A Quick Aside to Caregivers

Friends and family, please forgive me this one quick aside to any Caregivers who might be reading this blog.

My dear Caregivers, be forewarned, there is a greater enemy out there than any you can imagine when you take on this task. You can’t conceive of how hard it will be to go from a busy, engaged lifestyle to one of stillness, of sitting patiently nearby so that you can be bedside when you’re needed, but you come to adjust. You don’t know how little you actually understand about the processes of decline and the breakdown of the mind and body, but you will become an expert in learning on the job. You don’t understand what it’s like to care for an adult who has become, first a toddler, then an infant, but who still knows that they are older than you and that you shouldn’t be telling them when to eat or changing their soiled undergarments and clothing, but you will both get comfortable with the reversal in roles over time.

“What you don’t know” and “what you don’t understand” are all enemies that you can overcome with patience, love and time. The real enemy is the one for which you think you are prepared, but you are not.  The real enemy is the sadness, the sorrow that eats at you slowly in the night or in the quiet moments between your loved ones breaths, as they start to slow. You tell yourself, that you are not worried or stressed, that things are going “as expected”, until you realize that your psoriasis, a stress triggered skin rash, is exploding all over your body, or until you connect that every meal you eat gives you an acid stomach or until you realize that, whatever message your body is sending to you, it is becoming too obvious to write off as something else.

You assure yourself that you are prepared for what is coming and that you are strong enough to handle it; maybe you’ve lost a loved one before, so the second time’s gonna be a cakewalk. And you’ll believe that… right up to the moment when you realize, viscerally, that this is a no win effort. It doesn’t matter how hard you work, how diligently you have cared for your loved one, or how much you have studied and put into place all the little caregiver tips that you’ve found that “should help” your loved one, you are going to lose this fight. And you are going to lose it Big Time. The game was rigged against you from the start and you can’t stop it or even delay it beyond it’s time. You will lose and your loved one, who has been the focus of your ever shrinking world over the past few years, will leave you forever and you will be alone. That’s the Sadness. That’s the enemy against which you cannot fully prepare.

But I am telling you now, when the enemy strikes, you HAVE TO STRIKE BACK! If the sadness tells you to go get a glass of wine, that you’ll feel better, go get a cup of tea. You deny it control. If the sadness tells you to go eat another cookie, you get some fruit or the power bars you got instead of cookies so you couldn’t give in. You deny it control. If the sadness says just stay in bed today, someone else will be here to handle things. Then you get up, you shower, you dress and you Go Somewhere! It doesn’t matter if it’s just to the store or to the pharmacy to pick up meds or just a walk around the block, You Go. Or you set an agenda of work that you need to get done and a timeline to do it and you get to work around the house. Whatever it is that you can do, you do it and deny the sadness any control over you.

Yes, the sadness will still be there. You may weep all the way to the store and you my weep all the way back home, but you have gotten up and you have moved and you have fought off the lethargy and the despair that the sadness tries to place in you. And don’t you Dare weep in front of your loved one. They may not remember who you are anymore, but that instinct to protect you is deeper than the reach of the disease and it will upset them. So keep it to yourself.

Your friends and family will all say, “What can I do to help?” And they will mean it. They want to help. They will most likely feel very helpless themselves, being so far away or working during the day and caring for families of their own in the evenings, so that they can’t do more for you and for your dying loved one. They truly want to help, but in this, the hardest fight for you, they probably can’t help. Let them help in other ways, or, if they can spell you or “get you out” for a bit, call on them.  Remember, however alone you may feel, you are, most likely, not alone. Reach out; and maybe you can help others, by letting them help you.

Caregivers, you may not be able to beat the sadness, and I’m not sure I’d want a caregiver who didn’t feel its touch now and then, but you can fight it to a stalemate and refuse to let it color your last days with someone you love so much. Maybe you can find a fun outlet like writing a blog for family members and fellow caregivers into which you can pour some of your focus and thus keep the sadness at bay a bit. Whatever outlet you choose, music, reading, writing, learning a new language, I’m actually considering that as my “after the fact” distraction, do something that is beneficial and, if possible, a blessing to your life and, maybe, that of others. You will need a time to heal after all of this, and I assure you from my own experience, you won’t recognize that you need it, but from all I’ve read, you will. If there is any way that you can give yourself that time, take it. And always remember this line from a favorite show of mine, “You have done the impossible, and that makes you mighty.” You can put the sadness back in its proper proportion and in its proper place with time. Until then, treat it as an enemy and contain its impact on your life and that of your loved one, your family and your friends. That’s part of the job! Now, chin up and go get ‘em Tiger!!

 

Sundowner's Syndrome

“Sundowner's Syndrome” is a pattern of behavior that develops in Alzheimer’s patients and it is characterized by them getting their day time and their night time mixed up. When you hear of elderly Alzheimer’s patients who have left the house in the middle of the night and no one knew they were out, it is most likely as a result of sundowner’s syndrome. It can be very dangerous for the Alzheimer’s patient and families often have to take extra precautions when they realize that it is occurring.

I think mom may be developing her own version of Sundowner’s as she has been wanting me to leave the music or the TV on late into the night. Of course she is sleeping for most of that time, but if I turn it off or change the station then she wakes up and questions me about why I just did something that foolish.

She is pretty much bed ridden, at this point, so there is no worry that she might go outside and get lost in the cold spring nights. However, her night owl pattern of behavior is leaving her sleeping much of the day. OR is it the other way around? Is her sleeping all day making her more wakeful at night? It really doesn’t matter which is the chicken and which the egg as it works out to the same thing… Sundowner’s!!

It’s lucky for her that I like to stay up late and work on my blogs. By the time I’m ready to call it a night, she is ready to do so, too! Maybe I am in the early stages of Sundowner’s, too?!!

To The Rescue

I’m often asked if my siblings pitch in on the caretaking process. I usually respond with a laugh, because they don’t pitch in, they are ALL IN all of the time. There is no way that I could do this job alone and last week just brought that point firmly home. My regular caregiver ended up with strep throat running through her house and, following rule number 1, she did not bring the sickness into the house and risk exposing Mom. That proper action, however left me facing days of no help with an increasingly weakened and fragile patient.

Over the hill, I could hear the bugle calling charge!!! My sister and niece, who had planned to visit that week already, were landing at the airport with fortuitous timing! When the Cavalry arrived at the house, they not only pitched in, they took over in many circumstances so that I could supervise and let them care for mom. My sister even stayed with Mom one afternoon and entertained her while my niece took me off to one of my favorite places to walk and take photos. They both walked, or ran, the dog each day that they were here so that she had a lot of great exercise and fun, too. I know that it was by happenstance that they arrived at just the right time, but I have found that happenstance tends to be what you make of it… and they made it wonderful.

My family is nothing but supportive and they are often the driving force in getting things accomplished when I am forgetful or overwhelmed. They are the strength and the love that carry Mom and me through each day. They are the phone calls that cheer, the direction when we feel lost, the get it done when we are spinning in circles. They are critical to everything we do. So I guess the answer to the question is… Yes! We couldn’t do this without each and every one of them and we are blessed to have them at our side through this process.

Decisions and Dealing With Them

Well, I’ve dawdled over writing this post for long enough… As of Monday we are signing Mom up for Hospice. While she meets all of the criteria for Hospice, they also agreed that, with Alzheimer’s, that situation may not be as “final” as it sounds. For example, some Alzheimer’s patients have gotten better for a time and “graduated” from Hospice. They end up going back eventually, but they are back to normal care for a while. Also they indicated that some Alzheimer’s patients decline so slowly that, what would be a 6 month process for a cancer patient, could take a year for an Alzheimer’s patient. So we are not writing Mom off any time too soon.

Hospice is apparently more than just an “end of life” medical care program. There is also, apparently, a support for the family component to the program. I’ll have more information on the services available through Hospice as I go through the process. At this point in time, I’m just focusing on making this time easier and more comfortable for my mother.

That having been said, I want to talk a bit with other caregiver’s who might read this blog. This is as good a point as any to talk about some of the things that you will be going through. I am not one to wallow publically in sorrow, though I may weep on the shoulder of a sister or a friend. That doesn’t mean that this isn’t tearing me apart. I knew this time would come. I know that Mom is no different today than she was on Thursday before they said that she qualifies for Hospice. I know these things in my head… but my heart is telling me that I’m losing her and I can’t stop it. These are normal feelings. Don’t ever let anyone tell you that you should not feel the pain or worry about what comes next. These emotions and questions are all part of the process. Accept them, but don’t wallow in them. Acknowledge their place in your world, but don’t let them overwhelm you. If you need to cry, find a quiet place to let it out, and it’s always best if you can have someone there to just remind you that it will be alright, but when you’ve cried, then stop. Go walk someplace beautiful, go shopping, go out to dinner with friends, do something that you enjoy doing and let your mind slip back into the peaceful and strong place where you need to be to give the proper love and care your loved one needs from you. You have to stay strong and take care of yourself so that you can take care of those who need you. For me, I write, I take pictures and I spend time with people I love and enjoy. I don’t have to go away to get away, but I may be unique in that way. Take time and do what YOU need to do to stay sane and patient and loving.  

And enjoy the time that you have with your loved one. Whether it’s for 6 months or year, the time will pass too quickly and you want to be able to look back and know that you filled it with love and joy.  

Advice on Slowing Onset of the Disease

My sister recently reconnected with an old friend only to find out that she is working in the same Alzheimer’s Department at the VA Hospital in Seattle that is running mom’s Study program. In the course of their conversation, the old friend advised my sister that one n 5 people in our country end up with Alzheimer’s. Since there are 5 of us kids, my sister asked her if there is anything that we siblings can do to stave off the disease. She gave my sister some great information, which we asked her to put into writing for us to share with you. Her response is attached below.  I know what I’ll be working on now, because I’ve seen what happens with this disease and I’m going to hold it off as long as I can!

Additionally, based on the insights and advice she gave us regarding the final stages of the disease, I will be contacting Hospice Care next week to see if they can evaluate mom’s situation. As you know from reading this blog for just the short window in which I’ve been writing it, Mom’s situation has been changing dramatically and all the facets which are identified as part of the final stage are notably present and escalating in mom’s case. I know that’s now what we want to hear, but it is what I’ve been seeing. It’s also what the caregivers who help us have been seeing, based on my questions to them about her situation, as referenced below in the letter.

Here is the letter:

“I don’t have any literature to send with the prevention issues I talked about. I do want to clarify though, these are only ways that we can REDUCE risk factors for, and hopefully delay onset and/or slow progression of Alzheimer’s disease. The hope/thought is that if we can keep the “disease pathways” healthier, we can slow the progression or onset of disease. We cannot change our genetic risk factors, but we CAN do something about managing vascular risk factors i.e.

         Avoid developing Type II diabetes:  through lifestyle management like daily exercise and a low fat/low sugar diet, avoiding high glycemic index foods – things that the body breaks down quickly into simple sugars, like a popsicle vs low glycemic index foods, like an apple, that take the body longer to break down therefore avoiding big peaks of both blood sugar from eating the food and the insulin that is produced in response to those big spikes of blood sugar. Our data shows that just 30 minutes of aerobic exercise will reverse, at the cellular level, insulin resistance ( pre-diabetes) for 24 hrs!..exercise is very, very powerful medicine!

         Manage high blood pressure:  again, through lifestyle management of diet and exercise. Watch foods with hidden sodium (canned soups, sauces etc). If you have been prescribed blood pressure meds, take them.

         Manage high cholesterol:  again, through lifestyle management of diet and exercise. Have yearly fasting cholesterol labs taken. If you’ve been prescribed a cholesterol lowering medication, take it. I use Red Yeast rice tabs from Costco. My cholesterol is borderline high, but has stayed steady for the 5 years I’ve been taking Red Yeast rice. I also have very high HDL’s, which are especially protective for women.          

         Manage and REDUCE stress levels:  Chronic, high levels of stress are really bad for brain health. When your body is in a constant state of stress, you are releasing the “fight or flight” hormone, cortisol. We know that constant high levels of cortisol in the body cause an inflammatory response (because you are NOT supposed to have any hormones as a constant in your body, they work on peaks/valleys) that not only affects your body but your brain. We know that these inflammatory responses in the body (including your body’s response to high blood pressure, high cholesterol, type II diabetes) are damaging to both body AND brain.

To answer your question about mom’s increasing sleep time, could be winter time affects but also could be her body slowing down as her disease progresses. Your caregiver is probably picking up on some more clues with your mom’s behavior than just the increased sleeping and decreased alertness. The fact that she is spending most of her time sleeping may very well mean she is moving toward the end of her life. However, with this damned disease, sometimes it’s just hard to tell. When she starts to have significant decrease in wanting to eat or drink, along with the increased sleeping, you are probably nearing the end of her life.

It would not be unreasonable to get hospices services in now, to offer emotional/ physical/ spiritual support for your mom AND the family/caregivers. If her PCP believes she meets hospice criteria i.e. increased sleeping, decreased verbal interaction, bladder/bowel incontinence, ( and some others that I can’t remember right now) I would highly recommend it. FYI, she may well rally with some hospice team care, then no longer meet hospice criteria and then get pulled off of hospice!...Alzheimer’s patients often “graduate” from hospice care, then when they start to decline again ( which they always do), then they can go back on hospice. Hospice benefits do NOT end after 6 months of care. Folks just get re-certified as meeting hospice criteria (via the PCP/hospice team agreeing that they meet criteria again) and go back on. It is an old wives tale that you only get 6 months of hospice care, simply not true. That being said, her PCP and Providence Hospice, may NOT agree that she meets hospice criteria at this time. Hospice is used far too late in far too many cases!  It’s a wonderful service and highly recommend it, especially for end stage Alzheimer’s patients.”

Entertainment

We have found that staying awake is easier when we are watching a great movie…. or a really fun movie. We are drawn to the animated children’s movies, as a rule. Films like Tangled, Toy Story or the Ice Age films are almost always a guaranteed hit. Other non-animated kids movies, such as the newer version of Peter Pan, Babe or Nim’s Island are also great choices. They have plots that are easy to follow and, when she can’t follow the plots any more, Mom enjoys the large gesture laughs and the goofy situations. She enjoys the whimsy of animals talking, or children flying and delightedly fighting pirates. She can watch them over and over again and enjoy them just like it was the first time she’s seen them. She will also marvel each “first time” that I know all the words to the little songs in the movies…  Yes, a good old children’s movie works wonders for a sleepy mind.

However, nothing works like the great old movies that she has known and loved for years. Doris Day, Errol Flynn or one of those great old musicals will keep her smiling and singing along in delight. The old movies are the ones she loved when she was young, that she watched with my dad and that she still recognizes when she doesn’t remember the person with whom she was just talking. Oh, did I mention that the best movies, the movies she remembers so well that she will stay up late to watch them, would be anything with John Wayne in it?!  Well I should have. She wanted to go to bed at 4:00 and here we are, 3 hours later and one and a half John Wayne movies in and she’s wide awake and unwilling to go to bed until John Wayne saves the day! She may not remember which movie it is, but she does remember that John Wayne will always save the day!

It's the Small Things

With Alzheimer’s the brain stops tracking the way it used to on such things as words, memories, and conversational control. It also impacts motor skills, too. Doing simple things like dressing, feeding yourself and basic hygiene becomes less and less manageable as the disease progresses. I may be wrong in my approach, but I always try to have my mom do as much as she can by herself; from pushing herself up out of her big chair to walking instead of being pushed in her wheel chair and even to performing her own ablutions. I can judge how tired she is, by how many of the small things she can do for herself.

As she has moved through this process we went from a woman able to select her own clothes, dress and put on make-up, to a woman who sits passively while she is washed, dressed in jammies, in which she almost exclusively lives now, and her hair is combed for her. She can still brush her teeth quite thoroughly, but she really has no concept any longer of personal hygiene.

She has gotten weaker, as time has passed. On good days she can walk, with the aid of her rolling walker, back and forth from her bed room to her bathroom or from her bedroom to the family room/ kitchen.  On most days, she can only walk part of the way before being exhausted, but walk she does so that she can keep up some of her strength.

I have noticed at night that she is just fine when she’s sitting and watching the TV, but when it’s time to get up she goes wobbly and seems shaken. Sometimes she even sags over on one side or the other. I’ve done the stroke tests, smile, raise your arms, repeat after me, and to all of them she responds perfectly. Worried that she might be having TIA’s, I asked the Dr with the Alzheimer’s study program about the incidents when she called for the annual review. She indicated that it is most likely a result of the disease. When tired, Alzheimer’s patients can have little glitches in their circuitry that looks like a mini stroke, but is just a weary brain that can’t find the direct pathway it needs to accomplish its task.

We keep trying to stay ahead of the big things related to this disease, but sometimes it’s the small things that seem so big.  Unless we handle them together, then nothing is too big for us.

Being Still

There are those days when you have a million things planned and the schedule is going to be tight… and then the phone rings. Your caregiver can’t make it in today and suddenly you go from a screaming run to…. Stillness and slow motion.

I have to admit that coming out of the fast paced business world and having to learn how to be still is not as easy as it sounds. Your mind and your body are geared to a state of constant motion, always thinking through the current problem, prepping for the next appointment, coordinating with everyone involved in the process, pop, pop, pop!

And then you have to learn how to retrain your brain to notice the small changes in diet, or sleep patterns or behavioral shifts that could mean something… or nothing at all. You are the only one who can get her to eat, or bathe, or just get out of bed. You are the one she remembers and you are the one she looks for when she’s worried or confused or frustrated.

 You get out when you can, but chances are good that you’ll get at least one call to talk to her about doing something she’s pushing back against doing. The time away is limited and the time of sitting and watching is sometimes unending, so when you plan on a busy day and you get “That Call”… it’s always frustrating… at the very least.

Learning to be still means you find other ways to entertain your mind. It means you read, you meander through the internet, you watch TV while you keep a steady eye on the monitor that’s keeping an eye on her. When she’s awake and fed and sitting up in the room with you, then you can do things like clean the kitchen, vacuum the room or clean a bathroom. While she’s engaged in what she’s eating or watching on TV, you have a bit of move around time, but when she’s sleeping and could try to get out of bed unnoticed you don’t dare be too distracted or you will miss her move and she could fall.

So you learn to be still. When you get a chance to run, you run, but when that call comes in that tells you that your planned run is on hold… you smile, you sit down, and you go back to being still, because that’s what you need to be doing.  

You can always fill the still times by blogging about being still… it works for me!

Caregivers

When I first agreed to come and stay to help mom and dad, my father had insisted that we hire caregivers to cover the daytime hours so that I could get away now and then. I had told him that I didn’t need that help and suggested that he save the money, but he ignored my suggestion. These days, I really appreciate the wisdom and foresight of my father.

Caregivers are more than just a babysitter for seniors. We have been blessed to have worked with some of the best and most loving women I have ever known. They have their own lives and some days scheduling can get crazy, but they are there when I need them and they always bring their A game.

We have one who works Monday through Friday and one who works weekends. They cook mom’s breakfast and serve her lunch, or early supper as lunchtime sometimes works out to be late in the day. They do light house cleaning, they make sure that mom’s clothes and undergarments are always fresh during the day. They give her the medicines she requires and track her blood sugar. One of them helps me give her showers and both keep her clean in between those showers. They do all sorts of things for mom, but the main thing that they do for mom is to sit with her during the day. They keep her entertained when she’s awake and safe and warm when she’s asleep. And for me, they give me time to not be “in charge”. Sometimes I get out of the house and run errands, but other times I just hide in my office and work on my writing. I get to take walks with our dog or I slip away with my camera and connect with the peaceful joy that taking my silly little pictures brings me.

Each of the care givers who have worked with us has had their own array of training and experiences and they have proven to be a valuable resource in handling the new twists and turns of Alzheimer’s. They warn me when they see new behaviors developing. They alert me as they notice patterns that could cause mom physical harm. They are full of ideas and wisdom and they are more than willing to offer both as the need arises.

All of that said, I also have to add that they have proven to be generous and loving in their daily support of me, even when I’m tired and cranky. My life would be so very difficult and frustrating without them and I am so very grateful to them for all they do for my mother and for me.

Patterns and Routines

I have found that, in doing the everyday things successfully, it’s best if we establish and maintain a routine… a pattern of habits that we follow each time. Doing simple things like placing the walker/ chair in the same place each time we go to the bathroom, laying out the wipes and wiping our hands the same way, even using the same words when directing movements. While she may forget, with her mind, the patterns, the repeated ritual of doing the same things the same way lead to an instinctive response in those times when mom is most exhausted and unable to process instructions.

I’ve always talked a lot… a lot. I’m finding that habit coming in handy these days. Mom seems to relax and work with me better when I’m telling her everything I’m doing as I do it, or even before I do it if it involves sudden movements or loud noises. For example, “I’m going to pop the lock of the handles of the walker and then push you sideways so hold on.” Or "I’m going to roll you backwards and then pull you up to the sink, but I promise I’ll stop before your knees touch. So don’t worry.” Telling her what is happening makes her feel more in control and more at ease as things take place. When your mind can’t process a thought at normal speeds, then even things that move slowly can feel like they are spinning out of control.  

On the other hand, sometimes it’s best not to say too much. I usually prepare her tooth brush and water while she’s in the toilet. Then, when she comes out, we roll over to the sink and get our teeth brushed. I roll her into place, not banging her knees, as promised. Then pull out a Kleenex and fold it as I walk around her chair to reach her tooth brush.  The electric toothbrush always makes her nose run, so it’s best to have the tissue ready for her when she’s finished with the brushing process. I then hand her the toothbrush and tell her to put it in her mouth. When she’s done I help her stand to rinse and swish. Then I get her resettled and hand her the tissue before moving her out of the bathroom. It works smoothly... usually.

One time, I handed her the toothbrush and said, “Put this in your mouth and turn it on.” She heard “turn it on” last and so, halfway to her mouth, that’s what she acted on. With a fully charged electric toothbrush, that green gel tooth paste didn’t stand a chance. We had green gel on the mirror, the counter tops, the walls and all over both mom’s face and mine as I jumped in to grab the brush and turn it off. We were truly slimed. Needless to say, all I ask her to do these days is put it in her mouth. We let those patterns of habit do the rest.  

Alzheimer's Attitudes

I have heard many people say that, with Alzheimer’s, the patient becomes angry and aggressive as the disease progresses. I have to say, from my experience with my mother, that is not always the case. My mother has always been a loving person. She has always encouraged me to approach things from a positive perspective instead of taking a negative approach. When she was working in the business world she was a professional, pragmatic business woman. But beneath that lived the tender heart of a loving woman. I recall the time, when one of her tenants was behind on their rent, that she went to the house to post a pay rent or vacate notice. At that time she spoke with the tenant and found out that their child was in the hospital with cancer and they simply didn't have the money to pay the rent. Not only did she waive the rent for that month, and couple more for good measure, but she went out and bought groceries for the rest of the family and took it back by their house.

Now, with Alzheimer's very clearly in an advanced stage and advancing relentlessly every day, she is not angry. She is not aggressive. She may occasionally be a bit stubborn if she isn’t ready to get up or if she doesn’t want to change out of her warm pajamas, but she isn’t angry. She is, in fact, quite joyful, and happy and even silly on occasion. She makes jokes, in so far as she is able to do so, and always tells those around her how lovely their eyes are or that she thinks they are beautiful or handsome. She is a consummate hostess, greeting any visitors with a smile and a kiss on the hand. Nowhere is there a trace of the anger or the aggressive behavior that is so often associated with the disease.

Perhaps it’s because she is in her own familiar world, or maybe it’s because she knew what was coming and made arrangements in advance so that she could move into this phase of life with a peaceful mind. It could be any number of such things, I guess, but what I believe it must really be is that with Alzheimer’s you are stripped of all the pretenses, the professional fronts, the sophisticated manners and what you are left with is who you really are, the essence of the individual’s nature. In my mother’s case that is a joyful and loving woman with a natural instinct for caring and a positive approach to life. In other words, even in the face of this disease, she is a blessing to those around her.

The Beginning

Let’s start with a little back ground…

My Mother was born in Marshall, Texas in 1930. She was active and engaged in High School and went on to achieve a degree in Journalism from Texas Christian Women’s University. She married my father the day he graduated from West Point and they set out together to build a life and multiple careers in a variety of challenging fields and times. She was a brilliant business woman, an educator and a strong and loving wife and mother.

When her father was diagnosed with Alzheimer’s, she and all of her siblings realized that they too had a chance of developing the disease. When her memory starting giving her problems, my mother joined a study program for a new drug designed to treat Alzheimer’s. She went through many intricate, and sometimes painful, procedures in order to participate. I asked her once why she was willing to go through such things as a spinal tap just to help them study a drug that might or might not help her. She told me that if she went through all of that, then maybe it would mean that her kids or grandkids never had to face the burdens Alzheimer’s.

That’s my mom.

Every year, faithfully, since she finished the study program and the drug was released for public use, she has gone back to the VA Hospital in Seattle to do the follow on question and answer sessions, the comprehension tests and the memory analysis. This year, for the first time, I think she will simply not be able to make the run up to Seattle for the tests.

As I move through this blog I will be trying to make regular posts on day to day changes, the ups and downs. I’ll also try to fill you in on the background story. Who my mother was, who she is now and the steps, large and small, that have brought us to this point on the Alzheimer’s Path.