Category: Doctor’s Visits

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.

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.

Two years ago this fall I heard Kate burping when she took her medicine. It wasn’t something she did all the time, just periodically. I’ve heard it even in the past few days. It hasn’t been a big issue, but a short time after it started, I noticed that she was wiping saliva from her lips. She used almost anything she could put her hands on. In restaurants, that was mostly napkins. In those restaurants with paper napkins, she would have used her original napkin as well as the small napkins under our drinks before the meal arrived. We regularly ask for more napkins. That was how she began bringing them home and depositing them in a basket in our garage. At home, she used toilet paper and lots of it.

I spoke with her doctor about it. I told her that it did not appear that she was having a reflux problem. It seemed like she was just not swallowing her saliva. When I talked with Kate about it, she found it repulsive to swallow. I was able to get her to try it, but she would never continue.

Despite my sense that it wasn’t a reflux issue, we began to think about the burping. The doctor thought it might suggest reflux after all. She had been on a reflux medication for a couple of years or so. The doctor recommended several ways we might address it. We started by increasing her reflux medication. Then we tried an antihistamine. After that we tried another medication that is supposed to reduce salivation. Nothing worked.

A few months later, her doctor accepted a medical director’s position in a clinic offering free medical care to those who need it. Kate’s new doctor prescribed another medication that reduces salivation. That didn’t work. Finally, we went to a gastroenterologist. He couldn’t find any physical reason for her problem. He did, however, say that as we age we seem to accumulate a little saliva in our throats. He thought that might be causing her not to swallow. We decided to live with the problem. Later, her dentist told me she had observed this among a lot of her older patients.

My update today is to say that the problem continues. She still goes through lots of napkins and paper towels. I keep a supply of both in my car. If we have any extra paper napkins at a restaurant, I am quick to take them to the car for when we need them. I often keep a couple of sheets of paper towels in my pocket. When she doesn’t have a paper product, she often uses her hand. Then she wipes the saliva on her clothes.

I know that she does swallow sometimes. One day at Barnes & Noble, I watched her for a while. During that time, she never wiped away any saliva. As recently as the past week, I also noticed a short time when she was swallowing; however, those are infrequent occurrences. I would like to think this is a problem that will just go away, but it doesn’t look like it.

Yesterday via email, Kate’s doctor responded to my question about the pain in Kate’s knee. He suggested a referral to an orthopedic clinic associated with UT. We were fortunate to get in this afternoon. Her x-rays did not show a severe case of arthritis, but it is obvious that her mobility is hampered as a result of the pain she is experiencing. The doctor gave us a couple of choices. We opted for an injection of cortisone. I feel good about our taking action. We are headed to Texas next week, and I was worried about how Kate might handle the trip. Hopefully, this will help.

I also have a follow-up on the matter of her sleeping and the use of Trazadone. As he suggested, I gave her half of her normal dose last night. It didn’t help in getting her to sleep quickly, but it apparently lasted a long time. I let her sleep until 10:45 this morning. Then I felt I should wake her so that we could have lunch before going to the orthopedic clinic. She was sleeping soundly, so it took two other attempts before she actually got up. She was groggy at first but seemed fine after taking her shower. More importantly, from my viewpoint, she was, once again, in a good humor. We have quite a string of successes on that front. I just hope discontinuing the Trazadone doesn’t have any ill effects.

Two days ago, Kate had a routine doctor’s appointment. It was a timely one in that she had caught a cold that I had had during the previous week. In addition, she has complained of a pain in her knee for several weeks. She had said it was mild, but in the past two weeks it has led to her walking more slowly as well as getting into and out of the car more slowly.

Dr. Reynolds listened to her lungs and asked her to cough. He decided to put her on an antibiotic and to let him know if the cough persisted after she finished taking it. As of last night, her symptoms had not changed; however, I am glad that we were able to address it quickly. She went to bed a little earlier last night, and she is still sleeping right now at 9:30. That is good since she was up unusually early the past two mornings. I am hopeful that she will make some progress in the next day or two.

As for the pain in her knee, the doctor believes it is arthritis and recommended that she take Tylenol as needed. I hope that will address the problem. I also wonder if part of the problem arises from lack of exercise. She spends most of her day in a sitting position since she has not been working in the yard. I am going to encourage her to do a little more walking. I’ve already mentioned that to her, and she was receptive.

The balance of the appointment involved the normal procedure. Dr. Reynolds asked her to tell him how she thinks she is doing. She said, “Fine.” He asked her what she does with her time. The first thing she said was that she works on family photo albums. She hasn’t worked on photo albums for at least two years, but this is a customary response when someone asks her about her activities. She didn’t mention working jigsaw puzzles on the iPad, but I did.

Until now, the doctor has scheduled Kate’s appointments every six months. This time he set the next appointment for four months. He asked both of us if that would be all right. We agreed. Of course, I don’t believe Kate thought anything about this change. I believe he was reacting to an email I sent him prior to our appointment in which I outlined the changes that had occurred since her previous visit. I also wondered if his suggestion of four months indicates an expectation that she may be entering a stage at which change is more dramatic than in the past.

Here are a few excerpts of my email to Dr. Reynolds.

Dr. Reynolds,

Here is a brief update prior to Kate’s appointment this coming Tuesday afternoon. My general opinion is that she continues to do remarkably well considering that it has now been seven years and two months since her diagnosis. We continue to be active and enjoy life and each other. That said, I definitely see signs that she is entering a new stage. Here are the most significant changes since her last appointment in September:

1. Her memory has declined. Although she used to have trouble with most people’s names as well as our grandchildrens’ names, she is now losing the names of our children. It is not unusual for her to ask me the names of our son or our daughter. Just moments later, she is likely to ask again.

 It’s not just people names. She is also forgetting that we are in Knoxville. She often asks, “Where are we?” or “Where am I?” when we are in familiar territory. In most cases, she means, “What city are we in?” Sometimes she means the restaurant where we are eating. We go to Panera almost every day. Several times recently, she has asked me the name while we are there. She often says, “Does this place have a name?” I believe that most of the time she does not know what city she is in or what place (restaurant, church, etc.).

 2. She has become more dependent on me. She regularly asks (frequently with hand not her voice) questions like “Should I put on my night clothes?”or “Should I go to bed now?” The other day at a restaurant, she asked (in hand signals) if she could take a drink of her iced tea. Although I have ordered her meals in restaurants for several years, she occasionally tells me to order for her. If I give her a choice of options, she often throws it back to me to make the choice.

3. She is more compliant. She accepts more of my suggestions than she used to. I notice that especially with her clothes. If she is wearing something that is inappropriate for the occasion or if it is soiled, she is more willing to change than before. She also takes more suggestions from me without putting up a fuss.

One area in which she continues to do well is in short-term social interactions. Both family and friends are still amazed at how well they think she is doing when they have been with her a short time. I am very grateful for this. It means that we can go places, and she seems to be normal. I think this helps other people respond to her in like manner.

One other comment. During the early stages of the disease, Kate was quite frustrated over her symptoms. She displays little or no frustration now. She is happy and generally good-natured. I am grateful for that. We never talk about her Alzheimer’s. She has simply chosen to go ahead and live her life as though she doesn’t have the disease. Although I would have chosen a different approach for myself, I am comfortable with her choice. Especially at this point, I see little reason to inform her of where she is headed.

We’ll see you on Tuesday.

Richard