Doing The Weekly Dementia Pill Drill

Morning Pills and Evening Pills
Photo by Pam Stephan

Dad takes pills - 10 pills every day - as part of his daily routine. Sometimes he balks about taking them, but most of the time he just knocks them back five at a time with a slug of coffee. I feel fortunate as a dementia caregiver, because we haven't gotten to the point where he can't cope with taking more than one pill at a time.

My job is to keep track of ordering refills and to load his morning and evening doses. The medications are prescribed by different doctors and come from a local, as well as a mail-order pharmacy. 

Every time we see a doctor or a dentist, I take along a medication list. The list includes the names of all medications as well as the dosage. Below the list I have a table that shows what time of day these are taken. If we have to go to the Emergency Room, I just scoop all the medications into a small suitcase and bring them along. The medical staff always likes to see all the information they can get.

When Dad was having trouble sleeping, I looked up his newest prescription to see if it could be causing him problems. Side effects are always possible, and since any change in his medications could create a new challenge, I try to stay informed. When I can't solve a medication problem on my own, I ask the doctor. Being a patient advocate comes with the territory!

Good questions to ask are:

• What is the best time of day to take this medication?
• Should this be taken with food?
• Will this pill be compatible with Dad's other pills?
• Can we get this in a generic version, to save money?
• What should we do if he misses a dose?
• What are the most common side effects?

For memory he takes Namenda and Razadyne. He has atrial fibrillation, so he's got a fancy blood thinner to prevent stroke. There are pills for allergies and asthma, for high blood pressure. And he also takes a generic form of Zoloft for mood. Mom passed away 8 years ago and Dad still misses her daily. 

I load Dad's pill bottles a week in advance and sort them into Morning and Evening. He always takes pills right after a meal. I've learned to give him the pills only after he has finished eating, because he sometimes mistakes them for candy and chews them! When that happens, he spits them out, to get rid of that bitter taste. That is 5 wasted pills. 

One day, I handed Dad his Morning pills after breakfast. He carefully sorted through them and picked out the pink ones, giving them to me and saying, "Here, have some of these goodies!" While I was touched that he wanted to share, I showed him that I had my own pills to take. He consented to take the pink pills, and we went on to have another good day together.

Santa Sneaks up on Dad

Dad doesn't realize that Santa is coming to visit, until he hears a strange grinding noise. Indeed, Dad wasn't aware that Christmas was imminent, even though the tree was decorated and lights were up inside and out. Brightly wrapped packages were nearby and Christmas music was playing, but it didn't make any difference.

Holidays are different, when dementia is in the house.

Peace and Contentment in the Domino Zone

Dad (at right) plays 42 with other seniors.
Photo by Pam Stephan

At our house, we have a table that is devoted to dominoes. It gets used daily. When my husband comes home from work and I need a break from caregiving so I can make supper, my menfolk play dominoes. After supper, if there's nothing great on TV, the three of us play dominos. Sometimes we may watch half a hour of headline news and then play another match before doing our evening wind-down routines. You get the idea: we play dominoes all the time.

We have a good friend who comes over once or twice a week to be a domino partner, so we can play the more challenging game of 42. It involves trumps, suites, strategy and teamwork. Dad is a master of this game as well as Straight Double 6 dominoes. 

Dad and I go to three different senior centers weekly, where we get lunch and - you guessed it - dominoes! If we don't get a foursome, we might play Moon, a three- handed variation on 42. and if we arrive too late to join in a group, we just play a two person game of regular dominoes. We have tried, but it is a rare day at our house that Dad says he is tired of playing the game. Perhaps he dreams of "rattling dem bones!"

When Dad is at the domino table, regardless of whether or not he's winning, that's when he is at his best. He knows this game well, he feels confident, and he plays to win. Always! When Dad is on a roll during a game, his mood is one of contentment and quiet happiness. The years fall away from his face, that confused "where am I?" expression vanishes, he sometimes chuckles and makes jokes. He feels competent, and having dementia doesn't hold him back at this game - most of the time. That's when I feel about 8 years old and my father seems to be only 38, strong, healthy, and in his prime.

So one evening as we were playing and chatting, Dad got into that Zone where he feels content and secure. As he laid another domino on the board, he remarked, "I don't know where we are, or how we got together here, but I sure am glad we did." His voice was warm and happy, he was smiling.

What he said expressed a lot to me. "I think The Man Upstairs* had a lot to do with it," I replied.

"I think you've got that right," he answered, then said, "Gimme 10."

*the Man Upstairs is how Dad refers to God

Road Man: Going For A Ride With Dad

Dad goes for a ride.
Photo by Pam Stephan

Dad knows roads. His working life was full of surveying, building, designing, and traveling down roads and highways. He went to college after World War II on the G.I. bill, determined to become a civil engineer, a dream he was able to realize.

My father worked for the Texas Highway Department for 25 years. He worked his way up the hierarchy and before I got to high school, he was leading a design team.

Once in a while, my mother would drop me off at Dad's office. He would take me back to a room full of men bending over drafting tables, working on huge sheets of paper. Rolls of plans stood in a box or lolled, lying half open, on top of drafting tools. A monstrous mechanical calculator that made a sound like a hail of metal stood brooding in a corner. Drafting lamps angled askew when they were not in use. T-squares, as long as I was tall, rested across the mighty tables upon which penciled lines were shaped, later to become interstate highways rising into the air.

On Sunday afternoons, my father would often say, "Let's go for a ride!" My parents, my little sister, and me would slide onto the big green seats of the 1955 Oldsmobile, roll down the windows, and get comfortable. We knew what Dad really meant by his invitation. So we'd sit back and get settled while Dad would drive. He never used a map - all the roads he worked on were in his head. We would wind up at a road construction site out in the country, a road that he had helped design, so he could do a visual check on the progress. Mom might pack a picnic in a green wicker basket, so while Dad strolled around the work site we would have a snack. After he had toured the site, he might drive us  to other notable places such as Prairie Dog Town (back then, it was just a farmer's field full of these critters) or the zoo (it was free) or the Trinity Park Duck Pond (bring your own bread scraps). 

In November, when pecan trees were loaded with ripening nuts, he would drive us along a country road and find a tree on the easement. He kept a rope in the trunk, along with a brick. The brick provided a weight that he used to sling that rope over a branch, which he then shook, causing a rain of pecans. Down on our knees, we would pick the brown beauties and collect them in a brown paper bag. Back home, we would be put to work shelling those beauties and later we had them in pie. 

These days, Dad rides while I drive him around. If he is having the blues or feels frustrated or bored, going for a ride usually helps him. Sometimes we will actually do an errand or take the dogs for a walk in the nearby park. If pecans are in season, you can be sure we will pick up some. He loves going on long drives and will ask, once in a while, if I need a break from driving. I've never taken him up on his offer to drive. Once we are in the car and on the road, he likes to comment on the weather, the state of the road, the number of overpasses, other vehicles along the way. I might come up with a story for him from our drives when I was a child - these he always enjoys. The highway drives are his favorite. He relaxes to the sound of the road, the wheels going, rain or wind, swing music or classical tunes on the radio. If the drive is really long, he's been known to take a nap. 

When Dad and go for a ride, I know that I have precious cargo on board. His safety, his happiness, and his intact memories of road trips are riding along with us. He - not my mother - taught me to drive and this is one way we can be together. Dementia has kept my father from driving for some years now, but in his heart he is always the road man, with all the maps in his head.