The spirit is willing, but the flesh is weak

That is to say that Dr. Crane is amazed that Helen is even alive given the vascular damage in virtually all parts of the brain. Helen, I think, probably had a mini-stroke last night as she wasn't quite herself this morning, but she was fine by the time we reached the doctor's office. Dr. Crane was very pleased with Helen's high level of functioning given the physical state her brain. She saw no problem with Helen doing her own meds, unless we see some evidence of non-compliance, which I haven't as yet. Cindy asked if a sedative was in order and Dr. Crane said "no, it would probably have an adverse effect at this point." Helen did score a few points lower on the mini-mental health exam, which surprised no one. The surprise was that she has been doing so well. She went out on the deck, sat and enjoyed the sunshine after lunch today, and dressed herself appropriately for her appointment. The personal hygiene issue was brought up. Dr. Crane didn't even press it, leaving me to assume that neither should we, I guess. Helen, she said, was at risk to undergo a "vascular accident" [stroke, embolism (clot), heart attack] before the Alzheimer's gets too awful bad. At least that's the way I understood it, and I believe that she is probably right. R.

Alzheimer’s Disease (AZD) and Memory Loss

Symptom (s): “Why can’t mom remember who was at her house yesterday, but can relate in great detail what happened when she was a teenager?” We all have a Short Term Memory (STM), Middle-Term Memory (MTM) and a Long-Term Memory (LTM). Once new information is presented to us, it first enters the STM and from there the brain decides whether or not to store the information in the MTM part of the brain (I have a Dr. Appointment next week) or the LTM part of the brain (my brother’s new wife’s name is Julie) or we can just let the information go from the STM as unnecessary (a fly just flew by me).

Why: The part of the brain that is affected first in the person with AZD is called the hippocampus and its chief duty is to grab and hold onto new information while the brain decides where it wants it to go: MTM or LTM (Humans can only hold 7 bits of new information in our STM at a time, so this decision needs to be made quickly.) Unfortunately, no new information will “stick” in the AZD patient. The nerve endings in the hippocampus get covered with a protein plaque so that nerve cells cannot “pass along” information to the next cell. The result is that information goes, literally, “in one ear and out the other.” The person may suddenly stop using, say, the microwave, or the bathtub, or a cell phone because there are so many steps to using these things that they just can’t remember them at all. That’s very scary for them; embarrassing, too. Sometimes only part of the memory is damaged in as the disease progresses and the person will “make up” parts of or names to fill the “holes” in their memory. This is called “confabulating” and the caregiver must let the person give their flawed, inaccurate story. What’s it like for the person? When you get up and start out of the room, you will know you had been on the computer. A person with STMemory loss will have no idea of where they have just been, or where they are going or even that there is even a computer.

Caregiver Strategies: As with almost every facet of the behavior of the person afflicted by AZD, as a caregiver you must “choose your battles.” If the person cannot remember where their other blue sock is and puts on a red one instead, let it go (unless you are going out somewhere). Never argue with the person (Dad!? Don’t you remember?!). It puts them on the defensive, voices are raised, tempers flare, and the relationship suffers. More importantly, no, they really don’t remember. On the other hand, if they say “I think I’ll drive the car to the grocery store,” then intervention is required. Let their memory loss work in your favor. Distract them long enough and soon they will have forgotten all about the car. This is a technique that is helpful in all stages of AZD. Another good technique is to talk to the person about things that happened in their past, go over old photographs, play to their strength, their LTM. They will be more comfortable and so will you. Plus you may learn all kinds of neat stuff while they are reminiscing. R.

Issues

Yes, Suzanne, personal hygiene is on the agenda. Tabu will only get you so far. I mean how do you make an 80 year old woman trying to control what's left for her to control do something against her will? Also she has recently decided that she can take her own medication. I checked the pill box, every compartment was a wrong pill/dosage. I'll brainstorm with anyone who has a suggestion short of "Helen, you smell bad" 'Most likely she'll get a bladder infection with it's attendant hallucinations. G-mail robndor@gmail.com if you don't want it on the blog. R

Rob, thank you for the info. But unless I just read it too fast, it didnt mention a day or time. I dont want to "crowd" mom. But I do want accurate information. I trust you to do that if you are going with her.
I spoke with her yesterday evening ( 3/22) for about 15 minutes about her trip to Maggies, her trip home, Andrew and Sarah, etc..... I had the impression she never really knew it was me ( or who I was )

Also, after I talked with mom, I called Maggie to see how she felt mom was doing. One concern of Maggies is moms personal hygiene health. She wont bath.

oh yea, this is Suz

Dr. Appointment. Wednesday 3/31, 2:30

Helen will be seeing Dr. Monica Crane, a geriatrician in the same office in the old Baptist Hospital where the family went the last time she had an appointment there-6th Floor. Just take a right off the elevator then keep making left turns until you get to the Geriatric Assessment Program (GAP).

Helen said anyone can come, but she doesn't see why. Helen is fine, It's just time for her regular check-up. Nothing to get worked up about. Really. It's not in response to some crisis. Cindy booked the appointment a month ago. Helen is doing quite well.

However, for those of you who choose to come, here are a few strong suggestions:

Never, ever talk about Helen in the third person (she did that, she's not been doing this) when she is in the room. Not only is it bad manners, it makes Helen "feel like an object" as she put it. And only one person speaking at a time.

If you can't come, don't, as everyone tends to talk to Helen at the same time about different things and it confuses her. I will post an objective summary that evening of the visit. There won't be 5 different versions of what happened, Suzanne, but don't let that stop you from coming. Amy has to work that day.

No "Mom, you must, or need, or you should". It is demeaning and, if I know Helen, a waste of breath as well.

Try and keep the visit short, calm, and peaceful and to the point.

Dr. Crane went way out of her way last time because we took up time she had scheduled for other patients. I don't think we should expect her to do that again.

Whoever is with Helen, that person should explain what is going on as she goes through her exam. The office is waaaay out of her comfort zone, and she'll need things explained, if only to keep her oriented. Don't talk to her as if she was a child, because she isn't

Finally, don't crowd her. respect her "space" the same way you want others to respect yours. R,

I too would like to know date and time of mother's dr. appointment. I also would like to be there.

Would someone please advise when mom's next Dr's appointment is. I would really like to go. Rob, I appreciate all your imput.

Table of Contents

The material which I will be posting will be a combination from The Savvy Caregiver and The 36 Hour Day. A topic will be introduced, why it is, how it manifests itself, and what the proper response is now since you know why the behavior is there in the first place. For instance, Helen's recent "shoplifting" is not an uncommon symptom of people with AZD. Why did she do it? She may not realize she is in a store, something may have caught her fancy and she forgot that you go to the checkout register before you can have whatever it was she walked off with. Gently guiding her verbally through the checkout tasks. There really are a lot of separate tasks involved, if you think about it. Bottom line? Helen for some reason (and there are many) is like a little 5-year old in the toy section. As I recall, my own mom's solution was to put my hands in my pockets and keep them there until we left the store. Telling Helen to do that won't work, but giving her something to hold in her hands while shopping might. Future posts will be as follows: memory, language, reasoning, judgement, perception, abstractions, attention, and organization.

After that I will give examples of behavior motivated by the intellect and by the emotions and how to interpret the behavior and intervene, especially as we get deeper into the 2nd stage. A little knowledge goes a long way toward understanding/helping Helen and her Alzheimer's. R

As much as I hate to admit it, I think it's pretty clear that Helen is well into the early middle stage of AZD. I also think that if she is left in her rapidly shrinking comfort zone, let her sit in her chair and read her books and watch her Westerns, she'll be just fine. I agree with Amy 100%. Not many people are contributing to the blog. Yes, I need the information, but so does everyone else that comes into contact with her, so as to avoid or not make possible an adverse effect on Helen.

Come Saturday, I will make a list of how and how not to deal with Helen. It is from The Savvy Caregiver, Which the Downtown Library will ship to any Knox Co. branch. Free. If you asked me, I would say it is "recommended watching" esp.since Helen is getting the middle stages of AZD. Knowing the information in these DVDs will help you communicate and deal with the adverse behaviors that are just beginning to show themselves. I don't think a doctor's appointment would be out of line. Plus it will make interacting with Helen easier for her. R.

On the plane

I just found out yesterday, 4th or 5th hand, that Helen had a problem on the plane. I called Maggie after they had arrived and was told that "everything was fine" when it wasn't. I expect Helen was in the room and she c/n/ tell me.

Helen's distress is a result of the AZD symptom of not being able to think in the abstract. Like a small child who cries when mom steps into the next room, thinking he is all alone, so too with Helen, who, in her perception of reality thought that since Maggie was out of sight, she had abandoned her. It's an "out of sight out of mind" sort of thing. More evidence that Helen 's Alzheimer's is worsening.

To avoid any further stress on Helen, Cindy is flying to Texas and will fly back with Helen at her side. I was afraid that Helen and Maggie would be in different parts of the plane and should have said something, but I didn't. R.

This is Sunday am. I called Mom and Maggie last night to see how their flight went and check on them. Maggie told me how they had to page her. Mom was REALLY upset when she didn't have Maggie by her side. That broke my heart. To continually see my independent, self sufficient mom digress to the point where she gets scared when she finds herself alone and in unfamiliar surroundings is beyond sad.
I called Maggie and Mom back and told them that I am driving down to pick her up whenever she is ready to come home. Mom was really glad I would be coming to get her.
So, don't anyone worry. She WON"T fly back.
Becky

Sunday

Reality bites

Ok folks.... it's time everybody knew some happenings. I don't know why no one wants to air the dirty laundry. This is what this little blog is for !
Mom has started stealing. Whether she just forgets that she has something in her hands and walks out of a store or whether she is being shifty, there is no way to tell. But it is a symptom of this disease process. It isn't pretty. It is the reality.
Mom'll fool you. You can sit and chat with her and she'll seem fine. She isn't fine. She is never going to be fine again. You MUST know that and accept it.
Apparently she panicked on the flight to Texas when she didn't see anyone she knew. Aunt Maggie had to get the stewardess to switch seats for her so that she could sit beside mom. I am not sure it is safe for mother to fly back from Texas alone.
This is a long downhill slide, my brothers and sisters. It doesn't get better.

I set this blog up so that all of us could talk to each other in an open forum. It wasn't set up for Rob to simply report the occasional event.

Please post. If we all share the knowledge then the reality might be a LITTLE easier to deal with. But no way is it gonna be easy.

Please communicate. We are lost without communication. And it is for Mother's benefit, her safety, and her continued good health that I am asking for your input.

I love you.
Amy

So, where is the $800 ?

Tuesday morning, when the weather turned bad, I went out, left Helen and Maggie's lunch and hightailed it home. Dorothy called and said not to go back out. I wish I had not agreed with her advice. Instead I lay down and promptly went to sleep. While I slept. Brad [Gary's son] and one of his friends came by to visit Helen. This, after I had blessed Brad out telling him never to come back again. Helen and Maggie had just returned from Sun Trust, Helen having $800 which she counted and placed in her wallet in full view of the two visitors. When they left, the $800 was gone. But don't judge too quickly yet.

Maggie sat with a full view of the table where Helen had placed the wallet the whole time the two boys were there. Neither of them went near that area of the room, near Helen's chair.

What we may be looking at is a classic Alzheimer symptom. The person puts something somewhere special 'for safe keeping' and then forgets where they put it. This is Maggie's read on the thing, and she's pretty sure that is what happened. If someone took the wallet, Maggie would have seen it happen. Money has been "lost" before-without company. We all know this. We may find every penny of it in one tin or another.

On the other hand we may have two young thieves on our hands. I have a difficult time seeing Brad and his friend come over to "visit." The friend wanted to see the whole house. Helen showed him every room, every door. Was he casing the joint? I honestly do not know.

Did Helen forget where she put the money (again), I do not know either. R