Joined: Sun Nov 11, 2012 11:38 am
Location: So. Cal High Desert
Seven years in, still no diagnosis.
Good morning, my LBD-affected brothers and sisters...
My Mom is doing great this week and I (again) allow myself to believed we've turned a corner and gotten her health back on track at last. But in my deepest heart, I really believe that she has LBD.
MOM'S MEDICAL HISTORY.
Mom was physically healthy and quite energetic and active for most of her life. The only prescription drugs she took regularly were Zoloft (serataline) for chronic depression and, later Darvocet for the pain of degenerative spinal arthritis.
The only significant ailment I ever recall her complaining of was her first shingles attack which occurred when she was 63. The second one at 81 seemed to be less painful. I also know that she was on HRT for several years after menopause, Later in life she developed hay fever type allergies. She had cataracts removed from her eyes when she was in her early seventies. She will be 84 years old this December.
Her father died, possible of peritonitis or pancreatic cancer, at 63. Her mother died of congestive heart failure at 96. It may also be relevant to know that she remembers that her fathers mother had a "palsy" that was so bad she had to have someone to feed her.
YEARS ONE - THREE
Early Memory Loss
Mom, living alone on the othe side of the country, began to have particularly noticeable problems at age 77, talking in a new (for her) hyperactive manner, often repeating the same stories within the space of 5 minutes. I asked that she mention this problem to her long time physician and his dismissive response was that she was fine, and her daughter probably just 'wanted her money.' She switched doctors right away. Yay for Mom!.
Her new doctor sent her to a pain management specialist where she would go for an epidural every six or 8 weeks or so. She was still taking Darvocet as needed for pain.
The new physician did not recognize, and she did not tell him, that she was having mild cognitive impairment (MCI) issues, so I sent him a list of the symptoms I was seeing. In addition to a failing short term memory, she walked with a shuffling gait, complained of pain between the shoulder blades, and kept up a constant clearing of the throat. The physician then administered a memory evaluation test and added Aricept to her prescription list.
The only time she took this was when I was home to nag her about it. I recall that during one of those home visits she had a horrifying nightmare, but I attributed it to an drug-induced side effect and thought no more about it.
This doctor also discovered that she had a tumor on her thyroid gland. She had it and half her throid removed. The tumor was found to be benign and the constant throat clearing, and hyper and repetitive talking ceased. I continued to manage her health care as best as I could from long distance. At this point I thought that perhaps most of her problems might disappear as the newly prescribed Levothyroxine brought her T-3/T-4 thyroid levels back into balance, however Mom continued to grow weaker.
YEARS FOUR AND FIVE
Transcontinental Care and The Last Vestiges of Solitary Independence
Mom's P.A., who spends more time with her than the doctor, tells me that she doesn't think Mom has AD, because it is not progressing quickly enough. She has no other diagnosis to suggest.
Sometime between my home visits, the P.A. adds several more prescriptions, for shingles, constipation, and two, much stronger ones for pain. Mom takes these in addition to the Darvoset. She now develops an slight involuntary stagger and begins to have occasional falls. I request that the new additional prescriptions be dropped..
Mom does tell me that she is taking her Levothyroxine religiously, making it part of her Ensure and banana breakfast regimen.. Unfortunately I did not know, and did not think to ask if this was the right way to take it. As I would learn later, "Levo" is meant to be taken on an empty stomach and never with calcium. However, in spite of this her T-4 tests were still falling within the normal range, albeit at the low end.
Sometimes she complains of 'hurting all over'. and sometimes of a pounding heart which sends her to the emergency room, fearing that she is having a heart attack. She gradually became more reclusive, giving up her church and club work, and only driving to take the short, direct route to the nearest store to do her shopping.
Other than that, she loses almost all sense of local geography. When I take her for a drive, she does not recognize her favorite Bar-B-Que restaurant, the McDonalds that had the soft for ice cream she loved, nor the long time family drugstore. She still watches television every night, but now her short term memory is extremely bad. Reruns of Everybody Loves Raymond that played just the night before are always new to her.
She also enjoys reading and the company of her two cats, but seems to be living on Blue Bonnet ice cream. Though the intense craving for sweets worries me, her Fasting Lab tests do not indicate any metabolic problems. However, she is now beginning a period of serious physical decline and though she is extremely weak and shaky, the doctor offers no diagnosis beyond, "when the brain gets weak, the body gets weak."
My husband makes it clear that while he will move across country, he will only do so under great duress. I begin to research gerontological care options and learn about such professions as 'License care management." Mom and I start to have the conversation about the next stage of life.. It is time for her to make a change, but she resists all of my suggestions. However, we do have her will, PoA, and pre-need guardianship papers drawn up.
One year and two emergency hospitalizations later, Mom at last agrees to move into a local Independent Living Retirement Community where she has many acquaintances and where I can have her medication and eating schedules supervised.
The Community is located in a square six story buiilding with units surrounding a center atrium There are elevators at two diagonal corners and Mom's fourth floor apartment is directly across from one of them. It seems simple and obvious to me, but it takes her quite a while to grasp the geometry and logic of the layout of the building. She often turns and heads the wrong way when she gets out of the elevator on her floor.
She has now acquired some hearing loss. Enough so that she has a pair of hearing aids that she doesn't like and won't use, but not enough that she can't hear me when I speak in my normal voice.
At my request, Dr. X started her on the Exelon patch regime and this seemed to help a bit with her short term memory problems. I asked her physician to send her to a neurologist and he does, but with instructions only to look for nerve damage in a shoulder injured in an in-home accident over the previous holidays.
Mom begins to wake up with enormous black patches in the thin skin on her calves. The doctor says that she must be thrashing about in her sleep, but she insists that she sleeps well. To my knowledge and limited observation, I think that most nights she is a peaceful sleeper. although I am personally aware of one instance in the past year when she had a nightmare that she did not remember the next day.
I buy her arnica cream for the bruises and gotu kola in drop form, which is supposed help both memory and connective tissue problems. Motivated by vanity (she is beautiful and proud, and an elegant dresser, still) she uses the cream religiously, the drops, not so much.
Though she grew 50 percent stronger and fussed when I 'accidentally' took her car keys home with me for 8 weeks, by the end of this year she had given up driving entirely, She also lost interest in watching television, but on the positive note, she made a couple of friends and enjoyed the community social activities. After six months however, she began to fall again. A hospital stay resulted in no diagnoses beyond extreme low blood pressure caused by dehydration and perhaps, maybe, a heart problem, for which another prescription was offered.
Mom began to complain of vision problems and we got her new prescription eyeglasses. By the end of the year she reached her tolerance limit with the ever doubled Excelon and can no longer take it. Her memory loss now begins to include chunks of her personal history from years ago. She now has an additional prescription for another antidepressant, in addition to the Zoloft.
May-November: Moving forward while slipping backwards.
Mom was astute enough to take out Long Term Care insurance policy several years ago, but the the policy will pay only for her residence in a licensed care facility, which hers is not. This provides me with is the leverage I need. After another emergency hospital stay, I convince her that it is time to move across country to a Continuing-Care Assisted Living Facility near me. (A continuing care facility is one which allows residents to live independently as long as they are able, providing progressively more care as it is needed.) Mom will have her own apartment, but I chose a facility that allows residents of the memory care wing to bring their pets with them if and when they move in.
Though the facility floor plan is again, quite simple. even after 5 months she still does not have a full grasp of the layout, however she has learned how to get to the hairdresser, mailboxes, library, activity room, dining room and social hour. She is lonely and somewhat bored. She would love to make new friends, but feels that everyone is much older than she is and complains of meal partners who talk all the time, and of meal partners who are morose. Her ideal dining partner would share her interest in people watching.
She still cares for herself and her cats. She reads her paper (slowly) in the morning, sometimes writes letters to friends, reads light novels at night. She goes down to the first floor for meals Bingo, an entertainment events, but she can no longer interpret a bank statement and balance her checkbook.
Her current physician has her on Zoloft, Nature-Thoid, DHEA, Vitamin D and Namenda (this last, again, at my specific request). I supervise her medications by putting the daily doses into morning and night pill dispensers and leaving her big notes about what and when and how. She no longer receives epidural injections, but takes only Allieve as needed for pain.
Whether or not she is able to manage her own meds consistently remains to be seen. She went into a tailspin of depression and missed an entire week and the emotional and physical difference was quite noticeable. The stagger returned and the falling started again. Both of these symptoms stopped once she resumed her meds.
Less than six months from her last vision test, she complains that her eyesight has again grown significantly and suddenly worse. I note that she is now having difficulty with depth perception. She is diagnosed with age-related macular degeneration (AMD). We add eye vitamins to her pill box. I worry because the are the size of horse pills and mom has to place them way back in her throat to get them down.
Though she does not have a UTI, sometimes she has frequent, urgent urination urges and has had her first/last instance of urinary incontinence a few weeks ago. Within the past two weeks, she has had two occasions of fecal incontinence. But this stage seems to have passed, for now. She has been stronger and more clear, with better mental function for several days now.
According to one web assessment tool, while Mom is rated, mentally, at the "early stage of severe" on an Alzheimer's' test. I have investigated the various Alzheimer trials that are available for her, but even though she has not had hallucinations or delusions, I believe she has been showing symptoms of an LB-PD related disease from the very beginning.For one thing, the one consistency has been the inconsistency of progress from health to debilitation, and the cognitive flips from bright and aware to dim and confused.
Unfortunately while LBD is the second most common cause of dementia after Alzheimer's, it is the poor step child when it comes to being understood, or researched The randomness of its demands must baffle even the best experts!
What has been frustrating in Mom's case is that the symptoms have been masked behind several different possible causes...hyperthyroid, hypothryoid, depression, dehydration, Low blood pressure, Darvoset's side effects, other prescription drug interactions. (Her case history could be a great educational tool...."how many LBD symptoms are hidden in this picture?") It has been a diagnostic quagmire and Mom's PA once asked why, given my mother's age, I was pressing so hard for a diagnosis. After all, she implied, what difference would it make in the end?
My answer was a two-pronged one. In the first place, once Mom knew what she might be facing, she would be better equipped to make decisions about her future care and her lifestyle choices. And in the second place, without a proper diagnosis, how would I, diligent researcher that I am, be able to recognize advancements in treatments should they occur? (I didn't know then that said advancements were going to be few and far between.)
Right now, I would say the Namenda is helping tremendously. As long as it does, then we may be able to find relief for the other problems as they crop up. I have also had some hands on healing work done for her on two occasions and will again. She falls asleep and wakes up feeling refreshed and a little stronger and we both like to think that it helps in other ways.
And that's just about every thing I can think of to tell you about how this "Designer Disease" has affected my Loved One. I am sorry if I have been long-winded or overly detailed, but I remember how desperately I searched the stories shared by those of you who have walked this way ahead of us, looking for any scrap of comfort or knowledge. Just knowing what to expect, even as unexpected as it was going to be, has been comforting to me.
It has also been good have you reaffirm that it is up to us, the caregivers and care managers to become the experts in this disease and its treatments, because no one else knows as well as we, what stages and symptoms we are seeing. And our LOs have often crossed beyond the point where they can report and advocate for themselves.
Although I do not know what comes next, beyond trying to find a neurologist who knows something about LBD, I will try to come back and post updates here as we go through the next stages.