I talked to Dr. Lichstein about Dad. How he probably would be staying in California as he seems to be adapting to it. If he did come back I would have to put him in a nursing home (and Dr. Lichstein agreed with that.), which would not be as nice as the home setting he is in now.
I asked him what stage of Alzheimers Dad was. He said he would consider Dad in the moderate to severe range (though he hasn't given him a test recently). Because he probably would not know what year it was or where he was.
He asked me to record [if and when] Dad starts talking in Latin. A year ago we talked and he mentioned how the old memories stay the longest. I wondered if Dad's memories of Latin would possibly come out!
He said the end stage starts when Dad stops eating and drinking. (I don't think that has happened yet, but occasionally Dad does not eat too well).
Anyway, he thought Dad would not have issues with traveling, such as lung or heart issues.
I also talked to Karen Beard and she would be glad to help look up geriatric psychiatrist for Dad if needed, though she said he doesn't seem to have any behavioral issues.
Friday, April 17, 2009
Thursday, April 16, 2009
Response to Barb
I know you mean well, but please do not say that Dad remembers me because he recognizes my picture. (It sounded like I was complaining but really I was just expressing my thoughts.) And that is all the thoughts are.
The truth whether he remembers me or not is what it is. Nothing that I can't deal with.
And certainly when I see him, the memories are what they are, and the time I am there will become memories as well during the time I am there visiting.
The truth whether he remembers me or not is what it is. Nothing that I can't deal with.
And certainly when I see him, the memories are what they are, and the time I am there will become memories as well during the time I am there visiting.
More and Melanoma
There was one other thing I forgot to mention in prior response....I guess I don't feel that Dad's alzheimers/dementia has deteriorated since his arrival here. To me, he is more talkative, responsive, and uses more complete sentences than what I recalled, but I'm sure it's a much different perspective when being with him every day versus seeing him on an occasional visit. I'll be very interested to hear what Cathy thinks when she sees him on her upcoming visit.
Dad had the "Mohs" Surgery on his melanoma yesterday (right cheek.) The process involves cutting the area, sending Dad back to waiting room, testing the margins to ensure they've taken enough, and repeating until they have. In Dad's case, it took two times. He came home with a big bandage on his right cheek. Today, the bag under his right eye is bruised, which according to the paperwork is normal. The big bandage has been removed, and there is tape-type bandage on the sutures/cut. He doesn't seem to be experiencing any real pain, but was certainly very tired yesterday, especially considering he had to wake up at 6am in order to be at the office by 7:45. He got to bed around 8:15pm last night, and slept well. He has a follow up next Wednesday, and then we will see when they want to schedule removal of the squaemous cell cancer (right forehead). I think they've said that surgery is more complex, probably because Dad has such tight skin in that area.
Dad had the "Mohs" Surgery on his melanoma yesterday (right cheek.) The process involves cutting the area, sending Dad back to waiting room, testing the margins to ensure they've taken enough, and repeating until they have. In Dad's case, it took two times. He came home with a big bandage on his right cheek. Today, the bag under his right eye is bruised, which according to the paperwork is normal. The big bandage has been removed, and there is tape-type bandage on the sutures/cut. He doesn't seem to be experiencing any real pain, but was certainly very tired yesterday, especially considering he had to wake up at 6am in order to be at the office by 7:45. He got to bed around 8:15pm last night, and slept well. He has a follow up next Wednesday, and then we will see when they want to schedule removal of the squaemous cell cancer (right forehead). I think they've said that surgery is more complex, probably because Dad has such tight skin in that area.
Response to Cathy
I just wrote a long response to Cathy's post and it must have crossed paths with Justine's post or something, but it got lost! Anyway, will try to recreate. I said...
I think Dad remembers you and all of us. Lois reviews our pictures with him regularly...sometimes the names don't come, but I truly believe he knows each of us. If anything, yours is the name he does remember! In fact, I just went to remind Dad about your upcoming visit. He responded " I DEFINITELY want to see her," with an emphasis on "definitely"!
Regarding brushing teeth, Dad brushes his teeth by himself for me every night! I have tried to encourage Ken to have Dad do as much for himself as possible...pulling pants down, getting up and down from sitting, getting into bed, etc. It's really a mind-set and requires patience...it's natural to want to help when he's struggling, but for sure if you do it for him, he will do it less and less, which ultimately makes it more difficult for everyone. I have the same expectations with the caregivers and feel that they're doing a good job in this regard. Cathy, if you can assist Ken (assuming he's willing) by modeling some of your approaches, that would be great.
I also feel strongly that keeping Dad active (as much as possible) is good. As I've said before, Lois takes Dad for at least a 5 minute walk around the house twice a day, as well as engaging him in puzzles, reading and other. Ken has said that Dad doesn't do much at his house. This last trip (and on previous visits) Ken reported that he had trouble with Dad waking up in the middle of the night and not going back to bed, and also not eating. I would propose that activity might help to alleviate this. Of course I realize it's easier for me since Dad is here more regularly, and there may be other factors affecting Dad's behavior at his house.
I think Dad remembers you and all of us. Lois reviews our pictures with him regularly...sometimes the names don't come, but I truly believe he knows each of us. If anything, yours is the name he does remember! In fact, I just went to remind Dad about your upcoming visit. He responded " I DEFINITELY want to see her," with an emphasis on "definitely"!
Regarding brushing teeth, Dad brushes his teeth by himself for me every night! I have tried to encourage Ken to have Dad do as much for himself as possible...pulling pants down, getting up and down from sitting, getting into bed, etc. It's really a mind-set and requires patience...it's natural to want to help when he's struggling, but for sure if you do it for him, he will do it less and less, which ultimately makes it more difficult for everyone. I have the same expectations with the caregivers and feel that they're doing a good job in this regard. Cathy, if you can assist Ken (assuming he's willing) by modeling some of your approaches, that would be great.
I also feel strongly that keeping Dad active (as much as possible) is good. As I've said before, Lois takes Dad for at least a 5 minute walk around the house twice a day, as well as engaging him in puzzles, reading and other. Ken has said that Dad doesn't do much at his house. This last trip (and on previous visits) Ken reported that he had trouble with Dad waking up in the middle of the night and not going back to bed, and also not eating. I would propose that activity might help to alleviate this. Of course I realize it's easier for me since Dad is here more regularly, and there may be other factors affecting Dad's behavior at his house.
Dad Remembers Me.
I don't get the impression from reading the blog that Dad "remembers me". I suppose he will recognize me when I see him soon. And I think he knows who I am when I call.
I just wonder what stage of Alzheimers he is in now.
I do think changes are hard for Dad now (but I might be so inclined myself to not like changes either), so I wonder how his memory is doing at this time--is it causing more frustrations, or just resignation?
Kenny mentioned that he brushes Dad's teeth now. I wonder if Dad forgot how to do it, or whether it is easier to have a caregiver brush them? I miss Dad brushing his teeth.
I just wonder what stage of Alzheimers he is in now.
I do think changes are hard for Dad now (but I might be so inclined myself to not like changes either), so I wonder how his memory is doing at this time--is it causing more frustrations, or just resignation?
Kenny mentioned that he brushes Dad's teeth now. I wonder if Dad forgot how to do it, or whether it is easier to have a caregiver brush them? I miss Dad brushing his teeth.
Friday, April 10, 2009
Bed time
Just put Dad to bed. I reminded him that he would be visiting Ken and family this weekend. He responded..."It's always nice to see Kenny".
Thursday, April 09, 2009
Up Day
Dad had more of an "up" day today. I got him to bed relatively early last night, and this morning when I asked him how he was doing he said "Very Good!". He also showed more energy in his outside walks (We had "dueling walkers" with me and Dylan in his walker, and Dad with Lois in his walker and we crossed paths a few times. It was a nice day here today (high 60's, clear.)
Lois does have Dad read daily...today outside he was reading articles in the newspaper (she points to what he should read and he reads it...so he's not trying to process it, but clearly can still read). It's true that I haven't noticed him lately watching much television, but it was something I've noticed him doing before since he's been here in California.
I purchased a couple of puzzles at TJ Maxx today to add to Dad's repertoire...Lois utilizes these most days. They are the juvenile type that involve matching...one has about 75 pieces, and it takes 3 or 4 pieces to make one complete rectangle which has a picture and a name on it (e.g. "frog" or "sun"). The other has numerous pieces also, and you have to find the matches (e.g., horse hoof with picture of horse). Other suggestions are welcome.
Chip, Jennie...It would also be great to get the Navy discussion video and/or the paper that Faye wrote. Lois still goes through the U.S.S. New Jersey War book we have and if there was more accurate info that would be great.
Lois does have Dad read daily...today outside he was reading articles in the newspaper (she points to what he should read and he reads it...so he's not trying to process it, but clearly can still read). It's true that I haven't noticed him lately watching much television, but it was something I've noticed him doing before since he's been here in California.
I purchased a couple of puzzles at TJ Maxx today to add to Dad's repertoire...Lois utilizes these most days. They are the juvenile type that involve matching...one has about 75 pieces, and it takes 3 or 4 pieces to make one complete rectangle which has a picture and a name on it (e.g. "frog" or "sun"). The other has numerous pieces also, and you have to find the matches (e.g., horse hoof with picture of horse). Other suggestions are welcome.
Chip, Jennie...It would also be great to get the Navy discussion video and/or the paper that Faye wrote. Lois still goes through the U.S.S. New Jersey War book we have and if there was more accurate info that would be great.
General observations with Dad
I really enjoyed the opportunity to spend some time with Dad and see how he is doing. He is getting really good care and in general seems to continue to enjoy relatively good health. He mostly eats well and gets exercise every day.
I do think he seems a bit weaker overall since I saw him last, though he still gets around. I didn't observe any times when he wanted to walk without his walker though (which I had seen before on 'good' days). He is not quite as quick to recognize people, and does appear to be confused most of the times I talked with him. He did easily recognize Mom's picture, and us as well. I was showing him older photographs for the most part (when we were kids up to the early 70s). I tried to get him to talk about Navy experiences without too much luck. He mixed up the stories with references to me or other things in the room. He doesn't seem to respond to the television much at all any more - certainly doesn't talk about anything. We watched the Final Four basketball and he wasn't interested. I tried to work with him with a card game based on dominoes (but using pictures), but he said it was too hard to try and match the pictures, so I stopped. I didn't get a chance to try scrabble. He still reads well, so perhaps making words or reading words from the letters would be a good activity.
Barb and I started talking about arrangements for getting Dad to the beach this summer. I'm wondering if it might be his last opportunity to be together with a larger group. I think he could still have years left, I'm not sure such a big trip will be possible much longer.
I do think he seems a bit weaker overall since I saw him last, though he still gets around. I didn't observe any times when he wanted to walk without his walker though (which I had seen before on 'good' days). He is not quite as quick to recognize people, and does appear to be confused most of the times I talked with him. He did easily recognize Mom's picture, and us as well. I was showing him older photographs for the most part (when we were kids up to the early 70s). I tried to get him to talk about Navy experiences without too much luck. He mixed up the stories with references to me or other things in the room. He doesn't seem to respond to the television much at all any more - certainly doesn't talk about anything. We watched the Final Four basketball and he wasn't interested. I tried to work with him with a card game based on dominoes (but using pictures), but he said it was too hard to try and match the pictures, so I stopped. I didn't get a chance to try scrabble. He still reads well, so perhaps making words or reading words from the letters would be a good activity.
Barb and I started talking about arrangements for getting Dad to the beach this summer. I'm wondering if it might be his last opportunity to be together with a larger group. I think he could still have years left, I'm not sure such a big trip will be possible much longer.
Dermatologist - update
Barb and I accompanied Dad to the dermatologist (Dr. Iwasaki) on Tuesday, and we discussed in more detail the diagnoses and recommended treatments.
The squaemous cell cancer is on Dad's forehead. It is relatively large, and the doctor explained that surgery would require even larger excision. She recommended doing MOHS surgery (referred to another doctor for this), which provides the opportunity to test during the surgery to determine the depth required to remove all cancerous cells, as well as doing any required skin grafts or skin flaps to repair the surgical excision and minimize scarring.
The basal cell cancer is in a crease between the nose and mouth. Dr. Iwasaki said she would be able to do this surgery in her office, but that we should do the others first.
The melanoma (the most serious), is on Dad's right cheek. Dr. Iwasaki recommends MOHS surgery for this as well. She ordered one more test to be done on the biopsy sample (called a 'stain'), which will verify whether the cancer is superficial (extending only into the first layer of skin) or if some cells have extended further. If the cancer has extended further, it may be necessary to do a lymph node test to see if it has actually penetrated to a lymph node. Results should be received soon. The MOHS surgery has been scheduled for next Wednesday, April 15th.
Only one MOHS surgery can be handled at once, so a second appointment will be required for the squaemous cell cancer, once the first is done.
Once all of these surgeries are complete, Dr. Iwasaki suggests doing a full body inventory of Dad's skin marks to identify any other potential problems. She visually noted at least one on Dad's face (near his eye), but wants to wait until all the current surgeries are done before completing the inventory and determining a treatment plan according to priority.
The squaemous cell cancer is on Dad's forehead. It is relatively large, and the doctor explained that surgery would require even larger excision. She recommended doing MOHS surgery (referred to another doctor for this), which provides the opportunity to test during the surgery to determine the depth required to remove all cancerous cells, as well as doing any required skin grafts or skin flaps to repair the surgical excision and minimize scarring.
The basal cell cancer is in a crease between the nose and mouth. Dr. Iwasaki said she would be able to do this surgery in her office, but that we should do the others first.
The melanoma (the most serious), is on Dad's right cheek. Dr. Iwasaki recommends MOHS surgery for this as well. She ordered one more test to be done on the biopsy sample (called a 'stain'), which will verify whether the cancer is superficial (extending only into the first layer of skin) or if some cells have extended further. If the cancer has extended further, it may be necessary to do a lymph node test to see if it has actually penetrated to a lymph node. Results should be received soon. The MOHS surgery has been scheduled for next Wednesday, April 15th.
Only one MOHS surgery can be handled at once, so a second appointment will be required for the squaemous cell cancer, once the first is done.
Once all of these surgeries are complete, Dr. Iwasaki suggests doing a full body inventory of Dad's skin marks to identify any other potential problems. She visually noted at least one on Dad's face (near his eye), but wants to wait until all the current surgeries are done before completing the inventory and determining a treatment plan according to priority.
Saturday, April 04, 2009
Dermatologist report
Barb heard from the dermatologist Friday evening. Dad has 3 different cancers. One is a melanoma, one a basal cell and one a squaemous cell. We will take Dad to see her on Tuesday and discuss the treatments. She wants to do a full inventory of his skin as well. Barb couldn't remember if he had had any melanomas before. I sort of thought he had, but not sure. We will also try to get Southard to forward records to the new doctor's office.