The Mirror Reflects on Delirium, Encephalopathy, Dementia and Alzheimer’s

I probably could have added some other words to describe these, such as crazy. It is not politically correct to use that word, but when someone has any of these ailments it is how they feel. Sometimes their loved one’s feel the same having to deal with them during any of these. While they are all different ailments, they all have something in common. The person who has any of these becomes disoriented. When true reality and what is happening in the mind cross paths it leaves mixed up reality. With each of these there are similar symptoms.

I know more than I care to admit about all of the above. I did not look up the definition for each, as from what I have seen they are similar. Below are some of the symptoms of what I have witnessed of each lumped together:

Generalized or complete confusion. Not knowing what is happening, if it is real or in the mind, they may realize it or they may not know it is happening. They may forget who a person they have known most of their life is. They may think the person they have known most of their life is someone else. This could be someone they love or someone they do not like. If reading or watching TV, what they have read or seen may mix with the real world and they think that what they have read or seen is in their world. They may hallucinate. They may get angry, wanting to fight. They may get scared, afraid of everything, even themselves. They may not know who they are. They may not know where they are, what day or year it is. They may not know anything. Sometimes they revert back to childhood ways, which they usually do not realize. They may say things that they normally would not. Some of the things they say may be racial, sexual or somehow inappropriate. For the caregiver this symptom is extremely frustrating, because when you try to tell someone who does not know them, they will think the person always acts like that and you are just saying something to not anger or insult them.

To someone who is suffering from any of the disease’s I mentioned above and is aware they are having these symptoms, it must be scary. To not know what is real or what is in the mind. Sometimes when the person comes out of an episode, they are left with the feeling that whatever they thought while having the episode is still present or took place in some way. They must fear whether they can tell the difference between what is real and what they perceived or have felt is real. Most will act like everything is normal when they come out of an episode for fear of judgement, people questioning their sanity or even themselves questioning their sanity. Many people who suffer from these illnesses will come out of an episode and remember every detail, no matter how small. While their mind tells them it was not real, another part of the mind thinks it is because of the detail. It becomes a battle for the person to know what is real and what is not. Even then, some will think that whatever happened in their episode really did happen, that it was not a hallucination or dream but will keep it to themselves.

For those who suffer from any of the above and are not aware ever, it must still be scary. People they knew or trusted, they no longer know, yet alone trust. Everyone becomes a stranger. Reality is something so far removed they do not know what it is. They too try to act normal, as though they are aware. They may think they are living in the past and everyone and thing they see is somehow connected to that past or that everything/everyone has no connection. This is especially true, from my experience with Alzheimer’s. My grandmother on my father’s side had it. I would go to visit her once a week, she always told me it was nice for a stranger to come visit her. She always wanted to go home, even though she was in her home. The home she wanted was the home in her memories, no longer there. She seemed completely unaware that she had any mental type problem, she too tried to hide how she felt as though that would make everything okay. In the end she had to go to a skilled nursing facility that handled Alzheimer’s. She ultimately died from a stroke, but she was given very good care up until the end.

My grandfather on my mother’s side had dementia, though everyone said he was senile. He came to live with us after my grandmother died, before he had become swallowed by dementia. With dementia came many of the symptoms listed above. Because I was younger and had not seen anyone with these symptoms, it could be at times embarrassing when he was around my friends. They did not understand either, but always showed concern and were kind to him. He did not want to go to a nursing home. My mother would call an ambulance every few days as he thought he was dying and wanted to get to the hospital. Finally the hospital told my mother she had to put him in a nursing home as every time my grandfather had her call EMS someone else might be in critical condition and they needed to take care of those in need, not those who wanted to be at the hospital. It was arranged that the next time she called for an ambulance they would take him to the nursing home and tell him it was a hospital and he would stay. At first he was very happy there, but when he found out it was a nursing home, he refused to get out of bed and died not long after. My mother felt guilty until the day she died that she had put her father in a nursing home. But she had no choice. It is hard to tell someone who has a loved one that suffers from any of the ailments above that end up having to put their loved one into a skilled nursing facility or nursing home, that it is for the best. For my grandfather, it was. It may not be for everyone who suffers from these illnesses, but for some it is the only choice.

My father had cancer that was not curable. He was given 2 to 3 months to live after it was diagnosed. My mother brought in hospice about a week before he died, while caring for him herself most of the time. He died 2 months after the diagnosis. My siblings do not like that hospice was brought in. They feel guilt. As for my mother, she would develop dementia nine years later. She too would say inappropriate things, things she would never say if she were in her right mind. She would have been embarrassed if she had realized the things she said. It was hard. She had other health issues. My siblings wanted to bring her home from the nursing home that she was in after a fall. While on my last visit, I must have sounded cruel when I told them the rest of her life would be going from nursing home to the hospital and back. That they knew very little about health issues and they could not give her the care she needed. The words would come back to haunt me, as last February I realized that my husband’s life would be going from home to hospital until he died. The one common thread we all have is, we wanted to take care of our loved ones alone, at home.

My husband suffered from all of the symptom I listed at times. While he had a touch of this when he first became ill, the antibiotics he was given helped take the symptoms away in a day or two. When it first started for real, he was at a skilled nursing facility for rehabilitation after surgery for a 2 or 3 week stay. The nurses all said he had “institutional delirium” or the medication was causing his delirium. I did not think either were his problem. I did think that both made the problem worse. I called one of his specialists and they saw him the next day. They too knew something else was wrong. It was discovered he had an overactive thyroid that was causing the delirium. But there were other tests done. A CT scan, PET scan, MRI, EEG and a few more. Each of these showed signs of early onset dementia and early onset Alzheimer’s. The teams of doctors did not think those were his problems luckily. After the overactive thyroid was handled and he came home, he was normal, he was on prednisone. When his thyroid went back to normal, the prednisone was tapered. That is when the encephalopathy and delirium truly took hold. I could not leave him alone. There were times he tried to escape, thinking he was not in his home. He was truly experiencing everything I listed above and more. There were many trips to the ER. In the ER some doctors did not know him and quickly diagnosed dementia and Alzheimer’s. Luckily his regular doctors did not. Though it was not his normal doctors that realized what helped these episodes. After one of his many visits to the ER I realized that each time we arrived they gave him one shot of a type of prednisone and he became normal. After one hospitalization he was sent home on a higher dose of prednisone meant to taper off. When I began the taper he became confused again. I gave him the higher dose the next day and he was back to normal. So I called the doctor. He was sent to a neurologist who ran over 1,000 tests. This neurologist was not going to just give up and give an easy (wrong) diagnosis, thankfully. He promised me he would never give up and would find out what was causing these problems. My husband had a post traumatic stress autoimmune disease from his illness. His body no longer knew what was healthy and what was not. Luckily it was controlled with prednisone, but prednisone is not meant to be taken at large doses for a long time. There are other medications and they found one that worked after a few tries, though the prednisone was not tapered. Even though the medication worked, it did not all the time. The neurologist explained, in illness or during stress he would have episodes. My husband remembered most if not all of his episodes, when I would bring it up, he always told me he wanted to tell me when he was better everything he had felt and thought were real, that it was beyond comprehension. I never got to hear what he wanted to tell me, but I have a feeling I know most of it. My husband died before the prednisone taper could begin. He also had become very ill. He was back in the hospital when the doctor told me he needed to go to a Hospice Home. While my husband agreed and knew he was going, it was still hard. I was the one who always cared for him and I knew he would have preferred to be home. I must say that hospice gave him much better care than I ever could. Yet there still is that nagging feeling for not bringing him home, for letting him go to the Hospice Home. I slept there in a couch that turned into a bed or the recliner beside his bed for most of the 7 nights he was there. I knew he was dying, but he had beat death so many times in the past few years. The hope was in me he would beat death once again. It was not until I returned home after his funeral that I felt a twinge of guilt for not bringing him home. But the reality and rational part of my brain knows he had the best care he could have. Not having to care for him gave time for moments that I will remember for life. His days were still mostly confused, but he had moments of clarity in between, those are the ones that bring a smile to my face. Though I do not feel guilt, I still have sad feelings my husband ended up at Hospice. One other thing I still feel, the need to fight for him. I spent so much time fighting for him when he could not, it is a feeling that does not go away. It makes me feel useless, even though I know it not to be true. I used all my energy to learn how to fight for him, while forgetting how to care for myself. Now, I must learn to care for myself again. I was always independent, now I must find that part of me again and put it to use rebuilding my life. I do not like to tell my husband’s life story, I think it was his to tell. He did not care, he thought telling others might help. So I have not broken any confidence he put in me.

One of the hardest parts in dealing with a loved one who has any of these symptoms is, as their advocate you are making decisions on your own. You cannot ask them what they want. You cannot commiserate in bad times or rejoice in happiness together. You are alone. Even if you have family to help, you are still alone. You want to have the ability to snap your fingers and have things go back to normal. In my case, my husband was able to become normal but still had episodes. Even in his normal periods, he was not quite himself. I think some of that was fear or what he would say or do. I wonder when the person afflicted with one of these illnesses looks in the mirror do they see reality or do they see an alternate reality? Or maybe something else, maybe nothing. I would like to say I found a way to handle this, to some degree I did. But since I am being honest, it was much harder than I could ever explain. One thing I did know to do was to find something in the room, whether it be a sign, clock or just the wall color and have my husband look at it over and over, then tell me where he was. This helped when on rare occasions I came home and he would call not knowing where he was. Sometimes this happened at home. It seemed effective. That I was able to care for him during these periods surprised even the doctors and nurses. I wish I could give advice on how to handle someone with one of these ailments, but we all deal with things differently. I am just trying to shed light on what the caregiver may feel.

This too was started earlier to be finished sooner than now. I wanted to give some specifics of what both the caregiver and loved one might go through with these symptoms and ailments. That prednisone worked for my husband does not mean it would work for someone else. What I am trying to convey is not to give up. To continue to fight if you think the diagnosis is wrong. It may be correct, but all other illnesses should be ruled out first. Do everything you can to learn of the illness to help. Make sure to take care of yourself.  Forgive yourself for what you cannot do. If you come to the point where your loved one needs skilled nursing or hospice, you should not feel bad. My only reason for this blog is if I can help one person to have it a little easier and get the correct diagnosis, it is worth reliving some painful moments.


Anger and Other Emotions Reflect in the Mirror

Yesterday I wrote of cooking for one. While it is true I have thought of this and everything I wrote about it is accurate, it is not what I meant to write. I was angry yesterday. I have always said sleep on it when I am angry, as anything said in anger might be regretted. So rather than write about my anger I wrote fluff, something not really of importance to my moving forward. Today I will try to write of my anger and other emotions I felt yesterday.

I was trying to get ready to walk out the door, while still caring for my ailing pet when a counselor from Hospice called. They called one week after my husband died, then 3 months later, this was my next 3 month call. The man is very nice that calls. It seems he understands a lot of what I am going through. He also seems to feel as I do, that the printed papers I get from Hospice do not apply to me, most if not all of the time. While normally I would not mind talking to him, it had taken most of my courage to just get ready to walk out the door. On top of that my pet seemed so ill and was looking at me as if I should stay. I needed to go to the post office so putting it off another day was not possible. I was just about to walk out the door feeling guilt about leaving my pet when he called. So I was angry.

I know I could have been rude or told him I was busy, instead I felt obligated to talk to him. I told him of my pets impending death and how everything about the way he was dying was similar to what my husband went through. The lost weight, the weakening, the unwillingness to eat and having to try to use an oral IV to give him some food. These are all things that I went through with my husband. He told me most people tell him that smells remind them of the person they loved who has died. He told me he found it to be more images of the person dying that brought the sadness. He also told me of his pet who died last spring and how he had gone through a lot of what I was going through, how hard it was for him and his wife, that they still were sad almost a year later. This man understood. I know many do not. They feel as if a pet can be replaced and will be forgotten, but that is not so. I remember every pet I have had, as well as how they lived and died. Having someone understand how I feel helps, as there are only a few in my life that understand how losing my pet can be upsetting and I have not really talked in-depth to them. In talking with him, it brought comfort but it also brought up other emotions.

The biggest emotion yesterday was anger. When my husband and I were told he needed to go to a Hospice Home, we both knew it meant he was dying, though we also felt he beat the odds and had lived before there was still optimism by my husband and myself that he would beat the odds again. That optimism faded when we got to the Hospice Home. Once my husband was admitted to the Hospice Home, he was taken off all the medications that kept him alive. The only medications he was given were an antibiotic so MRSA would not return and endanger others, as well as tranquilizers and pain medications. There was also a lidoderm patch that they were not going to give him due to expense and they did not have it. I brought 2 boxes in for them to put them on as they offered some relief. By taking him off of his medications, this probably made his death come sooner. This is where the anger comes in. I am not angry with Hospice and to some extent it is not true anger, but it is with myself. Had I known his medications would be stopped I may have brought him home and he may have lived a week or two longer. There are moments when I think of him asking me if he were dying and that he did not want to die. He knew when he went to Hospice that he was going there to die, I am sure he must have felt afraid, wanted reassurance. I never lied to my husband and did not lie when he asked if he were dying. I did not tell him he was dying though. He had stopped eating. I told him that if he did not start eating he would die. It was not a lie, it was just not telling the whole truth. A truth I, myself could not accept.

Then I think of having him if he had died in the house. That would not have been easy to deal with either. I also think of how well Hospice treated my husband. Treatment that though I tried my hardest I could not give that level of care. Wounds he had that he was seeing a would specialist for, healed in 2 or 3 days due to their constant care. They made sure if any pain was shown he was immediately given something. The same with the panic and fear he was feeling, they gave him tranquilizers before he could even ask when they noticed how he appeared. So though there is this sense of anger, there is also this sense on thanks for caring for him so well.

But it was not just anger. There were many emotions that sprung into my mind. Sadness that my husband is gone forever and that my pet is dying soon. Sadness that the life I knew is now gone. Anger that I have to start a new life. Maybe it is not anger, if might just be uncertainty or some other emotion, but for now I will call it anger, it is not something I want to do. It is something I have to do. Irritation that though this man, the counselor is nice, I have to talk with him every 3 months. To be honest I could tell him not to call and he would not, but I know I need a little help even if I do not want it. Sadness that this counselor is correct in saying it is images that bring the most sadness. With every little thing, such as last night every time I tried to turn the lights off my pet cried, though my husband did not cry, he did not want the lights off at night. Each image with my pet or any image alone can cause this sadness. It is an overwhelming sadness. A feeling of despair. That there is no hope of a normal life.That in some ways there will never be a life, just an existence. Being a realist I know there is life ahead, but at moments of insecurity the realist seems to hide and the fear and emotions take over.

There were so many emotions yesterday that I cannot even begin to cover them all. I must say most of the feelings are still present. I also must say I feel no guilt over anything that happened. Though there is anger, it is not true anger. It is most likely an emotion I do not have a name for. I know I will deal with many emotions, not just now but most likely for the rest of my life. I know many will be sad. I also know that though sadness sometimes never leaves, happiness and sadness can live together. That though I am sad I will still experience happiness. That the happiness will most likely outweigh the sadness. But for now, I am angry.