Bobby Riner's "mild cognitive impairment" was first documented by Dr. Steven Hill October 3, 2011, at age 80. In 2012, Dr. Hill further noted "mild memory loss and forgetfulness". And on February 20, 2013, Dr. Hill noted "mild cognitive impairment but likely progressing to senile dementia." The physician prescribed donepezil (generic Arecept) at that time. Dad began seeing neurologist Dr. Martina Vendrame in October 2014. She prescribed Exelon patches, later swapping to generic Exelon capsules, twice daily, and also added a prescription of Namenda in 2015. Fortunately, the side effects were minimal to non-existent, but for dad, the benefits of the medicines seemed minimal too.
Dad's wife Peggy was terminally ill and moved into nursing care and later hospice care in February 2014. At that point, I (son Greg) relocated to Vidalia from Atlanta, moved into dad's home to assist with his care. From that time forward, Dad never spent a day or night alone. When needing respite, I often received assistance and relief from my sister Marcia and brother Jonah, but at all times, our dad had oversight and assistance to live successfully. We encouraged our dad to quit driving in the summer of 2014, and he did not renew his driver's license when it expired. We drove him wherever he needed to go. Dad had no history of chronic health problems, which enabled his longevity to live at home with family assistance. In the early days, his functionality was higher with only reminders or minor help required, but the gradual progression of the dementia resulted in decreased functionality on his part and greater assistance by our family.
Dad was generally able to walk without assistance and feed himself when a meal was prepared and served to him until the last week of his life, but he required much more help with all other tasks, bathing, changing clothes, shaving, taking medications and vitamins appropriately, toileting, staying hydrated, etc. His former skills of house management, cooking/cleaning, money management and bill pay, gardening, farming, and outdoor work completely eroded. At the end of his journey, he had no competent ability in any of these areas. His ability to read declined, but he often enjoyed scanning newspaper headlines and magazine photos. His ability to write, or sign his name, diminished by the fall of 2016. His ability to print his name diminished by the fall of 2017.
For the period from 2014 to the Spring 2017, dad took daily walks on land owned by his family. He showed excellent stamina for much of this time. That routine ended when he became less timely and predictable to return home, and strayed about three times from the walking paths, once unintentionally onto a neighbor's property and another time, walking the streets of an adjacent neighborhood. Dad's hearing was very poor and had been for over a decade, possibly contributing to the dementia onset and progression. His ability to speak declined significantly. For much of 2017, he could only say "yes", "no", "OK", "alright", short phrases, or sometimes just gibberish. He struggled to speak what was on his mind, often communicating with gestures. When he was sick, he was unable to say what is wrong with him.
During 2016, dad lost the ability to call any of his children by their first names, and by the end of 2016, dad could no longer say his own first name or state his birthdate. In 2016, he began to lose the ability to consistently swallow pills and tablets. We continued to try all of them regularly, because it was an opportunity to increase his water intake, which became more important than the meds or vitamins. In April 2017, I noted the appearance of blood in his urine. he was taken to the emergency room where he was diagnosed with a renal stone lodged in his ureter, reviving his dormant history of kidney stone troubles. He underwent a successful crush procedure by his urologist at the local hospital and recovered quickly. The effect of the anesthesia on his memory and function was noticeable and lasted for a few weeks.
Fortunately, most evenings he rested well, often sleeping 10-12 hours, even though the process of going to bed became more difficult in the last 6 months. He began to have mobility issues, unsteadiness, and inability to cooperate with daily personal activities during the weeks leading up to Thanksgiving 2017. He had a severe flare-up of a years-old hernia on Dec 18, 2017, requiring a trip to the hospital ER. He had two more hernia pain attacks over the next 10 days. After consulting with a surgeon and his primary care doctor, we agreed that he was not a candidate for surgery unless an emergency intervention was needed. His doctor recommended we meet with a hospice agency to consider home health care.
We began hospice care the last week of December 2017. He was under hospice care for only 2 weeks at home. The first week, Dad responded really well to his male nurse. He allowed the medical check-ups and was completely cooperative with the nurse bathing and dressing him. I cannot describe the relief I felt that week to have some in-home professional assistance, considering I had been thinking for about 2 months that we were reaching a point where a greater level of professional care and help would be needed to continue at home. During the second week, Dad went to sleep for about a week, and slept on into the next world. I'll describe those days in my next post.
January 19, 2018
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