Archive for September, 2013|Monthly archive page

What a difference a pill makes

About a week after I complained about Mom’s mood without her Zoloft, the nurse called again. The doctor had been in for the behavior meeting, and he agreed to put her back on the medicine – but at a lower dose. Mom had been taking 150 milligrams a day, and he started her back on 50 milligrams daily. I thanked the nurse with enthusiasm.

About a week or so later, I went to see Mom on a Sunday, not knowing what to expect. She was walking around the program area, and I just popped in front of her and said hello. She greeted me with a smile and a laugh, so we were off to a good start. We walked a little, and talked a little. She seemed a little unsettled, but eventually parked herself on a couch and relaxed for a little while. She was very cheerful, so much like her former self. I was relieved. She said very few coherent sentences or words, but she was in a good mood.

We stood again to walk, and she took my hand. Another good sign. It was almost lunchtime, so I guided her to a table. Turns out, though, that it was the wrong one. Since the state last visited to assess the Alz center, some things have changed. Among them: Each resident now must sit at an assigned table for every meal. This is standard in most nursing homes, but in a facility for patients with dementia, it doesn’t make a whole lot of sense. However, rules are rules. The husband of a patient pointed out Mom’s assigned table. An aide passed by to confirm it, but said it didn’t matter which chair she occupied. With some effort, I convinced Mom to sit down.

I got a bib to put on her and sat down next to her. I had seated Mom prematurely. It was taking awhile for her tray to arrive, so I had to keep her entertained. She was restless and wanted to stand up. I grabbed her hands and encouraged her to stay. She raised one of my hands and kissed it and said, “I love you, honey.” This sealed it for me, that Mom was feeling better now that she was back on her meds. I kept talking to her with a big grin on my face, telling her how glad I was that she felt better and that I loved her, too. She continued to try to get up, so I stood behind her with my hands on her shoulders and just patted her and rubbed her shoulders a little to keep her still. And it didn’t make her mad, thankfully. Sometimes, she is very willful when she’s being instructed.

Finally, her tray arrived: roast beef, mashed potatoes and cooked carrots. Plus cherry pie and strawberry ice cream. Classic Bonnie food. She ran her fingers through the potatoes and took a bite. She took a sip of her hot cereal. And then she lifted her fork to eat some of the meat. I was stunned she could still use a utensil. With her finally occupied, I decided to leave. I hovered my face in front of hers and we pecked each other on the lips goodbye. I haven’t been back in a week, but I look forward to more of the same on my next visit.

Not my imagination

I went back to visit Mom today, this time in the middle of the morning to see if it would make any difference in her mood. She laughed when I stepped in front of her and said hello. I took that as a good sign. An aide had told me on the way in that she had recently been taking a cat nap. I sat down in a chair facing her and asked how she was and told her she looked good. She spoke briefly and somewhat quietly. She nodded her head forward as if she were trying to get some more sleep. I gently rubbed her shoulders, hoping it might help her drift off. She had said a few nonsense sentences, but as I sat there with my hand on her shoulders, she said, clear as day, “I don’t like this.” I removed my hand. I moved my chair so I was out of her line of vision, hoping she might be able to fall asleep without the distraction of me sitting there, staring at her and trying to hold her hand. Her head would drop forward, but then she’d raise it again. She had her arms crossed and didn’t look at me much, seeming very withdrawn. She didn’t say she hated me, but she didn’t seem to like me, either.

I decided once again that my presence was no comfort to her, so I kissed her forehead and said goodbye. I stopped two aides and asked if Mom had seemed more irritable lately. “Yes,” one aide said emphatically. She described Mom as more difficult to deal with in the shower and now completely unwilling to sit down on the toilet. She yells out that she hates people and told one aide that she wanted her to die. “Thank you for asking,” the aide said. This convinced me that the lack of Zoloft is affecting Mom’s mood, for her to suddenly have turned into such a persistent sourpuss and not just the occasional willful Bonnie she had been for so long.

I stopped at the nursing station to share what I had heard about Mom’s behavior, as well as my own observations. One nurse immediately added Mom as a topic of conversation to the agenda for the next planned behavior meeting. I asked what had prompted the doctor to try weaning Mom again when it had not gone well the last time it was tried. Well, it turns out that it is a regulatory mandate to try to get nursing home patients off of medications. I am not a hater of the government. In fact, I’m a proponent of big government. However, the more I learn, the more I become dismayed by government regulations – I’m most aware of rules imposed by the state – concerning nursing homes. Especially at nursing homes exclusively for patients with dementia, many of the mandates just don’t make sense. “We’re on your side,” one of the nurses said. In fact, the two had recently talked about how Mom has been much more vocal lately, shouting her displeasure for all to hear.

So, I’m hoping this behavior meeting with the doctor will produce results, and that Mom will be treated again. One nurse said that the doctor might try Celexa instead of Zoloft, because Celexa has been shown in studies to be effective in Alzheimer’s patients through the end stages. “All I care about now is Mom’s mood. I don’t want her to be sad, or scared, or mad,” I told them. I also said I hoped the fact that Mom is more difficult for the aides to work with would bolster an argument in favor of restarting antidepressant treatment. There is no reason why she should have to suffer any more than she already is and has for many years.