.  It was not until 5:15pm that she was ready to get up.  At that point I did get out of the house for a short time to get a burger and fries from Wendy’s for her.  She wore the Lifeline and promised to stay seated while I went.  By that time she did not want to get out in the car. 

The roller coaster between lucid moments and hallucinations continued today.  At one point I couldn’t remember the name of Kyra Sedgewick’s (Star of Closer) husband.  She remembered his first name, Kevin (Bacon).   On the other hand, when eating the Junior Bacon Cheeseburger from Wendy’s, she stopped eating after in a matter of fact voice she concluded that there were shrimp, three of them, in the burger.  She held up pieces of the bun when I questioned her claim, and she said, “See?”

After the late nap, she stayed up a little later than usual, but is now in bed.  I don’t suppose the chances are very good that she will sleep well tonight, but 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.

 

January 23, 2010

The Hard Questions

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“How long do you intend to keep caring for Mary Ann at home?” he asked.  “Until I can’t handle it any more.” I answered.  Then the hardest of all, “How will you know when that time has come?”

Since we live in a world of denial that provides us the emotional and psychic room to live each day without constant dread, those questions are not often asked and answered.  First of all, I don’t know the answer.  I have intentions about how I intend for this story to end, but I have no answers to questions about how the future will actually play out.

Two days ago I was asked those questions with which I began this post.  Today I experienced to some degree elements of the answer I gave.  As I have said in earlier posts, my intention is for the two of us to stay together here at the house at least until one of us dies.  My intention is to use as many resources as I can locate and afford to help make that possible.  That intention is not just an intellectual decision about how I intend to proceed.  That intention lives in insides.

With that said, I had to answer the question rationally.  I intend for Mary Ann and me to be together here at the house until I can’t handle it any more.  The question that has to be addressed, the hard question is, how will I know when I can’t handle it any more.  I stumbled around some as I tried to answer that hard question.  The two things that came to mind are hallucinations that get out of hand and grow into a steady stream, and the inability to get any sleep.  The two are related.

Today was an example of those two problems converging.  Last night Mary Ann was up multiple times, as many as a half dozen in an hour.  Almost every one of those times, there were people, or raccoons or other visual images not actually present outside of her mind.  The lack of sleep during the night meant that the hallucinations came in a constant stream this morning when she got up.  She asked if we were the only ones in the house, implying that she thought we were not the only ones.

By the way, yesterday, as she was eating the last piece of strawberry-rhubarb pie with ice cream (pie she had eaten with great enthusiasm for the two days before), she decided that the filling in this last piece of pie had somehow changed into tomato sauce. She ate the ice cream, but left most of the huge piece of pie. I am afraid of the day when I can’t get her to eat enough food because of what her mind is seeing.

Today, she grabbed the bedspread as I was folding it at the foot of the bed preparing for her nap.  She said there was a sheet of stamps or stickers stuck to it.  The bedspread was right in front of our eyes, she had her hand on it, convinced that she was pulling off what was stuck on it.  She told me to turn on the bright lights on the ceiling fan over the bed so that I could see the sheet of stamps.  When the light went on, she reluctantly admitted that they were not there. On the way to the bedroom tonight, she stopped and told me to get rid of “that” and then stepped over something that was not there on the floor in front of her.

This morning, when the hallucinations were at their steadiest, Mary Ann simply could not sit down for more than a minute or some fraction thereof.  She would jump up to go to one spot or another to get a good look at or pick up whatever it was she saw.  I had to jump up every minute or fraction thereof to grab hold of her gait belt so that she did not fall.  Once she was so dyskinetic when she jumped up that it was all I could do to untangle her feet and help her sit back down before she fell into a couple of tables next to her.  The activity was so steady that I could do nothing but follow her from one hallucination to another, or one task she had in her mind to do, pretty much always losing track of whatever it was by the time we got wherever she was leading me.

If hallucinations came at that pace constantly, I would soon be completely unable to cope.  The lack of sleep impacts both of us.  The less she sleeps at night, the more she hallucinates, the stronger and more vivid and more frequent they become.  The less she sleeps, the less I sleep.  The less I sleep, the less able I am to cope with the hallucinations.  They compound one another, lack of sleep and hallucinations, and my capacity to cope.

Here is how my inability to cope expressed itself this morning.  I told Mary Ann that I had been asked about how long I could keep her at home.  I told her that my answer included two things that could make it impossible, lack of sleep and streaming hallucinations like the ones that we were dealing with this morning.  It was cruel to say that to her.  I have no excuse.  My frustrating inability to cope with the constant following her to one thing and then another, after having a very poor excuse for a night’s sleep was the context, but I chose to say those harsh words. She has Parkinson’s Disease Dementia!  She didn’t choose the disease!  She didn’t choose the hallucinations!  She didn’t choose the frustrating behavior!

I guess there was a part of me that hoped the words would get through to the healthy part of her mind that has some ability to control her actions.  What she said next, broke my heart.  “Then what would happen to me?”  Usually, whatever I say just bounces off with no reaction.  This time it broke through.

I need say just how hard it was to actually write for all to see those last paragraphs revealing what I said to her.  I am ashamed and embarrassed.  I can only hope that someone reading this post has been there and said things of which you are not proud also.  I have chosen to face my own flaws head on without pretense, since it is just too hard to pretend to be someone I am not. My hope is that facing the flaws head on, will allow me to grow into someone better able to cope, a better Caregiver.

In answer to Mary Ann’s question about what would happen to her, I immediately told her of my intention for us to stay here together until one of us dies.  I told her I would use paid help here at the house to help do the care when I could not handle it by myself.  I told her that if I die first the kids would take care of her, keeping her close to them.

All I wanted to do was to get her to stop hopping up, responding to the various things she saw. She did stop hopping up, and I was able to get my shower done, make the beds, write an email or two and finish getting her ready for the Public Health Nurse’s visit.  I don’t know if what I said had any impact in that change in behavior, but even if it did, I feel no less guilty about being so harsh.

It is at times like this that I am very grateful to have a God who has openly addressed our flaws and stolen from them the power to ward off the Lord’s love of us.  That is why the song is called “Amazing Grace.”  The power of that gracious love is transformational.  It frees us to face our failures.  At the same time it challenges us to grow and change, cradled in the arms of that love.

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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