## Saturday, August 20, 2016

### Mathematical Calculations

This is a picture I took last week after a heavy overnight thunderstorm. You can see the morning sun peeking through the trees. We've had an unusually  hot and dry summer, so any rain is so appreciated.

This is the weekend we had planned to travel to Philadelphia for a wedding. It was not to be. Jim is not feeling well. It's complicated, and hard even for me to describe. This is one of those times where his difficulty with word finding becomes especially significant. Based on my observations and on what I can gather from his efforts to describe what he is feeling, I think part of the problem may be some dehydration. The extreme heat we have had, along with his compulsion to keep the yard perfect have likely led to the perfect storm of some heat exhaustion and not enough fluids.

We've discussed how many glasses of water he should drink a day. But tracking it is the kicker. There now is a pad and pencil with a chart to check off each glass he drinks. However he could drink a glass of water, be looking at the chart, and still not remember (process?) that he needs to make a check mark! So, I'm on high alert, at least for a few more days, to try to keep track of how much he is drinking. The good news is that he has a new awareness of the need to drink more, so I'm hoping after a few days this will become more routine for him and actually counting/recording will no longer be necessary.

If he is not back to baseline by Monday, he is in agreement to go see his doctor. And he has agreed and wants(!) me to go with him. Meanwhile, we'll focus on more fluids and more rest.

This morning we were discussing the ages of our niece and her husband. Here's how the conversation went.

Jim: "He's quite a bit older than she is."

(Looking back, at this point I should have just nodded my head and said "uh-huh". I mean, what is the point? Who cares? But I was not running this through my usual high alert caregiver filter.)

Me: "Well, it's actually a 2 year difference; she is 24 and he is 26"

Jim: "No! It's 10 years difference!"

Me: "Well, she is 24 and he is 26.  26 minus 24 is 2, so it is a 2 year difference."

Jim: "No, no, no! That is a 10 year difference!"

Me: Thinking he just needs to visualize this I write on a piece of paper :   26
-24
2

Jim:" 4 plus 6 is 10! It is a 10 year difference!"

At this point I realize that I have done exactly what I should not have done. Every time I think I am getting good at just going with the flow, my exacting personality manages to rear its ugly head.

When Jim was doing his graduate work I'll never forget when he came home and told me he had just registered for the most advanced statistics course that the university offered. He excelled academically.  He always had an intellectual curiosity that spanned a lot of different topics. He was a voracious reader. He still buys books for his Kindle, but I notice that he seldom finishes any of the books that he starts. I'm guessing that he is having trouble processing and understanding all of what he is reading. And he is likely having trouble remembering what he has just read.

It is becoming increasingly clear to me that he has NO idea that is is cognitively impaired. From what I have read, that is a common finding in dementia. Some people know and are very aware, but many do not. I suppose that it is a gift to him, to not be aware of his loss. I can only imagine how devastating it would be for him to discover what is happening to his brain.

We always have a birthday party at our house in September for my mom. Almost everyone is able to come, which means about 30 -35 family members. When I think of last year's party, it makes me realize how much Jim has changed since last year. We'll see people that we only see once or twice a year, so it will be interesting to see if others notice.

So, with my caregiver filter back in place, the rest of the day is going well. I think we'll head out for some ice cream; that certainly counts as fluids :-) Hope you are enjoying this beautiful summer day. Thanks for stopping by.

1. Carole your exacting personality is likely to give you trouble in the days ahead but you are who you are and should not feel you should be anything but yourself. You'll learn to compensate. Now about this dehydration thing. That is a huge problem among the aging and if there's any dementia at all it becomes an even bigger problem. Makes me want to put a port in and hook every person in care centers up regularly to a bag of IV fluids. Dehydration plays very badly with any kind of dementia.

1. Thanks Linda. Learning to compensate is a top priority for me these days. I learn as I go along. I also learn from others, like you and your blog; we are learning to accommodate for these changes that come with aging.

Yes, dehydration is dangerous. It is more common in the elderly and is associated with dementia as well. I'm guessing that the part of the brain that regulates thirst has been damaged by this dreaded disease.

2. It's not only dementia that interferes with thirst regulation, but also simple aging. I've learned on my hikes that I need to carry at least two liters of water and drink it all! It's the only way I've found to keep from getting heat exhaustion. I can't imagine how hard it must be to get someone else to drink enough. My heart goes out to you in every single post, and if it helps to know that I care, you can be assured I do.

1. Thanks DJan, I so appreciate you and all my kind readers! Yes, it helps to know that you care.

You have first hand knowledge and experience with the dangers of dehydration and exhaustion. Fortunately Jim is receptive to my reminders to drink more water. He has a good sized water glass sitting on the counter that is left there during the day; a good visual reminder for him, and a reminder to me to remind him!

3. I know how hard it is to keep dehydration at bay, even with out dementia. I know I have to watch for myself as it is so easy to just not stop and drink or to think the meal beverage is enough. For my Mom, we put a day's worth of filled water bottles on the counter each morning so we could keep track of what she drank. She had sensitive teeth so warm water was the optimum. Now, I find I am putting four 16 oz bottles every day out for myself. I use glass that I can wash and refill. It helps me make sure I get enough, especially in this heat.

1. That's a great system to make sure you've had enough water. Jim is responding nicely to my reminders and to the reminder of seeing his water glass sitting on the counter. I like the idea of putting out a set number of bottles of water. That way no one is guessing, and I won't have to follow it so closely. Thanks Patti. By the way, glad you found your tomato thief! Hopefully there are no babies!

4. Beautiful pic. The sun rays coming out of the trees looks beautiful.

1. Thanks! I happened to catch the light just right. I'm not a great photographer, but this turned out to be a lucky shot.

5. Carole, I appreciate the dilemma of keeping track of things - water, rx, reading glasses - for a partner who really can't do it, but may not realize they can't, or that it is important.
As for the cognitive errors, it's so hard to learn how to respond when part of the time the spouse is "normal", and only part of the time "off" - words come out of my mouth before I realize things are "off" this time.
And, I'd like to offer a quiet suggestion regarding the large party at the house in September, to be enlisting a whole other level of assistance from people than you may have in past. Delegate like crazy. It might be that you are in a place when the time comes to really enjoy throwing yourself into the project, but it also could be very draining - especially if you are a detail-oriented, practically minded person.
Again, thanks so much for writing! It helps more than you know.
.

1. Thanks Jan for your comments and suggestions. I have wondered to myself how much longer I can keep up the tradition of the yearly September party. This year I am making concessions. Rather than make everything myself from scratch, I plan to use Mr. Costco and Mr. Wegmans to help with the food.

You are so right about not knowing if it is a "normal" vs an "off" time. Just this morning Jim was so confused, certain we had missed his birthday this month (no, it was 7 months ago), and then decided that it will be my birthday this month (no, it was in March). It actually is our 30th wedding anniversary tomorrow. We've talked about it for several days leading up to it. So I guessing he retained that there was a special event, but just got confused about which special event we were celebrating. A response to this requires carefully choosing words that will prevent him from feeling bad about not remembering.

6. Why not try giving him a large cup with a lid and straw with lots of water? He could sip it all day. David brought his cup home from the hospital and likes to sip coffee, juice, or water from it.

1. That's a great suggestion. Thanks Gigi. I'll see how he does over the next few days with these different strategies to keep him well hydrated.

7. That's such a good point of just agreeing instead of trying to debate specifics but hard to remember always to do as you describe. You'll probably become more adept at doing so, but nobody's perfect. I use the water bottle approach for myself to drink through the day plus keep one by my recliner for whenever I sit. Sounds like water bottles would be a really good idea for your husband.

1. Yes, it is easier on him and easier on me if I just go along with what is being said. So much of our day to day conversation is such that it is not important to be so precise. I am getting better at it. I'm learning to save my preciseness for those times where it really matters.

8. I love your after-the-rain photo. So sorry you had to miss out on a trip to Philly; you are a saint and your hubby is lucky to have you. And your writing inspires me.

1. Thanks Kathleen! A complement from you says a lot, given the skill with which you creatively write on your blog.

I don't feel like a saint, but I do feel we are both fortunate to have found each other so many years ago. We've had a good life, and hopefully some more good times are ahead for us.