Dementia Diary – Chapter 11

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December 4, 2022, 12 PM ET

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Shall We Medicate Me Or Thee?

Shall we pretend that caring for someone with cognitive decline is a “piece of cake?” If you know someone who seems to be handling it well, there is much they are not telling you. Let’s talk. Any form of memory loss or Dementia which affects a loved one, creeps into our lives through the back door. It may begin as forgetting things more and more frequently. Most of us have this to some degree. However, when someone forgets the year, or where he/she is going whilst driving, where he parked the car, why he/she was being sent on an errand, the faces of good friends, or which city he/she is currently in” this is a massive hint. It is then time for an assessment by a doctor. A small T.I.A. (Transient ischemic Attack) – which is also known as a mini-stroke may quickly alert us to question our previous assumptions about our health and our memory. Our belief that we can control our lives through, diet, meditation, exercise, prayer, is easily shaken. Even vegans can lose their memory! Warning signs vary from individual to individual. What is “a constant” is that which is waiting to be confronted in the days and years ahead - lots of doctor appointments while the specialists try to resolve the cause of these anomalies. A visit to the family doctor may then result in a referral to a Psychologist, Psychiatrist, Neurologist or Gerontologist. Tests will be done, and conclusions may or may not help one to move forward. The prognosis will range from mild inconvenience to more severe long-term issues, again depending on what is actually causing these occurrences. As concerning as it is for the patient, it is the spouse or caregiver whose life will be altered most profoundly. The luxury of having a mate who took on responsibilities in the past, which they may not be able to handle in the future life, slowly begin to dawn on us. With time, the ability to handle different facets of life can become monumental for the person with a debilitating condition. For the mate… it is one more responsibility after another, placed squarely on the back of someone who already thought they had just about all they can handle with confidence. There is little point in discussing every possible added burden. However, as an example- a wife may no longer have a husband who can work, or manage the finances, or repair the electrical problems or take the car in for its annual check- up. For the Husband, it might be that his wife can no longer manage the responsibilities of the home, family events, entertaining, cooking, or grocery shopping. Each case is different. The ultimate burden for all concerned, is the same unbearable stress. We think we can handle it, but we simply push it below the surface. Many years ago, I began waking up in the middle of the night, feeling that I was going to faint. I would get up, take my blood pressure, which would be extremely high. I would feel my body begin to shake – a form of shock. I was terrified not knowing what was happening. The paramedics rushed me to the Emergency Room the first time this occurred. By the time that the medical staff actually triaged me, took blood and got the results back, I was “fine”. Ultrasounds and cardiac tests and bloodwork later… no answers. Still, it continued. I decided, based on years of pseudo-medical education, that my problem was gastronomic. I was having a problem digesting my dinners! That was the cause! When I ate too much salt, my blood pressure rose, thus it was logical that the problem was food related. My family doctor, Dr. N, was not at all sure that my online medical degree (issued by the same college that certifies Preachers) was up to snuff. He suggested the possibility that I was having panic attacks. His opinion fell on deaf ears. I began reaching for my half tablets of 5 mg. valium for relief. They seemed to help take the edge off the fear of fainting when these attacks came in the night. I started eating earlier in the evening and refusing late evening dinner invitations. I was next, waking in the morning with the feeling that I was “choking.” I felt the need to vomit, but was not ill. I was hyper-ventilating. Deep breathing helped a bit so that I could go out and face the day. What I had not faced was my own change of circumstances. As Hubby exhibited more and more complex behavior sometimes on the verge of violence (although he never actually touched me.), overwhelming anger or severe depression, I was absorbing the changes and suppressing just how upsetting it actually was. The self-prescribed Valium helped for a short while, but Dr. N. warned me that it was not an answer. Of course, I knew better until I began to have nightmares straight out of Hollywood horror films with skeletons, vampires and gore. I was always “afraid of fear” and never went to frightening movies, so what should I do when my dreams are out of control? I moved on to sleeping pills, this time on prescription from Dr. N. They too had a limited value. The subconscious can take over when we are asleep, even with the pills. All the stresses of the day, exploded for me in the wee hours of nighttime slumber. Hubby could not help the changes that were happening to him. He could not help becoming more than “a bit paranoid.” It was part of his condition. The paranoia included being terrified every time I left the house. He feared that:

Someone would steal my handbag. He would always tell me to “watch your back” as I left the house.
He feared that I might never return because something horrible could happen to me.
Then the most stressing accusation of all: Every time I went to the grocery store, to have coffee or lunch with a friend, or to a meeting with the organizations to which I am committed the suspicions began to become obsessions. What was really happening when I was out of sight? Was I having a rendezvous with my lover? What other reason could there be for my leaving our home for a couple of hours? This was a terrible source of fear, suspicion and anger for Hubby, it was incredibly difficult for me to bare. I would joke that “I hadn’t had any good offers lately!” But that really did not placate Hubby’s fears. His unpredictable outbursts of anger were wearing me down. That on top of being in charge of absolutely every aspect of our lives, from plumbing and electrical problems, to paying bills, to medical appointments, hospital appointments, banking, purchasing of food, cooking, cleaning and the other sundry responsibilities of life. Hubby’s anger and distrust was like the proverbial “straw” breaking the camel’s back.

We had been referred to the Geriatric department of our Health care provider. Regular assessments and discussions were held as to periodic changes in Hubby’s behavior and quality of life. It was often helpful. Our doctor was caring and listened. Hubby was waking up in the middle of the night, obsessing about absolutely everything. He often asked for a complete review of our finances at 3 A.M. I was beginning to unravel. We went to an appointment with Dr. G (G is for Geriatrician), and I proclaimed: “Either you medicate HIM or medicate ME! I don’t really care which!” This began what I can only describe as a “process” of discovering which medications could keep Hubby calm, and measuring how long they would be active in the body. It was possible to time them, because when they lost their effectiveness, excessive and sometimes outrageous behavior returned. Not everyone experiences what I have. Many have variations on the theme. Some patients are mild and sweet. Others begin that way and chemical changes affect their behavior as their condition declines. A once very close friend of mine had to leave her husband of almost 50 years to the care of his daughters in America. He had become violent and the two of them had been asked to leave their assisted living facility. His daughters from a previous marriage, agreed to take the responsibility of caring for their father, but not for his wife, even though she had helped to raise them. The very sad fact is that once her Hubby was put on the proper medications to correct the chemical imbalance in his brain, he became much like his previous self and functioned very well. It was probably not necessary that they be kicked out of their home and torn from one another after all. A close friend of ours has her mother is living with her. Her mother is exhibiting bizarre behavior. I suggested that medications could create calm. The daughter’s reaction was that “My mother does not want to be medicated!” But her mother was in no condition to make such a decision, and the quality of both of their lives has been severely reduced without accepting of the benefits that proper medication has on offer. For many people, the image of a medicated patient, is one who is comatose. That is certainly not what is being administered today. Each patient is individual. The quality of everyone’s life is improved when family members are stable. For those of us who are spouses and caregivers, we must ensure that that our lives are not a constant battle. Medications with proper guidance can make all the difference. Well, I need to admit that Dr. N was right! I was not having a calamitous physical problem that made me feel faint and shot my blood pressure and pulse into the upper hemisphere. I was indeed having panic attacks. “Who me???” I discovered the truth when Hubby had a T.I.A. as we were eating lunch in the King David Hotel a couple of years ago. He looked at my face and said “I can only see one side of your face.” A quick call to our GP, confirmed that it was indeed a T.I.A. and within minutes an Ambulance arrived and whisked us away to a hospital. We never received our meal and I suspect I never paid for it either. As a regular customer, I presume they forgave me. When Hubby arrived at the hospital, he was transferred into the Severe Stroke monitoring unit. I hired a male care giver upon a recommendation, to be with Hubby through the nighttime hours. I desperately needed sleep to face the days ahead. I woke up at about 1:30 AM that night to a phone call from the care giver. I was already hyperventilating as I woke up and then what he shared with me on the phone was so unnerving that I began to shake uncontrollably. I went to find the Valium. I took the full 5 mg. tablet this time and within a half hour I stopped shaking and was able to call a taxi at 2 A.M. to return to the hospital to see what was happening. Hubby needed me! I was “spent.” I had no reserves left. That was the moment when I finally realized that I was indeed having panic attacks in my sleep. When I was no longer awake, my subconscious had to deal with the stresses that my conscious mind could not. At the end of the day, it was not “Medicate either Hubby or me…” it was “Medicate us both.” I lovingly call my medication my “happy pills.” They are amazing. The extra serotonin which athletes and runners enjoy as do those who exercise in their gyms, is now available in pill form! It took a while for them to “kick in,” but I am certainly not ashamed that I needed them to continue to function. Not all medications are the same. There are complicated reasons why one medication will work better than another for a specific individual. Self-medicating, is a recipe for disaster. Get help from your family doctor. He/she will most certainly understand! Some interesting facts about anti-depressants from “Dr. Google:” One in ten of all Americans use them. As of 2018 13.2% of adult Americans were using them regularly. 25% of all American women over the age of 60 use them. Presumably, these people are normal citizens dealing with the normal stresses of life. Pile onto that, the concerns of caring for an ill loved-one, and it may be easier to understand why some form of pill may well be your “best new friend!”