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Living with Covid Again

For the most part, Kate and I haven’t experienced many of the health problems that other seniors face, but we are far from being completely free. Clearly, the one with the greatest impact was her diagnosis in 2011. Then, she and I had Covid in 2020 just before the first vaccination came out.  The trauma of her hospital experience itself has had a lasting impact. Eight months ago, she also had a stroke. It was a mild one but a real one, not a TIA. That, too, has lasting consequences.

Now, we are dealing with Covid again. It all began last week when I had lunch with another resident. We were together for almost two hours. Saturday evening, I received a message that he had tested positive for Covid. At the time, I was feeling fine, but I awoke at 3:00 am Sunday morning with a sore throat. I remembered that when I had Covid the previous time, my only symptom was a sore throat. I went to the kitchen and used our last remaining Covid test kit. The test result was negative.

I was far from being confident I had avoided the virus, so the next day I bought several new kits. I took another test as soon as I got home. Once again, the test was negative. I took another test the next morning. It was also negative.

That brings me to Tuesday morning when I took my fourth test. It was positive. So now, we are quarantined at least through tomorrow if I no longer test positive. That also assumes Kate doesn’t get it, and I think that will be hard to prevent.

This experience is a reminder of the benefits of our move to a continuing care retirement community a year and a half ago. They have a procedure for things like this and took action immediately. The dining room will deliver all our meals. They also provided a supply of PPE gear for our caregiver. In the meantime, we are “Living with Covid” in our apartment. Several residents have volunteered to run errands for me. I took one of them up on that yesterday afternoon.

I’m getting better each day. My symptoms are minor. In addition to my sore throat, I have a stuffy nose and experience a few aches in my joints. My biggest concern relates to passing the virus along to Kate. I wear a mask in our apartment, wash my hands regularly, and wear gloves much of the time, especially when I am handling things that Kate might touch.

Our primary caregiver has been very helpful. She is willing to come each day. She also brought us some disinfectant wipes that I use for various places I frequently touch, like refrigerator doors, handles on cabinets, and counters. Kate can’t touch any of them, but the caregiver can. I still think it’s doubtful that I can prevent Kate’s getting the virus, but we will try. I’ll let you know what happens.

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A Brief Update

Once again, I find that I am behind on another blog post. On top of my usual excuses is that I’ve had computer problems that were finally solved yesterday. During the past two weeks, my computer wouldn’t connect to our Wi-Fi network or any other one. In the meantime, I’ve been occupied with Kate (many good moments) and other personal issues like an infection in one of my toes and pain on the right side of my other foot. Those involved several doctor’s visits that have solved most of the problems.

The best news is that Kate’s improvement has continued over the past few months. That has given us more quality time together which has boosted my spirits greatly. I’ve been particularly pleased that our evenings are once again very special times. Our love for each other is more consistently evident now than in quite a long time.

I continue to be pleased with our new primary caregiver (8 hours daily from Monday through Friday). I feel less stressed now than I did a few months ago, and my blood pressure is staying at normal levels. Prior to replacing the previous primary caregiver, my blood pressure was bouncing periodically to higher levels than those to which I had been accustomed.

I feel the need to stress again that I don’t mean that her Alzheimer’s is any better than before, only that she is more comfortable and at ease, than she had been since her hospitalization with Covid almost two years ago in November 2020. That, our move a few months later, and then a stroke were all significant events that brought about dramatic changes in our lives. It hasn’t been easy. Some of those changes have been permanent, for example, Kate now requires total care with all her ADLs (activities of daily living). Our world is much smaller now; however, we continued to enjoy life and each other. And I am grateful.

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My Experience with Paid Caregivers: Part 2

In my previous post, I outlined some of the unanticipated things that go along with having paid caregivers. I made the point that family caregivers remain managers of their loved one’s care. These things include dealing with insurance companies, selecting an agency that provides in-home care, (many insurance companies only reimburse fees that come through an agency), and handling the finances. As I confessed, they produced a few new sources of stress.

Today’s post looks at managing the caregivers themselves. That’s something else about which I hadn’t given much thought before our first caregiver arrived. I feel sure that I was heavily influenced by our experience with Kate’s mother in 2000 when we arranged 24/7 care for her in our home. That was a very good experience. The agency quickly arranged for 5-7 people to cover all the shifts. Almost every one of them was with us until her mother’s death over five years later. They were a dependable and competent group that could handle the tasks required for someone who needed “total care.”

When I first engaged caregivers for Kate, I didn’t think much about any special skills for her caregivers. I was simply looking for someone who could be with her while I was away for a few hours. I wanted someone who would be a good companion for Kate. After trying several in the first few weeks, we ended up with two who were with us for an extended time, one for more than four years.

The only problem I encountered was finding people who could establish a close relationship with Kate. I wanted someone she would look forward to seeing. The one who was with us for over four years was the best.

Before Kate had COVID, she was still mobile, able to occupy herself and take care of her personal needs. After her hospital experience, she required total care. That not only meant that I needed more hours of help. I needed caregivers with special training in caring for someone with her needs. That was a whole new ballgame. It’s been a year and five months since then and the management of caregivers has become a big part of my life and is often stressful. Here are some of the reasons.

Like other family caregivers, I value the time that I get away for lunch, meet with friends, or take care of routine tasks like grocery shopping. Some, like doctor’s appointments and my weekly Rotary meeting, involve a specific time, and I don’t like to be late. Inevitably, caregivers are sometimes late or have to cancel. That has presented a problem for me from the beginning. It has become a much bigger issue now that Kate needs more care, and there is a staff shortage.

On a number of occasions, our current agency has been unable to replace a caregiver who couldn’t come. Fortunately, our present agency has “floaters” on the grounds. These are caregivers whose job is to move from one client to another during the day to meet immediate, short-term needs like ours – helping me get Kate out of bed and back in bed that night. Between those times, I can care for her myself. Actually, I like that because her needs are minimal once she is up, and we get to spend quality time together. Even with the backup provided by floaters, I often need to change my plans for the day.

One of the biggest challenges (and another source of stress) is finding caregivers that are a good match for our needs. Kate now requires help with all of the “activities of daily living” (ADLs). If I want a caregiver who is trained for this responsibility, I need a CNA (Certified Nurse Assistant). Not all the caregivers at an agency have this certification, and not all CNAs are equally skilled; therefore, it often takes trial periods with different caregivers before settling into one or more who are best suited for our situation. It can be very stressful when I lose a caregiver and have to locate a replacement.

I’ve come to recognize that the qualities I want in Kate’s caregivers fall into two distinct categories that I consider of equal importance. The first, and more obvious, is the technical skills required to perform all of Kate’s ADLs (bathing, dressing, getting her out of bed, and feeding her. The second is to treat her with tender loving care (TLC) although I don’t expect them to treat her as I do. Our relationship as husband and wife is distinctly different. It is much easier for me to deliver TLC than any caregiver.

On the other hand, I have had only one or two caregivers who made any effort to provide the TLC that I would like. Typically, caregivers just sit in the same room with Kate without talking. That has bothered me because everyone, even people in the later stages of dementia, appreciates being treated like a person. I believe the root of the problem lies in the fact that Kate doesn’t talk much at all. This leads the caregivers to believe that she can’t understand and appreciate their effort to be friendly. I also believe that caregivers’ training provides much less attention to TLC than I think is necessary.

Kate’s early caregivers were better with TLC than those with her now. That was a time when Kate could carry on a conversation more easily. The only way a caregiver can do that now is to “get into her world.” That is not an easy thing to do, even for me. We’ve had only two caregivers (and they were filling in for one of our regulars) who could handle this. Each of them sang songs with/for Kate. Kate enjoyed it, and I was surprised when I came home and found them talking together.

I’ve learned that our situation is a bit unusual for most of our caregivers in that I am an active manager of Kate’s care. I am rarely gone for more than three hours of a 7-8 hour shift. The caregivers are accustomed to providing care without another family member’s presence. Usually, family caregivers leave right after they arrive and return at the time they are to leave. As a result, they can be annoyed and resent any involvement or suggestions from the family caregiver who spends more time at home. That has been a particular problem with one of my caregivers, and it has been very stressful.

That leads me to mention something else that can be a problem – the caregivers’ personality. I have also run into this, and it is with the same caregiver whose other caregiving responsibilities don’t include working in the presence of a family caregiver. I’d rather not go into the details, but this has become the biggest problem I have faced with any caregiver. I am working with the agency to replace her, but so far they have had no luck. Our agency is not alone. Caregivers are in high demand, and people who require total care are often the least preferred cases by the caregivers themselves.

In closing, I should say that I’ve been talking about paid caregivers for in-home care; however, what I have said is also true if one’s loved one is in some form of institutional care (hospital, rehab, memory care, adult daycare, or skilled nursing). Following a stroke, my dad was in skilled nursing for the last three and a half years of his life. I visited with him almost every day. From the first day until the last, I found it necessary to communicate aspects of his care that needed to be addressed. Twice, for example, I arrived to find him in a diabetic shock as a result of their continuing to give him insulin despite the fact that he had missed his lunch. The schedule called for him to get his insulin at 3:00. There was no requirement that he had to eat lunch.

All of this is to say that having paid caregivers is not without its own elements of stress. That often arises from the unanticipated consequences of being the family caregiver, the manager of the loved one who needs care. That said, I wouldn’t be able to handle Kate’s care without our paid caregivers, and I am very grateful to have them.

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My Experience with Paid Caregivers: Part 1

Sometimes being a #caregiver feels like I’m on a merry-go-round that goes faster and faster while I try and keep my balance. Life as mom’s caregiver has changed since she moved into Assisted Living, but the merry-go-round ride continues. https://advocateformomanddad.com/stop-the-merry-go-round/…

The quote above is from a tweet by Debra Hallisey, author of the blog, “Advocate for Mom and Dad.” It caught my attention because I was in the middle of drafting the following blog post that deals with a similar experience.

Typically, people who haven’t been caregivers of a loved one with dementia can’t imagine everything that is involved, but they do know or usually assume that it can be stressful. Thus, very early in our journey with Alzheimer’s, people began to ask me if I had “help” with Kate. For 6 years after her diagnosis, my answer was “no,” but I had thought about it long before then.

I was influenced by the experience with my dad who cared for my mom with dementia. My brother and I repeatedly tried to get him to bring in help, but he was very resistant. As Mom’s dementia progressed, I could see the toll it took on him.

I was determined not to let the same thing happen to me. We have long-term care insurance, and I planned to take advantage of it. The big question was when. The answer came in 2017 when I began to feel less comfortable leaving Kate alone. I had a regular Rotary meeting on Monday, and I was going to the YMCA on Monday, Wednesday, and Friday afternoons. I also needed time for a variety of other routine chores. I arranged for help before it was necessary. At that time, the caregivers’ responsibilities were minimal. I didn’t think of them as caregivers but as sitters or companions. All they had to do was be with Kate. 

Looking back, I believe engaging in help was a wise move. That’s been especially important since Kate’s experience with COVID-19 just before Thanksgiving in 2020. That coincided with her continued decline related to her Alzheimer’s. Suddenly, I really needed help. I arranged in-home care for 7-8 hours a day, 7 days a week starting the day she came home from the hospital. The caregivers were, and still are, doing things I wouldn’t be able to manage by myself.

While caregivers have minimized the stress that goes along with Alzheimer’s, in-home care hasn’t eliminated stress altogether. In fact, my stress now is greater than at any other time since Kate’s diagnosis. That is something I didn’t anticipate, and I don’t think I’m alone in that. It turns out that even with paid caregivers, family caregivers continue to play an essential role as managers of their loved one’s care. Quite often, that isn’t easy.  Let me explain.

To begin with, working with my insurance company and a home-care agency required more time than I expected. It was rare for me to get through to the insurance company on one call. After completing the appropriate forms, Kate had to go through an assessment interview to ensure that she was eligible under the terms of our policy. That was repeated twice a year for the first few years and is now an annual requirement.

Simultaneously, I had to select an agency. The social worker with Kate’s primary care physician helped me sort through that. Then, I had to initiate the paperwork to get the agency approved by the insurance company. That didn’t happen immediately.

Finally, it was time to select our caregivers. We went through several before settling on two, one for Monday and the other for Wednesday and Friday. Although I was uneasy about leaving her, I see now that I had a very good situation. That was because Kate didn’t need much care. It was also before the pandemic made it more difficult to find and retain caregivers.

I wanted caregivers who had the skills appropriate to Kate’s needs, someone that Kate liked, and who would stay with us for an extended period of time. During the first four years of in-home care, I was fortunate to have one caregiver who was with us the entire time. She has since taken another job. I hated to lose her because she was the caregiver with whom Kate was most comfortable. I don’t believe that was because she had been with us far longer than anyone else. She just had a personality that Kate and I both found appealing.

During the pandemic and after Kate had gotten COVID, I had to deal with an additional agency because our original one was unable to provide the necessary caregivers. Since then, we must have had more than ten different people who worked for varying lengths of time.

Adding another agency introduced a different problem. When I first met with the owner of the agency, we talked about the process of getting them approved by our insurance company. He said something that made me believe their agency would do all the paperwork. That sounded great to me, but it turned out that each of us misunderstood the other. Thus, they worked for us for several months without getting approved. I only knew because I wasn’t getting reimbursed. When I explained the situation to the agency, they said they would take care of it, but it didn’t happen. To make a long story short, I ultimately terminated the agency. Then I spent a month or more working with our insurance company to get our reimbursement. The good news is that I finally got it, but it took a lot more effort on my part than I think it should have.

The retirement community where we live now has its own home care agency. That has simplified things, especially managing the finances. They send our insurance company a summary of services at the end of each month. Two months later, I receive our reimbursement. Although the financial aspect of caregiving is working smoothly, there is still one other aspect of caregiving that presents a problem. That involves the caregivers themselves.

I’ll save that for another post, but my point remains the same: Family caregivers are always needed to manage and coordinate the services of paid professionals we engage for tasks that we can’t do ourselves. That management responsibility can also be stressful, even when professional services are delivered in facilities like assisted living, memory care, or skilled nursing.

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A Bump in the Road

Many people use the word “journey” when talking about Alzheimer’s and other dementias. I sometimes hesitate to use the term because it seems trite. On the other hand, it really captures a relevant aspect of “Living with Alzheimer’s.” It connotes something that is long in duration and involves a variety of experiences. How apt that is in our case.

Like so many other aspects of life, there are things we expect and those that surprise us. This past Monday we got a surprise, one that potentially may have lasting consequences. Kate had a mild stroke.

We almost always have good nights. That was true Sunday night. We spent the evening watching YouTube videos. A lot of them were choral favorites like “Danny Boy” and “Shenandoah.”

We had a very nice Monday morning as well. She awoke around 8:00, and I spent almost the entire morning beside her in bed. I turned on an assortment of YouTube videos focusing mostly on Broadway favorites. She wasn’t talkative. That’s normal at that time of day, but it was obvious that she was enjoying the music. Several times she commented that it was “wonderful.” I told her how much I enjoyed being with her. She indicated the same to me. Off and on we held hands. The day was off to a good start.

Not long before the caregiver arrived, she went back to sleep, and I went to Rotary. The caregiver let her sleep until 1:00 when she got her up and gave her something to eat. She said that Kate didn’t finish her meal. She kept chewing but didn’t swallow.

After getting back from Rotary but before reaching our apartment, I received a call from an old college friend. When I walked in, I greeted Kate the way I usually do. She gave me a big smile, and I told her I would finish my call and come back to her. About twenty minutes later, I got down on my knees beside her recliner, enabling me to look directly into her eyes, and told her how glad I was to see her.

She didn’t say much, but she looked pleased that I was there. She smiled. As I continued to talk to her, she closed her eyes, and her breathing slowed down. I had a flashback to being with my father and Kate’s mother when they died. Kate looked the same way. I felt she was drifting away from me. I mentioned that to the caregiver. She had the same thought. I told the caregiver that I didn’t want to lose her, but it would be a beautiful way for her to leave me. The precious moments we had the night before and that morning passed through my mind, and I said, “I love you. I always have. I always will.” To me, it seemed like she was trying to respond, but nothing came out.

I called her doctor. His office is in the building next door, one of the advantages of being in this retirement community. He and his nurse came over. By this time, she was in a deep sleep, but her vitals were normal. He checked her eyes. They appeared all right. He lifted each arm and found that her right arm was completely limp while the left was normal. He said he couldn’t be sure but thought she had a stroke. He asked whether I wanted to take her to the hospital. We talked briefly. He and I agreed that it wouldn’t be good to put her through the hospital routine, so we kept her here.

She slept well except for two events, one around 9:30 when her breathing seemed labored. I called the doctor. I described what was going on and let him listen to her breathing. He didn’t think it was serious and suggested that I continue to let her rest. She fell asleep while we were talking. Around 11:30, she screamed and held her right hand against her stomach and then her chest. I felt her left arm. It was warm. I checked the right arm, and it was cold. I pulled the sheet and bedspread over her arm. I didn’t hear a sound after that until the next morning while I was in the bathroom getting ready for the day. She screamed again, but, whatever the cause, it was over before I got to her bedside.

The next morning the doctor returned to check on her. He didn’t notice anything new except that the muscles in her left arm were twitching. He didn’t say that indicated anything special, but I have since learned that this kind of reaction is not unusual for people who have had a stroke. That occurs when the damage to the brain occurs in the part that controls body movement. That might also explain the limpness in her right arm and the fact that her eyes tend to focus to her left.

I told him I felt this was might be a dramatic change in our lives. He acknowledged the likelihood of that though he stopped short of saying she wouldn’t recover. That’s what I expected him to say. He also said that we might observe periods of improvement mixed with more of what we are seeing now.

Since then, she’s been making a little progress each day. Until yesterday morning, she was asleep most of the time, waking periodically for just a few moments, but she has regained some of the strength in her right arm. For a period of time on Thursday, she was more alert although she didn’t speak. She is also eating and drinking much less than normal.

Yesterday (the fourth day since the stroke) was her best day by far. She was awake an hour at one stretch that morning. That’s the longest she had been awake since the stroke. She smiled more and laughed. She responded to several YouTube music videos, mouthing the words to “Battle Hymn of the Republic” with the Mormon Tabernacle Choir. She was especially animated during the chorus, clearly remembering the word “Glory” in “Glory, Glory, Hallelujah.”

She’s coming to life again. I know we may see some permanent damage. My biggest concern is her ability to speak. Aphasia was already a problem, something often experienced by people who have strokes. Still, I am hopeful we may eventually be able to get out for our afternoon ice cream as well as our nightly dinner in the dining room. At any rate, I think that’s a reasonable goal. Time will tell.

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Morning Fright

For several years, Kate has periodically waked up and been frightened by not knowing anything (who she is, who I am, where she is, what she should, etc.). The “not knowing” has continued, but she has seemed less frightened or not frightened at all by it. I usually tell her who I am, her name, and that we met in college, fell in love, and have been together ever since. It doesn’t usually take long before she feels “all right.”

This morning her experience was different. It was much more like it used to be except her fright was less. It was more like she has been in recent years, somewhat more puzzled than frightened. I first noticed her less than ten minutes after beginning my morning walk. I walked to her bedside and could see immediately what the problem was.

My first effort to help her is what I described in the opening paragraph. It didn’t help. I got in bed with her, held her hand, and softly and calmly let her know that I wanted to help her. That seemed to give her a measure of security, but it didn’t solve the problem.

I had already turned on some relaxing piano music but decided to change to an album that had engaged her so much before Christmas. I started with “Edelweiss” and set it to repeat two times. As I was lying beside her, I created a playlist of other songs on the album that she also likes. I also interspersed “Edelweiss” several other times. (You may wonder how I can do this while staying in bed with Kate. The answer is that I control my audio system with my phone. It’s easy to use and has come in handy many times in similar situations.)

Once again, music came to my rescue. Before “Edelweiss” had ended the first time, she appeared more relaxed and closed her eyes. She soon fell asleep. I stayed with her long enough to be sure she was sleeping soundly. Then I finished my walk. It was forty minutes later, much longer than is usually required to calm her.

It’s been a long time since I’ve said this, but moments like this are among the saddest ones for me. Most of the time, Kate is happy. Of course, that makes me happy. I want her to be happy all the time. When she’s irritable, my emotion is “flat.” I mean that I’m neither happy nor sad. I do experience tension, but my focus is strictly on how to deal with the problem. When I’m not successful, I’m frustrated. That’s a different emotion altogether.

Kate’s being sad is much harder for me to deal with. I work hard to avoid her sadness. I don’t like to see her troubled in any way, and moments in which her brain is blank are the most disturbing moments of all for me. I talk a lot about our “Happy Moments.” I do that in this blog and in conversation with other people. I don’t do that to be deliberately misleading. I think those moments really are the most typical aspect of our journey with Alzheimer’s, but I don’t want to convey that everything is rosy. That’s impossible with life in general, and is certainly true for dementia, probably more so.

I’ve heard people say, “At least, she/he doesn’t know or is not aware.” That bothered me when my mother had dementia more than twenty years ago. I remember how often she said things like, “I don’t know what’s wrong with me.” She was bothered, and I have seen that many times with Kate. Her senses are still alive. She knows more than we imagine.

There is no way to solve the fundamental reason she becomes frightened. I can calm her when that happens, but I can’t cure her Alzheimer’s. That means moments like the one this morning will likely continue until the very last stages of her illness, and that makes me sad too.

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Music in the Morning

Regular readers of this blog know that music has been important in our lives. That was true before Kate’s diagnosis. Since then, it has played a more critical role both as entertainment and therapy. More than anything else I’ve talked about our nightly ritual of watching music videos on YouTube; however, it goes much further than that. Music plays throughout the day and night. It doesn’t usually start first thing in the morning, but when it does, its purpose is to solve a problem. That happened this morning.

I had just finished dressing and was about to go to the kitchen for breakfast. A few minutes before, I heard Kate say, “Hey” and then something else I didn’t understand. It isn’t unusual for her to talk while she is sleeping, so I hadn’t checked on her immediately. It was 6:53 when I entered the bedroom. Her eyes were open and she looked confused. It was one of those mornings when she awakes “without knowing anything.” She wanted to know what she should do. I explained that it was still early and that she could just relax and go back to sleep a while longer.

I should have learned from past experience that would not solve the problem. I think I was just eager to fix my breakfast and take my morning walk. I tried to calm her with words as I stood by her bedside but quickly decided to postpone my normal routine. I lay down beside her, put my head on her shoulder and my arm over her chest. I spoke softly to her and told her my name and hers and explained that we had met in college, fallen in love, married, and had children and grandchildren.

While this may have been useful information, she was still uneasy and wanted to know what she could do. That led me to go in another direction. Music can be comforting. Instead of trying to explain what she could or should do, I simply started singing “Edelweiss.” After just a few words, she seemed to relax. I sang it another time before pulling my phone out of my pocket and turning on the audio system to “Edelweiss.” I repeated it several times and hummed along with it. She was calm. Then I thought of several other songs that she likes (“Danny Boy,” “Shenandoah,” “Loch Lomond,” “Swing Low, Sweet Chariot,” and “Deep River”) and played them for the next thirty minutes. The crisis was over.

I don’t know what I would do without music. I’m hopeful I won’t ever face that.

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A Day of Rest

It’s too soon to say Kate has established a new pattern of behavior, but there was a bit of consistency the past few days. Tuesday, Thursday, and Saturday she was very talkative for significant portions of the day. Tuesday was the most extreme. She talked almost non-stop from 8:30 in the morning until about 9:00 when I gave her a tablet of melatonin. That worked, but I gave her a sedative (Seroquel) on Thursday and Saturday nights.

It was no surprise that each of the days that followed her talkativeness and agitation she was very tired. She slept late and rested most of the afternoon as well. Yesterday was a good day of recovery. She was tired most of the day until dinner time. By then, she was quite rested, and we went to the dining room for dinner.

After the caregiver left, we relaxed in bed. I watched part of the Buccaneers/Patriots game with the sound muted and music playing for Kate. It was a welcome moment for the two of us after the past few days. I hope we find our way back to something a bit more normal in the upcoming week.

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More on Kate’s Talkativeness

For the third time in the past five days, Kate was unusually talkative yesterday. I’ve welcomed some of that. That has been especially true during the morning when she has waked up much earlier than usual. I’ve enjoyed spending that time with her. The bulk of her conversation has involved delusions and hallucinations, but she has been happy and seemed at ease. That was true during the entire day. During the afternoon, we went to the café for ice cream. After Kate had finished eating, we went out on the deck beside the café. It is shady in the afternoon, and the temperature was so pleasant that we spent an hour there.

As on previous days this week, the pace of her talking began to pick up. She talked constantly while we were on the deck. We went straight to the dining room for dinner. I was somewhat uneasy because Kate was talking so much and can be loud at times, but the meal captured her attention. She ate well and seemed relaxed.

Upon our return to the apartment, we got her ready for bed. She was very cooperative, something that has become the norm in recent weeks. She began to talk a little more after the caregiver left, but she was relatively calm. Over the course of the next hour and a half, the pace of her talking picked up. At 9:00, it was obvious that she wasn’t going to be ready for bed anytime soon. I mentioned that I was getting tired and would soon get ready for bed. I don’t remember exactly what she said, but she conveyed that she wasn’t ready at all.

I prefer not to use Seroquel unless I have to, so I got her a melatonin. I muted the sound of the TV and turned on some soft music she likes. Forty minutes later, she showed no signs of sleepiness. At 10:00, I crushed a tablet of Seroquel and gave it to her in a spoonful of yogurt. I’ve only used Seroquel four or five times, and it usually takes effect within twenty minutes. An hour later, she was still going strong. I gave her another Seroquel and turned on a YouTube video of Andre Rieu and his orchestra accompanied by a very large contingent (at least 50) of brass instruments playing a very soft rendition of “Nearer My God to Thee.” I hummed along with the music. For a few moments, Kate eased up on her talking. She picked right up when the music ended. I switched to a recording of “Edelweiss” and hummed along with that. She started humming too. She also began to relax. I turned out the lights, and she was asleep by 11:30, almost two hours later than usual.

As I prepare to upload this post, it is close to 10:00 a.m. the next morning. She slept through the night and has shown no signs of waking. If she follows the pattern of the past few days, she will probably be tired and will catch up on her rest today. I’m still not ready to make any predictions. What will be will be.

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Addendum to Previous Post: Time Did Tell

In yesterday’s post, I talked about my looking for patterns in Kate’s behavior. I was motivated to talk about that because she had an unusually talkative day on Tuesday. She was agitated, and I resorted to melatonin to get her to sleep that night. Predictably, she was very tired the next day. Yesterday started out like a somewhat typical day except for the fact that she was awake at 8:30, several hours earlier than normal. In my final sentence, I suggested that “time will tell” if Tuesday’s talkativeness/agitation was a unique happening or the beginning of another pattern.

As it turned out, yesterday was not quite like Tuesday; however, around 3:00 p.m. she became talkative but did not appear particularly agitated. At 3:30, I left for a residents’ meeting. When I returned at 4:30, Kate was talking with agitation similar to that on Tuesday. The caregiver and I decided not to go to the dining room. I brought our dinner back to our apartment. She began to calm down a bit while she was eating.

I thought we might be home free, but she started talking again as we got her ready for bed and continued talking after the caregiver left. Before 9:00, she seemed somewhat agitated. As I had done the other night, I gave her a melatonin. It had no effect. Just before 10:00, I gave her ½ of a 25mg tablet of Seroquel (not crushed) in a spoonful of yogurt. She swallowed the yogurt and spit out the pill. (These tablets are very small, so small that I was unsure I would be able to split them when her doctor first prescribed them. I thought she might swallow it uncrushed.) Then I crushed a whole tablet and mixed it in yogurt. She took it without a problem and was asleep within twenty minutes, and, as usual, she slept through the night and is still sleeping at 9:25.

What’s in store for today? I’m not predicting. I’m just going to wait and see. She should be rested after resting all day Wednesday and sleeping well that night and last night. The focus of my attention will not be on the time she wakes, but her incessant talking during the day and especially at bedtime. By itself, talking would not be an issue. What concerns me is the agitation that makes the talking so out of control.

During the past year, Kate’s behavior has seemed like she might be experiencing sundowning. I haven’t been ready to say that is it because her symptoms haven’t always appeared in the late afternoon or early evening. One of the two occasions this week began much earlier in the day. Nevertheless, I would say that her behavior appears to match what I have interpreted as symptoms of sundowning. If so, I will probably see this again. One thing I know. Tuesday’s talkativeness was not unique. Whether or not this becomes a pattern still remains to be seen. Once again, time will tell.