Tag Archives: Alzheimer’s Routine

Alzheimer’s Weather Has Arrived in Time for Xmas

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“Do you have the AC on?”

“No it’s 72 degrees on the thermostat”

“It’s freezing in here.”

“You might try putting on a sweater.”

“Why is it so cold.”

“It’s only 65 degree outside.”

“That’s cold.”

“It’s December. Christmas is in four days.”  

“It is?” (Our house has two Christmas trees and an advent calendar the grandkids come and mark daily)

“It was not this cold last year.”

“Yes, you complained last year too.”

“No I didn’t.”

This conversation has actually occurred in some similar form for years, here in New Orleans but also before at the farm. One of Ralph’s earliest symptoms of cognitive loss was his weakening sense of time and another was his sensitivity to the weather. In the summer he complains of the heat unendingly—while often wearing a flannel shirt. And in the winter, he cannot get warm—while ignoring the sweaters in his closet.

I have not always been as patient as I could be during these repeated conversations, but I finally have made an adjustment in our lives that might help. After resisting covering our beautiful old French windows for selfish aesthetic reasons, I have ordered solar shades for the room where Ralph most often sits. And meanwhile it will be warming up here in time for Christmas, although the temperature might not stop Ralph’s discomfort or this conversation.

As for the holiday itself, I am not sure how it will go. Now that I’ve adjusted to Ralph’s move into “moderate” Alzheimer’s, I recognize that that this may be a period in our lives that I will be nostalgic about someday because while Ralph’s cognition may be diminished, he is also undemanding; as long as I don’t set expectations too high, our day-to-day life is not that demanding —as long as Ralph’s routine is not disturbed and he can stay within its narrow confines. But Christmas is going to disturb his routine big time, 

My son and son-in-law are arriving tomorrow with their negative tests in hand. So are my sister and her husband. Everyone is coming, despite the new covid risks, largely to see Ralph, not sure where Alzheimer’s will have taken us by next Christmas. This year will be in untraveled territory enough. As recently as two years ago, our last full scale celebration, Ralph was tstill he center of our big, raucous Christmases, while I cooked and cleaned in the background. 

Now all he wants is to be left alone and he can’t remember that it is December even as I ask him to water the Christmas tree. My guess is that even when the family gathers, he will prefer not to participate. 

And that will be okay too. 

Marking Ralph’s Alzheimer’s Six Years In

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Ralph usually has his annual cognitive check-up in July, but not this year. Because of Covid we have yet even to meet with our new neurologist.  After several rescheduling, our telemed introductory appointment is now set for the end of August and obviously won’t include intensive testing (at least I hope not—Ralph testing by phone would be a nightmare; zoom is going to be challenge enough).

Gauging where Ralph sits on the continuum these days is not easy. Between his hospital stay and slow recuperation, the long preparation for our relocation, the actual move one day before Louisiana went into quarantine, our new home/life under Covid, and Ralph’s anxiety in adjusting, not to mention my own, I have lost perspective. 

Last year’s check-up was uneventful, so uneventful that I wrote no more than a sentence about it in my journal. I had been concerned that Ralph seemed a little fuzzier in daily interactions but he scored pretty close to what he’d scored the previous years. We were assured he was maintaining a steady but unusually slow progression.

By then I was already house-hunting, and our practitioners felt we were moving at exactly the right time, with Ralph was still able to adapt and adjust to a new place.  I remember discussing that I should teach him the route to the nearest stores and coffee shop, then make sure he carried good, explanatory ID and introduce him to storekeepers and others in the neighborhood so they’d know his situation in case he got lost on a cigarette run. 

Fat chance. In the five months since we moved here, Ralph has taken one brief walk with me three blocks around the corner and back. Cigarette runs are unnecessary because he has forgotten smoking all together, thank goodness, and he has absolutely zero interest in leaving our porch. He has been to dinner at my daughter’s house once, seen his internist once and been to a hospital lab for blood tests once. Otherwise he has been in the house. We did spend a week away with my daughter’s family at a house with a pool to escape the heat, making no stops on the way and never leaving the house once we arrived saw how few others were wearing masks; Ralph enjoyed watching the rest of us splash around though he didn’t dip a toe in the pool himself, preferring to follow his usual routine of wake, eat, nap, eat, nap eat, bed.

But does his increased inactivity mean anything under the circumstances. He seems to function fairly well as long as he sticks to his rote routine, which is not that different than it used to be. The big change is swapping in BoyRalph visits for cigarettes, a clearly positive change. 

The less positive changes are all in the gray, hard to decipher margins.

He has never returned to a life list. He had been getting sloppy about following it and then he was so out of it during his recuperation from the blood infection, and so helpless.  Now I don’t trust him to mark thinks off. Or remember where the list is Or maybe the truth is that I find it easier to give him his pills myself, to tell him to shower, to track his meals that I would to nag him about the list plus the actual behaviors it tracks. He can still make a sandwich for himself at lunch but often asks me moments later if he’s eaten yet. I’ve also taken over feeding his dogs, a minor chore he used to like but never thinks about now. I worry that I’m coddling him, but then I try to stretch his world by asking him to do a minor chore like takeout the recycling and he gets slightly but noticeably befuddled.

He hasn’t paid attention to the world for a while, but now he seems to have lost his visual acuity a certain ability to react and judge. I’ve been filling bookcases the last few days and he doesn’t notice the difference between objects arranged on a shelf or placed there helter-skelter to get out of the way. In some ways those shelves are like his thought process, a random organization of discrete thoughts. He doesn’t always button his shirt correctly–true, neither do I on occasion, but then I am mortified; he could care less. 

But I need to take into account that everyone’s memory is worse these days. Everyone is a little depressed and a little disconnected.  A little spacier than usual. A little sloppier. Where does Covid Brain stop and Dementia begin? 

Thinking about that way, I tell myself that nothing I’m describing here about Ralph sounds that much worse than a year ago. But it is worse. I just can’t articulate or even pinpoint the deeper shift–a letting go, a deterioration. Not only of remembering but in comprehending. Conversation is gone which is sad. More depressing, so is my trust in his reasoning, in his ability to care for himself, to think clearly. Less than a year ago, I was able to leave him with his life list for days at a time. Now I am afraid to leave him alone in the house for more than an hour or two.  I’m afraid that is a marker more important than any test. 

AM I TOO TOUGH ON RALPH, OR NOT TOUGH ENOUGH?–THE MCI/ALZHEIMER’S BALANCING ACT

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dirty dishesRalph has been skipping the last item on his daily lifelist: putting Lola in her kennel bed before he goes to bed at night.Obviously this is a small issue and I am capable of putting her to bed instead. But I don’t want to. For one thing, I like not having to do it myself, like being off duty all together for an hour or two before I go to bed. More important, I like the idea that Ralph contributes, however small the gesture, to the practicalities of our life together.

The thing is, maybe I need to face that Ralph is no longer capable of remembering to put the dog to bed at night. Maybe his cognitive energy is used up by seven pm and I should not nag him the way I do now (and yes, sometimes if he’s still awake reading in bed, I make him get out and see to Lola).  And this realization makes me re-considering what I should be expecting from Ralph.

Never mind big tasks like running the tractor—our tractor crisis two years ago will never reoccur because Ralph avoids messing with the tractor at all now; thank goodness I have found someone who not only runs it but also can maintain it.  As for medium tasks, like changing light bulbs, I don’t expect Ralph to carry them out any more although once in a while he’ll surprise me like the other day when he was able to attach the propane tank thing to the grill (although he couldn’t remember how to turn on the grill itself).

It’s the small tasks that I’ve been counting on for normalcy. But can I really? It is not that Ralph is unwilling. If anything, he is more willing to than he was in his prime when he downright refused to pitch in any time he found it inconvenient. Now if I ask him to take a turn making coffee, he agrees. If I ask him to help bring in groceries, he agrees. If I ask him to help clear the dishes he agrees. He is happy to help.

But, and it is a big BUT, his ability to follow through can be haphazard. He’ll agree but immediately forget and I’ll be annoyed. While counting to ten I debate in my head whether to nag him or let it pass. Or he’ll agree but do the job halfway. Or look at me with a forlorn expression. The other day when I asked him to unpack his small suitcase after a weekend trip to visit friends (a trip he enjoyed immensely although I dragged him there against his wishes), he gave me that look Unpack a suitcase? Put my socks in the sock drawer? I quickly backed off but he caught my look back and asked outright, “What, you don’t think I can unpack?” “Of course you can.” So he unpacked. But none of the clothes ended up where they belong.

Again, not a big deal. And not that he doesn’t ever follow through, not that he doesn’t sometimes surprise me with his competence, the same way he sometimes surprises me by remembering a conversation I assume he’s forgotten. But there are so many other examples of disappointment. So many times I get annoyed because he doesn’t follow through. So many times I wonder Should I trust him even to try a task he seems reluctant to try? Is he unwilling or unable? So many times I wonder Am I being too tough? Am I being too coddling?

Of course, I am being both and neither. I never seem to calibrate the right balance because there isn’t one. Although Ralph appears more capable and competent some days than others, I have to face that his brain is going through its own climate change, a melting away sometimes indecipherable but undeniable. 

 

 

 

Care Giver of Care Partner?

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Gerontologist Elaine Eshbaugh’s recent post The Complicated Dynamics of the Care Partnership on her blog Welcome to Dementialand, offers a nuanced consideration of what she calls “the care partner relationship.”  I have been trying all week to get my head around the concept. I can’t say I’ve succeed, but Elaine’s piece sure has got me thinking about Ralph and my interactions.

To be honest, the first paragraphs, in which she described public advocacy by those with dementia as “the most exciting development in the field of dementia,” did not grab me. I’ve never been comfortable with the narrow focus of advocacy for specific diseases, including ones that have directly touched my life like heart disease and breast cancer, given the big existential issues like climate change no one is facing. And Ralph definitely has no interest in advocating or joining any kind of Alzheimer’s community, and the word dementia is not a term he embraces at all

But then Elaine wrote this:

 

In some circles, we are replacing the term “caregiver” with “care partner” to identify the partnership that develops between the person living with dementia and those who care for them.

Yes, it is a partnership. It is certainly a shared experience.

But being a person with dementia and a care partner are different roles.

 

I have to think about what I think about this change in nomenclature. Do I think of myself as a care partner? I am not sure. Marriage is supposed to be a partnership. Ralph and I are married. So yes I am his partner. But that is not what Elaine is talking about. Do I honestly feel like a partner? Frankly a lot of the time I feel most like a caring care manager.

But then again, last weekend we did have a moment of genuine care partnership, in the most literal sense.  Ralph recently had minor surgery ago to remove a squamous cell carcinoma on his arm and I have been in charge of changing the bandage daily. Because Ralph’s skin reacted badly to regular bandage and tape, I’ve had to apply the cotton bandaging with paper tape. Paper tape is a pain. I struggled getting it unspooled smoothly the first day while Ralph stood by patiently with his bare arm lifted until I finally got the tape on his skin. The next morning the damn tape was all stuck back together again. I dug at it with a scissor with little success. Then Ralph, whose natural ability for all things mechanical has been mostly dormant for four years, sprang into action and unspooled the tape in a neat single layer. After I applied the tape to his arm, I and was planning to use a q-tip stick to keep it unstuck.

“No,” Ralph said, “Just fold over the tip and it won’t stick.”

“Wow, why didn’t I think of that?”

He shrugged, matter of fact and clear-headed.

A nice small moment, but it would be dishonest to end here because it was the exception not the rule. Well, not exactly the exception. He will also bring me a cup of coffee in the morning if I ask him to. He will punch in my cell number on his phone so I can find mine. He will take the dishes to the counter by the sink. He will come with me to the dump. They are all small rituals that he will perform if I ask. What was different with the bandage is that he took the initiative to come up with a solution. That is the rare event for us.

But again, Elaine writes about partnership not in terms of equal but in terms of shared experience. And yes, living with a husband who is cognitively impaired is a shared experience. But it is mostly me sharing his experience. Ralph’s interest in my experience of the world is limited. Still, lately I have been trying to create more shared experience. I dragged him out for pizza last weekend and then for Mexican a few days later. Both times we had the same conversation.

“Do I have to go?”

“Yes. I don’t feel like cooking and I really think you’ll like it.”

Each time he did enjoy himself immensely.

I have also given him a new “job” to share. On several occasions in the last few months our dog Lola was caught crossing the busy road in front of our farm; so we (meaning me along with Ralph’s niece who was visiting at the time) decided to put in a newfangled GPS electric fence. Training the dog to know her limits is part of the process and requires once of those weird collars. I have added to Ralph’s daily life list changing the collar batter every morning when he wakes up, putting the collar on Lola before she goes outside, and taking it off every night before she goes to bed in her crate. I watch over the proceedings and make sure the jobs get done—it helps that Lola seems to love her collar and stands close to the counter waiting for it.

In terms of serious decision-making and even companionship, I still can’t say I feel in a partnership with Ralph. But even before his diagnosis, our marital partnership was a struggle because he liked being in charge and I had to fight to be heard; now it is a struggle because I am in charge and he is increasingly disengaged.

But these small acts of asking Ralph to share tasks and experiences have worked, up to a point. At least they give us a sense, however fleeting, of participating together in our life.

Stasis Defines this Alzheimer’s Marriage, At Least for Now

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“Stasis (from Greek στάσις “a standing still”) may refer to: A state of stability, in which all forces are equal and opposing, therefore they cancel out each other. Stasis (political history), as defined by Thucydides as a set of symptoms indicating an internal disturbance in both individuals and states.” From Wikipedia

Well Ralph and I definitely fit the definition, which I looked up after one of those small moments that clarify the big picture

 

knox toddlerWhile face-timing with me this morning, BabyRalph threw a little tantrum when my daughter wouldn’t let him hold the phone. As he kicked his legs, my daughter laughed, “He is becoming a toddler.” My emotional reaction was “Oh no, I want him to stay an adorable baby forever.” But of course, I also want him to grow up and am excited by every developmental step he takes. Just now, I had the odd and uncomfortable realization that my wishes for Ralph follow parallel lines, only maybe in reverse.

Ralph has maintained his cognitive abilities on about the same level for long while now, around five years. This plateau has been an incredibly lucky break for us. When I read and talk to other caregivers whose loved ones were diagnosed and then nosedived quickly, I marvel at Ralph and my good fortune.

We still live a mostly normal life, at least on the surface. If anything, Ralph’s routine has hardened and within its walls he functions very well. I keep his pillbox filled, his clothes clean, and his meals prepared just as if I were any wife (well any wife in the 1950s, although my housecleaning and disposition fail the Leave It to Beaver test). He spends most of his day in his “office,” even if all he does in the “office” is listen to the radio and talk to his dogs. So I have plenty of free time to carry on my life. We eat dinner together watching Jeopardy and then he goes to bed.

This is not a hard life. Yes there is the underlying stress of his shot memory and his general cognitive decline, the loss of his curiosity and engagement with the world beyond our mailbox. But really, life could be so much harder. Living with Ralph is now like living with a child who is not going to grow up. Whose developmental steps if he takes any will be backward, toward a kind of funhouse version of babyhood.

As much as I want BabyRalph to stay my snuggly grandbaby, it is fun to imagine him big enough to pull that rake in the picture above. I cannot and don’t want to imagine Ralph’s future. And yet I also have to admit an ugly truth. I imagine what my life will be like when Ralph’s cognitive abilities deteriorate with horror but also sometimes with a kind of relief. The urge to get out of the stasis–which in the case of Alzheimer’s includes both standing still and inner disturbance–is real, even when I know the escape will be to a much darker, harder place.