Keep going

I recently read a book, Ambiguous Loss: Learning to Live with Unresolved Grief , at the recommendation of a friend. It’s one of those books where, as I read, I’m seeing myself in the pages; I’m seeing my constant struggle to make sense of what is happening with mom - and, in turn, me - and I find myself feeling a sense of relief that there is a name for what is happening. 

Alzheimer’s and other dementias take so much away and leave vast uncertainty behind. It’s a terrible diagnosis for the person with the disease and for those who love them. And then there’s  the grief that comes in waves, along with sadness, anger, and yes, even self-pity. It’s hard to take sometimes. I had no idea what I was in for and even if someone had described it to me, I wouldn’t have understood. 

Twenty-four years ago my dad died in his sleep; one minute everything was normal and the next it wasn’t. That kind of grief, the kind that rockets into your soul and your heart and blows everything apart, dropped me to my knees. I remember looking around the room with the phone in my hand and it seemed as if everything had shifted. My world had changed and there was no going back, no easing in, no gathering myself up to face the inevitable, just a cannonball jump into a world my dad no longer existed in. 

The grief I’m experiencing with mom is different. I felt profound sadness and disbelief when this all started happening, and a lot of anger.  There was a sense of urgency to get her moved here and her medical needs taken care of, and tons of frustration with all the little things in between. Now that the logistics of her care is largely taken care of, the urgency is gone but the uncertainty never goes away.

In the book, Ambiguous Loss: Learning to Live with Unresolved Grief, the author, Pauline Boss, talks with a man named John whose wife, Sarah, was in the advanced stages of Alzheimer’s disease. When John was asked if his wife’s recent need for a feeding tube was the lowest point for him so far, his answer was not the expected ‘yes’; instead, he picked up a pencil and drew a staircase that was headed downward on a piece of paper. John explained that at each step, which represented each new crisis that came up, he had felt panicked and had no idea how he was going to handle it. But he did handle it, over and over again. At every new step there was a moment of not knowing what to do, or how to adjust, or what was needed but, every time, he figured it out. He kept going.

And that’s what we as human beings do - we handle life as it’s served up. Sometimes a regular Thursday afternoon turns into something unexpectedly wonderful and sometimes a Tuesday morning turns our lives upside down in a tragic way we never saw coming. We adjust, we re-calibrate, we learn, and we do the very best we can at every new turn and then...we keep going.

Mom and her dog, Susie. November 1958

This is going to cost you...

Having enough money to take care of mom is one of those things that’s always in the back of my mind. Right now, we’re in a good place but as her needs increase it’s going to start getting a little tight financially. I have investments in place along with savings but there may come a day when what she needs exceeds her retirement income and I’ll have to start tapping into those accounts. Yes, that’s what they’re there for but they aren’t bottomless; of course, I’ll make it work but it still makes me nervous.

All things considered, we’re lucky that we live in a state where assisted living costs are not as expensive as some. Here’s a breakdown of the $3,948.80 we’re currently paying a month:

• Room and Board - $2,930

• Tier 2 level of care - $960

• Art council - $20

• Cable TV - $25

• Oklahoma sales tax (8.625%) - $13.80

The National Center for Assisted Living  reports that more than 800,000 Americans are now residing in assisted living facilities, and that number is growing. The average median cost for an assisted living apartment in the United States is about $3,700 per month and the majority of residents are age 85 and older. If a resident needs to live in a memory care facility, you can expect to pay $600 - $1000 more per month.

Prices can vary widely nationwide and within the same state. Alaska is one of the highest with an average monthly cost for assisted living of $6300 per month. Just for fun, I looked at the average cost for Illinois, where my mom lived before we moved her here, and it’s $4030. From where she lived, Missouri is about 15 miles away and the average monthly cost there is $2844 which is one of the lowest in the United States. That $1,186 difference is huge, especially as the costs go up as the level of care increases. I found this state to state guide on the average cost of assisted living interesting; I had no idea the cost could vary as much as it does but from all I’ve learned so far, it’s not surprising. 

When it comes to having to pay for assisted living, there are a few things to consider. Retirement, personal savings, and other assets are where the funds will most likely come from but there are some other options, a few of which I’ve listed below. Remember, your financial advisor is one of your best allies and adding in an elder law professional can’t hurt.

Long-term care insurance is an option but do your homework before purchasing one of these policies. You’ll need to make sure you can afford the premiums and understand the stipulations of the policy, such as exclusions for addiction and mental illness. Other illnesses such as heart disease or Alzheimer’s may be excluded from the policy along with certain types of cancer. Also, there is a chance you may never need the benefits of the policy and should your ability to pay the premiums stop, you’ll most likely lose coverage along with what you’ve paid in. For more information, go to AARP's page on long term care insurance.

Veterans Aid and Attendance benefits can be used by veterans who are 65 or older and their surviving spouse; if the veteran is under 65 he or she must be totally disabled to qualify. In addition, the veteran must have served at least 90 days on active duty with at least one of those days being during wartime. There is a net worth limit and an investigation into finances over the three years prior to application along with several conditions that must be met. Go to the U.S. Department of Veterans Affairs site  and the Senior Veterans Service Alliance for more information.

Life insurance. You can use your existing life insurance policy to receive benefits before death through an accelerated death benefit (ADB) in which the insurance company “buys back” the policy. This benefit may be included in the policy or may need to be purchased as a rider and the buy back percentage can vary from 25% to 100%. The ADB is usually tax exempt if life expectancy is less than two years; however, receiving this benefit may affect Medicaid and SSI eligibility. For more in depth information, go to Investopedia's  page on ADB.

Annuities purchased as an up front lump sum payment can provide regular payments to the annuitant for a predetermined amount of time which could be the rest of your life even if the amount paid in is exhausted. If it is allowed in your state, an irrevocable annuity can be helpful if you or your spouse needs assisted living and you want to qualify for Medicaid but your assets are over the maximum resource allowance. There is a lot of information to consider before taking this route and I would strongly urge you to consult your financial advisor and an elder law attorney before making any commitments. ElderLawAnswers has a page that describes using annuities as a Medicaid planning tool.

I have a piece of advice to share that I learned the hard way. If you are in charge of paying for your family member’s expenses make sure you look at the invoice every single month. I used to have an automatic draft set up so I didn’t have to worry about writing a check for mom’s care and rent every month; I usually looked at the bill when it showed up in my email just to make sure everything was as it ought to be and it always was. However, somehow I got distracted or busy and for a few months I didn’t look, I just assumed things were going along as they always had. That is, until I got an overdraft protection notice from the bank. I couldn’t imagine what had happened since, at that time, mom’s expenses were well below what she had coming in every month. I went back and looked at mom’s last few months of invoices and I couldn’t believe what I was looking at - her expenses had climbed exponentially to almost $6000 a month.

I called the business office at mom’s and we finally figured out there was some kind of glitch in whatever billing system they were using. Easy enough to fix but here’s where the horrifying part comes in; I was told that if I hadn’t caught the mistake it would have kept on happening, to the point of potentially wiping out everything mom has. No one was checking to make sure the monthly statements were accurate, they were just generated and hopefully paid. What happens to the people who have no one to advocate for them?

Mistakes don’t just happen with living expenses, they happen with medical costs, too. So far mom’s physical health is better than mine so medical billing hasn’t been a problem. I’ve had issues with my own medical bills - I can’t imagine how much money is made from people who don’t know what to look for, don’t know the laws concerning preventative care, and don’t know that it’s ok to ask a question and ask again if they believe what they’ve been told is wrong.

As we age things like taking care of ourselves and our parents, along with handling Medicare and Medicaid can start to seem like a full time job and it can be exhausting. Make sure you have trusted professionals on your side and people you can turn to who have your best interest at heart. No one should tackle this kind of stuff alone.

Logan, Mom, and Leah at Lake Hefner June 3, 2003

It's never easy

Life is messy. Some of the dilemmas we’re faced with can be so tough - it can be hard to stay true to yourself when you know some of your decisions aren’t always the most popular or are not what others would have chosen to do.

When my daughter got engaged a year and a half ago, my first reaction was absolute joy; I was not only gaining a wonderful son-in-law, I was also gaining a twelve year old grandson - both of whom I love dearly. As we began making wedding plans and putting the guest list together, I started wondering how I was going to handle mom on the day of the wedding. The more I thought about it, the more anxious I became.

From what I’d learned about mom over the last five years, if I chose to be responsible for her she would be my full time job - if I sat her down somewhere there is no way she would calmly stay there until I was able to fully concentrate on her. I thought about hiring someone to be with her the whole time and transport her to and from the venue which was an hour drive each way. That way, I could enjoy being mother of the bride and greet our guests without being distracted or worried about her. Either way, she would definitely need to have someone with her at all times, just checking on her occasionally would not work.

Or, there was another option. I could decide to not have mom there at all.

After thinking about it and talking with family and friends, that’s what I decided to do. I did talk with my daughter about it and, if it were life and death for Leah to have her grandmother there, we would have found a way. Thankfully, I have a daughter who is as reasonable as she is wonderful. I’m so grateful she understood why I was leaning towards the decision to not have mom there.

The main reason I decided to not have mom at the wedding is because of the drain it would be on me. I know to some that sounds incredibly selfish but it’s the truth. Even if I did hire a companion, mom would be looking for me, would want to be with me, and would want me to sit with her and take care of her - all very reasonable things if it had been a different situation. If mom would have been happy just to be there and enjoy the celebration I would have chosen differently but, sadly, that’s just not the case.

In the end it was a wonderful day. We talk about it often and Bill and I agree that it was one of the best days of our lives so far. There’s nothing in the world better than seeing our children happy and, ever since Leah met Jason, that’s exactly what she’s been. How could the day have been anything but perfect? What made it even more special was that Leah and Jason asked her brother, Logan, to officiate so, with his sister’s internet skills and the blessing of the state of Oklahoma, that’s exactly what he did and he was amazing. Our hearts were truly full that day.

I know if circumstances had been different and mom didn’t have dementia, she would have been there and loved every minute of it. Before she was diagnosed, she talked often about how much she was looking forward to seeing Leah as a bride someday. I did show her pictures and she loved looking at them but, even though I told her the pictures were of her granddaughter’s wedding day, she kept asking me who the bride was or if the bride was me.

For all of us, and for me, I know it was the right decision. I know mom better than anyone; I know what her limitations are and I know what mine are when it comes to her. These kinds of decisions are the reason I write about my experiences - what we’re personally able and willing to shoulder is different for everyone. There is no right or wrong when it comes to things like this; all we can do is the best we can with what we have at the moment and remember to be as kind with ourselves as we are with the people we love.

December 1, 2018. Logan, me, Jason, Leah, and Bill

Where we are

A picture of mom and me taken in 2015 popped up on Facebook the other day. It’s a great picture of her - I remember having dinner with her that night and how happy she was that we were there. Not so long ago, but just thinking about everything that’s happened since that picture was taken makes it seem more like ten years rather than four.

In April of 2015, I was still eight months away from my Bachelor’s degree; it had been a very long road but now that I was hitting the home stretch, I was loving every minute of it. I even loved Statistics because it was a challenge. A HUGE challenge. I had recently been dealing with worse things and, as long as I gave those tough classes whatever amount of time it took to get it right, I could prove to myself that I was capable of just about anything. And, at that particular time in my life, controlling the outcome of something was extremely satisfying and strangely comforting.

In April of 2015, I was still able to talk to my mom about my classes and what the family was up to and have a semi-conversation about what she was doing with her day. She was still able to remember that I was in school and she would tell me often how proud she was of me for going back. I would write on her notepad what time I would be there next and, without fail, she would be at the front door waiting for me. If I was even a few minutes late, she would call me to make sure I was still coming.

I remember getting irritated at little things she would do like the four or five calls leading up to my visits, which were at least every other day, just to confirm when I was going to be there. Sometimes there would be several calls in a row in the middle of the night telling me “there’s something going on here that I don’t like”. She could never be specific but I’m guessing what she didn’t like was the staff telling her to go back to bed since she had, and still has, a habit of wandering the halls at night. I never expressed my irritation to her but people who know me may have heard a word or two.

Four years ago, we could still talk about my dad and our memories of him, she still remembered her friends from Illinois, and we could still laugh about certain silly things that had happened in the past. Mom still asked about my children, Leah and Logan, and made sure she had birthday and Christmas cards to give them. However, even then she didn’t call my son Logan by his name; she had been calling him “grandson” rather than his name for a couple of years prior. When she started doing that I thought it was strange but, in hindsight, I think I knew what was happening - the pieces of memory that fall away are so odd, so random.

Now, four years later, mom doesn’t always know who I am but she does tell me how much she appreciates what I do for her. She no longer remembers she has grandchildren, even when I show her pictures, although she always comments and seems to enjoy looking at them. She has asked me on more than one occasion if I am married and when I tell her “yes and it’s been almost thirty-one years”, she smiles and says “good for you”. If I take her to get her nails done, she forgets what we did within minutes but she does tell me that we had a good day.

Now, we have the same conversation every time we’re together; “How are you?”, “Is everything ok at home?”, “Are you going on any trips soon?”, and “When are you going to take me out of here?” - I answer, ask her a few questions that I hope she knows the answer to, and the loop is repeated.

Mom and me April 2015

A lot has changed. She doesn’t call anymore and she stopped waiting for me at the door a long time ago. She doesn’t look the same and the light that used to be in her eyes doesn’t show up as often. But she still laughs at my stories and enjoys the occasional outing. I know it could be so much worse and I do appreciate that she’s pretty easy to deal with but, no matter how you look at it, it’s not where either of us ever wanted to be.

Is it normal aging or is it dementia?

My last post was about the ten most common conditions that can look like the onset of dementia; this time, I thought I’d talk about the ten most common warning signs of dementia. The sad part is, this disease is usually so insidious that by the time dementia is suspected and investigated, a person can be well over four years into the disease. Some of the early warning signs such as forgetfulness, loss of concentration, and withdrawal from social situations can also be the result of depression, anxiety, or stress. In many cases, these symptoms are by-products of exactly that and can be treated with medication and/or therapy.

I still don’t know exactly when things took a turn for mom. She had developed what I would call “amplified” versions of her normal personality traits over a number of years; however, I think a lot of that could have been attributed to her developing a routine and not wanting to step too far away from her comfort zone. All perfectly normal, until they’re not. Hindsight being what it is, when I read through the early signs of dementia, I could instantly apply them to mom’s behavior. Even with all that, the lines can still get blurred. What’s normal and what’s not?

Ten Early Warning Signs of Dementia

1) Memory loss that is disruptive to daily life. Forgetting a random appointment now and then has happened to all of us. Two or three times a year is perfectly normal; we get busy and things sometimes fall through the cracks. The first thing that comes to mind concerning mom is I used to call her at 10 am every Saturday morning and we’d talk for one hour - nothing more, nothing less. This was her idea since it fit into her schedule and we did it for years. Then it started changing - she would act surprised I was calling, she’d be done talking in ten minutes, or she would seem really distracted. I couldn't figure out what was going on then but, looking back, it’s most likely she wasn’t able to recall what she had done in the last week and me asking specific questions probably made her very uncomfortable.

2) Retaining recent information or solving problems becomes a challenge. Mom has always been a list maker and when she discovered Post-It Notes it was a coup for her and for 3M. However, when we went to empty her apartment I was shocked at the number of notes and lists that were everywhere, even in her car. Some of the notes were a little odd: “Car is parked on the left”, “Sue called and her husband is sick”, “Melissa has a new job”, “Saw Marjorie and she looks good”, “The movie we went to on Sunday was Jurassic Park.” A lot of them seemed to be there for her to use as a reference or a prompt for when she was having a phone conversation.

3) Difficulty performing or finishing everyday tasks at home or at work. Mom had apparently stopped cooking and using the microwave, something that she used to do on some level every day. She had also stopped driving but for how long I have no idea. One of her water aerobics friends later told me that mom had asked her to lead the way back from the gym to mom’s apartment - where mom had lived for almost thirty years.

4) Confusion with days, time, seasons, or places. Most of us have had a moment when we think it’s Sunday but it’s really Saturday as in, “I’ve been thinking it was Sunday all day.” Once we’ve clued in, what day it is usually sticks - perfectly normal. Over a short span of time before her diagnosis, I had noticed that mom was progressively forgetting important dates or events, even those she wrote down, which was very unlike her. If I mentioned it she would get irritated or change the subject so I didn’t push. Now, she doesn’t know what day or month it is, or even the season.

5) Changes in visual perception. Most of us can use steps or step down off a curb with hardly a thought. A change in gait or a hesitation where there was once none can be a sign of cognitive change or failing eyesight. Hopefully, it’s the latter. Looking back on one of mom’s last visits here, she was extremely cautious getting out of her chair and walking around the hassock - enough to where Bill and I both noticed and, at this time, she had no problem with mobility. She also insisted on nightlights in the bedroom she was sleeping in, down the hall, and in the bathroom where before, one in the hall was plenty. Not a big deal, just peculiar. Once again, we just thought her weird idiosyncrasies were just getting weirder.

6) Unusual problems with words in both speaking and writing. Having a word or a name on the tip of our tongue but not being able to come up with it happens to all of us. Losing track in the middle of a conversation, or no longer having the ability to follow verbal cues or answer simple questions can be signs of trouble. We could always tell when mom was losing interest in a conversation but when she started losing track of what we were talking about or saying something that didn’t fit we knew it wasn’t normal behavior.

7) Misplacing things and not having the ability to retrace steps to find them. This is where the all too common “someone is stealing my stuff” comes in. Mom has always had all kinds of tiny decorative boxes sitting around and she was forever placing something in one of them and then forgetting which one but, eventually, she’d remember. If she does that now it can be weeks before we find the missing thing in the back of a drawer, in the refrigerator, or in a pocket of something she rarely wears. For a while, she was convinced someone was stealing her underwear. I promised her that of all the things in her apartment her underwear was probably the least likely to get stolen. Turned out she was putting them in a cabinet - mystery solved.

8) Poor judgment. Making a bad decision every once in a while happens and, when it does, we usually own up to it and fix it. Lesson learned. A change in judgment or doing something that is so far out of character that it’s alarming is a warning that something isn’t quite right. When mom was still living on her own, I remember her telling me that she had made a friend who was a stock car driver. That struck me as strange since a stock car race track would be one of the last places you’d ever find her. She then told me that he wanted to paint her name on his car and how flattered she was. I’m sorry, what?? I asked her if they were dating and she said no. I asked her if she had been giving him money and that’s when her talking about this guy stopped dead - I’m pretty sure the answer was “yes”. It wasn’t too long after this conversation that she fell and was diagnosed with dementia. I had the opportunity to meet stock car man and creepy doesn’t even begin to describe him - he quickly figured out that I wasn’t a fan and backed off. I’ll never know if she did give him money, and really, I don’t want to know.

9) Disengaging from social activities and hobbies. This can also be a sign of depression, so it bears investigation. Mom has always loved to socialize and go out; her social schedule would have exhausted me but she thrived on it. If an event got canceled due to weather or because someone was ill she would be crushed (not an exaggeration). Also, mom had played bridge for decades and was part of a group that met once a month to play; she loved the game and was quite good at it. Then, seemingly out of the blue, she stopped. I asked her a few times what had happened but I never got an answer and the same thing happened with going out with friends. I think part of the reason she stopped going out is that if she got up to use the restroom, she would forget how to get back to her seat or get turned around. She must have been so sad and scared but she never said a thing to me, she simply blamed the weather or some other circumstance for her not going out.

10) Changes in mood or personality. Again, this behavior could also indicate depression or an issue with medication so a call to a doctor is definitely in order. In mom’s case, she always had a specific way of doing things and certain preferences that sometimes seemed extreme but we knew they were normal for her. For instance, when she went to the airport alone she would call an Airport Express type of service to drive her to and from the airport and did it this way for years, perfectly normal. Then she changed to paying a friend to drive her and pick her up. Not entirely unusual, but odd. From what I put together, I think that telling someone she didn’t know which terminal she needed, coupled with being let out where it was convenient for the driver and not necessarily for her, and then not knowing where they were parked to pick her up got to be too much. If it was a friend, she could convince them to meet her at baggage claim and not worry about getting lost. Even if she forgot who dropped her off, she could be pretty sure they would call out her name when they saw her. The energy she expended trying to be “normal” had to have been staggering.

Even if I had all of this information or had thought to look it up when mom first started to change I don’t know if I would have taken the leap to have her looked at. Dementia isn’t obvious like a cough or a rash and things don’t change all at once. And when things do change and we question what may be going on, those first interactions can be met with denial and hostility which, being forever the “child”, can silence us for a time - until things become more pronounced or dangerous or catastrophic. Sadly, early intervention is no guarantee that dementia symptoms can be slowed down and, with the decline in funded research and the current lack of promise as far as drug therapies go, those of us who are watching the people we love change can do nothing more than care for them the best we can and learn from and lean on each other.   

https://www.alz.org/alzheimers-dementia/10_signs

https://www.alzheimers.net/2014-07-16/10-early-alzheimers-warning-signs/

What if it's something else?

If I started becoming confused about where I was, or where I parked the car, or how to get to a place I’ve been to a hundred times before, I know exactly where my mind would go - straight into panic mode. What if my family bought into the symptoms as an indicator of Alzheimer’s or my doctor didn’t investigate further due to that troublesome little gene I have? I’m really hoping they’d give me a chance and run further tests, or that I’d be cognizant enough to ask, but how many people have a disease or condition that looks like dementia but really isn’t and it goes undiagnosed?

There are several conditions that can mimic the beginnings of Alzheimer’s Disease or dementia. It doesn’t apply in my mom’s case, but I wonder how many seniors have undiagnosed conditions that have tragically altered their remaining years? For instance, I know how important nutrition is, especially for seniors, and poor nutrition or a condition that makes it difficult for the body to utilize certain nutrients can have a severe effect on mental cognition. Specifically, a deficiency in vitamin B12 can cause a certain type of anemia whose symptoms include mental slowness, irritability, and confusion. In addition, other vitamin deficiencies, most commonly vitamins B1 and B6, can mimic the symptoms of dementia. A deficiency in niacin or folic acid can also be the cause but it isn’t quite as common.

Those are just the first two of the ten most common conditions whose symptoms can look like the onset of dementia. As an aside, for the sake of simplicity, I’m going to use the term “dementia” since there are many forms of dementia and Alzheimer’s is just one of them. Here are the other eight  conditions:

3). Medication side effects. As we age, our liver and kidneys don’t function as well as they used to and certain drugs can build up to toxic levels which can cause symptoms that look like dementia. A review of all medications with one doctor would be a good place to start if a change in behavior is noticed, especially since as we age we get the fun of having specialized physicians for different conditions and sometimes wires get crossed or medications aren’t from the same pharmacy and interactions aren’t quite as easy to catch.

4). Depression. I can tell you first hand that depression can be insidious, it’s not usually the first thing you think is wrong when the symptoms begin showing up. All of us have experienced being forgetful, mental fogginess, lack of focus, and feeling out of sorts on occasion; however, when these feelings persist over time, perhaps for months, the first thought may be that something is really wrong, that perhaps you’re ill. Or, in the case of seniors, they may believe they're showing the first signs of dementia. If someone already has that fear in the back of their mind, you can understand how scared they would be to ask for help.

5). Thyroid. If there is too much or not enough thyroid output, the resulting symptoms can look like the onset of dementia.

6). A subdural hematoma. This is most likely caused by a fall that results in a buildup of pressure due to the collection of blood between the outer tissues of the brain and the brain itself and can be life threatening. Large ones may be able to be drained surgically while small ones may go away on their own. Any head injury, especially one in which there was a loss of consciousness, even for a second, deserves a closer look by a medical professional.

7). Normal Pressure Hydrocephalus (NPH). NPH is caused by the gradual buildup of brain fluid which causes pressure that can damage brain tissue. One of the first symptoms of NPH is a change in how a person walks; once they get started from a standing position, it looks almost as if their feet are stuck to the ground. Other symptoms include delirium and confusion.

8). Urinary Tract Infection (UTI). Seniors may not have the typical pain and fever symptoms of a UTI. They may, however, have sudden memory problems, confusion, dizziness, agitation, or hallucinations though it’s most likely these symptoms will occur in someone who already has dementia.

9). Brain tumor. Brain tumors are no joking matter but there have been days where I just know something must be going on to make me so disjointed. Alas, and thankfully, there is nothing to blame but me. In reality, meningiomas are a certain type of brain tumor that can cause cognitive changes, changes in personality, and changes in vision and hearing that may be mistaken for dementia. Being female seems to increase the risk of developing this type of tumor

10). Vascular dementia. When brain cells are damaged by a stroke or disease, cognitive impairment, trouble concentrating, and mood swings may be the result. It’s difficult to tell the difference between this and the beginning of Alzheimer’s; however, when these changes occur suddenly the cause could be a stroke or a series of small strokes that have gone unnoticed. Treatment of the cause of the stroke is the best way to keep the dementia symptoms from increasing and cognitive therapy such as brain exercises can help. Unlike Alzheimer’s, whose life expectancy is eight to 10 years or more, death is much more likely to occur within 5 years of the onset of vascular dementia symptoms, most likely due to a heart attack or stroke.

These are only some of the most common conditions that can mimic dementia symptoms - there are many more that are less common but still worth looking into. Any change in personality or ability to retain information, especially if your family members are concerned, should be addressed by a doctor as soon as it’s noticed. Not being able to remember the name of an acquaintance, occasionally forgetting events, or having to search for a word is normal. Not recognizing family members or very recent events is not.

I know of only one person who was suspected of maybe having dementia but due to his wife’s diligence and her nursing degree, she got him in to see specialists who later were able to diagnose his symptoms as being the result of a vitamin deficiency due to a medical condition. I remember when she told me he was having issues - my heart hurt for her and her husband. I also remember when she told me he was going to be ok - I still rejoice whenever I see pictures of them enjoying their grandchildren or having a night out. That small glimpse into what they could have lost and what they were feeling was so frightening and I’m so glad there was a happy ending to that chapter of their lives.

8 Treatable Conditions That Can Be Mistaken for Alzheimer's Disease

9 Treatable Conditions That Mimic Alzheimer's Disease

Mom and Dad before I came into the picture

The envelope, please...

I love science.  For Christmas this year, I asked for a telescope and I received a very cool one that I don’t have to squint my eye to use plus it tracks the planets as the earth rotates. I haven’t used it much because of how darn cold it’s been but as soon as the weather straightens up, just try to get me to come inside on a clear night.

The science of DNA and genetics has always interested me as well. A couple of years ago Bill gave me a 23andMe Genetic Testing and Analysis kit for my birthday. I love this kind of stuff - being able to take college biology in my forties made me a very happy girl. It took me a stupid amount of time to find my slide sample in the microscope but when I finally did, heaven. I was even able to make e.coli glow and not botch it up - pretty simple experiment but if anyone can make it come out a little odd, it’s me. My professor seemed to be amused by my backward way of doing things (I’m left handed so I have a permanent pass); I can still hear him announce, “Mrs. Geiser! How can I assist you today?” almost every time I set up lab space. I would take that class again if I could.

Anyhow, back to 23andMe. The ancestry part was interesting, no real surprises. I’m mostly Northwestern European; British, Irish, French, German, and Scandinavian. The part that really tickled me though, was that out of the over 1,100 people on the site that I’m related to, I’m in fourth place for having the most Neanderthal variants (there has to be a competitive gene in there somewhere). With 293 variants, I have more than 74% of all 23andMe customers and I have my Neanderthal relatives to thank for my height. Fascinating.

Stick with me, I’m getting to the point of all this.

The site also tests your DNA for carrier status and genetic health risks if you want them to. As more tests are done on my sample, I will occasionally get a notice that I have a new health report. For almost all the tests they have run on my DNA, I’m not a carrier nor do I have a gene associated with a genetic disease, like Parkinson’s. I say “almost” because I do have a genetic variant for age-related macular degeneration which is good to know. I told my ophthalmologist, he noted it in my records, and suggested some supplements to take. No big deal.

A few months ago, I received an email from 23andMe that there was a new health report in my records. I opened it and it, and after a few “disclaimers” and “are you sure you want to know?” windows I got to the report stating that I have the e4 version, or allele, of the APOE gene which is associated with late-onset Alzheimer’s Disease. I only have one, not two, so my genetic risk isn’t as high as it could be but I’d really rather not have any at all. The quickie stats* for females with one copy of the APOE e4 variant are as follows:

                                   Age 65                                         less than 1% chance 

                                  Age 75                                          5% to 7%

                                  Age 85                                         27% to 30%

                                  No APOE e4 variant                    6% to 10%

                                 General population of women     less than 1% to 14%

*this information was compiled by 23andMe

So now I need to sort out how I feel about this. I could take a glass half full approach and be happy that there is about a 70% chance that this little gene stays asleep and I skate through my 80s with my memory intact. If I had never been exposed to someone with dementia or Alzheimer’s (at this point, maybe mom has Alzheimer’s - either way that ship has sailed) I think I would have read the report and thought, well shoot, that kind of sucks and moved on. From where I’m looking at it, the glass is most definitely half empty and it more than sucks; it terrifies me. Not in a paralyzing, I can’t move on with my life, it’s all I think about way. It’s more like a little tic tac time bomb has been implanted in my brain and I can hear that bad boy ticking away. The ticking is very quiet and may not ever mean a thing, but it’s still there.

I did some reading about the gene and looked into what I could do to help myself: eat well, exercise regularly, and never stop learning and challenging my body and brain. Check, check, and check. Through my reading, I ran across some sobering facts at the Alzheimer's Association website. Did you know that deaths from heart disease have decreased by 14% since 2000? That’s great news. Did you know that since 2000, deaths from Alzheimer’s have increased by 89%? Well, hell. And there’s the movie Still Alice with Julianne Moore. That gave me something to think about. A lot of something. There’s so much information out there and so much to learn about Alzheimer’s; however, the more I read the further down the rabbit hole I found myself going so I had to put it aside.

There’s always a chance that being with mom is the closest I’ll come to dementia or Alzheimer’s. Plus, there are so many positive, wonderful things I have to look forward to - I’m not going to let something I have minimal control over muddy things up. And really, who’s to say I won’t get taken out by some wayward pelican on one of my walks by the lake? Or have my number come up on the Northwest Expressway? I’ve been in a wreck there, believe me, I know all too well it could happen in the blink of an eye. None of us are guaranteed tomorrow or even the rest of today so I’ll be grateful for what I have right now and keep doing what I’m doing the best way I know how.

In hindsight, would I still want to know? I can say with 100% certainty I would. Mostly because I would take my own advice. For example: Whenever my son took a test or a final while he was at OU, I’d ask him how he did - he’d tell me how he felt he did, but he refused to check his grade online until I threatened to check it myself. It was as if the act of checking it somehow made it gather up molecules and become real. For a kid who usually uses logic as a weapon, this behavior made zero sense to me. Whether you know the outcome or not, it’s still there. It exists. And you may have time to do something about it.

"Fear keeps us focused on the past or worried about the future. If we can acknowledge our fear, we can realize that right now we are okay. Right now, today, we are still alive, and our bodies are working marvelously. Our eyes can still see the beautiful sky. Our ears can still hear the voices of our loved ones." - Thich Nhat Hanh

A small bit of clarity

Last week my friend, Kathy, shared a video with me that explains dementia so well that I wanted to share it. It’s a simple analogy but it is the best explanation I’ve been given for what’s going on with mom. Here’s the link if you’d like to watch it: Alzheimer's Society - Bookcase Analogy . In summary, it explains that while short-term memories may be lost, there are many that remain; however, those memories that remain may mean that her “now” is 1950 something. Interestingly, while the memories of what she did today may be lost, the feelings linger. She may not remember that we’ve just gotten her nails done, but she does know that she is relaxed and happy and it’s been a good day.

The humanness of her is still there; she feels all the emotions I feel with a bit more confusion and perhaps fear thrown in. I can see the confusion when she first looks at me or when she asks me where she lives. Who I am and where she lives comes to her eventually but that’s not going to last. I haven’t seen her afraid yet but I have seen her concerned. Perhaps being alone scares her and that’s why she leaves her room constantly in the middle of the night?  I can see where that would drive her to want to sit in the halls and be around people. That may help me assign some understanding to her wandering but I still wish she would stay in her room; $800 extra because she roams the halls still seems awfully steep to me.

It’s tough to remember to boil everything down to how she feels, but I need to keep it in practice so it becomes easier for me to do. I know she likes it when I hug her or place my hand on her arm, she enjoys having me fix her hair and telling her how nice she looks. She loves putting on clothes that are still warm from my dryer -  it amazes me how long they stay warm once they’ve been folded and placed in her bag. She likes how the afternoon sun comes in her window and lights up the whole room. It’s simple stuff that can get drowned out by all the noise of questions like why does she make piles out of purses and clothes, why does she all of a sudden hoard styrofoam cups, why does she always have those little cups of butter in her purse? I could ask her why every time I see her and she wouldn’t be able to tell me and, really, does the “why” matter? Not in the least.

Even though I have a better understanding of how my mom feels, it doesn’t mean that all of a sudden I’m going to be all zen every time I see her. I know I’ll get frustrated, but I also know how to handle that frustration. Instead of asking her why she has ten glasses from the dining room in her room I just gather them up and say, “mom - really???”. She smiles at me and shrugs her shoulders and I take them back.

While writing this post I thought about a book I read last year. I had heard about it on a podcast and the excerpt that was read seemed so relevant to what I’m going through with mom. Turns out that there are about two parts of the book that could apply, the rest of it is an exploration of marriage and the difficulties that come about as we change and grow as a person while trying to accommodate and appreciate the change and growth of our spouse. I’ve read enough of those for two lifetimes. Overall it’s a good book and a quick read, just not my usual choice.

Back to why I thought of this book. There is one passage I highlighted because it seemed to resonate with how I feel about change and expectation, what is happening with my mom, how I’m trying to fit my own life into my days, how I’m trying to consider what really matters, and the questions I ask myself every day.

What are the forces that shape our most elemental bonds? How do we make lifelong commitments in the face of identities that are continuously shifting and commit ourselves for all time when the self is so often in flux? What happens to love in the face of the unexpected, in the face of disappointment and compromise -- how do we wrest beauty from imperfection, find grace in the ordinary, desire what we have rather than what we lack? - Dani Shapiro Hourglass

I’ll let you know when I figure all that out.

Nothing stays the same

No matter what fate chooses to play, there's nothing you can do about it anyway -                          Jackson Browne, For a Dancer

Mom has always written reminder notes to herself, they were all over her apartment when we moved her out. Because this is what she’s used to, she asks me to write down when I’ll be there next on the notebook by her phone. The notes are simple: “Melissa will be here on Thursday at 12:00 to pick you up for Thanksgiving” followed by my phone number. Or, “Melissa will be here on Wednesday at 1:00 to pick you up for your manicure/pedicure appointment. Bring flip flops”.

But for the past few months, she doesn’t remember to read the notes I leave and every time I show up it’s a “surprise”. This Thanksgiving she called me in the morning and said she needed to know “what’s going on” with a concerned tone to her voice. I told her I was going to be picking her up for Thanksgiving and asked if she still had the note I had left by the phone. She did, and she read it back to me. The thing is, before she called me, she had to look at the note to find my number; I just can’t understand the disconnect between her wondering what she’s going to be doing, looking at some words, and making her way to the bottom of the note for my number. I know there’s no “understanding” what’s happening to her, but that doesn’t stop me from trying to figure it out.

I know why she doesn’t “see” things like notes the way you or I would, I know she can’t help it, but it irritates the hell out of me sometimes. Every time she is “surprised” to see me I have to remind myself to not tell her that no, it isn’t a surprise, I wrote it down. Why continue to write down anything if she’s not going to read it?? I know the answer: it’s because, in some small way, that note by the phone is comforting to her even if the thought process to use the information on the note is broken. It still irks me even though I know the hows and the whys. Mother Theresa would be appalled.

Back to Thanksgiving. An hour after the first phone call, she called back which is normal for her; once she recognizes her schedule is going to be different she gets a little anxious. I explained again that I would be picking her up at noon, etc., and she said she was looking forward to it.

When I got to her place, I headed for the common area where she hangs out. I knew they were going to be serving lunch around that time so I expected her to be at her table with her friends. I was right, she was there - eating. And, when the aides saw me they all started saying things like, “look, Pat, there’s your daughter. We told you she’d be here”. She had obviously been concerned or feeling sad, although I’ve never not been there when I said I would be. I hugged her shoulders and she looked right through me - she had no idea who I was, even when I asked her if she’d like to come to my house for Thanksgiving. I think she sort of recognized me after I spoke, and the aides and her friends identifying me as her daughter probably helped her put it together.

We got to the house and I finished getting dinner ready. I poured her a glass of wine, we took a few pictures and then ate. She pushed the food around her plate, ate a couple of dinner rolls and waited for dessert. While we were eating, the kids decided to have a bit of fun with grandma and tell her that they weren’t the only children I had, there were more. Five more. I don’t know what got them started but Bill joined in and told her that he had other children as well, all over the world - most of them he hasn’t had a chance to meet yet. None of it is true, at least as far as I’m concerned, but she seemed tickled by the idea that she had a bunch of grandchildren. Then Leah or Logan told her that I had just had a baby but it wasn’t here, I laughed and said I gave it away because it was too loud. Mom’s answer to that was “Well, sweetie, you look really great for just having had a baby!”. I reminded her that I’m 52, a little past my baby hatching days, and she replied that I was holding up well. Mercy.

Some people may think it’s a little mean to tell stories like that to my mom but it seemed to entertain her and keep her engaged. My kids can ramp it up in no time and have everyone going in a good way - I think it was just what she needed. She was laughing and joining in and that’s way better than watching her push a spoon around waiting for ice cream. Besides, she’s not going to remember any of it anyway.

When she was done with dessert she said she was ready to go back to her room. I grabbed my purse and started heading for the garage and she asked where I was going. Um...to the car so that I can take you home? She got a confused look on her face and said, “I live here, don’t I?”. Ah, so this was new. I told her no, she had her own place not far from here and I pick her up and take her back. She still wasn’t getting it, I hadn’t seen her look that confused for a long time. I explained that once we got in the car and started driving she’d recognize what she was looking at. I don’t think she believed me but she got in the car anyhow.

We started driving and she started her usual chatter, remarking about the weather, asking how I was doing, how the kids were doing, did we have any trips planned, and how are the dogs. It’s a fairly tight script that she follows every time we’re together. I answered her like I always do but I did show her the pictures we had just taken of her and the kids and me. She asked when the pictures were taken. She had already forgotten and we were not even 10 minutes into the drive. She started running down the script again and I started answering her questions again but this time, I left out the pictures.

She seems to be doing well, she’s happy and doesn’t complain and she has friends who are always around her. The way her dementia affects me, however, seems to be changing. I know that there’s no recovery from this and I know that it’s only going to get worse; I’ve resigned myself to those facts. And I’m ok with her not recognizing me right away; I knew it was going to happen and it’s not going to get better. But lately when I’m going to see her, after I leave, and now pretty much all the time, there’s a new heaviness in how I feel. I’m trying to figure out just where it’s coming from in regards to mom because that’s what I do - I look for patterns in everything and try and put the pieces together in some way that makes sense to me. Once I do that, and the “thing” is figured out, I can put it on my mental shelf and move on.

But this is a whole different animal. There are no connections to be made, and even if something seems to fit one day, the next day or week it doesn’t. And it’s mildly unsettling - I think that’s the best way to describe it. I see the other “kids” of the residents and I recognize the look, I think we all have it. The half smile, the concerned and tired eyes, the yep, you’re going through this too and I get how you feel and it really sucks sometimes expression. So here we are, in our own special group. The membership dues to this exclusive group, though... man, they are a killer.

Today is her birthday

The past few nights mom has called at least twice between 2am and 4am, no emergency, so Thursday night I put my phone on mute. I woke up to 8 missed calls and 8 voice messages this morning. All the calls were from my mom between 4:55am and 5:30am. She started by reading back the note I had left for her on Tuesday when I dropped off her laundry. “It says here that you will be picking me up on March 18th at 4:00pm for my birthday dinner. I was just wondering where you are. I’m in my room.” The last one was, “I see it’s going to be your birthday and I’m supposed to be picking you up. I understand that you may not be able to be here, honey. I’m a little confused about the note.” She never gets upset, she doesn’t cry. It’s the spin that she gets herself into when she gets focused on something. It gets smaller and more concentrated until it’s no longer what it started out to be.

I'll be leaving to pick her up soon. I stopped by her place yesterday to remind her I'll be there today. I've made lasagna which she likes, and a salad which she doesn't. She'll pick at the dinner but she'll have more than one serving of dessert and then it'll be time to go. I'd like her to stay longer but one hour is her limit. All I can do is roll with it. 

My mom and me