Friday, April 28, 2017

"His Dementia is Very Advanced."

Why were these words so shocking to me? Perhaps because it was the first time I heard a medical professional confirm what I already knew.

There are times where it all seems like a bad dream, as if it is not real. How can this possibly be happening to us?

These past two weeks, there seems to have been a further decline. Every day, there is at least some lapse of his memory as to who I am. It occurs in the early evening or when he first wakes up in the morning. Sometimes, it is both.

Yesterday afternoon, just after lunch, he started talking about how the police were watching me, that I was a suspicious person, and that the police thought I was threatening.  I used diversion, turned on the TV, and it seemed to break this train of thought.

Jim's first appointment with Dr. S. (gerontologist), was late yesterday afternoon. The office staff are wonderful! We arrived 10 minutes early, and they took us right in. I provided up to date medical information and background, as well as a copy of his Health Care Proxy and Power of Attorney.

The nurse attempted to administer a Mini Mental State Exam (MMSE). This did not go over well at all. Jim told her that the questions were childish, and that "people have been after me for 20 years about this!".

At this point, Dr. S. came in to examine Jim. Through a skillful interview process she was able to ascertain his mental status. Jim did not object to this part of the evaluation. Although he did ask her to "Stop yelling in my face!".  (Over the last year or so, Jim has had a heightened sensitivity to volume of speech and any noise. I wish I had thought ahead to let the staff know this.)

While the nurse was drawing Jim's blood, Dr. S. reviewed with me her clinical findings. Her assessment that his dementia was very advanced really took be aback. She would like imaging of his brain (I expected this), but she is realistic that he may not agree to this.

We both agreed that the number one priority for Jim was to help him with his anxiety and agitation. She has prescribed citalopram at a reduced dose to start, to be titrated up if tolerated. This medication is often used to treat depression, but it also is used for treating anxiety and panic disorders.

Her plan is to start Aricept after six weeks of the citalopram. By starting just one medication at a time, it provides a clearer evaluation of the clinical response to each medication. She reminded me that medications like Aricept improve memory "only a little bit". It may help some with activities of daily living. Here is an interesting article that discusses the marginal improvements that are seen with drugs such as Aricept.

I'm not discouraged by that. I've known that cholinesterase inhibitors do not stop the progression of the dying brain; it simply improves some of the symptoms for a period of time (12 - 18 months). It doesn't help everyone, but does help some folks with dementia. Many times it is viewed as a way of delaying the need for institutionalization.

My brain is spinning. At times it just seems overwhelming. I'm hopeful that the citalopram will help Jim with his anxiety. This in turn will allow me to line up the help I'm going to need for Jim's future care. His agreement to others being in the home is key to everything.

Jim signed the Power of Attorney in 2012, giving me the power to act on his behalf. Five years ago! I knew then that I would be needing that POA for Jim. It's hard to remember exactly what his deficits were at that point, but they were such that I knew I had to get our affairs in order. I'm so glad I did.

Well, another post is written. Thanks for stopping by. My heart feels lighter already.

Monday, April 17, 2017

"You Need to Go Home"

It's been a rough few days. Jim has needed more than the typical attentiveness from me. I'm tired, but cannot sleep, which is unusual for me. Jim doesn't know who I am. But he is certain I am not Carole.

Jim's anxiety has been pretty high the last few days. This has required super high attentiveness on my part. It requires a presence; not just being in the house with him, but being in close proximity. I tire of the endless TV that helps to keep him entertained. My relief from the endless stuff on TV is my beloved math puzzles, KenKen. I love the challenge, and it actually is relaxing to me. I print one out, put it on a clipboard and go to town on solving it. My favorite ones are the 9x9, with 4 operations, expert level. I can claim no credit for my skills in this department; I inherited my math skills from my dad.

But today was different.  Jim took the clipboard from my hand and made some disparging comment. So, I set it aside, and focused on the mindless TV show he was watching. So much of what he said today was nonsensical. As I listened to him talk, it was almost like I was observing someone with a psychiatric break in reality. But that is what dementia can sound like. Words put together that don't make sense.

This is so incredibly sad. Jim doesn't know I am Carole, his wife. Who does he think I am? When I attempted to show him our wedding picture, rings etc, it did not change his thinking.

We finally went to bed, but he could not sleep. At one point he said "You have to go home."

Me: "I am home. I am here in our home that we have shared for many years."

Jim: "You're confusing me. You need to go home."

Me: "Why don't we wait until the morning to sort this out?"

Jim: "But you can't sleep in this bed. There is a third party...."

So, I said that I would sleep on the sofa because it was so late, and we would figure it out in the morning. He accepted this.

What will tomorrow morning bring? I don't know.

Most days I feel strong, and I know that I can do this. But in weak moments like tonight, I question myself and my ability to stay strong. I know we need help. And there is comfort in knowing that help is on the way.




Friday, April 14, 2017

Another Week in the World of Dementia

I've mentioned before the difficulty Jim has getting ready for the day. He struggles through the process, often saying "I don't know what to do next.". The hardest part for him has been getting dressed. He will go through several changes of clothing, sweating profusely, and experiencing a lot of anxiety in trying to pick out his clothing. My efforts to help him during this process have not been helpful to him, and seem to only add to his anxiety.

I made a wonderful discovery that seems to help! When he first gets up, he has a couple cups of coffee while watching Morning Joe on TV.  While he is sitting on the sofa watching TV, I quietly go into our bedroom, make the bed (an unmade bed is unsettling to him), and lay out his clothing for the day. I then hang a fresh towel by the shower, and put his toothbrush and shaver on the bathroom counter.

I had no idea! I've done this for the last 4 days, and it has worked beautifully. Apparently my presence while he was trying to pick out his clothing just added to how overwhelmed he felt. Now he walks into the room, everything is laid out for him, removing the anxiety producing effort of clothing selection. Such a simple solution that is working well, at least for now.

About a week ago, I had a precious few hours to myself when his friend Mike came by and picked Jim up for lunch. This week it was not successful. In no uncertain terms, Jim made it clear that he did not want to spend time with Mike. It sure was disappointing to me.

Jim is sticking to me like glue these days. As his dementia progresses I'm guessing that his anxiety is worsening as well. Perhaps he finds greater comfort in staying close to me. I'm finding the patience however, as I know that his appointment is coming soon. Once his anxiety is better controlled, I'm guessing that he'll tolerate being away from me for a bit.

I've decided to defer scheduling any appointments or making any firm plans for myself, until this can get resolved.

Yesterday I suggested that he check our mailbox to see if any mail was delivered. He happily agreed, put on his jacket and walked out the door. (Side note: I never worry about Jim wandering off. He is fearful of getting lost and would never wander off without me.) Meanwhile, I am taking care of some laundry. Jim comes back into the house:

Jim: "The mailbox is gone!"

Me: "The mailbox is gone?"

Jim: "Yes! I don't know where it is!!"

Me: "Let's go look together."

As we exit the house through the garage Jim walks over to my car.

Jim: "I'll look in your car."

Me: "Let's look at the end of the driveway."

We walked down the driveway together. He seemed absolutely amazed to see the mailbox. I'm not sure what happened. Did he even make it to the end of the driveway the first time? I don't know, but it  was another sad reminder of his memory loss of things that were once so familiar.

Jim's eyeglasses were broken beyond repair. They are bifocals, with a slight correction for distance, but primarily used for up close. He has several pair of "readers", but he was insistent that he get a new pair of glasses. I knew this was going to be a challenge.

I timed the xanax so that he would have the most benefit for the car ride and the actual appointment. His eyes were examined, and he picked out a nice pair of glasses, almost identical to his broken ones. Then comes the sticker shock. Frames were $245, and the lens were $310. Ouch!

We returned a week later to pick up the glasses. I timed another xanax to help him through this appointment.  Jim tried the glasses on, and long story short, he didn't like them. The optician was very good with Jim (I had given her one of my companion cards). He insisted that the frame was "not straight enough". After many attempts at adjustment, it became clear that Jim was not going home with these glasses.

The next day I called her out of earshot from Jim, and was able to get a refund on the frames, but not on the custom lens. Since then, Jim has asked a couple of times about glasses. I simply say that the optician is trying to locate the exact frame that he wants. I think he will eventually just let it drop. He has some good quality readers for up close, and the distance correction is minor.

The reason for sharing this story is because I surprised myself by how well I handled the eye appointment. In the past, I would have been totally stressed during the appointment with the optician. However, I was internally very calm. I think I am getting better at this. My conversation with myself: "No one died. We all get to go home in one piece, and it is not the end of the world. So just let it go, it just doesn't matter."

And so it goes, another week in the world of dementia. Nothing too exciting or earth shattering. I'm learning so much. As Jim finds his way through this next stage of his life, I'm glad I can be here to share this part of his journey.

Another post is written. Thanks for stopping by. As always, my heart feels lighter to be able to share with my dear readers. Thanks for listening.





Saturday, April 8, 2017

Dementia Challenges; Rising to the Occasion

Well, it has been interesting since returning home from Florida. I realize now that I never should have traveled to FL. It definitely was a judgement mistake on my part. I'm certain that my judgement was clouded by the dreaded winters in upstate NY. And sure enough, it was a typical, brutal winter. But in retrospect it was not worth it. We are done with travel, and I am OK with it.

Jim's dementia continues to decline. It is such a sad thing to see. Lately, his memory struggles quite frequently with how he knows me:

"How long have you been here?"

"Are you sure we are married?"

I go through the details, showing the marriage license and our photo on the piano. He accepts that this is the reality for that moment, until he forgets again.

He also asks a lot about our last dog:

"Where is our dog?"

"Why isn't our dog here?"

It is heartbreaking to have to keep breaking the news to him that our beloved Jack is gone. 

Dementia is a cruel disease. No concern for the person afflicted, or for those who love them.

Some encouraging news about driving and Jim's car. As I mentioned before, he was certain that the black Accord (his car) belonged to Mike, our friend who kept an eye on our house while we were in FL. After realizing that his perception was not going to change, I decided to go with it. The Accord is at Mike's house. We are now a one car family. This is a huge relief! It essentially solves the driving concern, at least for the most part. 

Yesterday we were headed to the mall and he said that he would like to drive. I responded "How about if I drive there, and you can drive home?". He accepted this, and as I thought, he completely forgot about this and I drove going home. 

If things go as I expect, at the end of the month I'll sign the car over to Mike. It is such a relief to be down to just one car. I've notified those who need to know to not ask Jim about his Accord. 

Jim's anxiety is very much present every day. I have some of the anti-anxiety pills left, but I am hoarding them for when he needs them the most. I just need to make it until we see the gerontologist at the end of this month. If we have nothing planned (no visitors, no appointments etc) I can usually manage his anxiety without the pills. But any variance to this, and help is needed. His anxiety when I am driving is almost unbearable for me. Without an anxiety pill:

"You almost killed 3 people!"

"You were going 100 MPH!"

"You could have killed us!"

It's all so real to him. In his mind, all of this is true. I can't imagine how hard it must be to be inside his extremely anxious brain. 

Getting ready for the day is extremely difficult for him. I try to anticipate his needs as much as possible, but I'm not always successful. I believe he is heading toward the moderately severe stage of dementia. Every morning, it seems he needs more and more help with getting ready. Yesterday he shaved twice (morning and evening) but never brushed his teeth. He had no idea what he needed to do next to get dressed after his shower. 

He gets very upset if I cannot figure out what he is trying to tell me. "Don't give me that! You know what I mean!" I  almost have to be a mind reader. Sometimes I can figure out by the context of the situation. 

I did a trial run with Mike spending time with Jim last Wednesday. I was able to get my hair done (I was desperate!), got my car washed, and stopped at the store for some groceries. I was gone for about 3 hours. Jim did OK, but not great. And this was after giving him xanax before I left. Mike told me that he was getting pretty antsy, wanting me to get home. Having that short period of time to myself was heaven. It felt so good. 

Once Jim gets some help from Dr. S. for his anxiety, I anticipate that I'll have better flexibility for some time to myself. Priorities include support group, seeing my mom, and my own Dr. appointments. 

I have to admit that the times when Jim falls asleep for a nap during the day it feels glorious! He is asleep right now, which gives me the freedom to write this post. I would describe my days as being in a state of hyper-attentiveness. I must always be ready to be there for him. 

Communication skills continue to challenge both of us. Yesterday morning:

"Where is my watch?!?" (Obviously in a lot of distress)

I knew that he hadn't worn a watch in over 15 years.

Long story short, he finally found a white t-shirt, picked it up saying "There's my watch!"

I am learning that when I speak to Jim, it is very important to speak slowly, with frequent pauses. This gives him a better chance at processing what I am saying. Also, it is important to give minimum information, keeping it all very concise and simple. I'm getting pretty good at doing this. I've learned so much on this dementia journey!

The challenge now is to find activities that keep him contented. If we attempt to go someplace, even if just to the grocery store, the anxiety rises to a high level, making it so difficult for him. If we stay home all day, he is "bored to death". I'm holding out a lot of hope for help from Dr. S. for Jim's anxiety. 

One of my favorite blogs by Dr. Elaine Eshbaugh inspired me. She wrote about the brain working very hard to interpret surroundings when you have dementia. This process is exhausting. This makes it difficult for the person with dementia to control their impulses and emotions. Elaine points out that while we as caregivers may say we are having a hard time when this occurs, the person with dementia is really having a hard time. I've learned so much from her.

Dementia challenges; I choose to rise to the occasion. This journey could be characterized as a sad, lonely and long one. But as Jim and I go forward, I'm appreciating the joy that we can still find in life. And I am ever so grateful for all the support I am receiving along the way.

Well, another post is written. Thanks for stopping by. I appreciate each and every one of my readers.








Saturday, April 1, 2017

Mr. Dementia and Jim Return Home

It's good to be home. We've been home for 5 days and we are settling in.

The morning we were preparing to leave FL, Jim managed to bump his head twice, really hard. It quickly turned into "Why did you hit me in the head three times?" He was so angry at me. In his mind, I had indeed hit him in the head, so of course he was very angry.

Remembering that you can't reason with someone who is incapable of reasoning, I simply apologized and said it was an accident. It did not do anything to dissipate his anger. It was especially worrisome given that he had already had one of his anti-anxiety pills. I knew we were in for a long, difficult day. And remembering that Mr. Dementia is NOT Jim (and vice versa) helped me to maintain my calm. I'm not saying I wasn't stressed out (I was!), but separating Jim from dementia always helps me when I am at my lowest point. Damn dementia.

I gave him a second pill. (This part is tricky, because for years he has had a few pills in the morning and a couple of pills in the evening. Giving an extra pill means I have to make up a story about how I forgot to give him his daily aspirin.)

By now, he is pulling items from the suitcases and throwing them around.

At this point I'm wondering if we will make it to the airport. It's a long story, and it was a long day, but suffice it to say that we made it home safe and sound. A total of 4 pills were given. Without them, I know that we would have not made it home. The anxiety level was very high, even with the pills.

The "Meet and Assist" service through JetBlue was of minimal help. When I initially requested this service, I requested a notation that Jim's deficits were dementia and anxiety. I'm certain that none of this was relayed to anyone. In retrospect, I think that because Jim's deficits are not visible, people assume that we are OK. At check-in we were supposed to be met by a helper. Didn't happen. The clerk eventually found someone to help us, but this young woman also was assisting an elderly couple, one of whom was in a wheelchair. The woman barely glanced at us, never said a word, and proceeded to ignore us the whole way to security. The one thing that was helpful, was that by following her, we easily found our way into the prescreened TSA line; we did not need to remove shoes, take out laptops etc.

There were a couple of tense moments. I needed to use the restroom. I situated Jim directly across and asked him to just wait until I came out. Unfortunately there was a long line. I went back out, warned Jim that it would take quite a while due to the long line. I worried the whole time. He was OK by the time I was done. I did not see one of those "Family Restrooms", which would have been perfect; we could have gone in together.

Prior to boarding, I went up to the desk (alone) and asked if we could board first, giving an explanation as to why this was needed. This part worked great. We were the first to board, giving us a chance to settle in prior to the regular boarding.

When we arrived home, Jim seemed to remember everything about our house, with the exception of new furniture that we purchased last summer for our great room. He still keeps asking "who bought this?".

While we were in FL, our friend Mike would come over weekly to do a walk through of the house and to start Jim's car (Honda Accord). Mike used the empty bay in our garage to store his mustang convertible. Mike took his Mustang home prior to our arrival.

Jim is totally confused about his Accord. He insisted that the car is not his, that it belongs to Mike. Showing him the title, the registration, bill of sale etc all in his name did not convince him. He had a brief time period two days ago when he realized that it was his car, but that did not last long. Part of his confusion may stem from the fact that he knew Mike was going to store one of his cars in our garage over the winter. So maybe he transposed some of the facts, thinking the Accord was the car Mike stored...I really don't know.

So, the plan is to wait out the weekend, and if Jim still thinks that the car belongs to Mike, then Mike will take it home with him. This certainly would solve the issue of driving. My concern is that with Jim's car gone, will he want to buy another one? Or, will he suddenly remember that the Accord is his, and wonder where it is?

In the back of my mind, I've always known that eventually I wanted Mike to have Jim's car. Mike and Jim are both car nuts. Jim's Accord is a beautiful black,sporty, V6, two door coupe. It only has about 28,000 miles on it, so still like new. If Mike could have this car now, it might solve the problem of Jim driving, and Mike could start driving and enjoying the car now so that it doesn't develop problems from disuse. We'll see how all of this plays out.

Jim  needs some minor help getting ready in the morning. "What do I do next?" Where is ...?" But all of this is fairly easy for me. I find that it takes him a very long time to get ready, including a few (sometimes several) changes of clothes. But all of this is doable. I know that much greater challenges are ahead for both of us.

It's so good to be home! And I think Jim feels the same way. Yesterday there was no need for any anti-anxiety pill. Hooray! I focus on low key, low expectations, minimal social activities, and a very calm environment. I'm hoarding the pills that I have left. We will be seeing his new doctor (gerontologist) in about 3 weeks, and I am expecting a longer acting, safer medication to help Jim with his anxiety. In the meantime he has an appointment with his eye doctor on Monday. His glasses are broken beyond repair. I have several pair of "readers" for him, but he is anxious to get "real" glasses. I know that the day will be incredibly stressful for him, so will give him one pill in the morning and one pill just before the appointment. Fingers crossed it all goes well.

Another post is written. As always, my heart feels lighter. Thanks for stopping by.