Friday, November 11, 2005

"Fluctuation of Cognitive and Motoric Functions"

One description of Lewy Body Disease includes the phrase "fluctuation of cognitive and motoric and psychiatric symptoms."
In other words, she can be good at thinking and moving one day, with her emotions normal, but the next day she can be terrible. And the day after that she can be fine again.
It happened today.
I arrived to visit her at 4:15 pm and found her in deep sleep. Her caregiver, Jona, had left at 2 pm or so for a doctor's appointment. She had carefully unplugged Mom's electric recliner and left her asleep in it.
"Hi, Mom, I'm here," I said loudly, figuring I should wake her up and get some greeting cards signed and exercise done before taking her to dinner.
"Oh, you're here. I was at Fitzsimmons talking to a doctor," she said.
"You were really asleep," I said. "You were dreaming that you were in Colorado."
"Yes," she said, continuing to tell me about her dream.
But then she said, "That thing on the ceiling has worms crawling in it. Every once in a while one falls out and falls on me. That's a public health disaster. And they are probably the thing that makes my chin so itchy that I have to get it cleaned."
"Mom, that's just the sprinkler for fires," I said, looking up at the spigot in the middle of the ceiling.
"That's what they tell me--fire protection--but it doesn't look like that."
"No, it doesn't. Now Mom, you can't keep scratching your chin. It's looking so good; the scabs have fallen off."
After we talked a bit more, I said it was time to walk to the bathroom.
"Did you do your exercises today?"
"Oh yes, I did. They say to me, 'You will or I'll kill you,' so I have to do it."
"They don't say that, Mom. They're not allowed to talk like that."
"Yes, they do," she said with a whimper. "And they say 'We'll let you fall by yourself and they really do it.'"
All this time she was talking to me with her eyes closed and clearly feeling sorry for herself, but I persisted in moving toward our daily walk and making her more alert.
With her chair raised to put her almost in a standing position, I put the walker in front of her and tried to pull her to stand up, but she was not taking any of her own weight. After four practice pushes to standing, I started moving her with the walker toward the bathroom. Her feet and legs were still not bearing much of her weight, but I figured we could make it.
When we moved off the carpet and onto the linoleum floor of the bathroom, however, her feet slipped right out in front of her as if she were on ice. I was holding her whole 120 pounds as she leaned backwards. I kept trying to get her back to standing, but each time she moved a foot, it slipped. I wondered if there was water or talcum powder on the floor, but there was nothing. Somehow I dragged her to the toilet and sat her on it. When I asked her to hold onto the white bar to stand while I removed her wet Depends, she couldn't hold her weight there. I had to hold her up while pulling them down, let her sit again as I put on new Depends, and then hold her up while pulling the Depends up. Twice her body sagged nearly to the floor, but I pulled her up to sit on the toilet.
"Don't let me fall," she was yelling.
"You're not going to fall," I kept saying calmly.
"Don't make me do this!"
"It wasn't my idea. You're the one who said you wanted to walk," I insisted.
It didn't help that she was wearing an ankle-length swishy skirt--I regretted letting her dress so elegantly instead of keeping her in simple long pants with an elastic waist.
I changed her shoes from slip-on style to white jogging shoes with shoe laces and tried to start back toward the wheelchair in the main room, with her at the walker, but her feet still had no grip on the floor.
Somehow we made it to the carpet and the wheelchair. We both sat resting and panting for a few minutes.
"We have to do this every day, if you don't want to be stuck in the wheelchair," I said.
But I had my doubts.
The deep sleep in midafternoon, the worms falling from the ceiling.
"Maybe she had a stroke or some downward LBD turn overnight," I thought. "Maybe she'll never be able to walk again as well as she did for the last five days. Or maybe it's because she was alone for two hours, dreaming and waking. No one was here to talk to her and pull her back to reality."
I'd been hoping to cut back on the one-to-one caregivers and rely more on the Ocean View staff to keep an eye on her, either as she slept in her recliner or sat out in the common area.
But now I realize she can't be left alone. Her mind will wander, even if she physically does not try to get out of the chair or bed.

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