Sunday, December 29, 2013

Travel, Dementia, and Dogs

Toto the Wonder Dog warms Dad's lap.
Photo by Pam Stephan
When we travel with Dad, the dogs always travel with us. That means making reservations at dog-friendly hotels. La Quinta gets a lot of our business. We make a travel plan and the night before, we start packing. Bags are filled with clothes, pills, and electronics for the people. We bring snacks and sometimes drinks, in case we get stuck in traffic a while and need a distraction. Because Dad has memory loss, he has no sense of how long we've been sitting still on the interstate, and frustration can come on quickly. Food is a great distraction, when you can't play dominos. Oh yes, and we always bring a bag of dominos, score sheets and all.

A big plastic box is loaded with dog food, treats, toys, bowls, and first aid supplies. Dog blankets are stowed in the car and each pet wears her harness and leash, while I stuff my pockets with doggie poop bags. The dogs travel well and they've been along on our journeys ever since Dad has lived with us. There are just two dogs and they are lap-sized. Dad can't remember their names, so he calls his pet "DogDog" even though we call her Toto. She is a toy fox terrier with a calm temperament and a strong loyalty to Dad. Toto is about 14 years old and going strong. Her favorite sport is Ball TossMy dog is named Pinky but she often gets called "YipDog" or "PiggyDog" or "Slim." She is a mix of toy fox terrier and chihuahua, a dog who was rescued from a puppy mill. Her favorite sport is Mealtime. Okay, well, she is overweight. 

My sister gave Toto to Dad 7 years ago, about a year after Mom died. Dad had been lonely, in his house on his own, but Toto changed that for the better. He had been living with dementia for a while, Mom had been his caregiver. My father has always had pets, usually dogs. But he has also had cats, a mockingbird with a broken wing, and a pair of baby possums. Dogs in the house were a constant part of our life and Toto was a natural fit.

Dogs don't care if a person has dementia. They aren't judgmental about that. Dogs can live "in the moment" very well. While they like routines, these dogs have been very tolerant of changes. Every morning, Dad gets dressed and takes Toto out to the yard for her morning break. They come in and watch TV news together. After breakfast, she hopes he'll give her a scrap of sausage, and she usually gets it. We take walks in the park, visit PetSmart, and do doggie baths together. Dad gets a sense of accomplishment and joy from caring for the dogs. Sometimes he calls them "the kids!" 

Seven years ago, when Dad and Toto moved in with us, the dog helped him navigate this house. She helped him learn the paths from his room to the door, to the kitchen, and to the garage. Petting her has lowered Dad's blood pressure. Feeding her is important to him. Keeping her healthy with regular vet visits and proper diet are things he's willing to help with. Toto might as well be a dementia therapy dog. She has become an important part of Dad's life as well as part of our family.

Now if we could only teach her how to shuffle dominoes ...

Wednesday, December 11, 2013

Doing a Little Minor Surgery

First Aid Supplies came in handy one day.
Photo by Pam Stephan
Dad and I were playing dominoes one afternoon when I looked down at his sleeve and saw a bloody spot. I calmly asked him about it. He said he wasn't hurting any, but may have "leaked" a little. My father is a pretty macho guy and not admitting to pain is a longstanding feature of his character. However, since he developed atrial fibrillation and is at some risk for stroke, he has to take a blood thinner - so when he starts bleeding, it can take a while before natural clotting takes place.

This was a triangular bloody spot about an inch long and half an inch wide, about halfway between the cuff and the elbow of his long sleeve. He offered to show me that "it was really nothing," so he rolled up his sleeve and there it was. A flap of skin had been sheared from his arm on two sides of a triangle. The skin, which was somewhat stiff and dry, was still attached along one long side of the avulsion, and blood and lymph was still weeping from the raw skin beneath. Ugh.

Now I know my father's habits pretty well. He had probably ignored the problem because it was covered by his sleeve, but now that it was clearly exposed, he would want to tear off the dead skin and let the wound "air itself" so it would heal. Keep in mind that he is 88 and that was how he was raised to treat wounds. Actually, he and his brother probably rubbed some sandlot dirt into their scratches to make things look more impressive. He didn't want any treatment for it. But he has one weak spot that I can always use - he loves personal attention.

I made a fuss over his wound and said I would clean it to make sure that no "bugs or germs got in there" and did any harm. So I assembled some first aid supplies:
  • hydrogen peroxide
  • cotton gauze
  • Neosporin ointment
  • tweezers
  • nail scissors
  • non-adhesive bandage roll
We started by cleaning the wound with peroxide. I warned him that it would sting, so naturally he didn't even flinch or blink. I soaked some gauze with peroxide and blotted the wound while I examined it for signs of infection or inflammation. The raw skin was unhappy but not puffy or much discolored. Then I got him to rest his arm on the table so he could hold it very, very still. Here's where the surgery got started. I used tweezers to lift the skin flap away from the wound and elevated it slightly, so it had a little strain on it. Then I carefully, slowly, neatly trimmed the dead skin flap off by using the nail scissors. The dead skin came cleanly away from the raw place (arm hairs and all) and it went to its eternal rest in the kitchen trash can. Here followed more peroxide blotting and then a coating of Neosporin to seal the surface.

Dad followed all this with interest, enjoying the concentrated attention he was getting. He chatted about his brother, the dogs, or whatever came into his head while this was all going on. I was grateful that he didn't squirm around.

We put a square of gauze over the open wound and Dad held it in place while I wound a length of non-adhesive bandage around the gauze and his arm. I really like this stuff - it won't pull on his long, long arm hairs and it can be reused when changing the gauze. That is, it can be used again if Dad doesn't discover it and rip it off, so the wound can "air!"

The bandage that we had on hand was blue. Dad's dog, Toto, recently split a dewclaw and had to have it worked on at the vet's office. We had been using the blue non-adhesive bandage on Toto's foot but it worked well for man and beast. Fortunately, neither the dog nor Dad required the bitter-tasting bandage that prevents chewing and biting by the patient!

Having completed our minor surgery, we resumed our domino game and I believe he beat me once again.

Saturday, December 7, 2013

Breakfast: 2-OM, Saus, Bisc, DeCaf

Dad gets his regular breakfast at the café.
Photo: Pam Stephan
Dad likes the morning routine of going out to breakfast. In fact, he says it is his favorite meal of the day! We've been going to the same café every morning except Sundays for the last 7 years. There are some advantages to being a Café Regular.

A Café Regular rates high with the staff. A couple of the wait staff will set up a table before we get there, so we always get our favorite spot. We like to sit under the skylight - this helps Dad read the morning newspaper. Our regular waitress, Jenny, sets out two coffee cups, two sets of silverware, and extra paper napkins. If she sees our car approaching, she will actually pour up the coffee before we come in the door! Now that's service! Jenny also keeps up with our family and knows the names of our dogs and what plants we have in the vegetable garden. We've swapped starter plants and tried each other's tomatoes.

A Café Regular rarely has to actually place an order. I've seen this happen at other tables, but at our table here's how it goes. We sit down to 2 DeCaff coffees, one with cream, one hot and black - that's Dad's cup. The waitress come over, smiles at Dad and says, "Want your regular?" and he smiles back, "I believe you've got my number!" Then she writes it down: 2 OM, Saus, Bisc. He has always has two eggs over medium, sausage, and a biscuit at this café, and they always get it just right. I'm the one that the girls eye eagerly, ready to write down some of my favorite meals. You can bring me breakfast tacos, french toast, biscuit with honey, or once - just for fun - breakfast quesadillas!  The order arrives in a timely way, I say the blessing, and Dad always replies, "Amen, Dive In!"

A Café Regular gets to visit with the other Regulars and exchange greetings and locally-sourced wisdom. There are men that sit only at the counter, read the paper while eating, and speak only with the staff. But at other tables, there are dependable groups of men who always meet up for breakfast, gossip, politics, and to see and be seen. The members of these tables may vary, but there's always a core group that keeps the table lively. Family groups also stake out a favored spot, and we've learned their names, too. There are colorful characters, oddballs, the occasional lawyer and client pre-court coffee time, and local musicians in need of an early morning beer.

With such diversity to the clientele, the staff at our café has seen everything. I'm pretty sure that most of them have figured out that Dad has some memory issues and that I'm always the driver and always leave a good tip. But they treat each diner with the same respect. Dad will order 2 OM, Saus, Bisc for years, because that is what he can remember. He never looks at a menu, even if we dine elsewhere. It may seem boring, but when a guy can't remember what his previous meal was composed of, then repeating his favorite breakfast isn't too bad.  It also makes him easy to please, and that works for me.

Tuesday, December 3, 2013

Changes and Transitions

Dad and I cross this bridge together.
Photo by Karl D. Stephan
I have stepped off of a cliff, or at least I feel like I have. It's not the first time that I've resigned from a job, but it is the first time I've quit because my personal life demanded more time than any professional duties.

Just before I started being my father's caregiver, I got a web-based job writing about breast cancer for I took on the task of writing this because I had gone through the whole breast cancer experience about 4 years earlier. For the record, I am an 11-year survivor. I spent 7 years and 7 months researching, writing, illustrating, and taking photos about breast cancer. It was a completely web-based job and it was a job that I could do from any place that I could hit the internet. Have laptop will travel.

About 5 months after starting that job, my father was told by his neurologist that he could no longer live alone. She also got right in his face and told him to stop driving, or else she would report him to the authorities! My mother had passed away one year before, and Dad had been living alone, eating 2 meals a day at a diner and a cafeteria, and mowing the lawn for fun. He also watched TV. Lots of TV - but most of it was like, The Weather Channel. Dad was on meds for high blood pressure, but he frequently forgot those, and sometimes passed out and fell. One time when I visited, he met us at the door with bruises on his forehead, elbow, and knee. Of course, he had no memory of how the bruises got there, and was unconcerned. He just wanted to visit with us and go hit the cafeteria!

My sister and I talked over the situation, and Dad agreed to try living with her. Four days later, he was back home. He also tried assisted living - also a four-day experiment. Next stop: my house, where he originally agreed to spend at least 2 months. I still have the paper he signed, agreeing to stay that long!  Seven years later, he's still here. Dogs and all. More on the dogs later, I promise.

Dad's dementia has progressed very slowly. It took a drop when he started having a heart problem - atrial fibrillation - about two years ago. He used to able to keep himself occupied around the house, he liked to read, watch TV, walk the dogs, and even took showers! 

Now he needs directed activities, has trouble reading, and cares less about television, unless it is specific programs. We tried having a hired companion once a week - but Dad actually remembered the guy and complained so strongly that we dropped the service.

So it is up to me - with lots of help and support from my husband - to keep Dad healthy, contented, occupied, safe, and on schedule. If he wakes up at 2:30am and wants to walk the dogs, its up to me to talk him down and get him back to sleep. I fill his daily med doses and make sure he takes the right pills at the right times, and gets refills in a timely manner, We keep healthy drinks around to prevent dehydration. I plan meals that he enjoys and can navigate even with low vision. Dad and I attend 3 different senior centers a week, we stay socially engaged. I keep his appointment calendar, steal his dirty clothes (and sneak clean ones back to him), and create small photo albums that cover areas of memory that help him. I'm busy. Did I mention that I give him haircuts too?

All that leads up to this: I've quit my job writing about breast cancer, and have stepped wholly into the world of  dementia caregiving. This is a role that I struggle with daily. But having Dad in my life is important enough to me that I decided to jump off that secure cliff  - the familiar world of being a working girl with a regular paycheck - into a more personal role. Dad is making this transition too, although he is aware of it only around the edges of his memory, he knows that I am there for him, every day, with every memory that he might want or need. That's what I am for now. That's my new mission.

Monday, December 2, 2013

Being a Cut-Up

Dad lets me give him a haircut at home.
Photo by Karl. D. Stephan
SpongeDad Haircut, or Getting More Than He Thought!

Dad loves personal attention (who doesn't?) and he is a bit of a tightwad when it comes to barbers. He is still shocked that a professional haircut costs more than $2.50, so if we visit Rudy the Barber, it's always my treat. 

My sister cuts her husband's hair, and for a while, she trimmed Dad too. So she showed me the electric clippers that they had - there were about four sets at Dad's house - I thought I'd give it a try and see how it went. My first challenge was his dirty hair. Like many folks with dementia, Dad isn't fond of baths or showers. But there are dry shampoos available, which just spray on, and those do a good enough job. 

I summoned my courage and told Dad I was setting up my Home Barbershop. His quick reply was, "Why don't ya just take me to the barbershop and let them work on me?" When he understood that they didn't do shampoos there, he agreed to be my client. He shucked off his shirt - a ritual in itself - and sat down so I could drape a towel over his shoulders. I warned him about how cold the spray-on shampoo would be, and off we went.

The dry shampoo leaves a deposit of cornstarch powder, but that makes it easy to trim his neck with the electric clippers. Once I had a base trim started, I brushed away the powder and picked up the scissors and comb. Now I have very little experience in cutting hair, so I go very, very slowly. Like, this one hair cut can take an hour. Over several years, I've learned to layer in a fairly reasonable way, so Dad doesn't look like he had a bowl thrown on his head and a razor run around the edges. He likes to look good, and I'd swear when he looks in the mirror and combs his hair, he does it as carefully as he did when he was 17 and competing for dates with young ladies. 

After some time, I was less happy with that dry shampoo, so I tried whipping up some foamy shampoo and washing his hair that way. That got his hair, head, shoulders, and collarbones very clean, especially during the rinse cycle. Rinsing was accomplished by pouring warm water over him and hoping for the best. At first, I felt bad about drowning his undershirt and I always got him a clean one.

Then the light dawned: I had a new opportunity here, for a sponge bath! As long as Dad would cooperate, I would routinely wet him down and sponge him off. This way, he got at least an upper body "bath" as well as a trim, clean undershirt, and new shirt. The combination of all these attentions resulted in good stuff for both of us. Dad came out feeling better, and smelling better. I came out with a sense of accomplishment and a new solution. Thus, SpongeDad Haircut!

Monday, November 18, 2013

Senior Game Day

Playing 42 - Dad is wearing the blue ballcap.
Photo by Pam Stephan
Today we went to the Senior Game Day at the City Recreation Center. All you have to do is to be 55 or over and show up with some food item to share. Nobody checks to see if you brought anything though, but several people attend regularly and bring the same item weekly. We always bring something different, just because we are different, I guess.

You see, most of these seniors may need walkers, or have knee replacements, or hearing aids, but their memory works well. They come in and head for their favorite game table, sit at their regular place next to their buddies, and play for all they're worth. Every week, every year, this is how they start their week. Dad's memory is - in his own words - "Shot!" He's been dealing with dementia (a word I hate with a special loathing) for at least 7 years and more. His short term and long term memory is faulty. The big exception in his case is: Dominoes.

No matter what else he is coping with, Dad can whup most anybody at Dominoes and is a keen partner at the venerable game of 42 (see the photo). I joke that he was born with the Double 5 in his mouth and cut his teeth on it. He's never cared to deny it.

We met up with a man named Micky - not his real name - who says that he has a faulty memory due to brain injury that he got in a car wreck. Despite this, our new friend is just as nuts about Dominoes as Dad is. He anticipates what other players will score and usually has his own "rock" ready when his turn arrives. Dad and he play with a rhythm born of long experience. I just about keep up with them, as well as keep the score pad updated. Micky appears to have an unlimited endurance for the game, and I wish we could meet up with him so Dad could have another person to keep company with. We think this man lives in a group home and his hours are rather regulated. But it would be wonderful if a guy with a brain injury and a guy with dementia wound up helping each other cope.

Just by playing Dominoes. It could happen. Couldn't it?