Saturday, 21 June 2008

Sleeper's aWake


Well. Today was interesting.

I’ve said recently that DJ does not appear well. A blood sample has been taken for analysis – this should be available (to the GP) on Monday. DJ is booked to go into Respite for a week from Wednesday. This allows not a lot of time to implement any medication changes and see if they are working before he goes away. But that’s another story.

Today ChickPea just couldn’t keep DJ awake. Even tho it was gone midday when he finally did get up. His not wakefulness affected moving, eating, drinking – EVERYTHING. He was drooling all the time. He looked awful. There was the thought that maybe we should get another GP review – his hands and feet are so swollen – but we got NOWHERE helpful last time. There was certainly the thought that maybe we are getting close To Something Terminal Happening. In which case trying to insist he be awake seemed somewhat inappropriate. .....

So we accepted a slightly lower than ideal fluid intake. And when he was begging to get to his bed (“How about distraction ?” you say – well – just YOU try distracting a very determined and extremely deaf 95 yr old who really won’t listen, and despite short term memory problems (!) will stick avidly to his agenda of getting to bed NOW…….), so we let him get to his bed about 5.45pm…….. After all - Would he see morning…….?

Will he, heck ! I hae me doubts….. but not from Natural Causes……….

Wide awake at 8pm – more awake than for the last 3 days – and on the floor again, of course. So now he’s in the lounge with us, in the wheelchair (I really don’t trust his walking tonight), and he’s been up again for nearly 2 hrs, and all he’ll do is fiddle with this….and that……and try to take his clothes off again………

I’ll stop the blog and get him a warm milk drink, and try the impossible likelihood of him settling back in his bed…….. Nite Nite. Sleep well…….

The Way It Is Going........


Not good. Not at all good. Unless a miracle happens to reverse current trends, it is increasingly looking as if DJ will need to be in permanent residential Care over the next few weeks (maybe days) rather than the months that ChickPea had been anticipating.

At midnight last night, again at 6am and again at 8am DJ had to be picked up off the floor of his bedroom. No evidence of specific injury, but certainly increasingly bruised. Wasn’t really managing to stand, let alone walk. Maybe that will have improved by the time he wakens. He was wanting to get up at 9.30am, sat up, took some fruit juice, then wanted to lie down again……. so having replaced his pyjamas, ChickPea made it so……..it is now 12.30md, and he’s still sleeping………

Dementia, of whatever type/cause, is a horrible thing. The Professionals used to persuade us to get DJ up in this situation, and not let him sleep on. On the basis that he would be less likely to sleep the next night. We trusted and believed The Professionals. So we did. And DJ got more and more tired, more and more anxious and fretful, more and more unsettled at night. It all got so desperately distressing for DJ, TH and ChickPea that we stopped, reassessed. And decided to Trust our Own Instincts. And let DJ stay in bed late (sometimes – ‘outside arrangements’ mean he sometimes has to get up at 8am – sometimes 7am). But Lo ! The Situation Improved (for a while). So now I Say To Others – Trust Yourself !

Sadly, as TH pointed out, caring for Someone With Dementia is an uphill learning curve. You just get to managing to cope with The Requirements…. And These Change. So you cannae cope so well until you’ve struggled a bit with the New Requirements….. and then you get to cope again…..but then All Changes Again……… Struggle Again……. Cope Again…….. Changes Again…..

That’s what it’s like for us. What the heck is it like for DJ ? He never was a great one for communicating or sharing his experience, and the dementia is steadily – and increasingly quickly – eroding his ability to think, to relate to himself, to relate to us. His speech has been deteriorating this last week. Saliva escapes more and more of the time. Balance, stance and movement are disappearing almost as we watch.

Nothing can prepare the Nearest And Dearest for that. But for us, none even tried. Just this week I found the ‘Seven Point Scale’ of Dementia, on the excellent Altzheimer Socy website (I’ll try and tag it on the blog, but I’m not good at these things yet…). Perhaps I should have been more proactive and spent more time researching these things for myself. But I was (attempting) caring for DJ…… but NOW we know that his condition ticks all the boxes for ‘Stage 6’ and several of ‘Stage 7’……… there is no ‘Stage 8’ on this earth. So why – WHY – when I have asked The Professionals to give us some clue about his level of dementia, have they just shrugged and said, “Well, you know it is difficult…” HA ! you don’t say. And how many big bucks are they being paid, and just why should the relatives be expected to jump thru’ technical hoops to access the official case record notes to find out what any decent Professional (I speak as a Professional) should expect to deliver to Relevant Others as a basic factor of Good Professional Practice….. ?

The GP seemed somewhat unmoved and unconcerned when she was in 2 days ago. Didn’t want to know how – if – we are coping. After all, he is 95. But so what ? I’ve known 98 year olds with a good quality of life. Age of itself shouldn’t be justification for poor quality of life – or poor care. I am very concerned that maybe - just maybe - Things Could Be Better for a wee while with a little tweaking of the medications. GP wouldn’t consider that without a blood test….. so the District Nurse would have to come in to do that another day…… How come the GP, who was here, couldn’t/wouldn’t just do it there and then and it’d be in process ? Oh no. (But surely that costs the system even more, getting someone else all the way along to the house to spend another 5 mins getting a blood sample, as well as at least another 24 hrs before the results will be available ?).
Sorry. ChickPea worked in Acute Areas of the NHS for well over 20yrs and knows how the system wastes money by such illogical behaviours – and care of the patient is compromised by so many stupidities of The System. If The Professional concerned will think outside of their box and push the system, you find it is made of stretchy stuff that WILL actually accommodate better – even best – care for the individual. But The Professional has to work much much harder to achieve that result now compared to 20 yrs ago……. And now we have a new generation of Professionals, who perhaps have never actually seen ‘best’ care to even know that it can be possible…..
Anyway, the blood sample eventually got taken yesterday. 24hrs was probably within ‘targets’…….

Sorry. This has been A Rant. Sadly, a Very Necessary Rant. I’ll try to do better next time…….

Friday, 20 June 2008

And it's FRIDAY

Good morning ! Sunshine creeping between the grey clouds and 3 comments have been posted – this will be a good day…….. despite DJ needing a shower at midnight last night, and then awakening ChickPea at 3.43am, 4.15am and 7am……

Mr Mutt is out in the sun already, watching the ‘baby blues’ on the peanut feeder and the ‘baby greats’ on the seed feeder. Now a week on from fledging, they are all flying without hesitation and busy with the business of staying alive. Maybe Mr Mutt’s presence will help – he’ll maybe deter the Fluffy Black Marauder Mog that likes to lurk in the flower (weeds !) border and reduce the Feathered Friends’ population…… Not sure if he’ll also deter the sparrowhawk…….. but I hope so.

The kitchen is too quiet. The recycling is lounging in heaps rather than waiting outside in a bright yellow sack for collection. The washing is festering in a pile from last night rather than billowing in the wind. The washingup hasn’t. Mr Mutt is dreaming longingly for his walk.

ChickPea is flagging. So is TH, with another working day of being essentially the only one – yet again - to handle the whole team’s workload.
We usually look forward to the weekend, but with DJ’s recent poor health and poor sleeping, the weekend promises little respite. The GP was out to see him yesterday, but was fairly dismissive – well, he’s 95 after all. Happy Birthday DJ.

Wednesday, 18 June 2008

ChickPea's current A-Z


Still very very tired….. DJ continues to be too unsettled between 12MN and 8am to allow much possibility of sleep for either TH or ChickPea. So we are Finding Life’s Challenges A Little Difficult just now.

To focus, I thought about my ‘A-Z of today’ – what’s yours ?

Animals
Blogging
CatsnChooks
Dog
Emails
Faith - and Friends
God - and Garden
Hubby
Interactions
Jelly (especially good if you put fresh fruits into it !)
Keeping Smiling
Laughter
Making scones
Not doing the washingup
Odd moments of Insight
Painting the fence (this is taking a while)
Quire (ancient spelling of ‘choir’ - ok – I cheated )
Recording for the BBC (! – didn’t expect that, now did you !)
SUNSHINE (now there’s a surprise, eh !)
Taking Mutt a walk
Ultimate luxury of a bath
Violets in the front garden
Wearing Wellies (one of Life’s Little Luxuries On A Wet Day)
Xcitement of finding a comment on the blog (yes – it has happened)
Yummy icecream on a hot day
Zzzzzzzzzzzzing ……….. (I believe in hope….)

Monday, 16 June 2008

Monday Menu : ChickPea Risotto.......

Monday morning. DJ has just been taken away for the day – so I shall take a few minutes for personal therapy before tackling the day’s chores. TH is working late tonight, so there may be more time later on – we shall see.

Risotto – lots of bits and pieces, plenty for a meal. No recipe, just chuck it all in and stir well……..

Q. Did the car trip work and stop DJ fretting about a bus ?
A. Thank you for asking. Not really – no, that’s not quite honest – partially.
It had the effect of quietening the endlessly repetitive phrases for about an hour. It was also fairly therapeutic for me, in that I don’t drive so much these days as I used to, and there are turnings we go past that I fancy exploring. So as I had the car, This Was An Opportunity. We live in a major city – well, kinda suburbs of – but can be out past fields within 5 mins. (Apologies to The Environment – too many car fumes - not so therapeutic on that score, but, I am afraid, this was a Necessary And Lifesaving Manoeuvre ……). After about an hour, when ChickPea was beginning to count her chickens (figuratively speaking), DJ shot them down. From apparently settled, silent state, came : “Am I going to be able to catch the bus then ?” (NO)……. “Have I missed the bus ?” (YES) ……..”I need to get the bus” (WHY’S THAT THEN ?) “I don’t know”……. (THIS IS THE BUS – YOU ARE ON THE BUS)….. “But where do I catch the bus ?”…….
Then the seatbelt was off – Thank God for the childlock.
We got home after about 2 hours’ driving around fabulous countryside. DJ was being fairly quiet again – clutching onto the seat in front (honest – my driving really isn’t that bad…) – hmmmn - not exactly relaxed…... but ‘Aha’ thought ChickPea – ‘Situation Sorted’. .....
“When will I get the bus ?” sez DJ………

Q. Anything to Give Thanks For Today ?
A. Oh yes – thank you for reminding me - sleeping has been improving a little. DJ essentially slept thru (bar some shouting) from about 10pm until 7am yesterday and again last night. ChickPea’s problem now is that the Sleepometer – which was coping remarkably well in the middle of this last fortnight of Grossly Disrupted Sleep - now reckons it can give up coping, has plummeted to below ‘empty’ and is taking a bit of catching up…. And I do believe there’s Sunshine creeping thru the clouds out there.

Q. How was the w/e ?
A. Mixed. Saturday was fairly non-stop, trying to eliminate the pile of Essential Washing, accomplish Essential Chores, and keep DJ clothed. (This has been A Recent Feature – ‘sitting quietly’ – but removing bits of clothing – one afternoon last week, DJ was quiet in his room while ChickPea answered a phonecall, and next thing, there was DJ, not a stitch on, staggering through the house without his zimmer – ‘WHY ?’ – “I don’t know” sez DJ….) Saturday evening had A Bad Moment. I hate stepping in poo. Before Mr Mutt joined us, both TH and I were most indignant when ShoePoo happened. Since Mr Mutt joined us we are probably even more appalled when this happens, as responsible dogpersons do not allow this possibility to occur. But this was in DJ’s room. And Mr Mutt does not venture in there, nor does Ms Mog. That Bad Moment was NOT something I could share with TH, because he has to live here.
Sunday am and DG was with DJ for the service, enabling almost Full Participation for ChickPea – which was Good. A big, fabulous service with orchestra and Haydn’s Little Organ Mass. PK was back. DG, DA and DI were their usual lovely, kind, considerate, supportive selves. Lunch out is always good (especially re. No Cooking, No Washingup…) – we’ll overlook DJ being Increasingly Unpredictable In Public……. TH was then out with the cameras to cover an event loosely related to work, so Mr Mutt, The Wheelchair and I took DJ out into the park – where he fell asleep for a while. Necessary Clearing Up was then attempted as J was in from The Altzheimer’s Assocn to keep DJ company for the evening, allowing ChickPea a few blessed hours off for real Full Participation in a demanding sing but good evensong and post-sing-lubrication.

Guess that’ll do. My cooking skills are fairly rudimentary, I’m afraid. Hope taste was reasonable, not too chewy, probably about 2 out of 10 for presentation……. at least it wasn’t burnt…………

Friday, 13 June 2008

Tripping the night fantastic.........


DJ likes to fret. Well – that’s the only conclusion I can find after several years of trying not to fret myself when he’s like this……….

He came home from the day centre - on a minibus – 2.5 hrs ago. Since then, at least every 5 mins, he has been fretting that he “will miss the bus”…… he’s not sure what bus, or where it’s going – but he’s increasingly anxious that he will miss it. I’ve tried telling him he caught it fine this morning….. and again this afternoon to come home……. that he’s been on the bus……. that there is no bus……. that it has been cancelled……. that the next bus is 3 days’ time on Monday……. I’ve tried distraction - ice cream, tea, cake, biscuits…… more tea. I’ve said the driver has gone home to his bed. I tried the telly on… the telly off……. the curtains closed so the room is dark ……..

All To No Avail.

He’s usually fretting to get to his bed by now. That’s what he needs. He looks tired – desperately tired. But he’ll force himself to stay awake in case the bus comes……. Will he fall asleep if I take him out in the car ? Who knows. But it’s maybe worth a try.

Any other suggestions ?

Loopy Loo

I guess most 24/7 Carers have to find coping strategies for the ‘WC’ aspects of care. Do they also have to get used to being woken at 5am ? Sorry – but I really REALLY need to get this one out of my head……..

The main Precipitating Factor for DJ requiring full time care was developing acute urinary retention. We / I had suspected at least an element of chronic retention for a while, but as DJ wouldn’t talk about it, and the GP wouldn’t address it, we were stumped until his ‘Lunch-provider-carers’ couldn’t get in one day, TH was called home (again) from work, and found DJ having fallen and very torn and bloody. His skin is just so fragile, he tears easily. So TH called me (working fulltime then) and took DJ in to A & E at our local hospital and I left the ward I was working on and met them there. This was mid-August 2006.

So it began. Life was Never The Same Again.

DJ was admitted to hospital that day, and it took a month to get him out. We now know that This Is What Happens when he ends up in hospital. Because of his dementia he cannot understand or relate to what is happening, who the staff are or what is required. He gets upset. He won’t stay in bed. They give him sedation and put cot sides on the bed. He’s still upset, now feels retrained and doesn’t like it. He climbs over the cot sides, falls further onto the hard floor and sustains injury. To keep him in bed they give him more sedation. He now feels very ‘odd’ and sore, as well as restrained, so gets more upset. They give more sedation. He feels more peculiar. Gets more upset. Certainly won’t stay in bed. Falls over……… gets given even more sedation until he finally konks out…….. Episodes when the sedation level is decreasing precipitate him trying to get out of bed to get away and escape……. He gets given more sedation. Then they won’t get him up to walk ….. (“well, he’s really not able …… he wouldn’t be safe”)…….. so then their assessment is that he CAN’T walk……. so couldn’t possibly be managed at home……..

You get the picture.

And The System is both holding the paintbrush and painting the picture, and DJ and his family are effectively now ‘bit players’ being cast into An Alternative Universe.

But IS that the Real Situation ? Is The System’s Perceived Picture the only option ? Is The System’s Answer actually The Only Answer ?

Having worked within the ever-changing system for over 20 years, ChickPea wasn’t going to get steamrollered.

So, to get him home, ChickPea (PEA ? !!) found it necessary to Develop Skills to deal with the waterworks (‘cos DJ would not and will not tolerate a permanent tube being left in place to deal with the necessary). And The System was a bit surprised, both then, and now, that we were willing – and able – and could do it.

That bit I can still cope with.

The Bowel Bit is another matter altogether. We all know about ‘Bowel Habit’ from our own experiences. This title ‘Habit’ suggests a certain predictability. HA !

Over these many months we’ve tried most professionals for advice – District Nurse, GP, Gastro-Enterology Nurse Specialist …….. Their ( mostly pharmacological ) advice had the effect of making the Constipation-Diahorroea Rollercoaster run even faster and more unpredictably.

We stuck with each new bit of advice thru thick and thin….. and, thankfully, eventually gained access to a regular supply of ghastly and uncomfortable ‘pant pads’ which kind of assisted the basic practicalities of coping (if and when DJ would keep them on ……). We changed his clothes, changed his bed in the middle of the night, changed it again, showered him at 3am as the only option…..(too much detail ? – sorry )….. maybe you know how it goes – tho I hope not.

Sooner Or Later we would achieve a modicum of success and reach a week or so of fairly normal…… Then All To Pot again……. or Not In Pot – hence the difficulties……..

This has been another of those ‘Have Confidence In Your Own Instincts’ aspects of care. I guess this is also One Of Those Things that new parents discover ……. Not having achieved parenthood, we had to discover it new. Parenthood perhaps has the hope of progress and improvement………

And so eventually, caring for Someone With Dementia, you accept that this is just The Way It Is….. and presumably Will Be. Sometimes ok, and sometimes NOT. And probably Going To Get Worse.

Meantime…… I Give Thanks Continually for latex gloves, reams of bogroll, moist wipes and even for horrid pant pads………..

( Afterthought : And I wonder why I wonder why no-one leaves any comments on this blog…….. ! )