Showing posts with label Alzheimer's. Show all posts
Showing posts with label Alzheimer's. Show all posts

11 January 2012

No news and good news

JON: A few weeks ago, I had a spot of masochistic fun. We got up ridiculously early and drove to Copenhagen where I had the delightful experience of a lumbar puncture. I’ve had one before so I know what I’m talking about when I say that this one was very professionally done. Although it involved me sitting rather inelegantly on a chair bent over to touch my toes (to separate my vertebrae and make room for a l-a-r-g-e needle), the doctor managed to make the procedure pain free by distracting me with old jokes and a bit of banter.

All was well, at least until I got in the car to go home, where to my modest surprise the anesthetic began to wear off and my back started to hurt. Only hurt a bit, though, just enough to give me something to complain about on the long drive.

We’ll probably not get the results until my next appointment in three weeks’ time – a clear case of no news being better than urgent news, as I’m sure I would have heard if they’d found little green men discussing Nietsche in my spinal fluid. We’re not entirely sure why I had the test in the first place, actually. When Marie asked what the neurologist is looking for, there was mumbling about ‘something something tau’ which means little to us or the internet. Oh well, if there’s anything to discover, you’ll hear it here first.

From the Dept. of Good News, section Relief, come glad tidings on my genetic status. The company http://www.23andme.com/ does genetic testing to determine whether you have an increased risk of developing a number of diseases, including Parkinson’s and Alzheimer’s. This costs money, but they have (had?) a special offer for Parkies who can get the testing done free, in return for answering numerous questions for research purposes about your medical history, your drink and drug habits, your favourite colour, etc. Free is a good price, so I applied (or rather, Marie applied pretending to be me). On my part, the most arduous task involved gobbing into a plastic tube for intercontinental dispatch.

My results came back recently and show NO increased genetic risk of either PD or Alz. That doesn’t make me move any better or think any quicker, but it does stop me fretting that I’ve passed on dud genes to my children and grandchildren. There will be dancing in the streets – or there would be if I could dance. Have I ever shown you my version of the moonwalk?

04 March 2010

Invisible illness

MARIE: There was a segment recently on BBC News about a campaign to educate people about dementia, so they did an interview with an Alzheimer’s sufferer – a pleasant-looking woman in her fifties, who gave her answers unflustered and in full, grammatical sentences (not easy on live TV, I should think). One of her points was that because she generally appears completely ‘normal’, people around her don’t realize how much the disease has affected her. As she said: “You can’t see that I can’t remember things, that I can’t count money, and can’t read a book”.

Yet even after she had said that, I was still surprised to learn at the end of the interview that she had recently stopped living with her mother and had moved to a care home. Nobody lives in a care home unless they have to (however nice a home might be, it is still a very expensive way to lose your privacy), so this really brought home her point: this disease can be so far below the radar that it remains invisible even after you’ve been told that it’s invisible. How can such a well turned-out and articulate woman be living in a care home? Because appearances can be deceptive, that’s how.

And as it happens, Jon and I had discussed just that point the night before. In fact, we had started out talking about this scientific textbook he is supposed to be writing with two old colleagues, and about which he has frequently moaned and procrastinated in his posts. The manuscript is contracted for delivery at the end of the year, so if it’s going to happen at all, then it’s got to start happening quite soon. So, decision time.

Jon’s co-authors are both busy people, and I suspect that perhaps more good intentions have been shown than actual work done. And I further suspect that they suspect the same of Jon, which is perfectly reasonable as he has not said anything to the contrary. But the fact of the matter is that Jon’s ‘invisible’ illness means the job is almost certainly beyond him, and although it has been a painful process for him, he now thinks it would be a relief to drop out of the writing and focus instead on smaller and more manageable projects.

‘Everybody knows’ that Parkinson’s is all about shaking, right? Wrong. Jon has very little tremor (except when stressed). ‘Everyone’ also knows that Parkinson’s is a motor disease, right? Wrong again. Although Jon has motor symptoms (rigidity in particular), his main symptoms are to do with fatigue, poor concentration, inability to multi-task, and poor response to stress.

Because everyone can see that Jon is doing reasonably well physically, and expect the disease itself to be mainly physical, nobody actually understands how much it affects him and his life. Nobody can see how hard he has to work to concentrate enough not to have forgotten the beginning of an article by the time he gets to the end. Nobody knows see that it takes him the best part of two days to produce a blog post. Nobody realizes that even the most routine practical task becomes a major undertaking – for instance, he used to do all the vacuuming but has had to give up because rigidity means he can’t bend to clean under tables and beds, back pain means he needs a half-hour lie-down after vacuuming one room, poor balance means he can’t walk backwards (which I now realize is what one does when cleaning the floor), inability to multi-task means he can’t lift something with one hand and vacuum under it with the other, and fatigue means that if he nevertheless persisted he would completely wiped out for the day.

But he looks fine, so people think he is fine. When we see friends, Jon pops an extra pill so as to enjoy the evening more, so he usually acts fine too. And of course he only calls up his co-authors when his drugs are at maximum effect, so he performs just fine – at least for the duration of the phone call. There is no way that they can be expected to know that Jon’s invisible illness is stopping him from writing his chapters.

So he’s going to have to tell them. And they are going to have to believe him, even if they cannot actually see the issues that are keeping him from holding up his end of the writing, and perhaps think they would be doing him a favour by encouraging him to stay in the game. I didn’t realize how badly affected the woman with Alzheimer’s was until she said she was living in a care home. Maybe Jon has to point out that nobody receives permanent disability benefits unless they really are unable to do their job anymore.

(BTW, Jon sees all my posts before they are uploaded, as I see all his. He approves of what I've said here, and actually encouraged me to write it.)

22 June 2009

Profit and loss

This blog regularly talks about losses – of function, of work, of certainties, etc. – but Parkinson’s also gives back in some round-about ways. There is this general idea that bad things also bring some good because their victims gain a new and better perspective on life, generally involving a greater presence in the moment and an enhanced appreciation of the small pleasures of daily life. At two extremes:

From the blog PD and me (www.not-likely.co.uk/blog)
‘I can live with the PD, it makes me realise everything I have to be grateful for. It took me a long time to accept my PD but it has made me realise I have so much that I should be grateful for and that we often take life way too seriously, my PD has grounded me with a bump and made me look around and take stock of things and I'm glad its happened.’

From the book C – because cowards get cancer too by John Diamond who chronicled his treatment and deterioration from the oral cancer that ended up killing him:
'I have learned a lot about myself in nine months, and a lot about those around me. Much of that knowledge is useful, liberating even. Equally much of it is banal stuff which I should have known anyway had I bothered to think about it. But the bad has outweighed the good a millionfold … It shouldn’t be like this. That I can face the fact that it is like this is, I suppose, something. But what a bloody meagre something it is.'

Jon and I fit somewhere on that great continuum from someone who has embraced his incurable disease to someone who rails against a disease that has a very good cure rate (only not in his particular case). The disease has enabled us to spend much more time together, which on most days we would count as a good thing. And it has most certainly refocused us towards the here and now.

We cannot know how Jon’s particular instance of the disease will progress, all we can know is that it will indeed progress. So we try not to put good things off until next year, until tomorrow, until after we’ve done the laundry. It doesn’t always work – it is, after all, quite useful to have clean socks – but is certainly very different from before PD. Likewise, I think we take more pleasure from the things Jon can do, mainly in terms of physical feats and general endurance, simply because these things are now not to be taken for granted in perpetuity.

Parkinson’s may also be giving another ‘gift’. A while ago Jon’s favourite author Terry Pratchett did a couple of BBC programmes about his newly diagnosed Alzheimer’s disease. We were surprised that Pratchett chose to visit the Alzheimer’s section in a nursing home – I would have thought this would be a frightening demonstration of the likely end-point of his journey. But, as he pointed out, Alzheimer’s by its very nature both gives and takes. As your mental faculties fade, so does any awareness that you have a problem (although I expect this still leaves a terrifying middle period when sufferers realize in their clear moments that they are slowly but surely losing it).

Well, in Parkinson’s the blessing in heavy disguise may be the apathy which, according to another book we recently read (Brain and Behavior by Joseph Friedman), affects a large proportion of PD sufferers and makes them not really care one way or another about the gradual loss of functions. Is apathy caused directly by the disease, Friedman wonders, or is it a common coping strategy? Either way, while apathy may make it easier for the person with Parkinson’s to get through the day, it is one of the hardest things for the relatives to deal with.

So I think we both really mean it quite literally when we tell people that Jon getting diagnosed with Parkinson’s was not exactly the best news we could get, but nor was it the worst.

12 October 2008

A good moan

Hello, it’s Marie again. We promised in one of the early blogs to give a bit of background to what came before the blog started. Since this has been a praticularly horrid week, we thought I should take the opportunity to give you a whistle-stop tour of our private Hades, taking it up to date with the latest set-back.

When Jon first got ill, neither one of us had any idea whatsoever what we were going to be faced with. I suppose that’s obvious, really. But we thought, you know, we can deal with this – one step at a time, us together against whatever comes at us, there’s nothing we cannot cope with. We had no idea. It has been so much worse than we imagined, every single bloody step of the way dogged not just by the “normal” disease but by special difficulties.

First there was the 18 months spent trying to get a diagnosis – Jon medicated increasingly aggressively for back pain when in fact the problem was Parkinson’s. Only no-one could see that, because the PD symptoms were believed to be side effects of the pain medication. Which wasn’t even working. Jon was taking higher and higher doses of morphine, and getting more and more difficult to reach with reason and affection. The pills were his only hope of relief and thus his only friends, while I who tried to limit his morphine intake became the enemy, to be at times physically fought off. I knew he was taking a lot of drugs, but I didn’t know how much morphine is too much, so was shocked to be told that towards the end, he was taking as much as is normally given to patients with terminal cancer. My sister, who is a nurse, was horrified to see Jon – still in agony, but now also high as a kite. A deeply unpleasant week of fast weaning off the drugs followed (the less said the better). That was the worst of it, but the period before Jon received the diagnosis of Parkinson’s also featured a failed back pain treatment involving a spinal injection of steroids which managed to make Jon even worse, and a thoughtless colleague of our then neurologist who was happy to inform Jon over the phone one Friday afternoon that his MRI scans showed clear signs of a stroke (particularly unwelcome news as it was multiple strokes that killed Jon’s mother).

When at last Jon got the diagnosis of PD, it felt like a relief, almost like good news compared to what we had feared. Hurra, a diagnosis, a treatment plan, a new set of drugs, clarity and a way forward. At first the PD drugs (and new pain meds) worked well, and the many books we read about the disease led us to believe that Jon would have years and years of excellent quality of life with the help of these lovely pills.

This state of calm did not last, though. Along came another, wholly unexpected, set of adversities when Jon’s employers refused point blank to accept that he was now well enough to work as normal again – despite the fact that there he was in office and lab every day, beavering away exactly as before. At first we thought this was merely some kind of bureacratic mix-up, but it soon became clear that Jon was trapped in a special Kafkaesque hell. First the employers wanted their own doctor’s opinion, which was that Jon was fine. But for some reason that wasn’t good enough for the personnel department, and the doctor had to meet with Jon and his immediate superior to discuss the situation. Again the conclusion was that Jon was fine, and again the employers refused to accept this. Jon was informed that the doctor’s opinion would be of no use unless the doctor had a copy of Jon’s job description – and since no such description had been produced before, the employers drew up a document that contained such obviously unattainable targets that it seemed designed specifically to further a firing squad. Trapped between a rock and a hard place – accept the job description and get fired for failing targets, or reject the job description and get fired for long-term illness – Jon was very much not a happy bunny during this time. In the end, with the help of legal advice, a medical arbitration service and a wife keen to fight a winnable battle, Jon was received back at work after seven months of stressful misery. But let’s be honest: not only did he so not need to have it constantly rubbed in that he was considered damaged goods, the very fact of the fight also soured his former love of his work – and the long drawn-out battle just simply exhausted his mental reserves.

We could both have done with a bit of a break after all that, but no. While the work problems were going on, Jon started sleeping less and less well, with predictably tired days to follow. And after a pretty long period of attempting to ignore the elephant in the corner, we admitted to each other that we were seriously concerned about his cognitive abilities – in a word, the big D of dementia. Jon’s dad had Alzheimer’s, and PD patients have a vastly increased risk of Alzheimer’s. Jon’s physical and mental deterioration also seemed to be much too fast to fit with our reading on Parkinson’s, so we started to worry that he might have one of the so-called PD+ conditions (which includes special kinds of dementia and the delightfully-named multiple system atrophy). So now he’s off work again. The neurologist makes encouraging noises to the effect that all Jon’s current problems could be the effect of yet another adverse drug reaction. However, it takes 6-8 weeks to change drug regimes (slowly decreasing one type of drug and increasing another) – and I don’t know about Jon, but I frankly don’t see as much progress as I had hoped for.

There has been quite a lot said in earlier posts about Jon’s sleep disorder. Yes, (some of) the individual stories about what he gets up to at night can be quite amusing, but in the long run it is so immensely draining – mostly for Jon, of course, but also for me – never to have a normal, unbroken night, and never to know what chaos you will have to clear up in the morning. I suppose in some ways it’s quite like having a baby, and people our age don’t generally have the energy for babies. We had both invested a lot of hope in this sleep registration Jon was going for a few days ago, where he was to be extensively wired up with a range of sensors that could measure in detail his every breath and jerk and brain wave throughout one night in hospital. All went well until Jon actually feel asleep – whereupon he acted out yet another dream and ripped off half his sensors. Night nurses aren’t trained to re-attach these sensors, so he got sent home with just 10 minutes of sleep recorded. It may seem a small thing, but it is yet another set-back, yet another disappointment, yet another delay in finding the true cause and (hopefully) remedy.

And lastly, as I said a few weeks ago, we are ceasing to be a team. There is less a feeling of us against them – or rather, against it – and more of a feeling of him against me and me against him. He resents being ill, resents what the illness does to him, and resents being dependent and needing my help – and so in one easy step he transfers his resentment to me. Likewise, I am angry about what PD is doing to my husband, my marriage and our plans for the future, and I guess I transfer some of that anger on to him. The conflict that has really brought us – or is it just me? – down is that, presumably as part of his campaign of denial, Jon refuses point blank to take any of the advice given by the various experts and therapists who treat him. If I push and plead, he only gets more adamant. If I don’t push or plead, well, I guess then he’s fairly content. But I find it immensely difficult to keep my peace since I can see so much sense in the advice Jon has been given, and I can see how not taking that advice is damaging both his and my quality of life. But so is pushing and pleading, so in some desperation I am now trying my hardest to disengage and concentrate instead on all the practical tasks. Feeling relegated to the role of nurse-maid, providing about as much affection as can be expected of the average nurse or maid.

This week I have ordered a book about how to survive life as a caregiver and have made an appointment for the pair of us with a psychologist recommended by a good friend. Fortunately, rather than the long wait I was expeting, the psychologist can see us in just two weeks’ time. Good. We need all the help we can get.