Friday, September 7, 2012

May I Have the Envelope, Please?

The drive to the doctors’ office was long.  It was one of those drives where upon arrival you wonder how you got there and if anything happened along the way.  My mind was several thousand miles away. 

As I walked down the hall to the doctor’s office I imagined I was walking down the actual corridor of the brain that goes on strike in so many people as they age.  Whether it is the process of aging, dementia or full-blown Alzheimer’s disease, the corridor is the same.  I imagined the plaque that develops along those corridors and saw in my minds’ eye large tuffs of yellowish-white masses hanging from the walls and the ceiling.  I intentionally walked slower down the hall not really wanting to hear what I already knew in my mind and in my heart.  I paused at the door and remembered when Mom and I brought Dad to this very same office in 2010.  Mom and I went out to lunch and did some shopping while Dad underwent a series of tests and here we are two years later, with so many stories have come and gone, and so many internal and spiritual tests as well.

I barely sat down and started reading the People Magazine on Prince Harry’s Las Vegas trip when the doctor came out and invited me back to his office.  Out his office window a large crane was hoisting construction materials on to the roof and I thought how much the place has already changed since Mom and I were here last, although we were in the office next door at the time.

The doctor presented me with Dad’s test results, knowing how much I love to research these things, and then proceeded to walk me through some of them.  In 2010 Dad was diagnosed with mild dementia, having scored fairly high in most of the exams.  Here we are two years later and Dad has received a diagnosis of moderate to severe Alzheimer’s.  The doctor explained that they traditionally do not ascribe to the seven stages of Alzheimer’s due to the fact that they cross over one another and they can paint an inaccurate picture of the patient.  He was, however, nice enough to tell me that if he were to ascribe to the stages, he would place Dad between Stage 5 and Stage 6, having some symptoms of both stages but not all of them.  He said that the neuro psychological world prefers to stick with three basic stages:  Mild, Moderate, Severe, and identify cross overs when necessary. In Dad’s case, the high end of moderate drifting in to the low end of severe. If we were to see the continued rate of decline that we have seen in the past two years, Dad will be in the high end of severe within the next two years and within 4 to five years he will require full-time nursing assistance and the man we know today will be, for the most part, long gone from us. 

A few of the tests were explained to me.  The scores can be thought of as percentages but its dangerous to think of them as ONLY percentages as that could paint an unrealistic picture.  For example, immediate remembrance of things that have occurred in the last fifteen to thirty minutes was scored at 89 in 2010, and now is around 50 today.  However, if you were to assume 50% it would be incorrect as Dad only recalled 10 items out of 40 (not all at the same time) even when prompted.  He would be presented with a list of items with words and pictures and they talked through each one.  Ten minutes later he was shown the same items and asked if he could recall if they were on the first list.  He was able to identify 10 out of 40.  He did worse when it came to numbers, not being able to recall any of them.  His ability to retain immediate information is severely impaired. 

Dad was disoriented at the testing and was only able to state the current year and state he lived in.  The examiner reoriented him, telling him the correct answers, but 10 minutes later, he was no better able to answer these orientation questions.  He was not able to recall 3 words after a brief delay and did not benefit from cuing.  The report goes on and on but I will not share all the details here.  Suffice it to say it was not a good result.

The Doctor is recommending to move Dad to an assisted living facility within the next few months.  They recognize that he is getting a high level of care provided by my daily visits and the tasks that I do for him, but they recommend moving him so that he can have access to the professional care should that time arise.  There are other financial reasons why moving him to an assisted living facility now is better than waiting especially if we wait  till we need it on an emergency basis.  Getting him there now will also ease the transition to a memory unit when that time arrives.

So what about the surgery and the hydrocephalus?  Surgery will be discussed with Dad but in conversations I have had with him so far indicate that he would lean towards my recommendation.  He’s not crazy about the idea of surgery.  The neuro-surgeon says Dad has a 40% chance of getting his short term memory back but that was BEFORE he read the results of the neuropsychologist.  Dr Schwartz says that 40% is extremely generous and that the number is likely closer to 15%.  There is significant atrophy of the memory pathways in the brain and you cannot reverse atrophy. 

The bottom line for me is that the risks of the surgery far outweigh the possible benefits.  I will present Dad with the facts and let him make his own decision.  The facts will also be shared with close family and we will all offer Dad our support.

Dad still has that great smile, a slightly warped sense of humor, and very healing hugs!  Love you, Dad!

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