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An episode of vascular dementia 
Started by JennJilks
21 Jul 2013, 12:47 PM

I have been watching the skies. We've had thunderstorm after thunderstorm. Having faced a drought last summer, it is glorious to have the rains.

I've been attending to a client with dementia. I feed him breakfast and dinner. Leaving his lunch out for noon. His son is out of town on a short-term work project. I've been there for 7 a.m., returning at 3 or 4:00, to check up on him. He managed his laundry, making it upstairs to the toilet, and watching the news.

Arriving in between a series of heavy storms in the afternoon, I found him in the kitchen, washing pretend dishes. Clearly thirsty, perhaps dehydrated. He was having some sort of episode. He was wearing only a shirt. This isn't the first time this has happened to me. Fortunately, as a 'professional caregiver' (according to Dr. Brian Goldman when he interviewed me for his radio show) I wasn't totally shocked. I've come across the same situation before, when a client who was abusing pain medications and drinking too much beer, met us in his living room wearing only a sweatshirt. Logically, he didn't have clean pants, he had soiled all of his pants, and didn't know how to use the washing machine. It was better to wear nothing.  But that is another story of self-abuse!

With vascular dementia, the blood fails to circulate to the prefrontal cortex of the brain. The thinking part. The lower part of the brain stem, the reptilian brain at the back of your skull, manages to keep on functioning. You carry on breathing, blinking, and the other autonomic functions.

Your long-term memory can work, deeply buried in the brains memory banks. However, you may hallucinate. You may not be living in your immediate reality. My buddy had locked the screen door and wasn't letting me in. The lightning was cracking around me. It was beginning to rain heavily. 

It took a half hour of persuasion for him to eventually arrive at the door and unlock the screen. What a relief! The lightning cracks were bad. The area had a total of 490 strikes, according to the radio.
He simply wasn't present. He responded to my talking to him, but clearly didn't know who I was, what I was doing, or what his next move would be. He shuffled closer to the door, but began to drink from the sugar bowl as if it was a cup of coffee. Standing two feet away from me, with the screen door between us, it was as if it was a whole different world he inhabited.

After I fed him, had him drink some fluids, he began to return. It was like he was in a fog.
He cannot process abstract concepts, such as what day it is. But his sense of humour returned, and we figured out that it was Wednesday. He was worried about his pills. The routine is to place 
them in an egg cup, and he knows which ones he's supposed to take. With swollen feet, due to poor circulation, he needs to put his feet up three or four times a day. But he's too stubborn to do so! 

You can get special socks, which keep the feet from swelling so much (my mother, with lymphedema, and wheelchair-bound father needed them), but his feet were too swollen for the pair he had. I let his son know. He attends an adult day away program on Tuesdays and Fridays, and I will drive him to that today. With his son returning tonight, we made it through the week.

 This is what many caregivers have to manage in their daily lives. The Ontario Government, in its infinite wisdom, keeps promoting programs to allow care recipients to stay in their homes, but that isn't right for all families. Not many can afford to stay home with failing loved ones.
 
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Reply by passirose
21 Jul 2013, 4:59 PM

Thank you so much for sharing this episode with us.
 Suzanne
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