A Very Good Day with our Son

Our son, Kevin, arrived Thursday morning from Texas. Weather wise, it was the best day we have had since last May. We took advantage of it by eating lunch outside on the patio of a sports bar a short distance from our house. It was a good start to his visit. Although Kate often has difficulty remembering that we have children, she responded to Kevin as though she knew exactly who he is. We had a relaxing conversation. The fact that it was just the three of us and that it wasn’t noisy added to the pleasure of the moment. There were times then and later in the day when she asked him his name as naturally as she asks mine.

She had a routine dental appointment at 2:00. Kevin went along with us. I thought it was good for him to be a part of the experience though he remained in the waiting room while she saw the hygienist and dentist. For the first time, I went in with her. I did so because of her experience on the previous visit six months ago. At that appointment, she was frightened when the hygienist cleaned her teeth, and they had to cut her visit short. This time I gave her a Xanax before going and went in the room with her. Everything went smoothly. I didn’t think that had anything to do with my being in the room with her, but the hygienist felt it was helpful and suggested we make this a habit in the future. Both the dentist and the hygienist commented that her teeth and gums were in excellent condition.

Once we were home, I picked up Kate’s “Big Sister” album and suggested that she show it to Kevin. They sat down on the sofa and started going through it while I went to the grocery to pick up a few things for Kevin’s breakfast. In just the few minutes before I left, I could see that they were having a good time.

When I returned, they were still enjoying going through the album. Kate continued to relate to Kevin very comfortably. He had a beautiful opportunity to see first hand the kinds of things I have noted in the blog. Since most of the pictures are of family, Kevin was able to tell her all or most of the names. I joined them in the room with the intention of just listening to their conversation. Kate asked me to sit with them, and I did. There were a few things I commented on, but I let the conversation between the two of them continue. At one point, Kevin pointed to a photo of Kate and me and himself. She asked his name. He told her, and she asked his last name. Then she said, “Who are your parents?” After two hours or longer, Kate said she was getting tired. It was also time for us to prepare to leave for dinner, but this conversation, like others she has had with her brother Ken, was a beautiful thing to watch. I love seeing her enjoy herself. That is especially true when she is engaged in conversation with someone with whom she is so comfortable.

We finished the day with a good evening at Casa Bella for Broadway Night. Kate enjoyed herself as usual although she was a little lost in the conversation. The other two couples were there ahead of us which left us with minimal choices about our seating arrangement. Kate and I sat across from each other. We could have sat side by side, but she would have been seated with her back to the singers. Everything worked out well until late in the program when I saw her looking around the room for me. She had forgotten where I was seated. I was able to catch her attention and reached across the table to take her hand. She was relieved and teary but recovered nicely. I doubt that anyone else noticed except the woman seated next to her.

Kate’s Final (?) Appointment with her Ophthalmologist

We may be reaching a point at which we no longer schedule routine medical appointments for Kate except for her primary care physician. It is becoming a matter of assessing the risks vs. the benefits.

Yesterday she had a routine appointment with her ophthalmologist. This is one in which I had a special interest. I have commented many times on her eyesight problems. Kate is unable to recognize that she has a problem, but she seems to see some things and not others. For example, she may not see a large object on a counter but notice a small spec of dirt on our carpet or small particles of food on a restaurant table. Until recently, I had attributed her vision issues to her Alzheimer’s rather than a physical problem with her eyes. Two particular issues, however, have made me wonder if it could be something like macular degeneration. In a phone conversation with her ophthalmologist I confirmed that at the time of her last check up in February, there were no signs of a physical problem and that it was unlikely that it would have developed since then. Nonetheless, I wanted to know for sure. Yesterday’s visit provided the answer. It was just what I thought. Her eyes are fine. Her vision problem must be related to her Alzheimer’s.

There is more to report, however. Appointments themselves are becoming a problem. Kate has little patience, and waiting is a normal process in most health-related professions. The notable exception is her primary care physician who is associated with a gerontological practice. The wait time in the lobby is not usually more than 5-10 minutes. The appointments are not scheduled as closely together. Her doctor, and the others we have seen, always take a lot of time with their patients, many of whom have dementia. They know how to relate to patients like Kate.

I don’t mean to suggest Kate’s eye doctor and/or staff are insensitive to the needs of patients with Alzheimer’s. They aren’t, but the system is set up for non-dementia patients. That means waiting times exceed Kate’s patience. Her appointment was at 1:15. She didn’t see her doctor until 2:15. To be fair, she was only in the waiting room about fifteen minutes. She spent another 15-20 minutes with the doctor’s assistant who was getting information, checking her vision, and giving her the necessary drops before the doctor arrived. That left about thirty minutes before she saw the doctor. Kate has trouble understanding the instructions anyone gives her, so that complicates every portion of the examination. Neither does she understand why she needs the exam in the first place. Yesterday’s exam was particularly difficult for both Kate and the assistant.

The good part is that she took it somewhat good-naturedly. She joked a lot, and both the assistant and the doctor got a kick out of her comments. Sometimes she was quite serious. When the assistant checked her eye pressure, Kate was startled, pulled herself away, and told the assistant to stop. Then she did something that surprised me. She looked at the assistant and spoke to her  as though she were a teacher. She said, “Talk slowly. Go one step at a time, and give me clear instructions.” That is exactly what she needs. Of course, not even that will insure that she understands. At the end of the visit, the doctor looked at Kate and said, “Well, I have good news for you. You don’t need to come back for a year.”

When we checked out, it was a challenge finding an afternoon appointment at our preferred location. We finally found one at 11:55 on August 28 of next year. I can’t imagine that Kate will be up to another visit when the time comes around. I feel sure her doctor felt the same way, but, like so many other things, we will see.

Another Milestone in Our Journey

It was January 21, 2011, when Kate received her Alzheimer’s diagnosis. Late yesterday Kate had a routine appointment with her gerontologist. As I have done prior to other appointments, I posted an update to Kate’s chart via her doctor’s online portal. That way I am free to explain how Kate is doing without worrying about her feeling talked about or my taking over the visit. It worked especially well this time. The doctor took far less time exploring how she was getting along.

She began by asking questions of Kate. Because my report had mentioned a concern with her vision, she asked Kate to read a sign on the back of the door to the room. She was able to see the first word, “Our,” but not pronounce it. She never got to the rest of the words. The doctor asked about her daily routine. Kate hesitated and then mentioned something completely unrelated to the question and unintelligible to us. I had feared that they were going to go through the usual questions related to the President’s name, date, drawing a clock, etc. but was relieved that the doctor felt she had enough without going further. Kate also mentioned working in the yard, but, of course, that is something she hasn’t done in two or three years.

The doctor was accompanied by a man serving a residency with the practice. She asked Kate if it would be all right if she and I stepped out for a few minutes and let the resident collect some additional information. That was fine with Kate, and we left. While we were out of the room, the doctor gave me the prescription and application for a handicapped sticker for our car. That is something I had requested in my update. She also gave me a sheet with a detailed list of symptoms for the 7-Stage Model of the Progression of Alzheimer’s. She agreed with what I had already estimated, that Kate is at the end of Stage 6 and about to enter the final stage. I looked over the list when we got home. It seems rather clear that is correct. As I said in a previous post about two weeks ago, no one can provide a precise estimate of the length of any of the stages, but it was sobering to receive the information.

I thought back to the time of Kate’s diagnosis 8 ½ years ago. Kate and I both expected to hear that she had dementia. Hearing the doctor say it; however, had a great effect on both of us. That was also true for her current doctor’s confirmation of where she is now. I suspect most people who are around her would never guess that she is this far along. I am personally surprised that she is able to function as well as she does now that she is on the cusp of the final stage of the disease. I am able to see all the signs without any problem, but it seems to me that she couldn’t be at this stage just yet. I was also struck by the specific symptoms of each stage. There are quite a few for Stage 6, but very few for Stage 7. I am copying them below.

  • “Frequently lose the ability for recognizable speech although words or phrases may be uttered.” Just beginning for Kate.
  • “Need help with eating and toileting, and there is general urinary incontinence.” Just beginning for Kate.
  • “Lose the ability to walk without assistance, then the ability to sit without support, smile, and to hold up head; reflexes become abnormal, muscles grow rigid, and swallowing is impaired.”) Just beginning for Kate.

Like so many things, I find myself wishing I knew more precisely how much time we have, but it may be better that I don’t.

Looking back, I am satisfied with the way in which we have approached her diagnosis. Our goal was to make the most of whatever time we had. That goal has served us well. It is my intention to continue the same game plan. I realize that we will reach a point at which we are much more restricted in what we are able to do, but we won’t stop until I find that it is wise to do so. I remember that my dad took my mom with him wherever he went, except Kiwanis, until shortly before her death. I hope that Kate and I will be able to do the same.

This is one of those sad moments, but I want to emphasize that we are still experiencing happy moments and will do so for the foreseeable future. Apart from that, I have accumulated a treasure trove of memories before and since her diagnosis. I never imagined that we could enjoy life so much while living with Alzheimer’s. I am truly grateful.

Dealing with Squamous Cell Carcinoma

Except for our regular appointments with our doctors and dentists, Kate and I have had little reason for medical treatment since her diagnosis. A year ago, Kate’s arthritis in her right knee led us to an orthopedic clinic for a shot of cortisone. She has gotten along well since then although she complained of a little pain a few months ago. More recently, I have asked her on several occasions if she felt any pain. She has always said she didn’t.

Four or five weeks ago, I noticed a small growth at the edge of her upper lip. It had been well over five years since she had seen her dermatologist. I made an appointment, and the doctor performed a biopsy. A week later, I received a call that the she has a squamous cell carcinoma. We arranged an appointment to have it removed. It was scheduled for noon yesterday.

I much preferred an afternoon appointment. That would have been much easier for Kate and for me as well. That’s because I would have to wake her earlier to have lunch before the surgery. Unfortunately, we would have had to postpone the appointment until much later. They didn’t recommend that.

Every time I face getting her up early, I do so with a bit of trepidation. This time there was no problem at all. Although I had to wake her, she got up easily. That enabled us to have a leisurely lunch and arrive at the doctor’s office twenty minutes before noon. I didn’t mention where we were going until lunch. Kate didn’t understand why we needed to see the doctor and quickly forgot. I explained again on the way over, but she never really grasped the problem.

The doctor who was to perform the surgery was not her regular dermatologist. This doctor is a specialist in squamous cell carcinoma. He immediately noticed that it was hard to see the spot where the biopsy had been taken. Her dermatologist had either removed a large portion of it or it had diminished since the biopsy. The specialist summarized five or six options for treatment. They included complete surgical removal, radiation, freezing, and a topical chemical treatment that we could give at home twice a day for three weeks. After a brief discussion, we settled on the chemical treatment. That requires a compounding pharmacist. I took the prescription to the pharmacy, but they said it would be 24 hours before they would have it ready. I’ll pick it up later today.

As you might expect, the whole process was confusing for Kate. I tried to translate the doctor’s explanations, but she never really understood why she was there and that she had almost had surgery. In this situation, I didn’t think that was a bad thing. She didn’t seem annoyed or frustrated by it all. She wanted to understand what the doctor was saying. She just couldn’t.

I had a United Way meeting at 1:30 and had arranged for our sitter to meet us at the dermatologist’s office at 1:00. She arrived a few minutes before that as we were checking out. Perfect timing. This was one of those times it was really nice to have a sitter. She was able to take Kate home while I went to my meeting. Kate mentioned that she was hungry, so they dropped by Panera on the way. That meant she had a second lunch, but it also helped Kate pass the time until I got home later.

The balance of the day went well. At dinner, we ran into three people we know and had nice conversations with them. At home, we watched an Andre Rieu concert from London on YouTube. Kate enjoyed it more than usual. I’m glad to report it was a good day.

Meeting Kate’s New Doctor

We are very fortunate to have an excellent gerontologists’ practice here. My mother and father were the first in our family to be patients there. That was 1998. Two years later Kate’s mother joined them. My mother died in 2002, and my dad had a significant other who became a patient. Kate became the next member of our family to go there. She had an excellent doctor who left the practice two years ago. Kate then switched to the same doctor that treated Dad. He was recently assigned to hospital duty. This past Tuesday Kate had her first appointment with her new doctor.

In advance of the appointment I sent the doctor an update on Kate. I have done that before each appointment for the past several years. It enables me to give the doctor an accurate picture of what is happening and the changes that have occurred since her previous appointment. I feel it is a better way to communicate than talking with Kate in the room.

I was very pleased with the new doctor. I went in with high expectations and discovered they were justified. My only previous connection with her was about six years ago when I spoke with her on the phone about my dad. She was on weekend duty and took my call to the office. I don’t remember why I had to call her or what she told me. I just remember that I was impressed with the way she handled my call.

Kate’s appointment yesterday was a simple checkup, not her annual physical. The doctor spent an hour with her. Most of that time she focused on getting acquainted with Kate. Very early in the conversation, she told Kate she would be asking her a variety of questions and would address some of them to me if that would be all right with her. This is one of the things I like about this practice. All of the doctors are very careful to make sure their patients feel they can express their own thoughts about what they are experiencing. That is difficult with Kate because of her memory loss. For example, on the way to the appointment, she complained about pain in her knee where her arthritis is beginning to cause her problems again. She didn’t remember to tell the doctor. When the doctor gave me a chance to make a few observations, I was able to bring that up.

Kate was quite comfortable in the doctor’s office. She was especially talkative with the doctor’s nurse who took her vitals before we saw the doctor. The doctor got to see a bit of her confusion about our relationship. Kate told the doctor that I was her uncle. She looked at me. My expression must have conveyed that wasn’t right. She asked me if that was right. I said, “Actually, I am your husband.” She was surprised. As we were leaving, she said goodbye to each of the staff we passed in the hallway.

It was a good visit. Her next visit is in four months. We had just started that schedule with her previous doctor. That seemed to make sense to me. Except for her arthritis, her problems are those associated with her Alzheimer’s. She seems to be following an expected set of changes that accompany that diagnosis. That is enough to deal with. I am glad we don’t have any other complicating issues facing us as yet.

Day 9: The Cold Becomes Something More

I was interested in getting an idea of how Kate was doing yesterday morning, so I tried to get her up for lunch. That would have given us time to be together as she was getting ready as well as at lunch. This was one of the many occasions when she just wanted to remain in bed. The first time I walked into the bedroom, she was lying in bed awake. I took a glass of water and asked if she would like some. She said, “In a minute.” She looked mildly confused or disturbed. When I asked if something were wrong, she held her hand up to let me know she didn’t want to talk about it. I sat down on the bed and said, “It looks like something is bothering you. Could you tell me about it?” She shook her head no. Then I asked if she would like me to let her rest a little longer. She did. I told her I would be in the kitchen if she needed anything.

About twenty minutes later, I went back to let her know that I would be going to the Y a little later and wondered if she would like to go to lunch with me or let the sitter help her dress and take her. She opted to stay in bed and let Mary handle things. Then I noticed she was wheezing slightly. It wasn’t much, but I took that as a warning sign and called her doctor. Unfortunately, they had just closed for lunch, but her doctor’s nurse called me back as soon as she returned to the office. She advised us to go to an urgent care center to have her checked.

We went to a nearby office that has quite a few locations in various parts of town. We have been to one of their other offices in the past. I like the fact that you can schedule appointments online and wait at home until they text you thirty minutes before your appointment. That doesn’t mean that you don’t wait in the waiting room, but the wait is significantly shorter. I also like that they have a TV that lists the order in which patients will be called. Both times we have used this system, Kate has been the next person called. That happened again yesterday.

This was a time I could have used my cards indicating that she has Alzheimer’s, but I forgot. Instead, I discretely told the woman at the front desk and the nurse who led us to the examination room. That was good because Kate had trouble following very simple directions like stepping on the scale to be weighed and where to sit. I knew that when we got to the x-ray room, she was going to have a problem. It worked out fine, but she did get confused and spoke fairly strongly (for her) to the nurse to be clearer about what she was supposed to do.

Her vitals were just fine. Her blood pressure (139/80) was higher than it used to be, but her temperature was 98, and here blood work showed no sign of an infection. She had lost five pounds since her last doctor’s appointment in the fall. Of course, scales can vary, but I couldn’t help thinking that might be a result of eating fewer blueberry muffins. That doesn’t happen nearly as much now that we are not at Panera every day. The x-ray, however, did show congestion in the bronchioles. Although it appears that she does not have a bacterial infection, the doctor put her on an antibiotic and advised us to contact her doctor on Monday.

She slept well through the night and had only one coughing spell that occurred shortly after going to bed. She was up at 6:30 to go to the bathroom. I took the opportunity to give her the next antibiotic and Mucinex. I didn’t detect any wheezing; however, a few minutes ago, I went to her beside and listened carefully. She was wheezing very slightly, less than she was yesterday. I hope we will see some improvement today.

Kate’s Cold and Her Pre-Operative Appointment for Cataract Surgery

I had hoped Kate’s cold would have improved significantly yesterday, but it didn’t. I am glad that it didn’t get worse. She had a good night, no coughing until the morning. Even that didn’t last long. That has been the pattern since her cold began five days ago; however, when she coughs, it is quite loud. Because of that I called the agency that provides our sitters. I arranged for someone come to the house this morning. I am attending a luncheon and need to be there at 11:00. I had planned to take Kate with me. Under the circumstances, I felt it was best that she stay at home. Our regular sitters were already committed to other assignments. This will be the first time that I have had a new sitter without having interviewed her before hand and letting Kate meet her. She will be here at 10:15. I will give her instructions and introduce her to Kate before leaving. If this is like most days, Kate is likely to be asleep when she arrives and continue to sleep after I leave. Kate needs help dressing now, so I will be eager to see how well she accepts the sitter’s help. I am already a bit uneasy about leaving her. The good thing is that we may be approaching the time when I need to add another sitter. It will be good to have someone else who might be able to fill in from time to time.

Speaking of sitters, yesterday was my day for Rotary. Kate was still sleeping when Valorie arrived. She walked into the bedroom with me when I told Kate goodbye and that Valorie was here to help her get dressed. She said, “Thank you.” Then she closed her eyes, and I left. Kate had a 3:40 pre-operative appointment with her ophthalmologist in advance of her cataract surgery scheduled for February 12, so I asked Valorie to take her to the office where I met them. Unfortunately, it wasn’t a time when I could talk to her privately to see how things had gone after I left for Rotary.

I was waiting for them in the lobby when they arrived. I stood up and walked over to Kate. She didn’t recognize me from a distance. When she got closer, she looked somewhat puzzled and said, “What’s your name?” I said, “Richard” and stopped to see if she said the rest of my name, “Lee Creighton.” She does that sometimes, but not this time.

Valorie left, and we took our seats in a separate waiting area for the pre-op patients. There were several other patients waiting and Kate waved and said, “Hello-oh” to them before we sat down. She didn’t do it in a natural way. It was more like someone with some kind of mental problem. I may have imagined it, but I thought several of the people gave her strange looks. No one returned her greeting.

We did not see the ophthalmologist on this visit. First, we saw her assistant who explained what we would need to do in preparation for the surgery and gave us prescriptions for three different types of drops we are to use several days before the surgery. Kate was unusually active in our meeting. I think she felt too much of the conversation was between the assistant and me. At one point, she said something that indicated she was the one to get the surgery and would need to know what to do. I was amazed at how well she understood that. She also stopped the technician a few times to ask her to tell her what certain words meant and re-explain what she had just said. It was an interesting combination of wanting to be on top of the situation but not being able to. It reminded me of her continual attempts to remember names, where she lives, or to understand the news she hears on the radio of TV. She wants to know but can’t remember.

When we finished, one of the technicians took us to a room where they performed two different scans of her eyes so that they can properly size the implant. Having tried to give various instructions to Kate since she got her cold, I took particular note of the challenges the technician had with her. The first issue was getting her to sit on the stool in front of the scanner. I suspect there were two issues. First, was her eyesight. As with many people with dementia, she often overlooks things that are right in front of her. Second, this was a short, round stool. It didn’t look like a typical chair. After she was seated, the technician asked her to “put your chin right here.” It took a little more coaching for Kate to know where to put her chin. The technician was very sensitive to Kate’s situation and treated her just the way I would have wanted.

The scans didn’t take long. We were soon on our way. As we walked out the door, Kate said, “I have no idea where I am.” I told her we were in Knoxville, Tennessee, where we live and were leaving the eye doctor’s office.” Although I had told her about the cataract surgery and the appointment, I know she can’t remember. Thus, the entire process must have seemed strange. I can’t imagine what it was like for her.

We went directly to dinner from the ophthalmologist’s office. When we got home, Kate started to work on her iPad while I watched the news. It wasn’t long before she encountered problems with her puzzles. She said, “What can I do?” I said, “I have an idea. Why don’t I put on some music on the TV while you get ready for bed?” She liked the idea. I selected several brief choral videos and then an entire concert by the Wartburg College Choir. She enjoyed it while lying in bed. At the end of the concert, I turned off the TV, and she gradually went to sleep.

Several times during the night, she coughed but not for long. She is still sleeping. I don’t intend to wake her before the new sitter arrives. I will introduce the two of them and then let Kate choose whether to get up or stay in bed. I would be very surprised if she wants to get up.

I feel like a parent leaving his child with a new sitter. I will be occupied while I am gone, but I am not going to be comfortable until I return home and find that everything went well.

Our Appointment with the Ophthalmologist

The biggest event on Kate’s birthday was her semi-annual visit to her ophthalmologist. We have been monitoring her cataracts for the past several years. During the previous two visits, they had reached a point that her doctor said we could go ahead or wait a little longer. After our discussions, I decided her vision wasn’t poor enough to necessitate surgery. Since the last visit, however, I had noticed what I thought was a significant decline in her vision. She was being exceedingly careful when going up or down stairs or curbs as well as pavement with light and dark sections or cracks. I wasn’t sure if the problem related to her Alzheimer’s or the cataracts or something else. Yesterday’s examination confirmed my suspicions about the decline and that the cataract in her left eye is the problem. We spent most of our time talking about the procedure itself and how comfortable the doctor felt about doing it with Kate at this stage of her Alzheimer’s. She was quite comfortable but said it was my call. At first I said I wanted to think about it and would call back with an answer. We talked a little bit more, and I decided to go ahead. We made an appointment for surgery on February 12. We have no plans to follow up with the right eye since it is a long way from requiring surgery.

It was interesting to observe Kate during yesterday’s examination. At the very beginning the woman who took care of the initial eye test asked how she had been getting along, if she had noticed any changes since last time. Kate said she could see just fine and had no problems. As the technician was about to jot that down in her record, I asked if she would like my impression. Then I told her that I thought the cataracts were causing more problems now.

It wasn’t easy for her to follow the instructions. When asked what she could see, Kate often asked, “Where?” She actually expressed some irritation when the technician tested her peripheral vision by holding up her fingers and asking how many fingers she could see. Twice Kate said in a stern voice, “Wait a minute!” The biggest challenge involved her reporting if she could see the “Big E.” That’s the one that encompasses the whole screen and must be 12” high. Kate first said that she couldn’t see anything. I think this was a result of her Alzheimer’s and not her eyes. I believe she saw the E but interpreted it as a bunch of lines and not a letter. Finally, she recognized it as an E.

The exam made me more appreciative of the challenges Kate has seeing everyday things. This happens a lot when we are in the car. I will say, “Look at that” and point to something. We often have passed whatever I was pointing out before she can figure out where to look. There are also many times that she doesn’t see objects that are in plain sight, for example, the clothes I lay out for her. She doesn’t know what to focus on. I believe this is largely a problem created by Alzheimer’s and not a physical problem with her eyes.

Having made the decision to have the surgery, I am now eager to see how much her vision improves. I am optimistic that it will help her feel more secure when she goes up and down curbs and stairs and across pavement. It would be great if it also makes it easier for her to work her jigsaw puzzles. We’ll soon find out.

Our Trip to the “Doc-in-a-Box”

The other day I wrote about Kate and conversation and mentioned that I wondered if she might not have a buildup of wax in her ears. This has been a persistent issue for her since childhood. Yesterday seemed like a perfect time to find out if wax had been a primary source of her hearing problem. On one other occasion, I took her to a local clinic (Doc-in-a-Box) to have her ears washed out. Since then, I had learned that you can go online and book an appointment. They will call you thirty minutes before they are able to see you, so that’s what I did. It was interesting that they ask if this was something that would require a nurse or a doctor. I indicated a nurse figuring that would make it easier to get in.

Except for a brief sign-in procedure to update our/their records, we waited only a few minutes. In less than ten minutes, they checked Kate’s vitals and put us in an examination room. Shortly thereafter, a physician’s assistant came into the room to take a look at Kate’s ears. She quickly discovered a good bit of wax in both ears. She left and someone else came in to handle the task of cleaning it out.

The interesting part of the experience was Kate’s response. After the PA came in and introduced herself, I introduced myself and said, “This is my wife, Kate.” To my surprise, she said, “And I am smart. <pause> That’s what my mother and daddy tell me.” Later, during the examination, she repeated that she is smart.

Once she was on the examination table and the PA started to look into her ears, she became anxious. She wanted me beside her and to hold her hand. Both the PA and the person who did the cleaning were very gentle and non-threatening, but the exam itself scared her. This has to be another consequence of her Alzheimer’s. Even though I told her where we were going and why, she couldn’t remember where we were or why. This was only the second time we had been in this office, and that was three or four years ago. In addition, she didn’t seem to understand the instructions she was given. For example, when she was asked to lie down on her side so the attendant could put drops in her ears, it was very difficult for her to understand. I wonder now if part of the reason was that her ears were blocked up.

After she had gotten the drops in one ear, she had to lie on her side for fifteen minutes. Then the attendant came in to “irrigate” the ear and put drops in the other ear. Once again, I could see the power of music. She wasn’t fully at ease yet, so I got my phone out and played one of her favorite songs, “Send in the Clowns” from A Little Night Music. She loved it and seemed to relax. I was surprised that she was able to mouth some of the lyrics before they were sung. From there, I played a variety of songs from folk to opera.

It took a little longer than might have been expected because they weren’t able to remove all of the wax on the first try. Kate got a little restless, and several times, she asked when we could go. While we were waiting, she asked, “Who are you?” I told her I was her husband. As frequently happens, she was surprised and didn’t believe me. A few minutes later, she asked, “Are you my daddy?”

As we were about to leave, the PA asked what we were doing for Thanksgiving. I told her we were going to Texas to be with our son and his family. Kate said, “What’s his name?” I am sure the PA understood the situation. Their records should have shown that she has Alzheimer’s. To make sure, I told the attendant who took Kate’s vitals. As I said earlier, they were very understanding.

Latest Doctor’s Appointment and Opera Night

Kate’s getting up earlier helped to make the day go smoothly yesterday. We spent about an hour at Panera before going to lunch. Then we had just enough time to drop by the house to brush teeth before going a routine doctor’s appointment for Kate. This was an uneventful visit. Dr. Reynolds asked Kate how she was doing and if there were any special things she wanted to report. She didn’t have anything. That, of course, is not surprising. Even if she did, she probably would have been unable to remember it. I did mention that she had been sleeping later in the day but didn’t think we needed to do anything special to counteract that. I told him we had continued to keep up an active schedule. He asked that I drop the Ibuprophen I had been giving her. He doubted that the low dose I was giving her (one tablet in the morning and one at night) made any difference at all. I had also cut back on her acid reflux medication. He said it is best to continue as it was before.

From the doctor’s office we stopped by Barnes & Noble for an hour and a half. Then we came home and changed clothes before going to opera night at Casa Bella. I got Kate’s clothes for her. After I had changed, I went to check on her. She was wearing a pair of black pants I had given her but had not put on the top I picked out. I found it in the bathroom and brought it to her. She put it on. As she did so, I noticed that she had put the black pants on over the tan ones she had worn all day. I decided not to say anything. A few minutes later, I saw her going through a drawer in her bedside table. She took out a small plastic container that had several ball point pens. She also found a glove and put it in the tray as well. She took it with her to the car. We were off to Casa Bella.

As Kate started to get out of the car at the restaurant, I noticed that she was about to bring the pants she had brought to the car earlier in the day. I told her I thought she could just leave them in the car. She accepted that without a question. It has been a good while since she has expressed any reservation about following any suggestion I make. I feel this is further evidence of increasing sense of dependence on me to know what it best.

The evening went well. A new couple sat with us and the couple we always sit with. We had a good time getting acquainted. At one point, the wife asked Kate about her work. She said she was retired and had been a teacher. The husband asked her where she taught. She was stumped and said, “Around Tennessee.” I interjected and gave the names of the schools. The wife asked her what she taught. She was unsure what to say. Once again, I spoke up for her and said that she had been an English teacher and school librarian. The rest of the evening went smoothly. It had been another nice day.