Thursday, July 30, 2015

Book Review: Going Gentle Into That Good Night by Sandra Ross

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After exploring and appreciating Ms. Ross’ blog and website, Going Gentle Into That Good Night,  I discovered she had written not one, but two books on Lewy Body Dementia.  One is a sort of primer that will be reviewed later, and the other is her account of caregiving for her mother who was afflicted with LBD.  


Her account details the struggles of keeping her mother at home while attempting to understand the disease.  There is a bond between them that is very sweet, and it is strained at times, but she manages to maintain an environment of comfort and joy for her mother.  


She discusses her mother having experienced TIA’s, which are never defined.  TIA’s are Transient Ischemic Attacks which are events, sometimes called a mini-stroke with symptoms lasting less than 24 hours.  This is something many dementia patients face, I discovered in further reading, and it would have been a kindness to have had a definition so I wasn’t struggling to find the meaning on my own.  


That aside, I found myself admiring the courage of Ms. Ross, and also her relationship with her mother.  She has profound strength!  This meant finding the right doctors, firing the ones who didn’t meet the needs at the time, and ensuring the plans were on target for her mother’s care.  


I understood this dilemma of finding the right doctors.  I understood the struggle for finding out what was truly happening.  I also empathized with the guilt associated in dealing with one who used to be so vital becoming so helpless and a shell of what they used to be.  


I know I would not be able to accomplish what Ms. Ross did.  I could not have kept my mother at home.  This was another element at which I marveled.  Her mother contrasts mine.  Mine would need to be watched constantly, and she would be making demands on a continual basis.  I haven’t the source of income that the author seems to have and must work to survive, and my mental health would be in question in no time (my mother is no saintly woman!).  


I also understand Ms. Ross’ philosophy - that your parents sacrificed for you while you were young, so should you for their sake.  I believe that as well.  However, from my viewpoint (which does differ from hers) my mother is better off with others, and surrounded by others to keep her safe, stimulated, and healthy, rather than be kept at home where there isn’t anyone else there for her but myself and the occasional care-worker.   It’s a conundrum, for sure.


Through the experiences of Lewy Body Dementia, TIA’s and Vascular Dementia, Alzheimer’s and Congestive Heart Failure, the author learns a great deal and imparts her learning to the reader.


This is a very good book to read for those who are experiencing many of the same questions and issues, as well as those who have an interest as to what caregiving truly entails.  


The title of her book and website does come from the Dylan Thomas poem, which has always been one of my favorites, but it plays on the opposite meaning - which is appropriate in this case.  I have provided the poem for your reading, below:

Do not go gentle into that good night

Dylan Thomas, 1914 - 1953

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.


Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.


Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.


Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.


Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.


And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.
From The Poems of Dylan Thomas, published by New Directions. Copyright © 1952, 1953 Dylan Thomas.


Going Gentle Into That Good Night - Sandra Ross.  Amazon Digital Services. 2013.
This title is available in both Kindle and Paperback.  


Available at:




Tuesday, July 28, 2015

Lewy Body Definition, Symptoms and a Video to Help

Thanks to the Lewy Body Dementia Association (http://lbda.org/), there is a plethura of information available.  This includes webinars, videos, booklets, forums, support groups (still forming and growing in most parts), and information on the disease, along with medications and their uses.  It is a truly viable and reliable source of information for anyone who wishes to discover more about the disease.  


The following information is from their website, so I cannot take any credit, but to parlay it to you, the reader.


What is Lewy Body Dementia?
It is a progressive brain disease and the second most common cause of neurodegenerative dementia after Alzheimer’s disease.  Lewy body dementia is a “spectrum disorder”, meaning it can occur alone or in combination with Parkinson’s disease, or co-exist with Alzheimer’s disease.


Lewy Body Dementia is NOT a Rare Disease!
It accounts for up to 20% of dementia cases in the US - that’s up to 1.3 million cases in the US alone, with only 30-50% of LBD cases being accurately diagnosed, even in dementia centers.


Here is a link to a pdf on the Comprehensive Lewy Body Dementia Symptom Checklist, to be used for your information, and that of your medical team:  LBD Symptom Checklist

Early and Accurate Diagnosis is Important
Antipsychotic drugs may cause extreme adverse reactions in those with LBD.  Cholinesterase inhibitors may improve alertness and cognition and potentially reduce hallucinations and behavioral symptoms.


Lewy Body Dementias (LBD) Include:

Parkinson’s Disease Dementia                           Dementia with Lewy Bodies (DLB)


(Items in bold are included in LBD diagnostic criteria:


Dementia Symptoms Specific to Lewy Body Dementia:
  • Fluctuating Cognition
  • Neuroleptic Sensitivity
LBD Symptoms that resemble Alzheimer’s
  • Progressive Memory Loss
  • Changes in Mood or Behavior
  • Decreased Judgement and Insight
  • Loss of Initiative
  • Disorientation Regarding Time and Place
  • Difficulty with Language and Tasks


Dementia Symptoms that Resemble Parkinson’s:
  • Extrapyramidal Signs*
  • Muscle Stiffness and rigidity
  • Very Slow Movements, Frozen Stance
  • Balancing Difficulties, Shuffling Gait
  • Tremors
  • Stooped Posture
  • Blank Facial Expression
  • Difficulty Swallowing, Weak Voice
  • Restless Leg Syndrome
  • Repeated Falls, Fainting, Myoclonus*


Additional Symptoms Typical of Lewy Body Dementia:
  • Visual Hallucinations (also smell, sound, taste, touch)
  • Transient/Unexplained Unresponsiveness
  • Delusions, Mood Disorders
  • Illusions
  • Visuospatial Impairment (depth perception, object orientation)
  • Sleep Disturbances, such as acting out vivid nightmares and dreams
  • Autonomic Dysfunction (blood pressure fluctuations, constipation, incontinence, sexual dysfunction)


Clinical Management is Challenging Because
Antipsychotic drugs may cause worsening of confusion, Parkinsonism, heavy sedation, neuroleptic malignant syndrome.


Benzodiazepines, anticholinergics, and some surgical anesthetics, antidepressants, and over-the-counter medications may cause sedation, motor impairment or confusion.


Some medications for Parkinsonian symptoms may increase confusion, delusions, and hallucinations.



Please also view the video presented below:









*Neuroleptic Sensitivity:  The patient may experience a state of apathy, lack of initiative, and a limited range of emotion while taking the drugs to ease confusion, agitation, and to help with normalizing psychomotor coordination (Medicine.net)


*Extrapyramidal Signs: Physical symptoms include tremors, slurred speech, akathisia (state of agitation, distress, and restlessness that is an occasional side-effect of antipsychotic and antidepressant drugs), dystonia, anxiety, distress, paranoia, or bradyphrenia (a slow thought process brought upon by antipsychotic drugs), that are brought on by improper dosing or unusual reactions to antipsychotic drugs.

*Myoclonus:  Spasmodic jerky contraction of groups of muscles.

Sunday, July 26, 2015

Slowing Down with a Busy Agenda - or The Week Ending 07/26/2015

What an odd week!  We began with concerns of Mom spending too much time asleep in her bed - refusing to arise and join the rest of the world.  The weekend nurse contacted her providers stating that empathic treatment would be best - that is in looking at a UTI.  I had already made a doctor’s appointment, but then canceled it; I wasn’t aware of the situation.  But then, I remade the appointment as this seemed to be a bridge that needed to be crossed immediately.  

Mom was refusing to provide the staff with a urine sample - this is mostly because she believes it’s just gross and she sees no real rhyme or reason to do so;  in other words, she has no comprehension and there’s nothing they can do that will make her comply (she’s a bit of a rebel, you know).  

I warned the RLC that she may be still abed when they arrived and braced them for a non-visit.  However, Mom was up and about.  

Hi, Tony,
Connie and I checked in at St. Anthony's at 1:20 today.  We knocked on Norma's door, then opened it; it was not locked.  Norma was standing there, and I asked if we had awakened her.
She said graciously, "No, it was a pleasant jolt."  What a nice way to express, "Yes, you did wake me."
She was wearing beige long shorts, a beige shirt with a few food stains (we do not mention those anymore) and a jacket.  Her legs were quite swollen, including her feet.  She was wearing her compression stockings and good-looking brown sandals.
I showed her the three oranges I had brought for us; none was in her frig, either.  Only four Diet Pepsis were there.  The rest, she said, were "on the shelf in my closet."  Nope, nor atop her little frig; forgot to look under her sink.  Someone must have taken them, of course.
As stealing her things seems to be real to Norma, I told her that a criminal check is done before anyone is hired there, as well as calling personal references to learn if each person is honest, with no suspicions of thievery, and if the applicant enjoys working with older people.  
Norma read to us the first paragraph of today's Oregonian story about the Spruce Goose.  Strong, clear reading; then we discussed that huge plane for a short time.
Seems there was some kind of a meeting in a very large room this morning.She did not go; the purpose for the meeting was vague.  As Connie put it,"Sometimes Norma cannot connect the subject with the predicate."  As you know, her sentences have promising phrases at the start, then the rest does not make sense, even though several phrases have meaning.
Lucile was busy today, working with a volunteer group, we think. She keeps busy, sometimes with Ruth.
Larry is alive, but nothing we could decipher about him.  So we asked what kind of book he wrote about Japan. She looked surprised at that.  I mentioned that Larry went to Japan to study, met Keiko, etc.  Asked which order of priests he was in Norma didn’t know.
When Connie said that Christopher had been in the seminary at the old Holy Child place, Norma did not remember that; but she did not argue. Connie said it was a short time; do you know?
A picture on a note card from Nadya came today; was posted July 20.  Norma read it to us--twice.  Again, the strong reading voice.
Again we suggested a short walk in the garden.  Norma said, "Okay," and took off her jacket, as we told her it was balmy outside.  She handed me another note, printed in my handwriting.  She asked me to read it, so I did.  It was Sept 8, 2014.  She said that was ten months ago.  Something I said brought a hearty laugh; now I can't remember.  I called Connie to ask her; maybe one of us will remember.
Josepha offered us powdered sugar  donuts.  The three women urged me to take one, but I was firm. Norma saved the little cardboard dishes. They may come in handy another time.
We took one turn around the North end of the garden, noting flowers, especially the various kinds of hostas. We were outside half an hour, then went inside to get ready to leave. There were none of the usual protestings, nor wanting to go with us.  She might have been sleepy; I don't know.
A big change was noted when I stopped to say Hello to the McEntees. (Norma and Connie went outside ahead of me.) Josepha was with them.They were sitting close together, and I said Hello--loudly, so he could hear.
He leaned forward, "Who are you?"
"Jean Alice, I said loudly." Big smile, then said,"Of course!  We went to St. Rose together, and you went to Marylhurst with Lucille (his wife)."  He's not forgotten that.
But when I told Norma and Connie about it, Mom had no memory of who he is. "You know, the man who talks about himself all the time, drinks a lot of coffee, and is married to Little Lucille."  Wow! That was a big sign of something.
On the way out, we chatted with Mike Manning.  We said Norma seemed more agreeable in general. (Connie later wondered about the anti-anxiety med, if it caused more calm.)  We always debrief on the ride home; it is helpful.

On Thursday, I picked Mother up and we scooted out the door to make our appointment.  Traffic had been bad on my way over so we were running a tad under the wire.    We arrived at the doctor’s office on the dot (thanks to the free valet parking service at the clinic!).  
I had asked Mom about Connie and Jean’s visit earlier in the week, but she stated that they were going to be coming after we returned.  She stated she really enjoys their visits.  





They took her weight and blood pressure - all good.  Then I brought up the sleepiness and the doctor stated that we may be seeing a great deal more of this, as it could be the progression of the disease.  However, she was eager to treat for a UTI empathically (meaning giving her antibiotics for a few days to determine if this was causing the excessive drowsiness).  
She also called for a blood test to determine renal function in Mom as well.  
Mom’s veins aren’t really great.  The poor nurse kept trying to get the needle into a vein, but Mom kept screaming about the pain.  Her skin appeared rather translucent.   He did make it into the vein, once, but no blood came.  I told Mom she was bloodless and, therefore, unappealing to vampires.
“Don’t say that!  You’re going to give me nightmares!” she exclaimed.
“You shouldn’t be frightened, though, they won’t want you!”
“You know how easily frightened I am!”
We all laughed.  
An expert blood tech was called in and she rubbed Mom’s arms with  a warm water-filled glove.  This did the trick.  Mom was soon pumping blood out into the vial.  
The doctor did mention that the Quetiapine (Seroquel) may be also to blame for the excessive sleepiness, so she was going to have a conference with Mom’s neurologist, who she stated was one of the best (this truly encouraged me that I had put together a great team!).  
We left the clinic, and on the way Mom demanded lunch.  “Where are you going to take me?”
“I’m going to take you where they have lunch all ready for you, as they’re expecting you,” I remarked.
We arrived back at St. Anthony’s and Mom asked, “What type of place is this?”
I was startled, to say the least.  She didn’t recognize the buildings or the parking lot.  
“I’m not doing any stairs or going up in another elevator!”
We walked in and Mike Manning was there to open the doors for us.  I gave him the doctor’s orders for medications and live-culture yogurt.  
Mom walked down the hallway and was surprised at discovering her room.  She walked in to see what was there.  She was pleasantly surprised!  
I left and shopped for her biotene, her eye drops, and the yogurt.  When I returned she was happily eating at the table with some of the other residents.  
Sunday -
Mom was up and at ‘em at a regular hour.  When I went to see her she was finishing the paper and drinking her coffee.  Her speech was a bit confused, but she understood what she was saying - even if I didn’t.   It didn’t take much to get her up and out to the car.
On our way to Jean’s house she kept chatting away about this, that and everything else, but none of it made sense.  She was lucid then delusional then more delusions, then focused on trees, then discussing something about someone then a tree came in sight.  Seriously, it was interesting to listen to, but exhausting to attempt to track.
We arrived at Jean’s house in good time and sat with our coffees.  Jean is such a gracious hostess.  She and Mom discussed a few things and Mom was able to carry on the conversation - although not everything she said tracked.  I began making our lunch of lasagne and salad with asparagus.  
After a good meal and the ladies having had a long and wonderful chat, it was time for us to go.  We had been there over 2 hours, but for once Mom seemed in no rush.  
She didn’t take dessert today, but she did have some fresh cherries before lunch.  
Finally, I was able to get her out the door and into the car.  She always marvels at Jean’s garden whether coming or going, and Jean loves to discuss the plants with her.  

When we finally arrived back at St. A’s, Mom sighed heavily and asked what we were doing there.  I told her we were there to get her purse.  This made her move a little faster.  She still seemed a little clueless as to where we were, though, as we entered and went down the hallway.  
I left her in her room ready to take a nap in her recliner.  
So, all told, a very good and busy week.  She’ll have forgotten it all by the time you read this, but I like to think there’s a little park in her brain, with a basket full of the things that happen each week.  It’s no bother that all those who have left this life come along to share them with her - in fact, the more the merrier.  

She’s slowing down, and her movements are stiffer and more tenuous (balance-wise) than before, but she’s in awfully good spirits.  And it is the spirit that overcomes obstacles that may be put in the way.  

Thursday, July 23, 2015

Book Review: My Mother, My Son: a true story of love, determination, and memories...lost by Dwayne J. Clark

I had heard rumors that Dwayne Clark had done well for himself.  He and I didn't really know each other in high school, even though it was a very small class.  One of our classmates had told me to look him up online, which I did.  It was quite a surprise to see he'd written a book about his mother and their journey through dementia.

I was somewhat ambivalent about beginning the story but found myself entranced.  The style and format of the tale are wonderful.   He writes well, and the flashing back and forth from the present to his mother's history (as well as his) is delightful.

The story isn't only about dealing with dementia (in this case it's Alzheimer's) but about real people leading real lives.  The history of his mother and himself creates a relationship between the reader and the characters that makes the results more personal - it's not just about the disease but remembering that the patients were people who have histories, families, quirks, and the lot.

The decision to bounce back and forth between decades helps to enhance this, but it also runs into a danger of breaking apart that kinship developed by telling such a tale - perhaps it has to deal with making the book a tearjerker, or that being able to see all the facets together make the elements of the biography impact the reader with more empathy and knowledge.

Dwayne's mom begins her journey in India, the daughter of a British Railroad administrator.  She lives the life of privilege, attending boarding schools, having servants, and enjoying an enchanted childhood.  She enlists in the army during World War II and meets Jack Clark, the father of her four children, who abandons them and leaves Colleen to manage on her own with her young son, Dwayne.

The story speaks to those who have a relationship with their parent(s) and reminisce about those early days when memory and function were all sublime;  nary a care in the world.  Then the onslaught of dementia occurs and the trauma entailed in that adventure, as well.

I must hand it to Mr. Clark.  This book made me harken to the early days with my parents and grandparents, remembering how both grandmother and mother were before they were diagnosed- grandmother with Alzheimer's (and my mother caring for her at home) and Mom with Lewy Body Dementia (currently).

I understand his philosophies and commend him for passing on great advice and philosophies that can be used for nearly everyone.  In fact, he also has a chapter devoted to the lessons he learned in his journey, with resources and advice.

I do recommend this book, not only as a diversion from dealing with the disease of dementia but also as a springboard to remembering loved ones before they were afflicted.  This also helps reinforce lessons learned and helps understand what may have been overlooked.

The proceeds from this book go to the Potato Soup Foundation, which helps those in the Aegis Care Community with emergency funding for medical, funeral or other needs.

I hand it to Mr. Clark.  He has much to be proud of.

My Mother, My Son: a true story of love, determination, and memories...lost.  Dwayne J. Clark.  2012.  294 pp.

Tuesday, July 21, 2015

Sundowning Syndrome - What Is It?

I recall one of the first times Mom experienced Sundowning Syndrome in my presence.  She began asking me where her mother was.  While this took me aback, I answered as truthfully as possible, which only led to her becoming upset.  Later, there were phone calls, which could also be determined as Sundowning, in which she would demand her mother’s phone number.  She had tried her old number and found it wasn’t any good any longer - so she would phone my brother or me for the information.  

One of her friends had also phoned me as she had seen it happening.  As Mom declined at home the syndrome became more prevalent.  I had to begin asking whether or not this was symptomatic of Alzheimer’s and Dementia? or was it simply caused by age?

No one truly knows the actual reason for the phenomenon.  It affects 1 in 4 Alzheimer’s patients, and it also affects many who are not succumbing to dementia.  This has left the medical community with a puzzle.  However, what they do know is that there is such a thing and it seems to begin around 6 pm nightly.  

What is Sundowning?    

Sundowning is represented by late-afternoon, early evening changes in the person.  This is exhibited by:
  • Agitation
  • Restlessness
  • Irritability
  • Confusion
  • Disorientation
  • Being Demanding (more so in cases like Mom)
  • Suspiciousness
It may also include:
  • Yelling
  • Pacing
  • Hearing/Seeing Things (Delusions or Hallucinations)
  • Mood Swings
  • Ataxia (the lack of control during voluntary movements, such as walking or picking up objects.  A sign of an underlying condition, Ataxia can affect movement, speech, eye movement, and swallowing)  A Caregiver's Guide to Sundown Syndrome

Also, some of these symptoms may not necessarily be caused by Sundowning, but rather “manifestations of dementia, delirium, Parkinson's disease, and sleep disturbances.  Sundown Syndrome in Persons with Dementia: An Update

There are theories that either pronounced age, later age hormonal fluctuations, or the root causes of the dementia have toyed with the person’s circadian clock.  This is the organic clock that allows the body to coordinate biological activities in the day-night cycle.  But, then again, this isn’t well-documented and is only a theory, as are most causes at this time.

What they also have determined, though, is that light stimulation begins to decrease at a certain point in the day which can trigger confusion with the loss of light and growth of shadows.   

Some of the triggers that have been noticed are:
  • Fatigue
  • Depression
  • Boredom
  • Pain
  • Hunger/Thirst
  • Low Lighting
  • Shadows
  • Disruption of the body’s internal clock
  • Difficulty separating reality from dreams
  • Confusion Surrounding Increased Activity
  • Confusion Surrounding Changes

The last two on the list may have more effect on those who have caregivers in a facility or home, where the staff changes occur later in the day.

Patients may begin following staff, have troubles with redirection, become agitated, and wandering.  

There have been studies in which there has been promise by giving the patients melatonin, but then further exploration denied those conclusions.  

According to the National Institutes of Health and Aging, the following are acceptable interventions to use in preventing and controlling the syndrome:
  • Light Therapy
  • Aromatherapy
  • Music Therapy
  • Caregiver Education
  • Multisensory Stimulation
  • Simulated Presence Therapy
  • Following Sleep Hygiene Routine
  • Structured Daily Routine with Strict Adherence
  • Physical Exercise

There seems to be no real effect in using any drug therapy at this time.

So, This is my little synopsis of the syndrome.  I’m hoping you learnt something along the way!