Category Archives: Alzheimer’s Spouse Issue

Moment of Reflection: Where We are On Our Alzheimer’s Journey

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Last week I had the opportunity to speak on a panel about caregiving in to a group of nurses and nursing students at Emory University in a conversation titled Lived Experiences in Coping. The other two members of the panel, the wife of a man with Parkinson’s and a woman who has MS, were actually nurses themselves so I was a bit intimidated at first, but I think I held my own (although I fear I went beyond my 15 minute time limit). And it was a fascinating morning as we shared perspectives and answered questions from the professionals who asked over and over what they could do to improve the care experience.

As valuable as the meeting was, what was most useful to me was the preparation. In the invitation to speak I was asked to discuss how we arrive at Ralph’s diagnosis, and how the news and illness trajectory have affected my and Ralph’s lives.

Not surprising questions or ones I haven’t thought about in the past, but ones I have avoided thinking about for a while. I used to take stock regularly to keep perspective, but lately it’s been easier (i.e. less scary or anxiety producing) just to rock along day by day without considering the long picture and the implication Being asked to talk at a symposium forced me into that area of necessary discomfort.

So what I jotted down:

Diagnosis came in 2013. Before that I didn’t want to think his memory problem was serious in part because his failing memory coincided with a personality change I liked. In fact I realize that for those few pre-diagnosis years we were in a SECOND HONEYMOON—he was less angry than he had been as a younger man and a sweetness emerged that he had not shown before. If he was secretly stressed, I didn’t choose to notice.

Then for maybe six months before the diagnosis, Ralph went from forgetful to what I found at the time annoyingly inattentive. I thought he wasn’t paying attention when I had to repeat things over and over. And he was often argumentative at night, so we went to bed angry at each other, but while I’d wake up still angry, he’d wake up denying there’d been any friction the night before. But still we were closer than we’d been for years.

Then his memory tripped him up more obviously—I have written about the fishing trip that made him realize something might really be wrong because he couldn’t keep up with the other guys—and he saw our family doctor who sent us for tests. Ralph and I were convinced he had Lyme’s disease.

Between taking the tests and learning the results we went from honeymoon to LIMBO. In real time I am only talking about a month or two from test to first diagnosis and another three months until we saw Dr. Lah at Emory’s Brain Clinic. But the period felt much longer—one of those crucial moments in time that stretches as if time has slowed down to allow for the heavy significance. We didn’t know much about Alzheimer’s. We were both anxious. Neither of us knew exactly what to expect but we were talking about it A LOT. I remember a car trip, six hours talking away, feeling oddly close as we faced an uncertain future together, both of nervous but open and oddly upbeat. The ride was actually kind of fun.

Then we got the diagnosis and went from Limbo to PURGATORY. One day he was one person, the next he was someone else. Not that his condition changed, but one it was NAMED, it was much more scary. Suddenly he was terribly, terribly anxious and suddenly I felt the need to limit plans, to take over his business (and close it), to act as a buffer between Ralph and all the people who didn’t know he had an actual condition that was causing him to act certain ways. Purgatory lasted for a long while. He seemed to slip dramatically and then, once he began his drug regimen, he regained some ground, only to slip a little more over time. His memory did not get worse—it was already terrible in the first tests—but slowly other aspects of the Alzheimer’s spectrum showed up, like passivity, lack of time awareness, loss of sense of direction, withdrawal from the world, and a general malaise along with the frankly beneficial loss of memory of all arguments and disagreements as he embraces those with whom he had fallings out. My symptoms as caregiver also showed up—greater impatience and loneliness balanced by a kind of desperate energy and new to me gregariousness as well as moments of patience I didn’t think I could manage.

For a while now, we have been on a PLATEAU. Ralph has been holding steady more or less. Some days he’s more with it than others. But I can’t really see much difference from week to week.

The big difference is in expectations. It’s not that I have bad ones. Or not exactly. I have none at all. The rule of thumb is that Alzheimer’s progresses, but the rate is so varied that I have no clue how it will progress in our case, what route it will take or how long. But I do know that when we move from this plateau, the next stage will not be good.

Alzheimer’s and Nurturing Men

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I was picking out apples at the grocery story yesterday when I noticed a woman having a kerfuffle over by the oranges. After she knocked over a small display, her husband rushed to her side and gently steered her away. As I picked up the display, I couldn’t help watching how he spoke quietly to allay her anxiety and confusion. Walking walked past him on the way to the spinach, I whispered, “You are a lovely man.” (To be clear I was not being flirtatious and he was definitely not lovely in any literal sense.)

A few moments later we found ourselves standing together by the avocados. I explained to him that I spoke to him because I wanted to make sure he got credit for the nurturing way he dealt with his wife. I said I understood his situation as a spouse caregiver myself. The look of calm that washed across his face was different that gratitude or relief, was closer to what I imagine war veterans must feel when they connect. We talked for maybe a minute or two and then I moved on before he could see that I had tears in my eyes.

One of those brief moments that reverberate and reverberate.

But it got me thinking, not for the first time, about how much harder it may be for husbands than wives, at least those of my boomer generation. We were a generation who adopted feminism but were not born to it. There was a lot of intellectualizing about women and men’s roles, but there remained an emotional pull to the way we were raised. The men, however “progressive” or “liberal” or even “radical,” paid lip service but under the surface, our roles only shifted so far.

So men now in their fifties, sixties and seventies with wives who are struggling with impairments are having to learn to nurture the way women in similar situations have known how all along. And men like my grocery store friend are stepping up. I am amazed at their openness about how hard it is and their willingness to go all out. Frankly they often seem more open and more willing than I am.

Like many a good feminist of my generation I have never been above a little vicious, resentful man-bashing, let alone husband-bashing. But this is my little shout out to the guys. We are all in this together.

Alzheimer’s Benefit–Exposing A Goodness Quotient

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I am prone to cynicism in general. And like a lot of people, I have been more demoralized by the state of the world than usual lately. So I am a bit surprised to find myself celebrating what, for lack of better phrase, I’ll call the goodness quotient in human beings.

Martin Luther King Jr., Gandhi, Anne Frank, Nelson Mandela, Saint Francis—their lives are awe-inspiring and intimidating in equal measure. They have had their human imperfections here and there, but few of us aspire to their level of goodness. At least I never have. (In fact, I admit to spending MLK Day sitting around the house when I should have been out volunteering.)

But after reading the recent spate of articles surrounding Reverend King and John Lewis as well as a post entitled Gratitude in the Land of Dementia on the blog One of Life’s Little Surprises, I am struck by a reality that I seldom consider, the capacity of so many “normal” people to help others.

In particular, how do so many people find themselves able to accept challenges and responsibilities they never imagined they would face when their loved ones became increasing cognitively impaired. Why don’t they walk away (as I am often tempted to do from a so far less difficult situation)?

Individuals may answer, “I love my husband/ wife/ mother/ father/ sibling/ friend/ partner;” but that’s not it, not in any conventional sense. Of course I can’t speak for anyone else when I acknowledge that whatever emotional chemistry existed between Ralph and me before his diagnosis—whether the early passion or deep marital affinity—has definitely altered since his mind and identity have altered along the Alzheimer’s spectrum. I suspect the same kind of alteration has occurred between other caregivers and caregivees.

So, what specifically is the mix of loyalty, generosity, duty and sympathy/empathy that makes so many of the caregivers I’ve run across (who know who you are, Mary, Nancy, and all you others) tick?

I certainly don’t have an answer, but it is heartening to realize that when faced with the challenge, a large number of flawed, normal people are capable of being kinder and more caring than we expected of ourselves

Alzheimer’s Friendship

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Last week I had lunch with a new friend.

A month or so earlier I received an email from E responding to a post. She mentioned that we once met at a support group meeting run by the Emory Brain Center. I didn’t recognize E’s name so wasn’t sure who she was; because of the distance involved, I attend the support group infrequently at best and haven’t been back for ages.

But as soon as I saw E in person, I remembered her. I remembered sitting across the conference table from an attractive woman whose name I didn’t catch and thinking  she is really angry—angry and exhausted—and what’s more, she’s willing to admit it! She had recently convinced her husband to downsize their home, only to realize in the selling, packing and moving that her husband was more incapacitated than she’d realized. Scrunched down in my seat, listening to E talk so honestly, I recognized that I was not facing my own complicated mix of anger, stress and protectiveness toward Ralph. E’s directness and her honesty were a truly liberating epiphany.

Now here we were over a year later, sitting in a café catching up, and as E said, it was “like looking in a mirror.” Our husbands had different careers but in many ways we shared similar lives before they were diagnosed with Mild Cognitive Impairment within months of each other and began seeing the same neurologist at the Emory Brain Center. Now both men are enrolled in the same Merck study I have written about . They both are devoted to their dog. And E and I are both…. Well, we are that same complicated mix of stress and protectiveness.

As E and I sat and talked over our salads last week One of us would begin a sentence and the other would be able it finish it. We didn’t have to sugarcoat, we didn’t have to explain. The words poured out. Being with E was so relaxing.

We lingered and lingered and then we went back to E’s house and talked some more. I drove away almost giddy with excitement, the way I felt at ten or eighteen when I met a new friend.

When Ralph was first diagnosed, one of the vows I made to myself was that I was going to maintain my life, that I would keep my friendships. And I have. In fact I have a larger circle of friends and more active social life than I used to. I have worked at building a network, professional writer friends, volunteer organization friends, political friends, literary friends, movie going friends, fun and conversation friends, family friends.

And online friends through the Memoryland community—and it feels to me like a community—along with other caregiver/caregivee blog communities.

Now I have an actual Alzheimer’s friend.

Taking Stock For Future Reference

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In preparation for Ralph taking part in testing of the new Merck anti-plague drug, our nurse at the Emory Brain Center  asked me to make a list for the nurse to show Ralph’s current baseline. Of course, I put it off (just as I often put off writing here because it means facing stuff I may not feel like facing). But now  the list is done and it seems worth sharing.

WHAT RALPH CONTINUES TO DO:

Make small repairs around the house when asked; Pick vegetables and do light farmwork when asked; Take his meds on his own from his filled weekly pillbox; Make his own cold breakfast and lunch; Make coffee as needed; Use the microwave; Buy beer at the convenience store; Feed the dogs daily; Drive around the farm in his truck to “walk” the dogs; Dress, bathe, shave etc on his own; Talk on the phone at length to his sister and oldest son; Attend his art class; Walk occasionally on a farm path circuit; Watch nightly news and Jeopardy over dinner; Listen to NPR on the radio; Read quality full length books of fiction and non-fiction; Use his credit card (as long as no tips are involved); Pay cash for small purchases; Cut his own hair ; Turn on the gas grill and change the gas canister when needed; Interact socially with people who visit or whom we visit; Fish from a dock; Clean fish he catches; Share stories from his childhood; Offer witty one-liners out of the blue; Analyze a situation/problem presented to him and show insight even though he forgets his analysis (and the problem) shortly afterwards

WHAT RALPH CAN’T DO ANYMORE:

Pay attention to business or financial matters—important since his professional life was all about real estate investing and managing; Use the stove; Use the grill although he does turn it on when I ask; Drive on his own except those places noted above or under duress and if I am there to give him directions; Use his boat; Hunt ; Go to movies—says he finds them “boring”; Watch narrative television dramas or comedies except on rare occasions; Listen to music on his own; Keep up with or show interest in family and friend activities; Remember details of relationship history with friends

 

WHAT RALPH MAY OR MAY NOT DO:

He may still be able to play guitar, but shows no interest; He says he can drive tractor (and was told it would be ok by Stephanie) but avoids doing so.; While he goes to art class, his output has greatly diminished; he spends most of his “painting” time sitting in his office smoking and listening to talk radio; He claims to take walks but I have not witnessed him walking

 

RALPH’S TEMPERAMENT CHANGES:

Extremely passive—used to be extremely assertive; Never gets angry—used to be hot tempered; Without curiosity—used to be extremely curious and factually knowledgeable ; Emotionally totally focused on his dogs; Less outgoing but more jolly most of the time.  

I kind of love having this information down in black and white and red and blue and green.  In a year or two or five, I will look back at what I recorded–whether with relief that the Merck pill has worked to keep Ralph at his current activity level or in bittersweet nostalgia for this time when the Can Dos on Ralph’s list are several lines  longer than the Can’t Dos and Maybes list combined. May it stay this way for as long as possible.

 

My Car Is My Caregiver

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Dear Red Prius,

My first car was a bright blue sedan that I drove to Atlanta when I was 22. I don’t remember the brand, only that I hated how visible it made me, especially since I was not the best driver.

I traded the blue bomber in for a used telephone “van” that had been refurbished by Ralph—his first entrepreneurial venture was buying and fixing  up used phone trucks, then selling them to counterculture types like me; the streets of Midtown Atlanta were full of Ralph’s trucks in the early 1970s.

The brakes went out on my van a week after I bought it. I was rounding a curve and ended up down an embankment. Fortunately I wasn’t hurt. Naturally Ralph felt terrible. He helped me fix the van and sell it.

(Actually, Ralph disputes my car history, says I got the blue bomber after the truck disaster, and he may be right. In any case I don’t remember what I drove next.)

We got married five years later, and for the next multiple decades I drove a series of practical, second-hand sedans (with baby seats), SUVs (for carpools and horse-trailering), and (once the kids were gone) compacts. They were all non-descript, aside from the dents I added, and I could care less.

A year and half ago, though, I got you,  Red Prius. I bought you for practical reasons like gas mileage and comfort, etc., and I admit that I chose your red color because you were cheaper than the silvery blue model.

The irony is that these days what I love most about you is your color. It makes you  So Visible, so easy to spot among the sea of tans, blacks, grays and whites on every road and in every parking lot.

I often find myself writing here about the difficulties, the frustrations, the borderline depression care-giving causes me. I think one of my secret worst fears is that my memory is going too. I said this to a friend recently and she laughed, “But Ralph isn’t contagious.”

Maybe not, yet I often feel as if my brain is clogged with the details of thinking for two. An adage of care-giving is that if we are tense or irritable, our cognitively impaired spouses (or parents) sense and react in kind. The flip side is that I am vulnerable to catching Ralph’s anxiety, and when I’m anxious my brain does not function at its best.

Lately I have an urge to simplify: the less I have to worry about the better. Less stuff means less stuff to keep organized and clean without Ralph’s help. Fewer commitments mean fewer complications to arrange for Ralph. But I also want to stay active and involved. Simplification can be a slippery slope that I don’t want to begin sliding down too fast.

Red Prius, you have been a godsend. It takes one item off my overloaded mental table—no more walking out of the supermarket or doctor’s office or bank or lawyer’s meeting or movie theater or restaurant or political meeting worried where I parked. One glance each way or a click of my key button and there you are, Red Prius, brightly reminding me that I am in control, at least to the best of my ability…A small comfort maybe, but it’s the small comforts that count.

So thanks for making my life better Red Prius. I promise to take care of you as well as I take care of Ralph.

Gratefully,

Alice

 

ALZHEIMER’S CALENDAR GIRL

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For everyone who has MCI or Early Alzheimer’s or who lives with someone with these forms of loss THE CALENDAR IS KING (QUEEN).

You don’t have to have memory loss to have trouble keeping up with scheduling complications of course. Dental appointments, meetings, pick up times, they all swirl through our lives and seem to swirl faster now with the advent of electronic calendar keeping. In fact my highly intelligent, mentally acute son texted me two weeks ago to arrange when he would pick me up from the airport that day, only to have me tell him I wasn’t arriving for my visit until a week later. LOL. Haha.

Still, driving Ralph home from his dental appointment yesterday morning, clutching the little card that noted the dates for his next two appointments, repeating to him the dates fifteen minutes later as I wrote them down on our big kitchen calendar, then again last night when he asked, and again this morning when he asked as soon as he woke up, it struck me how much of our daily life now revolves on what used to be a taken for granted detail.

In my first support group for dealing with newly diagnosed Mild Cognitive Impairment at the Emory Memory Clinic, there was discussion of calendar keeping—one man explained that he printed up a schedule daily for his; others had taken classes in calendar keeping—but I didn’t pay much attention. At the time, Ralph, who in his business life was always a stickler for keeping precise calendar records, still carried around his mini-notebook calendar. And frankly his life was not so busy that I thought it would be hard to keep up.

Well, his life is less busy now, so keeping up is not exactly a problem. He gets everywhere he needs to. But keeping track has become an obsession, really for both of us. As soon as there is something coming up, whether a dental appointment or a dinner date, or any other minor routine change of plans, the discussion of WHEN becomes endless. As usual the underlying issue is anxiety. But I think the matter of keeping up with days and calendar dates dominates over every other issue in our lives right now.

I gather many caregivers of those on the Alzheimer’s spectrum, especially spouses and children, deal with this WHEN problem. I am never sure I am dealing with it as well as I should but we muddle along. We have an erasable board that tracks the weekly schedule. And we have a large book calendar that I found at Office Depot; I looked at every one in the store and the best one for our needs includes a monthly at a glance as well as the weekly at a glance. And frankly his week-long pillbox is the best reminder of all what day it is.

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Ralph will take his pills and then, sometimes go read the weekly calendar. He rarely looks at the big calendar, but once in a while it comes in handy for him to get a time line straight. He does not have a calendar on his phone and has never learned to use a computer.

The fact is that Ralph doesn’t need to know what day it is most of the time. And he doesn’t need to know when his next eye doctor appointment is ahead of time. But he often wants to know. And then wants to know again and again.

As for me, I am having a little trouble letting go of my need to have him know things ahead. The marital habit of talking about the details of an upcoming birthday party, a worrisome doctor’s appointment, a visit from or to our kids, is hard to break. And I have not solved the basic conundrum:

Does bringing up what is coming up days or weeks ahead creates unnecessary tension for Ralph and is it a waste of time anyway since he won’t remember? Or does carrying on a conversation about future events, even if it means carrying on slight variations of the same conversation many times, have value in maintaining Ralph’s involvement in his own life whether he remembers or not?

PANIC ATTACK! (mine)

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IMG_0342It is 3:57 and I am wide awake thinking I may have screwed up royally this time.

We are at our vacation cottage in North Florida (actually a garage apartment with no house attached but that’s another story for a another time). We got here around seven this evening after a rough day. I had risen early to bake brownies for a baby shower I was co-hosting at a friend’s house . While I was at the shower, Ralph and my 12 year-old granddaughter loaded our truck according to my checklist. When I got home at noon, I quickly cleaned the brownie pans, went over the checklist, packed the coolers, and into the truck we all jumped.

It was a long drive of especially after we received a couple of texts from our daughter and son-in-law who arrived in Florida the night before.      1. They texted that the garage was infested with fleas and they had set off a flea bomb.          2. They  mentioned that Ralph’s boat motor seemed to be missing a part.

So Ralph divided his fixated attention between the fleas and the motor, asking me questions I couldn’t answer on one issue, then the other for five hours. Thank God for the car games my granddaughter insisted we play. I have never enjoyed Ghost and Twenty Questions so much.

By the time we reached the cottage I was exhausted. We had a quick, late dinner before I unpacked and went to bed at around 11:30.

About an hour ago I sat up wide awake

—Ralph’s doc kit? The kit where Ralph keeps his toothbrush, his razor, his e-cig charger and his Alzheimer’s meds. The thought of it had pulled me out of my deep sleep.

Or rather the thought that the kit wasn’t in the black footlocker when I unpacked it. So I tiptoed barefoot down the narrow stairs and outside to the truck. One carton of diet soda left under the back seat, but no doc kit.

Which brings me to now.

My mind is racing: Ralph and my granddaughter said they had packed it when I went over the check list but why did I take them at their word. Ralph can’t miss his meds for five days, that’s the bottom line. It’s the wee hours of Sunday morning. Can he miss a day until I can get his doctor to call in a prescription Monday?

Up pops the angry question, “Why can’t Ralph remember one thing!” followed by the obvious answer, “Because he literally can’t remember.”

So it is my fault.

Why didn’t I check the truck before we left? When am I going to learn not to take Ralph’s assurance he has remembered as actual assurance? When am I going to accept that I have to check and double check behind him? When am I going to realize that I need to pay attention to Ralph’s needs with more undivided focus?

  This trip is going to be a disaster!

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Nine A.M. Sunday morning and guess what—

Disaster Averted. My wonderful, adorable granddaughter did follow the check list to the letter. She did put the doc kit is in the truck after all. It was lying on the floor by the front passenger seat where I guess I didn’t look carefully enough last night.

I am the one who forgot. I am the one repeating myself this morning. “I am so relieved!” “I am so relieved!” I am giddy with relief. (But really, I should have double-checked the truck before we left, and will not make that mistake again, for my own peace of mind as well as his well being.)

Now, if it ever stops raining, we might just have a good time…

 

 

Taxes + Alzheimer’s =Anxiety x Ten

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We were due a nice refund on our tax bill this year, but a few days ago a letter came from the IRS saying they would be “reviewing” our return before any payment would be sent or further action was taken.

I emailed my accountant, “Assume this is routine but thought you should know.” Less than a minute later she emailed me back, “This is not routine, but I’m not saying you have anything to worry about.”

Yikes. I have been through an audit and it was not fun.

The next day I received another letter, with a form to prove Ralph and I are really the ones who filed the return. So now I am trying to convince myself this review is part of the government’s crackdown on fraud returns and that the IRS doesn’t want to send our check to the wrong person.

But of course I am a nervous wreck.

I share this TMI (I know I know; talking about money is a turn off) because I cannot share it with Ralph.

And as I type the words “talking about money” I realize such talk is in fact one of the more intimate aspect of a marriage and that Ralph and I did a lot of such talk, weirdly enough, with gusto. Weirdly because money should have been a sticking point; he came from a working class family always on the brink of financial disaster while I was a pampered daughter of the bourgeoisie. He was a self-proclaimed capitalist, I was a righteous democratic socialist. But although as I’ve written here before, we argued about most things—childrearing, politics, how to spend our free time, where to live, what to eat, making friends, you name it and we argued—we seldom if ever argued over money. Money we discussed rationally.

We were in agreement that Ralph was the one with a talent for earning money, I was the one with patience for nuts and bolts bookkeeping. He went with his gut instinct. I played devil’s advocate. We could while away hours, days, TV seasons, analyzing a financial decision together. Even than nightmare audit was not a cause of tension; we were in it together, like partners in a school science project we discussed endlessly.

But I can’t talk about money issues with Ralph anymore. It’s not that he drives me crazy asking the same questions repeatedly (although he does) or that he might bring up a financial question at an inappropriate time (although the other night our dinner guest blanched when Ralph asked how much we had in the bank in front of her).

It’s that the anxiety of financial decision-making is more than Ralph can or wants to handle. He’s made it clear he doesn’t want to know too much but wants to feel secure. So I give him the basics and repeat them as often as necessary.

But knowing there is a difficult decision to make or a real problem (because I’ve foolishly spilled the beans) spikes his anxiety and the issue gets lodged like a loose widget in his cognitive gears. He can neither grasp it nor let it go.

There’s been no value in putting him through that pain. And selfishly, re-explaining a problem every time he returns to it has usually raised my own anxiety even higher than it is already. So I am keeping this new financial glitch to myself.

If this all sounds dark and self-pitying, there is an UPSIDE of sorts. As I teach myself how to think about money and compartmentalize that thinking, I see more clearly than ever that money, while necessary, is never the end in itself. As Ralph now jokes, as long as he has five bucks in his pocket and me on his arm, he’s happy.