Monday, June 19, 2017

Help

Why does obtaining help have to be so difficult? If there's one thing I've learned from this disease, it is that our medical care system is majorly flawed.

A couple of years ago, Senate (NOT doctors and medical teams) revised Medicare guidelines for receiving hospice with certain diseases. It used to be that if a person diagnosed with dementia reached the point where they were having trouble swallowing and were losing weight due to that (and decreased eating), they could be labeled as "failure to thrive" and receive hospice care. Under new guidelines, Alzheimer's patients can receive hospice under those conditions, but other dementia patients cannot. The problem is, they fail to recognize that dementia is a terminal illness. Anyone who says that it is not is not educated on the disease. When the brain loses function to the point where it cannot tell the body how to swallow or how to process food or how to ward off infections, the consequences are terminal. And such is the way with dementia.

Mom is now into the phase of swallowing difficulties and weight loss. From September to April, she has lost approximately 50 pounds and has lost another 10 pounds since April. Her eating habits have continued to change, even within the past few weeks. The amount that she has been eating has continually decreased. She went from eating whole sandwiches to eating only half and over the past few months we've decreased her portion size to 1/4 sandwich sizes because she wasn't finishing much more than that. Even though she was eating frequently, she was only eating 1/4 portions at a time. Yet, she was finishing them. Over the past few weeks, she has decreased her portion size to mere bites of that quarter-sized sandwich. Sometimes, she will point to the bread and pb&j, watch us make it, and then get up and walk away from the table. Other times, she will get her plate from the cupboard, place it on the table (her signal that she is ready for another sandwich) and walk away. It is as if she is simply going through the routine of doing something (making the sandwich) but is forgetting about the actual eating part of it. We've been tracking her intake of food and water. Last summer she was eating, on average, about 5-7 sandwiches a day, plus drinking 2 ensures and at least 32 oz. of water. Now, she is down to only 16-20 oz. of water a day, no ensures and an average of 2-3 sandwiches per day. When I sit back and reflect on that significant change over the past year and witness the weekly and even daily changes, it leads me to believe that she won't last another year.

In addition to the drastic decrease in eating and weight, swallowing is becoming more and more of an issue. Most times that she drinks her water, she chokes on it, sometimes to the point where she coughs/spits out everything in her mouth. This puts her at risk for aspiration, which leads to pneumonia. She has been choking on her pills over the past month to the point that we've had to eliminate all unnecessary pills (my dad has been giving her lots of vitamins to keep her healthy, but they are too much trouble now to swallow). With her sleep medication, my dad has been crushing it up and slipping it into her nighttime sandwich. She seems to do better swallowing the sandwich than the pills. The trick now is getting her to finish the sandwich!

At the prompting of several people in my online support group, I called and ordered Mom a hospice evaluation (I actually emailed her doctor who sent in the referral). Many people said they were able to receive this service for their loved one by this point and even had them receiving hospice for a year or two! Receiving hospice can be helpful because they pay for all medications, diapers, medical supplies, etc., plus they'd have medical staff come in to check on Mom and help with the bathing. I thought it might be nice to get some extra help and support for my dad. I don't know if it's fortunate or unfortunate that she didn't qualify, but I'm leaning towards unfortunate simply because of the fact that this is a service she would've been able to receive at this point if her diagnosis were Alzheimer's or if they hadn't have changed the guidelines. Basically, the hospice nurse told me at our assessment that they wouldn't be able to step in until Mom becomes non-ambulatory (not walking). The crazy part is that with Mom's specific diagnosis and all other factors (her young age, overall good health), she could very likely be walking up until a few days before she passes away; that's what we're hoping for-we don't want to see her bedridden for months on end. It doesn't matter if she has not eaten or drank in 5 days, they will not step in until she's bedridden.

To put this into perspective, I recently had a conversation with another young lady from my support group whose mother passed away last month. Like my mom, her eating decreased more and more each week until one day, she decided she was done eating altogether. From that day, it took 11 days until she passed on, and she was ambulatory until 2 days prior to her passing. The hospice nurse also told me of a family she had assessed in a similar situation where the patient hadn't eaten in 5 days, yet couldn't qualify for hospice yet because she was still ambulatory. So basically, this isn't a service that we will likely receive until we are days away from death.

To add more insult to injury, we were told that Medicare wants to see us place her before we can tap into anymore services. See, while we didn't qualify for hospice, we did qualify for a home health nurse to come and assess Mom. Things were looking up when the nurse told us Mom would qualify for in-home help! She originally said that Medicare should provide a caregiver to come 3 days a week for several hours to help with mom, including help with the bathing (which I've been handling for the past 2 years). After trying but failing to not get my hopes up, it turned out that she only qualified for bathing help. Still, we were happy and relieved to get some outside help especially with the summer approaching. Unfortunately, that was also too good to be true. Despite the recommendation from the nurse, Medicare only approved 3 weeks of help with the bathing; I'm not sure what the point of that was! On Friday, the nurse came by to reassess and close out Mom's case. Until she ends up with an infection, in the hospital for some reason, or becomes non-ambulatory, our help is done. UNLESS we decide to place her in a facility; if we do that then we'll get extra help. Apparently the people sitting behind the computers are better equipped to tell us where Mom would be better off and will only offer help if we do it their way. No thank you. It's not anybody's business to tell us how to take care of Mom, least of all those who don't know her!

I really don't mind bathing Mom. In fact, I felt a little guilty for those 3 weeks to allow someone else to do it. I feel like it's my job to take care of her. I will admit that it's not always easy or convenient, especially during the summer with the trips we have planned and the time I want to spend with my kids. Through this ordeal, a couple of our caregivers have stepped up and offered to help with the bathing. I still plan to be here when I can to help with that process, but it's nice to have peace of mind in knowing that she'll be taken care of when I'm unable to be here without placing the extra responsibility on my dad-he has enough to worry about! Even though I am extremely frustrated with the lack of care in our system, I feel extremely blessed to have the help that we do have. This isn't going to last forever, so we are all just doing our best to keep Mom happy and healthy for the time she has left with us.

Tuesday, May 16, 2017

Dear Mom

Dear Mom,

This time of year is always a little tough for me. On Sunday, we celebrated Mother's Day and a few days before that, your birthday. You've made it another year, 56 years old! For some reason, it hit me a little harder this year. As I wrote your birthday post on Facebook, the tears slid down my cheeks, just a few at first and then as if a dam had burst as I was overcome with my grief. People tell me that I am strong, but there are moments (like that one) when I'm not so sure that is true. I posted a beautiful picture of you with my Aubrey (taken on her first birthday) and so many thoughts and emotions surged through me. So many things that I wish I could say to you and share with you. Sometimes I talk to you anyway. I know you don't understand, but still, I tell you about the kids' accomplishments, things that are going on in our lives. I suppose it's more of a comfort for me to feel like I can still tell you what is happening. And so I write you this letter with the things that have been in my heart over the past week.

Looking at that picture reminded me of the deep love and devotion you had for your grandchildren. Sometimes I can't help but to daydream about what life would be like if you were still here with us, free of this disease. I imagine the family dinners, the family trips and vacations that we would have. I imagine the holidays and all of the festivities and traditions that make them so special. I imagine shopping trips and mother/daughter days out. I imagine you sitting with us on opening night of Aubrey's theatre shows, or her voice recitals, or the boys' ball games. No doubt you would be so proud of the accomplishments of all of your grandchildren.

This birthday we wanted to celebrate you, even if you didn't understand. Jeff called me from work and offered to pick up dinner from Miguel's in your honor, since it was your favorite place to eat! We took our dinner over to your house and ate and reminisced about the birthdays spent at Miguel's. When you came into the room, we all sang "Happy Birthday" to you and the grandkids showered you with affection. I had a faint hope that the song might spark some recognition with you. I don't know that it did, but you did get that cute grin on your face that you sometimes get when anyone tries to hug you.

There is nothing left I can give to you but my love. For your gift this year, I decided to make your famous English Toffee to sell and raise money for your caregiving fund. I was blown away by the love and support from friends and family. Over 100 pounds of toffee was ordered!! We spent all week working on filling those orders-Jeff, dad and a few friends from church all pitched in to make this happen. You would be so proud of Dad; he's become quite the accomplished toffee maker!! It was such a sweet thing to be making your toffee recipe, keeping your legacy alive while doing this act of service for you. Though 100 pounds of toffee seemed a bit daunting at times, I never felt anything but love while I worked. This was my gift to you.

Some people ordered just to show support (some continue to order because they've become addicted to your recipe! Ha ha). Some friends gave donations to your caregiving fund without ordering toffee at all. Other friends left large tips to go towards your caregiving expenses (one dear friend of yours left me with a $180 tip!!) Through all of the ordering and the cooking and the tipping, I began to realize how much you have affected other people's lives. I think you would be truly touched to see the outpouring of love and support of your friends, family and church family. Your journey has even touched those who have never had the honor of meeting you personally. If I could bring you back for just one minute and tell you just one thing on this birthday, I would tell you just how much YOU ARE LOVED. You are loved by so many people. I love you, Mom. Not a day goes by that I don't miss you. That ache in my heart will never go away. I will put on my brave face for you. I will continue to fight for you and to care for you, as best as I am able. I will forever hold the faith and hope in my heart that we will be reunited again someday.

Happy Birthday and Happy Mother's Day. I love you more than you know.

Your devoted daughter,

Cassandra

Monday, April 24, 2017

Weight Loss

Last summer, Mom experienced a significant decline and it got me a little bit worried. With every rapid decline, I can't help but to wonder if this is the turn that is going to lead us to that final stage. I could write all the details of what transpired, about our evaluation for hospice and home health care, but it's a long and exhausting story. To sum it all up in a nutshell, some members of my support group suggested that we get her a hospice evaluation claiming that their loved one received hospice much sooner than the phase my mom was in at that time. I kind of got my hopes up; not because I wanted hospice necessarily but because I thought we might actually be able to get some (free) outside help. Well, after the evaluation, it was determined that she was not eligible for hospice yet, even though she did fit some of the criteria. One of the biggest factors, they told me, was weight loss. Significant weight loss indicates that their eating habits are changing; at the end stages of the disease, weight loss will occur, signaling the advancement of the disease.

This left me a little confused. For one thing, in everything I've read up about semantic dementia, it says that weight gain is very common in the late stages of the disease. Mom was at her all time heaviest weight, weighing in at 234 pounds. Her average weight (at nearly 5'8") has always been somewhere between 150-160 lbs. Nevertheless, Mom's eating habits were changing. Some days she'd eat hardly anything at all; other days she would devour 6 or 7 pb&j sandwiches. She was still drinking Ensure though, which is packed full of calories. The hospice nurse recommended that we keep track of her weight and her eating, stating that we could call back for a reevaluation at any time, and especially if we could show changes in her eating patterns and weight loss. So, for the next few months, we kept a log of the times and the quantities of Mom's meals.

After a couple months of doing this, we didn't really see much of a decline (especially in weight) so we decided to quit tracking for a while. The last time I weighed her was early fall and not much had changed. BUT, since that time, Mom has quit drinking her Ensures. Dad has left them out for her on the counter and has even tried personally giving them to her, but she won't drink them. She will only drink water from a plastic water bottle and she is now on a 100% pb&j sandwich diet. We generally only make 1/4 of a sandwich for her at a time because so much of the sandwich ended up going to waste. She was taking one or two bites and disposing of the rest and she will not eat leftovers. She has to watch it being made if she's going to eat it!

I've noticed her slimming down a little bit over the past few months, so today I decided that I should get her on the scale-just to note the changes. Our caregiver was at the house with me when I showered her so she helped me to get Mom on the scale afterwards. This is no easy feat; Danielle had to pick up her feet and move them onto the scale while I held onto her upper body. I was shocked when I read the scale. In fact, we put her back on two more times just so I could make sure that we read the number right and that it wasn't a mistake. All 3 times, her weight came in right around 183 pounds; 50 pounds less than she weighed in the fall!

I am understanding more now about the weight gain/weight loss issue in the last phases of the disease. While those with semantic dementia do tend to gain weight in the later stages of the disease, there is an order to that very final stage that I am finally starting to comprehend. As one enters into the very last stage, there comes a disconnect between body and mind. The body forgets how to eat, how to swallow, how to walk, how to talk, how to hold in human waste. We've seen some of these changes already, but we still have a ways to go. I do think it's time to start tracking her weight again. It's possible we could now get her qualified for hospice, although she could still have a long way to go-there's no way to know for certain how long this phase will last. When she begins to have more trouble with her mobility or complications with infections (pneumonia, UTI's), etc., then I think an evaluation will be in order. Until then, we take it one day at a time.

Monday, April 17, 2017

Shoe Fetish

Lately, Mom has a bit of a shoe fetish. When she was in moderate stages of the disease, she used to be OCD about laying out her clothes for the following day, shoes and socks included. She'd also place her pajamas on the footstool that sat in the corner of her bathroom/vanity area. The obsession has continued, even though she no longer changes her clothes by herself anymore. I think it's just the motion of doing it; she remembers that she has to put clothes in the corner but she doesn't remember why she does it.

The thing is, Mom is not only laying out her own clothes and shoes. She collects dad's shoes and whatever shoes she can find throughout the house and puts them in her corner. There have been several occasions where my, or other family member's shoes, have gone missing. When that happens, we know the first place to look: Mom's corner. And sure enough, that's where we find them! One day, not long ago, I actually had to hide my shoes because she kept coming out to the living room to retrieve them and take them back to her room! It gives us all a good chuckle.

Sometimes, Mom will actually attempt to wear the shoes she collects. Last week, I heard heels clacking down the hallway as Mom made her way out of her bedroom. The sound made me raise my eyebrows and I laughed out loud when she made her grand entrance wearing my dad's church shoes.

Sometimes, with all the sadness that dementia brings, you've gotta find things to laugh at. I know as we look back on memories with Mom, her shoe fetish will always give us a good chuckle!

Monday, March 20, 2017

Memory Masquerade

I've always tried to be very open with our journey on this blog, sharing every part of it; the good, the bad, the ugly. The other day I realized that I have been holding back a big part of my journey with dementia. Why am I doing this? I don't really know, but I suppose a big part of it is fear; mostly fear of what people think.

I have mentioned The DEANA Foundation on here before, but I don't mention it often. I think a big part of that is because I don't want to come off as though I'm trying to advertise or "sell" something to my readers; that isn't my intent with this blog. With that said, the foundation has become a huge part of my life and a big chunk of this journey and I feel that I'm not being authentic by holding back and not talking about it. The truth is, I spend a portion of nearly everyday contributing something to the foundation, whether it's phone calling, making presentations around the community, working out details on events, etc. Some days, I feel like I am crazy to have started all of this while in the midst of caring for my mother and my young family. There are moments when I question myself if this is what I should be doing and focusing on. There are moments when I feel very inadequate, like I am a tiny fish in a giant pond. There are moments when I want to throw in the towel and quit (not gonna lie). Yet, there are other moments when I feel like I was definitely meant to carry out this work, especially when we are able to award grants to help families that have nowhere else to go. It gives me a positive direction to channel my emotions and it is a way of honoring my mom. While at these events, I'm able to talk about her, talk about what we've been through while trying to make a change within a broken system. I feel that in some small way I am making (or attempting to make) lemonade out of the lemons we've been given. That is becoming my new mantra for life: making lemonade out of lemons!

For those who aren't up to speed on The DEANA Foundation, you can visit our website to learn more, but basically our goal is to raise money to help middle-class families (since they are the ones always left behind) with caregiving costs associated with dementia. We do this through donations, fundraising and hosting events.To date, we have been able to help 3 families in our community with our grant program. We have done so much over the past couple of years and have many great things in the works right now, so I'm optimistic that number will continue to increase each year.

Right now, we are planning our first annual Gala fundraiser, which we've given the theme of "Memory Masquerade". The goal is to raise money for the foundation, which we award as grants to families who need help. This will be our biggest event so far and is going to be a beautiful evening; our guests will get dressed up and enjoy a nice, catered dinner. We will have a photographer there taking photos and we are having a silent auction, which we've gotten some amazing items donated for (including a helicopter ride, an autographed copy of Kimberly Williams-Paisley's book as well as an autographed copy of "Still Alice", lunch with the Mayor, themed gift baskets...just to name a few of many fabulous things we are auctioning off...and the donations are still rolling in!). We'll have some entertainers throughout dinner and a guest speaker is coming from The Alzheimer's Association. We are also planning a very special tribute for those affected by dementia. I don't want to spoil the surprise of everything we are doing, but we are making some lovely, meaningful keepsakes for caregivers to take home and will also have a special presentation dedicated to all of those affected. Given the fact that this foundation wouldn't exist were it not for my mom, we are paying her a special tribute as well, which gives meaning to me and my family on all that we are doing. I'm really excited about the evening but if I'm being honest it has brought a bit of anxiety as well. For one thing, it's been a lot of work and at times it is overwhelming. It consumes my thoughts and I'm constantly second guessing myself. For another, I'm so afraid of failing. With all of the hours that I and my volunteers have put into this so far, and all of the emotion and energy and focus we have given- I don't want it all to be in vain. Nevertheless, I am optimistic that the evening will be a success and that this work will move forward! When I sit back and look at what we've been able to accomplish this far, I am proud of our work and feel motivated to keep pushing along, hard as it may sometimes be.

Even though I don't speak of it often on this blog, know that the foundation is still plugging along! It grows stronger with each passing year and I feel like we are finally gaining momentum and heading in the right direction.

To view our gala information, you can view our website or click here for our Facebook event page.

Tuesday, March 7, 2017

Five Years

Today marks exactly 5 years since my dad took mom to UCLA and received the dreaded diagnosis: semantic dementia. I remember it like it was yesterday; the tears in my dad's eyes as he delivered the news that night while standing in his kitchen. The struggle to understand and come to terms with what the diagnosis meant. The grief, the anger, the acceptance (still working on that one). The course of my and my family's life was altered drastically that day. The past 5 years have brought about the greatest heartbreak and deepest challenges of my life. Yet, I know that the worst is still to come.

Five years ago, I wouldn't have guessed that Mom would still be with us today. According to the pamphlet that UCLA sent home, the average duration of FTD is around 7 years (at a follow-up appointment, the UCLA doctor told us the average for semantic dementia is 12 years, though it's different for everyone). Although it's hard to know exactly when this all started for Mom, we can trace signs back as far as 2007. By late 2009, we knew there was definitely a problem. That means that, while it's been 5 years since diagnosis, Mom has been dealing with this disease for 8-10 years now.

At this point, she is in the later phases of the disease, nearing the last stage but not quite there yet. Cognitively, she is very late stage, but the final phase brings about a disconnect between body and mind; the mind stops telling the body what to do (walking, talking, swallowing, eating, etc). Mom is still ambulatory (mobile) but I believe we are starting to see swallowing issues now. I would say that a majority of the time that she eats and drinks her water, she ends up coughing on the water. She isn't completely chewing her food either. Sometimes when she coughs, she will spit out chunks of her sandwich. A few times, she has coughed so hard that she's thrown up and we've seen the same issue with her partially chewed food. Other times, remnants of her food remain in her mouth and she doesn't swallow it all. Luckily, all she eats is pb&j and that is pretty soft going down and dissolves after being in her mouth for a while. If she were eating meats or vegetables this would be much more problematic.

If I'm just being completely honest here, it's a blessing and a curse (maybe curse is too strong of a word) that she is still here with us, 5 years later. It's a blessing because we've had time to make preparations and process what is to come-although I don't know if I will ever be fully prepared for "the end". It's a blessing to be able to serve her and care for her, even though she may not understand it now; it is a growing and learning experience for all of us. This has stretched me in ways that I didn't know I could be stretched. It's a blessing because she is still here physically to hug and love on (even though she pushes us away, lol), to say I love you to, to remember. I think one of the things I fear when she's gone is that people will just forget her. The hard part with this disease dragging on is watching her suffer and lose all quality of life, watching her forget everyone around her, watching the tears as she struggles. It's hard to see my dad go through this; I know he struggles but he handles it like a champ. He doesn't ever complain about her, even when he's up 20 times a night with her (no joke!) In fact, just last night we were talking on the phone and he told me that if she wants to get up 10 times a night and fix sandwiches or look out the front door, he'll get up with her 10 times a night and he will re-tuck her into bed just as many times. "One day I will miss it," he told me. His strength, love and dedication is a great lesson to me (it brings tears to my eyes just thinking about it). [He is probably going to be embarrassed that I write this, he is very humble and doesn't see himself as the inspiration that others do].

Five years goes by in a blink. I'm fairly certain that we don't have another five years with her; I'd be surprised if we have two (although I never thought we'd make it this long!) But as long as she is here, I will continue to love her and care for her to the best of my ability. Like my dad said, one day we'll miss this.

Below are pictures of her progression, from before diagnosis and then from 2010-2016.


Before diagnosis


2010- right around the time when we knew something was wrong and were seeking answers


2011-a year before diagnosis


2012- her birthday, the year she was diagnosed


2013-our last family camping trip


2014-the year of dark make-up and (later) the blue eyebrows


2015-the best picture I could get for Mother's Day


2016-taken last Mother's Day


Not quite 2017, but close enough (taken at Thanksgiving)

Friday, January 20, 2017

Update on Mom

One question I get frequently is,

"How is your mom's progression? Does it seem to be a consistent downward slope or does it plateau before going down again?"

I used to think she was traveling a continual downhill slope; her progression seems fast at times. Six months ago she definitely seemed to take a quick turn downhill. Practically overnight, we had to transition her to diapers full-time due to the daily accidents she was having. She was eating less, sometimes going hours at times without fixing herself a sandwich. She even had a couple of incidences where my dad found her on the floor, unable to get up on her own. I thought the worst was quickly approaching and I had a terrible pit in my stomach for what was lurking around the corner. However, things seemed to have plateaued since then. There have still been slight declines in almost every area, but not the full downhill slide that I was expecting. In fact, in some ways things have improved. For example...the summer presented so many diapering and poop issues. I won't go into detail, but suffice it to say that those issues are not arising at the moment whereas in the summer it was a frequent (and sometimes daily) occurrence. I know it could change again tomorrow, but for now we are counting our blessings!

So here we are, at the start of 2017. I like to give a full update each year (sometimes twice a year, if I'm really on the ball). Comparing the last year to the present year always puts her progression into perspective. This is what Mom's stage is looking like as of right now:

LANGUAGE: The only real recognizable word is "Bud". She attempts to say my name; it comes out as "Cuh-suh-suh-suh". Every now and then we might pick out a familiar word, but she mostly speaks gibberish. There are some repetitive "words" that she says daily, but we aren't really sure what those words are. Sometimes we can figure out what she's saying by her gestures.

HYGEINE: She no longer brushes her teeth. On occasion, she will pick up the toothbrush off the bathroom counter and swish it in her mouth for 2 seconds before briefly running it under a quick stream of water and returning it to it's place. Her gums are very red and swollen and her teeth have seen better days. I picked up an electric toothbrush for her about a month ago and started brushing her teeth while she's in the shower; she doesn't remember to spit out the toothpaste. She cries the entire time I'm brushing, so I try to keep it brief. I'm not sure how much difference it's really making at this point, but at least we can say we've tried. When it comes to brushing her hair, she used to allow me to brush it for her while she pat her face with a make-up sponge (going through the motions of putting on her daily make-up). She no longer makes an effort to put on make-up and won't stand still long enough for me to brush her hair. I usually follow her to her bed after she's clothed from her shower and try to quickly brush her hair before she swats my hand away and lays down. The other day I was able to cut her hair again (it had to be done quickly, in the one minute that she sat down to eat her pb&j) and the shorter length does help with the hair washing and brushing.

BATHING: She does not participate in any of her own bathing. Six months ago she would hold out her hand and at least rub the shampoo onto her hair. She might do that every once in a while, but for the most part shower time consists of me getting her in the shower and her fighting me to turn off the water the entire time. Sometimes I try to sing to her and distract her a little bit; if I'm lucky she'll give me a grin but she really hates being in the shower these days. We have a system: I rinse her down, she turns off the water so I then wash her down with soap (while she tries to get to the towel on the other side of the glass). I then turn the water back on. I rinse her off, she turns off the water and then I quickly get in to brush her teeth, followed by one last rinse off. The whole while she is usually crying; this is relatively new. She really hates showering. I always feel so bad when she starts crying, but it has to be done. When I'm finished, I then pass her a towel but she doesn't dry herself off. She grabs the towel and then attempts to put it on the floor to stand on (despite the fact that I already have a towel laid down on the floor for her). I dry her off, top to bottom, and I get her clothes on her. She will hold up her arms for her shirt and help pull up her pants.

TOILETING: Mom is in diapers full-time, mainly because we never know when she's going to end up wet. She does use the toilet still, interestingly enough. But she usually wakes up with a full diaper in the morning and is wet by the end of the day.

EATING: Mom's been on her pb&j kick for quite some time now. The most significant change within the past 6 months in terms of her eating is that she longer drinks her Ensure. Now she is on a 100% pb&j diet. My dad gives her vitamins with her meds and she only drinks water.

ROUTINE: I remember when her routines were such a headache for us because we could never get her to stray away from it; she was so rigid and so unflexible. She wouldn't even take a pill one minute too soon! She no longer has a schedule but she has a routine of sorts and it usually runs in 20 minute cycles. All day long, she makes a circle from her bedroom to the kitchen to make a pb&j sandwich, to tapping her plastic medicine dish on the counter for medicine, to banging on the front screen door to get out, to looking out the window, to going back to her room to lay down. As she makes her way down the hallway, she tries opening every door along the way. We've had to add baby locks on the bathroom door (because she was getting into the soaps and rubbing them on her face) and dad now locks the office because she was pounding on the computer keyboard, which was messing up the computer. Once she lays down, we may get a 5 minute break (sometimes longer if we're lucky!) and then the cycle starts again. If the weather is nice and we are able to take her outside, it helps to settle her down as she sits on the patio and watches every passerby. We've had a lot of rain this winter, so she hasn't been outside much which has added to her stir-craziness. She rarely tries to go for walks anymore and she doesn't ask to go to Ellen's (this is all new within the past 6 months), although I suspect she might be trying to ask to go to her sister's house; it's too hard to understand anymore. Since she wants to make pb&j constantly (and usually only takes 1-2 bites out of each sandwich she fixes), we cut the bread into quarters for her now to cut down on waste. If her dish banging becomes too much to handle, we slip some Jelly Belly jelly beans into the dish and she swallows them as if they are medicine. So I guess I lied when I said she's on a 100% pb&j diet...she gets those jelly beans in there ;) She does wind down at night, but still gets up several times during the night and goes about her routine, which makes for lack of sleep for my dad. But he never complains about it. He just does what he has to do (and I have no idea how he does it!)

There you have my bi-annual report on mom and her progression. Like I said, she has, for the most part, plateaued over the past 6 months. But things don't last for very long with dementia. The scary part is thinking about what the next downhill slope will bring. She is so advanced in the disease that the next big hurdles to face are issues with choking and swallowing, mobility, complete incontinence and muteness. I wish that she'd never have to go through any of that. Every decline breaks my heart more and more. :(

Here are a couple of recent photos of mom, taken on Christmas. It was a Christmas miracle that we got her looking (and even smiling!) in the direction of the camera!