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Very Tired Today

Kate was in bed by 7:30 last night and was up about 8:45 this morning. She was in a very pleasant mood when we made our morning trip to Panera. She did something unusual. She brought three books with her. That is interesting because she doesn’t read. It also surprised me that she was taking them to Panera where she spends her time working jigsaw puzzles on her iPad. She only took one of them inside, It was a book about the history of our church. She did actually spend a short time looking through it. After an hour there, she said she was ready to go home. As soon as she came inside, she went directly to our bedroom where she took off her coat and got into bed. That is the second time she has done that since we returned from Texas Monday night. While this was a very common occurrence a few years back, this is most unusual nowadays. In fact, occasionally when I have thought she was tired and asked if she would like to lie down, she has said she feared sleeping too long.

She is clearly acting differently. She is having more trouble with names and shows some confusion. Yesterday she received a touching letter from her brother, Ken, along with a gift of a spinner. He noted that one of his sons gave him one for his last birthday. He keeps it by the coffee pot and spins it each time he makes coffee. He also indicated that it is a time of reflection in which he thinks about “family, friends, and the ‘circles of life’ that have brought me to my current understanding of my life.” He says it is a time for counting blessings and giving thanks. Then he suggested to Kate that “every time you ‘take a spin,’ think of the people you love. And know that I will be thinking of you and Richard every time I spin.”

Before leaving for Panera, I read the letter to Kate and showed her the spinner. We were both moved by his loving words. For me, it was especially touching as I realize just how far Kate is into her journey with Alzheimer’s and that Ken is at an earlier stage of this journey. Life and the people we love are more precious to all of us who travel this path, and we have lots of sentimental moments.

When I finished reading the letter to Kate, she said, “Now who is this from?” This was a painful moment that reminds me of the reality of this disease and where we are. Life is not the way it used to be, and the toughest part remains ahead.

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Post-Trip Symptoms

Kate was very tired when she returned home on Monday. She was in bed with eyes closed before 7:30. Yesterday she was up at 7:30 and ready for Panera shortly after 8:30. She wanted to come back home after an hour and got back in the bed where she remained another hour before wanting to go back to Panera. During the balance of the day she got along normally. She was in bed about her usual time last night, around 8:30. This morning she slept until after 10:00. We were so late getting to Panera that I ordered lunch along with Kate’s usual muffin.

This was the day for the sitter, so I made sure that we were back home before her arrival just before 1:00. I went to the Y and then made a stop by the grocery before meeting Mark Harrington for coffee. We talked about my blog that I intend to launch this Sunday, the seventh anniversary of Kate’s diagnosis.

When I got home and the sitter had left, Kate was ready to leave the house. She picked up her iPad and got her coat. She didn’t say anything. I know the signs. They signal she wants/expects us to leave for someplace, usually Panera. This has become something of a habit on the days when the sitter comes. I am sure that is because a good bit of her time with the sitter is spent at the house, especially right now when the weather is quite cold. My presence is her sign that she can go back to Panera. Often it is only 30-45 minutes before we go to dinner. That was the case today.

Until this point, I felt everything was going well. At dinner, however, she asked me where we were. I thought she meant the restaurant and told her. She gave me a look that told me that wasn’t it. I said, “We’re in Knoxville.” To the best of my knowledge she has only asked that question when we were traveling in another city; so I was surprised. During the meal, she asked me the name of the restaurant and the owners of the restaurant. She never remembers these, so I wasn’t surprised at that. As we were finishing our meal, she asked me the way we would walk out of the restaurant. I pointed to the front door. In another minute, she asked me where we were. Once again, I told her we were in Knoxville. After paying the check, she again asked me where we would leave the restaurant. I pointed to the front door and got up. I said, “Follow me. I’ll show you.”

When we got home, she got ready for bed, put up her iPad and got under the covers about 7:30. I am wondering if these things are in any way caused by our travel over the weekend, or if this is just another sign of her decline that would have occurred anyway. Regardless of the specific cause, for me it is a sign of change and in a direction that I don’t like. It tells me that 2018 is going to be a different kind of year.

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Memory, Confusion, and Dependence

Earlier today I mentioned an experience at lunch when she didn’t recall that her cousin Chester had died and that we had attended his funeral two days ago. That is a rather dramatic experience that she would have recalled several years ago. I am still somewhat surprised that it didn’t ring a bell at lunch.

Before going to dinner this evening, I told her again about the pictures I had sent her Ken and Virginia as well as our son. She said, “You should also send them to Chester.” I told her that he had died last week. She said, “We were just with him.” I assume she was referring to this past weekend and said, “We were there for his funeral service.” She hadn’t remembered. This is clearly a change from several months ago. I have been noticing the change and commenting on it, but it is still somewhat surprising when she says things like this.

Her increasing loss of short-term memory is not the only change. She seems more reflective. She talks more about the past, her family, our relationship, and about me specifically. She expresses more appreciation for the things I do for her. She is also much more accepting of my suggestions regarding her clothes or whether she can work outside and, if so, where and with the clippers.

In general, I would say there is a striking change in her dependence, acceptance of her dependence, on me. She accepts  my help more readily and even asks for it. That is especially true with respect to her clothes. For example, for quite some time, she has put on clothes that are backwards or inside-out. That seems to be more of a problem now than in the past. Today,  she has asked me to help her with her coat when she couldn’t easily put it on. Tonight, she started to put on her night gown. She said, “Wait a minute, I might need your help with this.” She was holding it up and trying to decide which was the top and which was the bottom of the gown as well as the front and back. She started getting frustrated and asked me to do it. I finally put my hand through each of the sleeves and grabbed her hands and guided them through. I can see that this is going to be worse very soon. She got into bed and then said, “I can’t live without you,” something she has said many times along the way. Right now, it takes on a more serious meaning.

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I’m surprised.

We are back at Panera for the second time today. We spent about two hours here this morning. We were back home by noon. It is a much warmer day today, so Kate wanted to work outside. She came in after a couple of hours and took a shower. Then she was ready to leave again. We arrived here about fifteen minutes ago and had a conversation with a medical student whom we had met before Christmas when he was here studying for his exams. When he left, Kate looked at me and asked, “What’s the name of this place?” I told her. Then she said, “I don’t know why I can’t remember that.” Then she tried to repeat but asked me to tell her the name again. She was having a hard time pronouncing it as though this were the first time she had ever heard the word. She was trying to pronounce it with a “T” rather than a “P.” I corrected her and she practiced saying it several times.

In some ways, I feel I shouldn’t be surprised. After all, she forgets most things. On the other hand, Panera is such a large part of our lives that it seems like a name she would hold on to for a while longer.

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Wanting to Help

Among the first signs I noticed related to Kate’s Alzheimer’s was her lack of attention to some of her major household responsibilities. The most obvious one was that she often didn’t have dinner ready. It also included less obvious things like washing clothes but leaving them in the washing machine for a day or two before putting them into the dryer. Over the years, I have jumped in to take care of these things without our ever talking about it. It was as though she didn’t notice that I was taking care of meals, the clothes, and other household chores.

Thus it has come as a surprise to me that on several occasions recently she has asked if she could help me with something. Two of those occurred yesterday. She saw that I was taking clothes from the washer and putting them in the dryer. She asked if she could help. I felt little need for the help. This is a pretty easy task, but I was so pleased with her offer that I said yes. Later, I brought the dry clothes into the family room where I usually listen to music while folding them. I had already separated her things from mine when she walked into the room. Once again, she asked if she could help me. I quickly said yes. She picked up all of her things and walked back to her room. I later discovered that she hadn’t folded or picked up her clothes, but I was happy with her offer to help. That and her enjoyment of Darkest Hour that we saw yesterday afternoon made yesterday another good day.

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Good Moods Make for Good Days

In my previous post I failed to note that Kate was in an especially good mood yesterday. I am sure that played a significant role in my own sense that we had had such a nice day. It is not that she is usually irritable. She does continue to show more irritability than before her Alzheimer’s, but those moments don’t last long, and, fortunately, at those times she is not difficult to get along with. That said, sometimes she is especially happy and cooperative. That is the way she was yesterday.

She also continues to be reflecting or thinking a lot. Over the course of her illness she has occasionally said something that sounds like we had just been talking about something and expects me to know what she is talking about. There were a couple of those experiences yesterday. She said, “I’m going to be very careful.” Instead of acting puzzled and asking what she was talking about, I said, “That’s a good idea.” She said, “I’m going to stick close to you whenever we are in public.” I told her I would watch out for her. She said, “I know you will. I feel safe when I am with you.”

When she says things like this, as she has done in recent weeks, I tend to impute more to her actions than may be justified. In this case (as in others recently), I believe that she is grappling with a sense that she is less and less in touch with her environment and the people around her. It may be her way of expressing her own insecurity. Overall, she seems not to associate her challenges with her diagnosis, but she still knows she is not normal.

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Coming Home

I am glad to report that our travel home yesterday was uneventful, that is, we had no trouble at all. Anytime we are facing activities or appointments that have definite time demands like airline flights, I worry a little about making sure Kate is ready. It may seem strange, but we actually encounter fewer problems like that now than in the past. I find that Kate really works harder to get ready than she used to. That is part of a general pattern. It is as though she recognizes that she is not in control and feels the need to work harder. I don’t mean that she appears frantic about it. It is just that she seems more attentive to doing things “the way they should be done.” For example, until Alzheimer’s began to take its toll, she always made up the bed shortly after she got up. Over the years I have heard her say, “My mother taught me to always make up the bed.” She stopped that for quite a while. Within the last six months she has begun to partially make it up once in a while, not daily and not completely. She pulls the covers over the bed and throws the pillows in their approximate places. She also hangs her clothes up more regularly though she doesn’t hang them in what I consider to be the “proper places.” Although it saddens me somewhat to see that she has to work hard to do the right thing, I believe it is a good thing that she is taking more responsibility. She still wants to be independent. I want that to continue.

She was still sleeping soundly yesterday morning at 8:15 when I woke her up. Kevin came over for a short visit before we went to the airport. She didn’t want to get up, but she did without a complaint. Kevin dropped by at 9:15. She was ready, and I had everything packed. That gave us a brief time to be together before leaving at 10:00.

The rest of the trip went smoothly. We arrived in plenty of time. I had been a little worried that we might be rushed, but we had sufficient time to gas up the rental car, return it to Avis, check in, have lunch, and still be early enough to have some waiting time before boarding. This eliminated any potential stress that might have occurred otherwise.

We stopped by our favorite Mexican restaurant on the way home from the airport. Our server last night was a comparatively new one. It turns out that she is from Venezuela. I had a nice conversation with her entirely in Spanish. We told her that we had visited Venezuela many years ago. I think she liked that. We also bumped into an acquaintance from the Y. He was with his wife, children, and grandchildren. We had a nice conversation with them as well. For me it was just another reminder of the value of eating out.

Kate got into her night clothes pretty quickly and right into bed. She worked puzzles on her iPad for well over an hour before calling it quits for the evening. She and I both slept well although she coughed a good bit during the night. She seems better this morning, but we are both still struggling from the cold we got three to four weeks ago.

We got right back into our routine this morning. We made it to Panera about 9:30. Kate was ready to come home at 10:30. After a short break, she wanted to work in the yard despite the fact that it was 36 degrees. At least the sun is shining brightly. She has been out there almost an hour. I am about to call her in so that we can make our way to lunch.

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Amidst the Joy of Christmas There Are Moments of Sadness.

This has been a special Christmas season for us. My feelings are no doubt influenced by the belief that next Christmas Kate may be less able to enjoy it. Since her diagnosis we have tried to “live in the moment.” That has carried us through the rough spots along the way and continues to do so. At the same time, there are moments when the progression of Kate’s illness is evident in new ways. When this happens, I feel sadness overtaking me for a short time. That happened in the car after lunch today.

It occurred when I told her that we had plenty of time before our haircuts at 3:00. That would give her time to work in the yard. She tried to get the words to tell me she wanted to do something else. They wouldn’t come. At first, I didn’t guess what she was trying to say. Then I asked if she wanted to work on her albums. She did. I told her I would be glad to get out her computer. She paused for a moment and then said, “First, I would like to pull a few leaves.” I told her that was fine. She could do whatever she wanted. I knew the moment she said she wanted to start by pulling leaves that she would forget the albums. That is exactly what happened. She has been doing something like this periodically. Not once has she actually started on her albums.

These family photo albums are very important to her. She frequently tells me to “remember that for the album.” She says that in response to all manner of things that come up in our conversation. When we are with other people and someone asks her what she has been doing, she often tells them she is working on her albums even though it has been at least two years since she has done anything. Long before that, she was only editing photos, not taking any steps that led directly to assembling the photos for her album.

It is not just this episode that makes me pessimistic about next Christmas. It is many other things that I take to be signs of her decline: Her more compliant nature when I make suggestions, especially about her clothes, her growing dependence on me as reflected in her asking for permission to do so many things, or to help her with her clothes, and more.

We have been very fortunate for such a long time, but I see our quality time together diminishing as she moves into another stage. I will continue to be thankful for the many good times we have had, but I already feel sad about the prospects for the future.

 

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Enjoying Time With Long-Time Friends

Two days ago I mentioned that I had received a call from Jan and Scott Greeley while we were in Barnes & Noble. They were in town for the memorial service of a friend and were to let us know when they were ready for lunch. We met them and had a great time catching up on things they were doing. They are among our most traveled friends. Recently they returned from trip to Costa Rica. Scott and Kate have been friends their whole lives. Their mothers were friends and were pregnant at the same time. I understand from Kate that the two mothers occasionally tried to encourage a more serious relationship. By the time that might have happened, Scott’s family had moved to Midland, Texas. The two families saw one another from time to time, and they both ended up at TCU where Kate and I met.

I say all this to convey that Scott is someone Kate has known well and liked her entire life. Since they have lived in Nashville as long as we have lived in Knoxville, we have been able to get together several times a year, especially during the past few years. So when I told Kate, that the call was from the Greeleys and that we would be leaving to meet them for lunch, I expected to see her eyes light up. Instead, she said, “Tell me who they are again.” I explained and thought she understood though she still expressed no excitement. I put away my computer in preparation for us to leave. I expected her to close her iPad. Instead, she told me she wanted to finish her puzzle before going. It turned out that she was not just on the last couple of pieces but several. It took her another five minutes or so to finish. Then we left. For me, her nonchalant response to our meeting the Greeleys was a significant sign of how much her memory is deteriorating. It is one more of many little signs that tell me we are moving more quickly to another stage of her disease.

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More Signs of Confusion

Before we went to Casa Bella last night, Kate started to put on an outfit that I thought was less appropriate than she should wear. She told me to pick out something. I did and put the pants and top on the bed in her room while she was standing there. I left the room to get myself dressed. Shortly she came into our bedroom wearing the same thing she had been wearing. I told her she didn’t put on the things I picked out. She gave me a puzzled look and asked where they were. I told her I had put them on the bed. We walked back to her room. I found the top on a hanger in her closet. She had thrown the pants across a chair. It was obvious she had no recollection of my having picked these out for her. I stayed with her while she took off the top she was wearing. I told her she didn’t need to change her pants although they were more casual than the ones I had picked out. Again, I went back to get ready. She came into the bedroom where I was getting ready. Once again, she was wearing the top she had been wearing to start with. I went with her to her bedroom and helped her into the top I had picked out.

This morning she was a little disoriented. Shortly after 8:30, I went to the bedroom to see if she was up. She was walking back to our bedroom. She asked, “What can I wear?” I asked her if she would like me to find something for her. She said, “Oh, yes.” There was no effort to express her independence. I walked to her room and picked out something from her closet where there were many options she could have chosen. When I returned to our bedroom with her clothes, she thanked me and put them on.

On a related note, I have noticed that she is having increasing trouble putting on her clothes. For quite a long time she has frequently put on her tops and pants backwards or inside out. This tendency is increasing. Last night as we got ready to leave for Casa Bella, she had great difficulty getting her top on correctly.

She has had similar problems today with two different coats. Late this afternoon, we went to Panera. The sitter had taken her there earlier, but she was eager to get out of the house. We had another hour before going to dinner; so back to Panera we went. Since it has been cold and rainy today, I gave her a coat to wear. I watched as she struggled to get it on. She wanted to do it without my help. She ended up getting in the car with her right arm in the right sleeve but couldn’t find the sleeve for the left arm. Before we left Panera, she started to try to put on her coat and then asked me to help her.

Because it has been such a nasty day I was concerned about Kate’s being occupied while the sitter was with her. Working outside was impossible. That only left the iPad to keep her busy. As far as I could tell, that did not turn out to be a problem. Neither Kate nor the sitter said anything.

As she has been doing, Kate warmly greeted the sitter. She also thanked her when she left. After she was gone, Kate said something about how sharp she is. I said, “It must be nice to have somebody here with you.” She nodded agreement and then said, “It really is. More than I thought at first.” I still don’t know if she realizes she has two different sitters, but she has never mentioned anything that suggests she does. She seems equally happy with each of them.

We reached a significant milestone with the sitters this week. It marks the end of the first ninety days since they started coming. The importance of this is that our long-term care insurance doesn’t start reimbursing us until after that period. If everything goes according to plan, I will need to submit records of all the payments made through Tuesday of this week. After they have accepted them, they will reimburse us for all future expenses up to a daily maximum set by our policy (12.5 hours). At the moment, I can’t begin to estimate how long it will be before we hit that maximum. I hope it is a long time.