Rehydration Results in Response

We all know how dangerous it is for someone to become dehydrated. I warn my students about the body’s need for water in my nutrition classes each semester. Since the human body is made up of approximately 55 to 70 percent water, it is easy to understand how important the element is. According to my textbooks, if one loses about 2 percent of body weight in fluids, he or she becomes thirsty. Lose about 4 percent, and you become weak; but if you lose about 20 percent of body weight in fluids, you can lapse into a coma or die. Thus the concern of football coaches and their staffs for their student players in the Texas heat each summer and fall. The precautions taken by trainers, coaches, band directors and many more are legendary, since there have been tragedies in the past that no one wants to see repeated.


When infants are ill, doctors caution—plenty of fluids. When someone has a fever, we urge fluids to replenish what they are losing. Several years ago, I contracted salmonella food poisoning. I thought I had a bad case of flu and tried to “throw it off” for 8-10 days. Mom came to help take care of us while I was in bed and the boys went to school. She and my husband kept urging me to drink Sprite, tea, or water. But I was unable to hold any food or liquid in my stomach.

I kept lifting up the skin on my arm and saying, See, I’m not dehydrated. Yet when I finally gave in and went to a doctor, the first thing he did was lift up the skin on my stomach. This was much more startling than the skin on my arm. It actually “stood up” when he pulled on it. The second thing he did was send me to the hospital where I spent three nights recovering, receiving antibiotics and much-needed glucose and water.

Friday morning (Nov. 6), Joyce called Nancy to come help her with Mom. Mom’s blood pressure was low, and she would not respond to Joyce. When Nancy arrived, she was unable to get any response either, plus Mom’s blood pressure continued to drop. So Joyce called an ambulance, and Nancy called the sisters. We all dropped what we were doing and headed for McKinney immediately. I went by and picked up Pop. None of us uttered the words aloud, but later we admitted that we thought we might not get there in time to see Mom alive.

Several hours in the emergency room ensued, interspersed with trips down the hall for MRI’s and CT scans. Mother’s blood pressure came back up after a while, and we all just wanted to hover around and tell her we love her. She was not allowed to have anything by mouth, just the glucose dripping intravenously, while in the E.R. Joyce had given Mom her pills that morning, but after that there was nothing. Late that night we fed Mom a few bites of a sandwich and some fruit cocktail. Then everyone but Diane left, and she and Mom spent Friday night in the hospital. Mom was in pain only when her legs were moved, and we thought perhaps she had somehow aggravated the fracture from last May.

However, the tests showed nothing new, and all day Saturday Mom continued receiving glucose. When I called her room the ones there assured me that she looked like her former self, smiling and bright-eyed! At one point during breakfast she had some trouble swallowing, so the doctor determined that there should be a swallow test. (That did not happen until the next morning!)

Since Mom did not receive her daily meds after Friday morning, by Saturday evening she was becoming restless. Agitated by then, she began wanting to go home. Vicky stayed with her through the night, and she said Mom did not sleep at all, just talked continuously and fretted with her oxygen tube and finger clip (monitor for blood pressure). By Sunday morning, Mom was not a happy camper. Having regained some of her old spunk, she was determined to get out of that place!

After passing the “swallow test,” the doctor saw no reason to keep Mom in the hospital. So she was dismissed and transported back to her residence, where she promptly settled into her recliner. She ate what was offered and drank a glass of Ensure, then took her routine medications. The only med added was the Exelon patch to enhance the effect of the Namenda.

After much thought and discussion among the sisters, we believe it is very likely that this entire episode was brought on by dehydration. Many people nowadays carry bottles of water with them at all times; however, if a person has not ever formed a good habit of drinking water continually, it is a difficult one to adopt. Mom has never cared for water. She prefers tea but does not drink enough of it. The caretakers at her residence keep a glass of water on each of the resident’s trays. When they walk by them, they reach down and hand the glass to the resident to encourage them to drink more water. But it just has not been enough.

Mom’s dehydration caused many symptoms: constipation, swollen abdomen, and vague pain; and it worsened first her mental status and then her state of consciousness. Now we look back and think that it is no wonder her blood pressure dropped and continued to
do so for a time.

In Mom's fragile condition, the slightest of negative changes can cause havoc to her system. For example, they also found a slight urinary tract infection and started antibiotics in her ‘drip.’ As far as we can determine, both conditions played a part in her sudden decline. We are thinking that the urinary tract infection was
also caused by the dehydration.

All in all, we are very thankful to have Mom back at her residence with a smile and a good appetite! We were concerned initially about the effect of moving her to the hospital, but she seems to have weathered the weekend quite well. There is one thing that is different from last week, and that is that Mom is not walking as well as she was before. Right now she is using a wheelchair, and it may or may not be permanent. Yet we are all so happy to have her with us. Thinking of her adds pleasure to each day!

Coach Broyles' Playbook

Diane mentioned Mom’s difficulty with language in her last article. Communication is getting more difficult for her every time we are with her. Yes, she has alert times when she remembers quite a bit. However, the actual calling up of the right word she needs is difficult as well as frustrating for her.

Recently a friend handed me a book to read entitled Coach Broyles’ Playbook for Alzheimer’s Caregivers. It is a “practical tips guide” written by the University of Arkansas Athletic Director Frank Broyles whose wife suffered from Alzheimer’s Disease.

In discussing how communication changes in the Middle Stage of the disease, he offers several tips for the caregiver. He states,

You may have seen that she does not talk like she used to. She is having more trouble finding words. Her sentences are short and choppy. The loudness of her voice may have changed. Her words may not make any sense. This is called “word salad.” As you listen, you know she is trying hard to tell you what she wants. The words just come out wrong.

Communication Tips

• Be patient and calm
• Touch (holding hands) is very important.
• Don’t use baby talk.
• Stop what you are doing. Really listen to what she is trying to say.
• Think about the feelings behind the words she is trying to say.
• Look at what her body is trying to tell you.
• If she looks upset or angry, then ask her if she is.
• Treat her with dignity and respect.
• Say exactly what you want her to do.
• Use ordinary words. Instead of saying “Hop in the bed,” say “Please get in the bed.”
• Turn your questions into answers for her. Instead of “Do you need to go to the bathroom?” say, “The bathroom is right over there. I can walk with you.”

A Few More Suggestions:

• Don’t argue with her. It is easier to agree with her and then do what you had planned anyway.
• Don’t try to reason with her. You will just get angry and she won’t know why. Change what you are talking about to something she likes.
• Don’t correct or fuss at her for getting something wrong. Does it really matter? It will only make her feel bad.
• Don’t say “I just told you that.” Just repeat the answer you have already given to her.
• Don’t ask her to “remember” things that happened in the past. Talk about what you remember happening and how she was a part of it.

You may find as time passes that she will not be able to start a talk with you. She may not ask many questions either. She may sit or walk around the room and say nothing unless you begin talking to her first.

Thank you, Coach Broyles, for sharing wisdom gained from your experience.


For Playbook copies and Alzheimer’s disease information:
www.alz.org
24-hour helpline—800-272-3900 (toll-free)
Playbook on the Web: www.alzheimersplaybook.com

Nan's Turn to Share

How different we all are! Yet we all dearly love the mother who gave us life and has helped us each through tears and years of all kinds of living experiences. Nancy expresses herself today, thoughts and feelings common to us all, but written in her own unique way:

Today I miss Mom! I am here with her, and I don’t want to leave. I keep thinking I can make her smile, even get half a smile. Maybe I’ll see a smile in her eyes. I have her repeat her five daughters’ names according to birth order. With a little help and coaxing, she does it! And I say, “Good job, Mom!”

Later…I wonder if calling our names is like a test to her, or is it a good mental exercise? I hope it's the latter. I want her to speak to me, to interact, to laugh out loud, but I would certainly settle for a smile. I want to do something that she wants to do. But she doesn’t know what that is. I try to guess, but Joyce (one of her caretakers) reminds me that she doesn’t know what she wants to do. So we settle for helping her move from the kitchen table to the recliner. There I can take her shoes off and rub her feet. That must feel good!

If I could curl up in her lap, I would. I need to be close to her. Does she need to be close to me? I wonder. I think she does because when I get near her, she always puckers up and I get to kiss that precious face. And she kisses me back. I thank God. That is my blessing today. I can go home now.

A Happy Visit

My September update is a few days late, but here I am to report on a wonderful time with Mom. She and I had one of the best visits we’ve had in a long time Friday evening (10/2).

When I first arrived, I almost didn’t recognize her, but she knew me. The reason I had to do a double-take was because she looked so different. The beautician had not been there to wash and set her hair. I can’t remember when I have seen Mom without her hair fixed. But there she sat—with her hair brushed flat and straight. Her smile of recognition when she saw me calmed me down immensely. I was so happy to see her and happy that she was pleased with me being there that I forgot about the hair.

No, in the past Mom would not have been seen in that condition, but now is now. Things that matter now are: being recognized, seeing her roll her eyes at what one of the women says, and having her ask, “How’d you find me here?” And always that sweet smile when she responds to one of us with, “I love you, too.”

As we walked to her bedroom to have some relief from the volume of the ever-present television set, she seemed genuinely glad to see me. She appeared to have more strength in her legs than the week before. Perhaps she’s better because of something the doctor prescribed for her edema. (For a couple of weeks her feet and hands were very swollen.) We spent some time going through a photo album Pop had brought to her. Many of the people neither of us knew. Yet every time there was a member of her family, she would stop and look closely at the picture. She was calling the names of almost all the children, the grands, and the in-laws. I was amazed, and my heart was warmed by her alertness.

The whole time I was there, I could hardly keep my hands off her. I just wanted to hug and pat and tell her I loved her over and over. When we think about how well and how long she has cared for all of us, I suppose our purpose now is obvious—to love and care for her as much as we can for as long as we can. We love you, Mom. You’re the best!

For those of you who have been so kind to ask about Mom, I apologize for taking a while to get back. This summer of ’09 has been one for the records for several reasons. In order to stick to the blog’s purpose, I will sum things up by saying this. Mom was in rehab for about six weeks. Then we moved her to a lovely home in McKinney where she will continue to live for as long as possible. Now Diane will continue the narrative:

After Mom fell, it was clear she could not go back home. Pop used the time Mom spent in the rehab facility to locate a place for her to live. It is a hard decision to make. You have to consider so many things, such as leaving your loved one in the hands of total strangers, knowing that she can no longer tell you what happens when you are not there. The legal matters are complicated, and the financial burden is costly. There are many publications and websites full of information, but we received the best leads from the hospital social worker, along with doctor recommendations.

Mom has now been in her new home for a couple of months. We could not be more pleased with Pop’s decision to put her in a “resident facility.” She is now receiving her medications on schedule, regular bathing, and home-cooked meals. She can roam around the house as if it were her own and visit with the other residents. She has her own room overlooking a large back yard, and she can watch the birds gather around the bird feeder just outside her window.

There are now no more days filled with worry about Mom falling. We don’t wonder if she will go outside and wander down the street. The time now is spent trying to communicate. Mom’s speech is no longer what it was. She struggles with each thought, trying to get the correct word out. Most of the time the words she uses don’t make much sense, but at least she is still trying. We are hoping for approval for Mom to get the new “patch,” thinking that maybe it will help with her clarity. “Exelon” is the newest drug for Alzheimer’s/Dementia/Parkinson’s Disease.

I recently read a very helpful book entitled The Validation Breakthrough, by Naomi Feil. In it the author teaches simple techniques for communicating with people with Alzheimer’s-type dementia. I highly recommend this book to help people maintain a measure of communication with loved ones who are prone to withdrawing due to this awful disease, and possibly prevent progression toward a vegetative state during their later years.

The Rehab Center

The way I understand it, Mom will be in the rehab center for several weeks. The bone she fractured has to be treated in the same way an injured rib is cared for: with a great deal of patience and TLC, to allow it to heal properly on its own.

Mom doesn’t appear to be in any pain, except when she sits up. She requires help to get into a wheelchair. Then, once she settles into the chair, she seems comfortable again. She travels to the dining room in the wheelchair, and her appetite is good. She has never been an extremely picky eater, which is probably fortunate for her, since she is in for a bland institutional regimen now.

Today is Mom’s third day at the center; she entered Friday evening. Each day she has eaten her meals at regular times; she has taken her medications at correctly spaced intervals; and she is clean and wearing fresh clothes. She seems to be confused by the move, in that she doesn’t know where she is. Yet she is not acting out in the least. For so long, she has “wanted to go home” each evening, but now she says she is at home. Yesterday afternoon she told me that she and Pop had gone to lunch and then come back home. (Lunch was in the dining room, and we were in her room visiting.)

We don’t really know what to expect from day to day. She may wake up one morning soon and decide she doesn’t want to be in this place any more. But for now, she is comfortable, as much as possible with the fractured bone. And the Lord has used this fall that caused her pain to ensure that her needs are met.

Pop, on the other hand, is probably not doing so well. I use the word “probably” because no one really knows how he feels most of the time. He is not an expressive person. Opinionated,yes, but not one to talk about feelings. So we assume he is lonely without Mom at home with him. He has no one to talk to, no one to eat with, and so on. He is spending several hours a day at the rehab center, watching television with Mom. He has even mentioned taking a more comfortable chair from home out to her room.

It is heart-rending to imagine being separated from your best friend of 20 years and being unable to help the situation. He has tried to hang on, to keep Mom at home, to take care of her himself, to make the best of things. But now his best-laid plans are not working. He can take comfort in the fact that she is well cared for, but now he must take care of himself. And we must continue to pray for the Lord’s protection over him.

Romans 8:28

And we know that all things work together for good to them that love God, to them who are the called according to his purpose.

On April 5, I wrote of frustration. Today I write with a grateful heart of Romans 8:28. Feeling so helpless, I have continued to pray for the Lord’s protection over Mom and Pop. Not knowing what to ask Him for, I ask Him to keep them safe, wherever they are. I gave up a while back that Pop was ever going to make any moves on his own. He does not seem able to make a decision to move Mom from their home. He and I had a little “showdown” one afternoon when I confronted him about leaving her by herself while he went to church. It was then that I saw the light—he was not going to take any of our suggestions. Period. Whether he didn’t want to, or he was not able, I don’t know. Since then I have continued to pray for them.

One evening recently, Mom fell and fractured her pubic bone. The next morning she was unable to get out of bed. By noon, Pop was calling Diane to leave work to help him. That evening, about midnight, Mom was finally resting in a hospital bed after much aggravated waiting in the E.R. and many x-rays.

Two days later we moved Mom to a rehab center where she has been resting well. To be continued....