Monday, April 23, 2007

April 2007

It is the April 17 email from my mother that inspired me to start this blog. This episode was so stark, so incredibly sad and yet funny at the same time. It's one thing to logically know that people with Alzheimer's Disease simply are not in control of their words and actions. And yet, their irrational behaviors can seem so incredibly personal. I wanted to collect these experiences and share them so that others faced with parents, spouses, or siblings with Alzheimer's disease can get an idea of what to expect. My Nana is really not trying to make my mother suffer. It's just seems like it.

The April 26 and 29 emails demonstate two of the most common and frustrating aspects of Alzheimer's disease. People affected with this disorder become very prone to wander off and must be watched vigilantly. They also have a very unpredictable ability to recognize the people in their lives where sometimes they know exactly who someone is to them and other times they do not.

April 5, 2007
Nana had a good day today. But she seems to be having very vivid dreams that she confuses with reality. She does seem to know that someone will come every night to fix her dinner.

April 8, 2007
Yesterday S came to see Nana bearing a huge flowering plant. Unfortunately Nana did not remember who he was. But S said that she pronounced his name perfectly. Obviously I did not. But Nana must have remembered all the times that Barney talked to her about his son. At any rate it was nice to see S. Nana really liked him even though she could not remember who he was. We invited him to come to see us again.

April 14, 2007
Nana is very agitated tonight. She keeps saying that she needs to put the outside lights on because someone is coming to take me away. Every time I close the front door, she opens it again. I keep hoping that she will go to bed so that I can lock up and go to bed too.

Now Nana has just spent thirty minutes telling me that I must get out of her house. She does not like me. She is going to throw out my computer. For several days I was beginning to think that she was letting some of her anger go. I was mistaken. She is more angry now than she has been for a long time. If she stays this angry, I may need to move somewhere else. Maybe tomorrow will be better.

April 15, 2007
Nana seemed to be a little less angry today. But she did take down the towel bar in the bathroom again. This time M was not able to fix it.

April 16, 2007
Nana was more confused today than she usually is. She keeps saying that there are other people in the house besides the two of us. Tonight she went around turning out all the lights. I have been leaving several lights on at night so that she will not fall if it is too dark. Maybe tomorrow will be better.

April 17, 2007
Today I needed to leave the house before A2 arrived. In the past when this was necessary, Nana was OK. She was OK today, but Fluffy is not feeling well. First Nana gave her another container of wet food. Then she gave her some ice cream. The she gave her a whole pint of my sour cream. We are not sure about the cookies. Then she gave Fluffy half of the dinner that Amanda cooked for her.

When I came into the living room, I discovered that Nana had attacked my computer. The other night she threatened to through it away. She did not do that yet, but she did through the keyboard and the mouse on the floor. Then she turned off all the power. Then she slammed the door closed so that it locked. Then she even took my chair away. These things may not sound so terrible. But even moving a chair across the room is very, very difficult for me. On the good news side, when I got everything put back together, I was able to turn the computer back on again.

Oh yes, she also took the small blanket that I keep on the chair. I still have not found that.

April 20, 2007
Nana had a good day today. She got her hair done and then A took her out for dinner. A said that she was happy during dinner. She ate a yogurt and a banana when she got home. Now she has decided to sleep in her clothes, but she was happy about it.

This week has been pretty good for Nana. She is still confused, but she is more accepting of the situation.

April 26, 2007
On Monday night, A2 forgot to lock the studio door on her way home. At around midnight, Nana came to tell me that the door was not locked. I told her that I would check it before I went to bed. Nana often tells me that I need to fix something that really does not need my attention. About an hour later Nana came to tell me that the car door was unlocked. I have been leaving my car door unlocked lately because sometimes it is difficult to unlock. I knew if Nana knew that the door was unlocked, she must have been outside. If she was outside, then the front door to the studio must not be locked. So I went to check on the door. It was unlocked. So I locked it. On Tuesday when A2 came, I made sure that she knew how important it was to lock the studio door at all times. We were lucky this time that Nana came back into the house. We can’t always count on that happening.

April 29, 2007
On Friday afternoon C called me. Nana picked up her extension after we had said hello. He said “Hi Nana this is C.” She immediately said “I will let you talk with your mother.” Then she hung up. I was shocked to hear that she knew who he was, and that he was my son. Most of the time, she does not even know who I am. But later that afternoon when she went to get her hair done, she did not recognize the woman who has been painting her fingernails for years. So I guess that we are going one step forward, and several steps back. She was OK today.

March 2007

The symptoms of Alzheimer Disease can be incredibly variable. Some days are terrible and some days the person can seem almost completely normal. It is impossible to predict from day to day.

March 19, 2007
Nana had a good day today. Her friend R came to visit tonight.

Yesterday was not so good. I had made plans to go to church for the first time since early January. Nana woke me at 4:00 AM saying that she needed to escape and she could not get out. I explained that it was the middle of the night and she was in her own house and she should go back to bed. Then she came and told me that someone had put a banana in the fish tank and that she had to work and work to get it out. I was too tired to go back in the living room so I suggested that she leave the fish tank alone and go back to bed.

When I left the house to go to church, I did not see Nana. But the bathroom door was closed, and Fluffy was on her bed. When I came home from church, M was all upset because she could not find Nana when she got here. She looked everywhere. She even called her mother. She finally found Nana upstairs. She had not been up there since last fall when K was still here. M had difficulty convincing Nana that she needed to come back downstairs, and that she should not go up there again.

A2 spent a long time working on the fish tank filters tonight. Nana had taken them all apart yesterday trying to remove the banana, I guess. But A2 got them working again. Life sure has been an adventure around here lately.

March 30, 2007
The past several days have been good for Nana. She is even playing the piano some afternoons. Today she got her hair done. Then A took her out for dinner. We have had sunshine and warm weather two days in a row. Maybe spring really is here.

November 2006

A different cousin spent time with Nana in November. One problem with aging is just about no medical problem shows up in isolation. Along with her dementia, my Nana is fighting high blood pressure and some other problems. Aricept and Exelon are two of the drugs used to treat Alzheimer's disease.

November 6, 2006
I took Nana to see her cardiologist, Dr. L, today. When she was in the hospital she was taken off of her BP meds because it was running low. Today she was between 130/90 and 145/100 in various positions, so he is starting her back on Hyzaar (a combination of Losartan and Hydrochlorothiazide).

The main concern now is Nana's memory. She has some good days and some bad, but overall the trend seems to be downhill. She sees me and J about everyday and is now having trouble remembering our names. She also believes A is her mother, not the opposite. The days she has more familiar interaction seem to be her better days, so I would like to encourage everyone to continue the phone calls. Please don't be shocked or offended if she doesn't recognize who you are.

We are going to consult Dr. G and see if Aricept or Exelon might help.

September 2006

Through the summer and into September, Nana was in a rehab center. Many from our family visited her there and wrote about the experience. One of the most troubling experiences for families is the loss of recognition of people they have known for years. By this point, Nana was mixing up many people in our family. This is also the point where we started to realize that Nana simply was not going to get better from this time forward. We were into the slow decline.

Sept 5, 2006my sister in law
I am glad we came up to see Nana last weekend but I am so sorry to hear she is not getting better. I am also glad K and R are visiting. Though Nana didn’t really know who we were, she was really happy to have the four of us visit – we stayed for about 3 hours, had a good (though cyclical) conversation and looked through lots of old photos.

Sept 5, 2006my cousin
Here’s the latest:

Mom talked to Dr. G yesterday. He told her he thinks that Nana will be miserable and die if we send her to a nursing home for the next 6 weeks to get antibiotics. He also said that the drain for Nana’s cyst will be in for the rest of her life. She will need to go in periodically to have CT scans and have the drain repositioned, but that can be done on an outpatient basis.
Nana’s cognitive state hasn’t improved.

It sounds like at this point it’s just a waiting game. Nana isn’t going to get better.

July 2006

Over the summer of 2006, Nana spent several months going in and out of the hospital and in and out of rehab with a recurrent liver cyst. The stress of this experience worsened her other symptoms as you can see in this email from my cousin.

July 29, 2006
I just wanted to give you all an update on Nana. We still don’t have a clear diagnosis. They’re keeping her in the hospital on a diagnosis of undifferentiated belly pain. Her white cell count was high when she went into the hospital and they have taken 500 cc’s of fluid out of a cyst on her liver. They did an x-ray and a CT scan of her abdomen. They did more blood work today, but we haven’t gotten the results yet.

They were going to release her today, but she told the doctor she was still having pain, so he didn’t release her. Her belly is also still very distended. We’re trying to get more answers as to the belly distension. I’m really not sure why that seems have nothing to do with why she’s staying in the hospital.

She is also complaining of having pain from moving around, but that could be from being in bed for 5 days. She is getting up and getting herself to the bathroom.

The trip to the hospital has also highlighted her mental decline (which can be exacerbated by sickness and changes in routine). I don’t want to imply that this won’t improve when she gets back home, but it’s what I’ve witnessed and what my mother has told me.

Nana seems to know who she is and where she is, but not necessarily when it is. She seems to swing in and out of remembering things. Today she thought I was J’s daughter (the writer is A's daughter). She only remembered having 2 grandchildren (me and R - she has 4 grandchildren) and only remembers D (not M and B; her great grandchildren). Also, at times she didn’t remember all of her children. She seems to be associating J (my mom) with everything.

I don’t want to scare any of you. She seems generally comfortable and in no major distress. She is eating. I would feel better if we had a diagnosis and I’m trying to push my mother to get as many answers as possible before they release her.

March 2006

By this point, my Nana's memory was beginning to noticeably impair her day to day interactions. Impulse control is another common sign of Alzheimer's disease.

March 1, 2006
Nana saw her doctor last week. He told her that she was fine and to come back in a year. She wheezes sometimes, but she has an inhaler that works pretty well. Each day seems to bring a new crisis. But so far we have managed. I was able to show her how to use the coffee maker today. We will have to see if she remembers tomorrow.

March 9, 2006 - an email from my cousin
Things with Nana are tough. Nana is definitely declining. There are signs of dementia and her eyesight is an issue. It makes her dependant and that makes her frustrated. She is also having impulse control issues (wants what she wants when she wants it) and it's getting more inappropriate (both with family and with others). But that's not unusual in someone 88 years old.

I've been trying to get my mother to put Nana (or at least talk to her about it) on an anti-dementia medication. I can't get her to understand that once Nana is bad enough to be an issue, it's too late.

Sunday, April 22, 2007

February 2006

I am missing a year of emails from my mother. In this time Barney died. Many details are missing. I asked my mother whether she saved any messages from that period and she sent me the following:

I am afraid that I purge my sent messages about every two or three weeks. Most of the messages I send are very brief and not very important (I disagree but I didn't save them either). But I think that I can remember how Nana was when she was with Barney. Nana did the driving, but Barney did most of the thinking. Nana functioned pretty well during that time, but there were signs that she was already having problems with her memory and judgment. She was still playing the organ at church and at a funeral home. She always remembered when she needed to be somewhere for a service. When she and Barney were at D's (my cousin) wedding (September 2003), she sideswiped a truck that was parked along the road and broke the side mirror on her car. Barney and I advised her to just pay for it to be replaced without calling her insurance company because it was not very expensive, and the insurance company would raise her rates and maybe even make her take a driving test. So she paid for it herself.

A few weeks later, she backed into a woman in the parking lot of CVS. Nana’s car was not damaged, but the other lady was crying because her car was new and Nana backed into the side of it. So Nana told her not to worry, that she would pay for it to be fixed. She told her to get an estimate. The woman and her daughter came the next day and Nana wrote her a check. I looked out the window of my room. The two doors on the side were clearly bashed-in. Later I asked Nana why she did not call the insurance company. She said that Barney and I told her not to when she broke her mirror. The car she hit was a brand new BMW. I did not even ask what it cost her. It was too late to do anything about it.

As Alzheimer's disease progresses, it is common for people to lose skills they once had. This is frustrating for them and for the people who live with them. There is a depressing, but outstanding, Patrick Stewart movie that shows this progression clearly: Safe House.

Feb 28, 2006
A (my aunt) gave Nana a coffee maker that will make just one cup. She showed Nana how to use it Sunday night when she brought us home. Tonight Nana told me that it does not work. It spills hot water all over the place. I suspect that she is not locking the coffeemaker before she turns it on. I told her that I would try to teach her how to use it tomorrow. She can no longer use the microwave, so I might not be successful. But I will try.

November 2004

I sent my Nana flowers for the Anniversary of my Pop's death. I really struggle with this type of event. Is it better to acknowledge the event and the pain or to not remember it? That year I sent flowers. In later years, as my Nana's memory had faded, I have just skipped it.

Anger can also be a sign of Alzheimer's disease. You can see here that my Nana has spikes of anger that are difficult to anticipate.

Nov 22, 2004
The flowers that you sent arrived this morning. Nana was thrilled. You are the only one who remembered the anniversary for her. Nana spent an hour on the phone with Barney’s son S this afternoon. They talked about the fact that Barney is dying. Barney told Nana many times that he wanted to be buried with his parents in Hillside Cemetery. He told her that his name is already there, just waiting for him. Unfortunately he never bothered to tell his son. He was planning to bury him in the Russian cemetery with his mother. Nana is feeling distressed about the whole thing.

Now she is mad at me. She does not wear her hearing aids. Then she asks me the same question over and over again because she can not hear my answers. I finally asked her to put in her hearing aids if she wanted to ask me questions. For some reason she heard that and went upstairs mad. I think that part of her anger is about Barney and maybe even Pop. I am the only one handy to be mad at.

October 2004

Oct 2, 2004
Barney is in the hospital again, Overlook instead of Muhlenberg this time. Barney’s son S says that his father is in lala land. But he says that Barney is happy and not in pain. I guess that the doctors are trying to find out if the bladder cancer has spread to other places. Things do not sound too good for Barney, but you can’t feel sorry for a man who lived to age 93 without taking any medicine. Until a few weeks ago, his mind was sharp, and he was a wonderful story-teller. Even if he does not make it this time, Nana was lucky that he came into her life at a time when she was thinking that her life might be over. He made her smile again.

Oct 12, 2004
The rats seem to be gone. They finally had to put poison in the basement to get rid of them. One night a rat ate one of Nana’s cockatiels. The next day she gave the surviving birds away, and decided to put poison in the basement. We are still being careful to put all the food away immediately.

Nana went back to the eye doctor today. The first laser surgery fixed most of the problem. But the doctor found some leakage today. Nana is to go back for a second laser surgery in three weeks. She came home very disappointed. She had hoped to get glasses so that she could see again. Maybe she can next time.

Barney was just transferred to a rehab center today. They hope he will get strong enough for surgery to remove his bladder. Evidently they found cancer on the outside of it. His son is hopeful that he will get better. We hope so too.

On Friday Nana and I had lunch with W (a high school friend of my mother) and his mother (Mrs. S). The two mothers seemed to bond immediately. Perhaps they can understand each other because they both have trouble with sight and hearing. At one point I saw Mrs. S touch Nana’s ears. Nana has hearing aids that fit totally inside her ears. Mrs. S has the old fashioned kind with a battery pack attached. It was a very nice lunch for us all.

Oct 22, 2004
Today I took Nana to get her hair done. When she came out and got into my car, the car would not start. The battery was dead. B&B Auto Repair could not come to get my car. So A (my aunt; my mom's sister) rescued us. B&B will pick up my car tomorrow. A took Nana to see Barney tonight. A said that Nana and Barney were just glowing. Nana thought that he looked a little better tonight. It is a shame that we can’t get them together more often. Those two really love each other. Barney still has many medical problems, but I am glad to hear that he was feeling a bit better tonight.

September 2004

Depression is one of the hallmark features of Alzheimer's Disease. These emails highlight my Nana's early stuggle with depression over her loss of vision and independence.

Sept 2, 2004
Last night Nana’s mood had changed. She said that she wanted to learn more about what acupuncture was. Today she is back to saying that she thought that she would stay in bed all day because there was not any reason to get up now.

Sept 20, 2004
Nana is doing OK. She swings between eagerness to go somewhere and depression where she says that there is no reason for her to get up each day. The good news is that a small amount of vision has returned. Perhaps that is why the doctor who did the cool laser surgery told her to come back in six weeks. Perhaps it takes that long for the eye to stabilize so that she can be given glasses to maximize the vision that is left. A (my aunt; my mother's sister) and I are trying to take her places. On Thursday I took her to get her hair done. On Saturday A took her to the drugstore and to the A&P. On Saturday night A is having a birthday dinner for R’s mother

Barney is out of the hospital and the rehab facility and happy to be at home again. He is not driving yet, so we have not seen him. But Barney and his son S are both invited to A’s on Saturday for the birthday dinner.

August 2004

I received these emails from my mother in August of 2004 about her experience living with Nana. I've redacted all names except my Nana's. It is my feeling that my Nana's loss of vision and independence accelerated her decline. She is understandably frustrated in these early emails. I cannot imagine how difficult this experience must have been after more than 80 years of being self-sufficient.

Aug 22, 2004
Nana has been having serious trouble with her vision. She can’t see her doctor until next Wednesday. She is hoping that the problem is just a cataract that can be removed. Until then, she can’t drive or play the organ. She is not a happy camper.

Aug 23, 2004
They put down rat poison about ten days ago. I have not seen or heard any rats lately. It has been a real battle to get Nana to put food away. The other day I found three Ritz crackers with peanut butter on the counter. When I asked her about them, she said that she planned to give them to the dog later. Peanut butter is what they put on the rat traps. She just has left food around all her life. She does not think that it is important. So I guess that I will just have to keep putting it away for her. She has no plans to change at her age.

Nana’s vision is more of a concern. A (my aunt) is taking her to a specialist at the moment. She couldn’t get an appointment with her regular eye doctor until Wednesday. I do not know if it was a lack of good communication skills, or if the girls at that doctor’s office were just being difficult. Nana’s vision seems to have become very poor in just a couple of weeks. She thinks that it is a cataract. But I have never heard of a cataract problem getting so bad so quickly. I will let you know as soon as we hear anything new.

Aug 23, 2004
It appears that Nana has macular degeneration in both eyes now. About three years ago when Nana was first diagnosed, the doctor told her that there was no treatment for the problem. Today she was told that there is treatment that is still experimental. But at least there is some hope now. A will take her back on Wednesday for an office procedure, and to JFK Hospital next Monday for some laser treatment. When Nana told the doctor that she would have to quit her church job, the doctor winked at her and told her not to do that yet.

Introduction

This blog is dedicated to my maternal grandmother, Nana. I had the good fortune to live with my Nana and Pop between ages 4 to 11. They were an amazing couple who first met when they were about 5 years old. Even after 50 years of marriage, they still had regular date nights and held hands often. They did everything together.

I have many small memories of my Nana. She burned hamburgers and just about anything else she tried to cook. She often went on diets consisting of a hamburger patty and cottage cheese, long before anyone had heard of the Atkins Diet. She took mega doses of vitamins and ate grapefruit long before it was faddish. She saw auras. She always had birds - parrots, lovebirds, cockatoos, parakeets. But she got rid of a favorite cockatoo, who had bonded to her, when it bit me to the bone one visit. She taught me to play Rockmaninov on the piano before my hands were big enough for the chords. Most importantly, she taught me it was OK to be quirky and that one's manners were much more important than one's looks.

My Pop lost his battle with COPD and congestive heart failure on November 22, 2003. It is this moment that I believe started my Nana's decline or at least made it more noticeable. She worked full time teaching piano and organ from her home as well as playing music for churches and funeral homes until she began to lose her vision to macular degeneration in 2004. It is not many who can say they had successful careers into their mid 80s.

My Nana had a brief interlude of joy after my Pop's death when she reconnected with Barney, a childhood friend who lost his wife within a month of my Pop's death.

My mother, who lives with Nana, has been emailing me with stories of Nana for the last few years. It is amazing to me how Alzheimer's disease creeps in. The signs have been there for years, looking back at these old emails, but it is really only recently that it has begun to impede her functioning and interactions with others. Unfortunately I am missing some great blocks of time where the emails have been lost. Even so it should be possible to see the slow loss of function and the oddities of behavior.