Our Families Journey Caring for a Mom with FTLD-MND

It is important to know as you read this journal that this was Cathy's life post diagnosis...

To know Cathy Truly you must know that she was: a Wife, Mother of 3 boys, Grandmother of 9, Sister, Niece, Aunt, Daughter, and Friend.

Our families journey began with Cathy's diagnosis the week of Thanksgiving 2006, Cathy was 52. Her original diagnosis was Pick's Disease/FTD. Looking back her symptoms most likely began 3-5 years before diagnosis. Most of the Doctors have told us that from onset of symptoms to death... the average timeframe is 4-7 years. (sigh) In the end her brain autopsy showed Frontotemporal Lobar Degeneration with Motor Neuron Disease FTLD-MND. (Basically... Frontal Lobe Dementia with Lou Gehrig's Disease)

Monday, September 29, 2008

Visiting Cathy ~ Hospice

This past weekend the kiddos & I headed over to spend the weekend at Grandpa & Grandma's. Rhonda & Larry were up for the weekend also and a friend of ours came along as well. I was hoping to get to spend some time alone with Cathy this trip... since usually I have the kiddos with me & that is becoming more and more difficult. Mia just does not understand & Chase seems so sad... although when we have discussed it he still wants to visit Grandma.

Before we headed over Rhonda called me... it had been a few weeks since she had seen Cathy and the changes overwhelmed her. As she spoke to me she was in tears telling me about how weak Cathy is. She was unable to lift the hangers of clothes into her closet. The skin on her hands is so thin now... as if she is an old lady. It is so hard to see her this way.

On Saturday Rhonda watched the kiddos for me so I could spend more time with Cathy. When I got there she was in the main TV room watching I Love Lucy and laughing. She looked at me & looked back at the TV... no reaction. (my heart sank... I was prepared for this... but how can you really prepare for her not knowing who you are?!?!) I knelt down beside her & rubbed her back. She looked at me again. I took my glasses off & said, "Cath, it's me, Beth. Do I look better without these silly glasses?" And she smiled, stood up, took my hand & walked me to her room. I put in a DVD for us to watch (she is now mostly unable to use her TV, she cannot remember how to work it, & has had to have help many times getting DVDs jammed out of the slot. She crams up to 6 DVDs in the single slot)... Pride & Prejudice... of which we have watched together many times the past 3 years!! I slid a chair over next to her recliner and just sat with her for about a half hour. She rubbed at her hands. I noticed how thin her skin was as well. I asked her if she was in pain anywhere & she shook her head no... but then she rubbed at her knuckles. Her hands looked so frail, and her joints looked swollen... maybe her arthritis is bothering her? I took her hand and massaged it a bit. She just looked at me sometimes with a blank look and sometimes with a smile. It is as if she snaps in & out of knowing who I am. Maybe she doesn't know me at all. I feel as if for a few split seconds she does... such a guessing game. It is so frustrating she cannot speak to us... it takes me back to when our kids were babies & unable to tell us what was wrong.

I talked to her... I told her about our kids, our new home, Brad's job, Toby's family, Ryan's family... I tried to talk in short and simple sentences. Hoping that maybe she would catch a few things about what I was saying. (It is so hard to share our joys with her... when she cannot share them with us. For Example: Toby's youngest son just began to pull himself up on his own... he told me this & said how hard it is to not be able to share the joy of it with her.) Then she reached out for my hand and laid it palm up on her armrest. She spread my fingers apart and placed her hand on top of mine and just looked at me. I slid her fingers in between mine and held her hand. She smiled. (My heart broke again... once again wondering what was going through her mind at that very moment)

We sat for awhile longer and then she began walking in & out of the bathroom. (Each time she would get out of her recliner she would sway a bit... catch her balance) She would walk in to the bathroom, stop next to the trash can, face the wall, stare down at her feet, & then walk back out... not turning the light on. Hmmm??? guessing games again??? She did this a handful of times & I thought, 'maybe she needs to go to the bathroom?' So I got up and followed her in, turned the light on, & helped her. She laughed at me, sat down, & went 'potty' (sorry, I have little kids) for quite a long time. She did not have the strength to pull up her pants... so I had to help her with this as well. I thought... 'ok, she did, now it will stop.' But it didn't... she continued to go in & out.

I stayed about an hour and then Jean came with her sister for a visit. Jean was just as puzzled as I was about the 'in & out'. Maybe she was pretending to weigh herself? Maybe it is another one of her repetition things... Jean & Shelly said at Bingo she always covers all the numbers right away, but always uncovers 'O71' if it is on the card!!??!! We didn't figure it out. Then it was lunch time and she was off to lunch. I was thankful for having that alone time with her. Time to just be around her... even though it is difficult.

Sunday on our way out of town the kids & I stopped for a visit. Barb S. was walking Cathy down the hall when we got there. She wanted to go outside... headed for my van... I had the doors locked and she tried to get in and just looked at us. I felt bad that I didn't have time to take her for a ride... we needed to get home before dark, plus with the 2 kids it is hard to take her out now. With the help of Barb we redirected her and ended up going for a walk around the building. (She had already gone for a walk with Gayle, Rhonda, Larry, & Misty (her dog) earlier that day and gotten tired out... but she was off again!) She held the kids hands on & off. When the walk was over she went back to my van again... once again we had to redirect her to get her inside. Once back to her room we stayed a short while and then it was time for supper. When I have the kids with it is hard to make a 'speedy' exit... which is required in order to keep her from following you out. At one point she headed through her unit doors again, setting off the alarm again, & I had to physically block her & attempt to say something that would make her turn back around. It is getting harder to know what to say since I am not around her as much now... but what I said worked "Cath, I have to get the kids home for school tomorrow, & you need to eat supper. Lets go to the table to eat." She went from a cross look on her face & pushing me away to a big smile & laugh... spun around and headed to the table. (She changes so fast!) Barb & I rounded the kids up and headed out quicker this time.

Chase keeps saying to me, "Mom, Grandma tried to kiss me, but like you guys said her lips didn't move. But I know she Loves me!"

It was nice to have some time to visit with Rhonda, Jean, & Barb this weekend. I talked to Barb about the Hospice issue. We have all mentioned to Gayle about having Hospice come in. When he mentioned it at the home they said, "It would be a duplication of services." What?!?! To me Hospice would support the family, relieve the family & friends because they would know someone is available to visit her & help with cares. Plus the staff at the home is great... but they do not have the time to 1 on 1 with her! I didn't understand their view! But I didn't push it at the time. After going to Mayo with Gayle 2 weeks ago he rethought it... it was discussed at the meeting. He has been trying to get her Hospice now but hitting Brick walls again as usual with this disease!! The Dr. in LaCrosse says she doesn't need it yet?? What??? (He hasn't seen her in a long time... he wanted a swallowing study... I might just have to call the office... but I don't want to step out of my bounds. However I have met him a few times & I think he would understand.) And Dr. Boeve says she does! YES! But Hospice is unfamiliar with her disease and not wanting to help out. (What?! Can Hospice turn someone down?? As a nurse I cannot imagine telling someone No!! You just research the disease & become familiar!) And the Dr. in town doesn't want to get int he middle.... ARGH! Gayle has to feel so beat down by all of this! I mentioned what I knew of the situation to Barb & she agreed with me... Cathy deserves Hospice!!! She deserves to have all the care she can get! Things are changing so fast now!

So... tomorrow Brad will be heading over on his 1 day off a week. He is meeting up with Barb & they are going to see what they can do. You would think with how fast Cathy is going downhill she would be a Hospice candidate... swallowing problems, balance problems, incontinence problems beginning, etc... I am hoping that my next update to the Blog is good news... Hospice says Yes... Hopefully!

Wednesday, September 17, 2008

August - September ~ Tough Times

I have been putting off posting... well, now for over a month. Cathy has rapidly been going downhill & it is quite frankly hard to post about it... each visit is harder & it is difficult to find any humor in any situation/something to make you smile as you think of her.
____________________________________________________
Here is an email I received from Jean this week:

Hi Beth, Brad and family
Haven't E-mailed you in awhile,
just got back from my daily visit
with my buddy Cathy, It sure is
getting harder and harder to visit
with Cathy, she's gone down hill
fast this past two weeks, lost more
weight, needs to have pants that
she can pull up with elastic waist
band, doesn't have the strength
to snap or hook jeans.... very, very
vocal also, I'm thinking she's having a hard time just swallowing
her own saliva???? I did take her
for a walk and then when I thought
she would like a car ride, she walked back into the building, first
time she's did that....But I will continue to visit and help when I
can... Love to all....Jean
_________________________________________________________________

I have not seen her now for over 2 weeks. Gayle & I went to a caregivers conference at Mayo last Thursday. (I am mostly keeping up to date on these things for Brad & the kids at this point... I want to stay involved... in the know about this disease) On my way home I didn't stop to see her as I drove through because I was beginning to feel sick. I struggled with not stopping as I drove past... but felt that was the last thing she needed right now, getting sick. And to be quite honest... I don't feel that she knows who is or isn't visiting at this point. (so I don't feel as guilty not stopping... I don't have the feeling of 'letting her down' or thinking of her feeling sad because we have not came to visit) I know she is in a safe place & getting good care. We were there when she needed us... and now she just needs to be safe. It helps knowing that she has 2 Amazing 'Angels' close by... Jean & Barb S... they both visit her often in their free time and are a comfort beyond words to her & us. Gayle still visits daily (unless he is on the road for work) & we know that Ryan is close by & stops in when he can. The nurses are Wonderful, especially Angie! And Shelly, in activities, is Amazing with her as well... keeping her as involved as she can & caring for her!

I have kept a sticky note in my purse the past month... hoping to add little things to it to put in the blog. One funny story that jumps out at me is when Brad & I took the kids over 2 weeks ago. We were walking out of the home & headed to our van, the kids ran ahead of us & bent down to pick some wild flowers (they had done this the week before & given them to grandma... however they didn't notice she threw them directly into the trash), as we walked by them Cathy tapped Mia on the butt! Mia was stunned & Cathy just shook her head 'no' at Mia and kept walking towards the van. Brad & I just looked at each other & laughed... not alot of those moments any more. One tiny moment that passed where she was still being a 'grandma' & telling Mia not to pick the flowers... or at least that is what it felt like. It made me long for her... long for the Grandma my kids are missing. That day we got ice cream again & then stopped by the house... she fed the birds & sat on the porch with us for a few minutes & then was ready to go back.

Gayle, Brad, & Ryan's family went to the home a week ago for a 'family day'. Brad said it was a bit of a challenge to have her there. She is now in such a routine of wanting to be in the main dining area every day at 2 (coffee or bingo time) that she kept wanting to go in & finally did... sat at the table & waited for her snack & coffee... even though no one else was in there. Cathy's snacks are now applesauce & pudding. She still wants the cookies... you have to keep an eye on her or she will sneak one... and then she is coughing/choking. Meal Time is beyond difficult for the staff... we are told that she is constantly choking & difficult to feed... Gayle was in for a meal last Sunday and said it was so difficult to watch. She is even choking on her own spit.

She still sneaks out of the building... well, the alarms go off... but she is FAST! And they find her trying to get into people's cars or actually in someones car!! One man found her in his truck parked outside... seat belted in ready to go... luckily she didn't attempt to drive away since he had left his keys in the car. ~ Don't get me wrong on this... we are not upset with the staff that she gets out... they are doing their best! Understaffed as usual in the nursing home field & her unit is not a lockdown unit, only alarms... and they have long hallways & not alot of extra help to go chasing her down over & over again. That would be my one wish for that unit... a door that locks with a pass code!!! Instead of just an alarm!! It would give us peace of mind & give the staff much needed rest... plus prevent any accidents from occurring.

Gayle & Ryan have taken her to a few 'Music in the Park' events in town. Which have presented to be a challenge in themselves. We have not been to one with her, so it is hard for me to say how they are.

Family/Care Givers Conference at Mayo: It was a great meeting that would have helped us out tremendously 2 years ago. But, unfortunately most of what was covered we have already experienced in the past 2 years with Cathy. We had to 'learn on our feet' & create our own path... but luckily for the newly diagnosed at Mayo... they now have a bit of a 'light' to guide their way. (HUGE Thanks to Dr. Boeve & his staff for all they are doing to help families in the future!!!!) We did learn a bit about some tough issues: Hospice & Autopsy. Gayle is hoping to get Hospice in soon to help with Cathy. Autopsy... basically (in my unscientific words) from what we gathered if the autopsy shows Pick's disease then the boys have a 50% chance of inheriting the genetic 'problem' that causes FTD... if not, 20% chance of having the same type of signs/symptoms Cathy has. However, Cathy signed her forms stating NO autopsy... but keep in mind she signed these 'after' she was diagnosed with Pick's Disease & not before... is this really what 'Cathy' would have wanted?? Or was it a decision based on the fact that she didn't really think she was sick & felt someone was 'out to get her'?? This is a prime example of why EVERYONE should have their living will, advance directives, etc... done now!!! So their loved ones know their wishes & don't have to struggle with them... wondering... wishing... but knowing it is what they wanted.

We also learned at Mayo that the person with FTD differs from a person with Alzheimer's in the fact that they remember people much much longer, if not the entire time. They may forget names, they may not interact with people in a way that expressed knowledge of them, but they feel the connection with people they are familiar with... even though they do not show it/express it the same way they used to. We have all been struggling with this the past few weeks. Does she still know us? Does she really... or does she react this way when anyone comes to visit?? It is especially hard now that she does not speak. She is still VERY vocal... but just with sounds. ( In fact, it is difficult to take her out because she is increasingly making more noise & louder noise! Upsetting others... especially at Bingo!) When I visit I go back & forth about it... at times during the visit she seems to know me... but then she will just randomly walk out & not come back, I will find her sitting at the dining table. It makes it easier... knowing that she is not sitting there waiting for visitors... but yet do we really know how she is feeling??? If she is feeling anything??? If she is sad or capable of hurt??? ARGH!!! You could go round and round and round... She seems to connect with Chase & our nephew. But not with Mia & our niece... is this because they are boys & remind her of her own boys when they were young?? Or is it because she cared for Chase when he was a baby??

Jean told me this story the other day about a visit she had with Cathy. It was right after her diagnosis & Cathy had told Jean something the Dr. had said to her: at some point she may be running down the streets naked without a care in the world about it. Cathy had told Jean this would not be her, she was too modest to let that happen! Yet... recently Cathy has been found taking clothes off in front of visitors (much to their discomfort!), standing in the dining area in her jeans & a bra... Cathy would be horrified by this. And Thankfully she is not aware, it is one of the only gifts this disease has given her... the ability to not realize at this point what she is doing. Or at least it seems this way.

I know there is much more going on in her day to day life that I do not know... the ones taking care of her now know her better these days... but I am Thankful for that. I want to still hold on to the memories of her... and not just this disease. I don't want to be a caregiver anymore... but a daughter in law. Making the decision to put her in the home was difficult... & the worst day of our lives up until this point. But... as Dr. Boeve told us at the Mayo meeting... you are able to be a loved one again (a wife, husband, son, daughter) once they are in a care facility. You are able to take off the hat of being the caregiver & put back on the hat of being the loved one. You have given them the gift of caring for them. And now you are able to have peace with that... comfort in knowing that for a little while... you did your best... and now you can just be. Be a loved one.

Photos

Below I am adding a few pics of Cathy... they are from my Cell Phone (Lately I tend to forget my digital camera when I need it!) so they are very small. But if you can make them out one is of Brad & Cathy sitting on the porch at the house in September, the kids playing Bingo with Grandma in July, & Mia watching Grandma add birdseed to her feeders in August.



(Note: I have no pics of Cathy with her other Grandkids on the blog... as someone asked me about it. This is not because I only want pics on here with our kids... but because both of my sis-in-laws have asked me to keep their kids pictures off the blog... & as a Mom I am respecting their wishes.)