Moved better today

Dad was more willing to walk and move today. Appetite remains good. He was commenting about seeing Dylan in his casts..."looks like he has white socks on!"

Dad having a harder time transitioning

The gals and I are starting to see an increase in times in which Dad doesn't want to get up (not necessarily out of bed in the morning, but from say a seated position to go to eat or do an activity.) I hadn't seen it so much before when i'm with him, but now it's starting to happen to me too. Before Lois would sometimes need me to step in to encourage Dad to get up. Now I sometimes have to recruit Paul to step in to get Dad to get up for me! Tonight was one of those occasions. It also seemed like he was having difficulty knowing the right things to do with his hands. For example, going to the sink after toileting...usually knows when I show him the toothbrush to grab it and start brushing...instead reached for the soap with just one hand. When I placed the toothbrush in his hand, he treated it like it was a bar of soap and ran it under the water instead of putting it in his mouth (until I corrected him.) When I try to talk to him, I'll ask him..."do you want to have dinner"..."yes,", so you need to get up .. "I don't like that." Tonight, after Paul prompted him to get up, he did eat his dinner that was placed in front of him, (though needed a lot of encouragement and instruction for holding the corn on the cob...though then ate it all.)

It could be that this is just a "tired" day after the big outing from yesterday. It's also interesting because last night he actually woke up and got up in the room around 11pm (I could hear him over the monitor.) It was similar to what he's done before in that situation in which he's looking for his shoes, and/or confused and seemingly trying to get his bearings. Was also questioning..."where's my bedroom", and needed to walk around the house a little for me to convince him that was his bedroom. But anyway, the interesting thing is how in that situation, his physical capabilities seem better...he walks much more quickly and is anxious to try and get around (unlike today in which he won't move.) Makes me think that the lack of movement, slow walking has more to do with his mental state than physical. Just a thought.

I'll keep you posted. I also talked to Lois today about doing some blogging, so will try to get her set up soon.

Day at the park

Today, Haydee was here for Dad, and Laura was here for Dylan. The four of them went to a park in San Pedro (about 20 mins from my house) that is by the marina...nice flat area with lots of benches and walking paths Gorgeous day here. They recently returned and reported how much Dad seemed to enjoy the location. I noticed it earlier today, and they also mentioned that Dad was really talking very coherently. Apparently he was very talkative during their visit up until he woke from a brief nap he took while there.

Physically it seems that Dad has been putting up more of a fuss lately about moving. Not all the time, but at certain times he seems to get situated and doesn't want to get up. He continues to do a lot of scratching of his scalp and shoulder areas. He's also gotten into this mode of "screeching" or making shivering-type sounds. As I mentioned before, it seems like it started during the hemorrhoid episode (in reaction to the suppositories).

Justine asked, and i will follow through on asking Lois to start blogging on Dad's day... particularly now that he's got his computer and I have it set up on his desk in the bedroom (though it is a very small screen and keyboard.)

Dad is scheduled to go to Ken's house this coming Thursday thru Sunday.

Father's Day

Dad had a nice day today. Haydee took him out for ice cream during the day. Tonight he had a turkey noodle casserole, which is a recipe I got from Mom who got it from Aunt Thelma (I substituted ground turkey for ground beef.) I just put Dad to bed...every night I put Dad to bed, I always tell him "I love you" and his usual response is either nothing or "ok". Tonight, he said "Same for me."

Friday night was interesting...Paul and I were up late watching TV...around 1:00am I heard Dad get up...he had made it out to the hallway in his walker and wanted to know where his shoes were. His walking and manner of speaking was more "normal" than his usual slower gait. I let him know it was the middle of night and starting directing him back to his bedroom. He made the comment "How did I get in this house?" He said he needed to pee, so we walked to the bathroom and he walked towards the toilet and pulled up the seat and starting pulling down his pants to pee standing up! Had never seen him do that before...I made sure he was close enough to the toilet, and sure enough, he peed! We made it back to his bed...he asked to keep the bathroom light on and insisted he keep on his slippers in bed, as well as his glasses. THe next morning I asked him if he remembered getting up the night before and he said no.

Dad's week

Last weekend, Dad experienced quite a bout of painful hemorrhoids. I first became aware of it last Friday evening after Lois' shift. During a trip to the bathroom I could see how inflamed they were (external, and quite large and protruding!) I applied Tucks pads that night and he seemed to sleep comfortably. On Saturday, with Lois, it was day 3 since he had a bowel movement...they tried a couple of times with no success. By the evening, I tried inserting a Prep H suppository while at the toilet, but he was really reactive and complaining, so I couldn't get it all the way in (to be honest, couldn't even see around the hemorrhoids where to put it!)...anyway, it dropped out in the toilet. I was able to apply Prep H cream all around the area. He went to bed that night and still slept OK.

THe next morning, fortunately, I had Lois (Haydee got the flu last week so had to cancel...Lois agreed to come in on Sunday, her normal day off...she had asked if she could take Dad to church with her, which I agreed to.) Anyway, they never made it as Lois stayed with Dad mostly on the bed and in his room that day. He was very uncomfortable and could hardly move. She was able to insert a couple of suppositories during the day. By the end of her day, they had had success with the bowel movement, so Dad was quite relieved as you can imagine. I have to say I was quite impressed with her demeanor and treatment of Dad throughout the day, not to mention her patience! Per California labor laws, since that day was her 7th day in a row of 8 hour or more days, she was to be paid double-time...she definitely deserved it in my opinion.

During this past week, Lois has continued to give Dad the suppositories to help bring the hemorrhoids down. His BMs have been fairly regular, so it doesn't appear they are as bad. He has however clearly become a bit traumatized...he's doing this thing of "screeching" or saying "Ahhh!" when you barely touch him, for wiping example.

I'm also a bit disappointed in myself and Dad's new doctor...he had an appointment with the GP, Dr. Gee, this past Thursday. My understanding of this appointment was that he was to do a full bloodwork for Dad...we had talked last time about following the every 6 months that Dr. Lichstein had done. I was planning to meet Dad and Lois at the doctor's office around 11:30 (appointment was at 11am), because I had some work to take care of at home first...I assumed I would have plenty of time to be there when the doctor was with Dad (assuming the nurse would be doing other checks first.) Well somehow the appointment was listed only as a "blood pressure follow-up", and when I arrived at 11:30, Dad and Lois were just walking back into the waiting room. I went into the back to ask to speak to the doctor, but apparently he was already gone. They sent the nurse out and she said he was probably gone for the weekend! Lois did say she asked about the hemorrhoids, though the doctor didn't examine him...he said to continue with the suppositories. I asked the nurse to have him call me this week and I suppose we'll get on the schedule again to do a more thorough examination.

Today Lois asked if she could take Dad to lunch with her at Red Lobster...she wanted it to be her treat, saying it was like a "father's day" gift for her. Dad is scheduled to go to Ken's next weekend (first visit since the full week when Paul and I were in Fiji.) He will be going to Ken & Judy's new house! Ken...does Judy deal much with patients and hemorrhoids at her job?

I haven't had a chance to try out Dad's new laptop yet, but it did arrive. Hopefully in the next couple of weeks. Ryland and Dylan both have "promotions' this coming week (8th and 5th grades), so lots of parties and events scheduled.

Visit With Dad

It was difficult coming to see Dad, I was anxious to see how he was doing. I was relieved to see he was getting good care from Lois. Lois is very disciplined and has Dad on a schedule that helps him.

Things are more hectic at Ken's house, but Kenny seems very caring and helpful with Dad. Judy is very busy with her work and children, but seems very caring towards Dad as well. The only thing is that the change of coming to Ken's house makes Dad regress such that he only gets settled in by the time he has to go back! I recommended to Ken that he get a toilet seat riser that would help Dad sit down easier. They are on sale at the pharmacy near his home and also I have one that I could mail.

I really wish Dad was back in Winston-Salem! I go back and forth because obviously he would need to be in a nursing home and of course that is not as good as one-on-one care that he is getting with Lois and living in a home is also a better situation. When I asked him he said he wanted to go back to Winston-Salem, (but it would not be the same situation of course).

DAD is very much a part of my life; I still feel emotionally attached to him especially on weekends, when I normally spend a lot of time with him.

Anyway, this is the end of my Blog--it now belongs to Barb and Ken! Best Wishes and enjoy your time with Dad!

p.s. i might add more later when my thoughts start to gel about the week there.

Dr. Lichstein and Karen Beard

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.

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.

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.

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.

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.

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".

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.

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.

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.

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.

Dad's Dreams & Conversations

I am glad to hear that Dad is still able to carry on a conversation with Barb, Ken and/or the caregivers. That is nice that he can understand enough to respond to remarks.

It is nice also to hear that it might have even been fun! Not sure, but the snake conversation sounded very interesting--something that Dad is fearful of, yet maybe would like to confront? Or just a dream to get rid of the tension in his life.

I think Dad might have said a similar comment to me once.

The comment that Barb said to Justine that "she was also your daughter" was interesting as well.

Dermatologist visit

Dad was able to get a last minute appointment with the dermatologist this past Monday. There were 3 spots on Dad's face she was concerned about, and wanted to do biopsies, which we agreed to. One of the spots was a dark irregular shaped one on his upper right cheek area. Perhaps he's had that checked out before...I looked at photos I had from when Dad was first here (Dec/Jan) and he did have it. The other spot was the one at the top right of his forehead...looks like he may have had that before too...I noticed it when it got more red than usual. Third one she wanted to check was a pimple-looking mark to the left of his mouth in the crease area. Dad braved the needles for the lidocaine to numb the areas, as well as some pressure when she cut the skin for the samples. I don't think he liked it. On the way out to the elevator he said "I just as well die." He has an appointment on April 6th to get the results. Which brings me to the question of us discussing whether certain procedures will be worth it or not. If it gets to that point (hopefully not), we should probably have a skype to discuss.

Justine will actually be here for that next appointment...she's coming to visit Dad (April 3-8) and will also help me with finalizing his taxes, preparing his first quarterly state tax payment and other as needed. When I mentioned to Dad that Justine would be coming soon, he said, "it's nice that you'll get to visit with your sister." To which I said, "and you your daughter!"

Dad is off to Ken's for a 3-day weekend. Lois drove him there this afternoon.

Visits to Dermatologist and Dentist

I hope Dad has a good visit with the dermatologist. He hasn't been to see Dr. Southard for over a year, so you could mention that he has his upper back, shoulders and face examined on a regular basis for possible growths that are "frozen" off.

I just cancelled Dad's Dentist appointment with Dr. Clarke for teeth cleaning. It would have been for April 6.

Sunday

Dad didn't seem as tired today and was transitioning much better. Definitely seemed in better spirits this evening too. I love it whenever he gets up and as he's walking, if he sees something to eat, say on the counter, he will grab it and eat it while he's walking...tonight, there was a bowl of pistachios and I had to tell him to spit it out because he had grabbed the whole thing including the outer shell. Tonight when I put him to bed he said "Make sure you don't wrap me up with that snake." LOL.