Showing posts with label Cognitive Impairment. Show all posts
Showing posts with label Cognitive Impairment. Show all posts

Wednesday, December 4, 2013

My Cognitive Impairment Doesn’t Need a Name to Be Real




I notice that I'm allowing the uncertainty of my diagnosis to inhibit my blogging.

As I said in my last post, the uncertainty is not that difficult for me personally; my symptoms are no less real to me than before. I do realize, however, that, for many other people, the lack of objective evidence of cognitive impairment renders the value of this entire endeavor questionable.

Whatever my subjective experience, if there's no medical evidence of Alzheimer's (or, worse, no evidence of cognitive impairment at all), then, for many others, this blog might be an interesting study in psychosomatic illness but of little interest to those who are concerned about the inner experience of Alzheimer's. For those particular people, my writing about my symptoms may seem an almost pathetic, last-ditch attempt to convince myself and my readers of the reality of these symptoms.

All of which makes me a bit defensive while writing this blog. Nevertheless, this blog is about my experience of whatever-I-have, so that's what you'll get. Of course, the doubt of others and my defensive reaction to it are all part of the process, anyway. I just wanted you to know what's going on internally as I try to sort out this new phase.

Anyone with early Alzheimer's, I suspect, has such doubts. As I've worked with my uncertainty during the past few months, it's been helpful to categorize my symptoms into two rough and overlapping groups.

First, there are the "Well-that-could-happen-to-anyone" complaints, such as loss of memory, difficulty in word finding, deterioration of my ability to type, and so on. Everyone has experiences like these and they increase as one ages. They're poor evidence of disease.

Then there are the "Now-that's-real-impairment" symptoms: getting lost in a place I knew fairly well, the severe loss of ability to work with spreadsheets, the episode with the keys and others. These are not easily dismissible.

Over the course of the last three years, I've had a number of the latter "Now-that's-real-impairment" symptoms. They occur only infrequently—the last was at the beginning of August—but they've been important in helping me and others to accept my diagnosis.

There are also two things about the "Well, that-could-happen-to-anyone" symptoms that remove my doubt. First, their frequency has been staggering:
  • I now search around the house multiple times a day every day to find things I've just put down. Not only have lost my beltpack three times over the past couple of years, but I would also have lost it several more times if someone else hadn't noticed and pointed it out to me.
  • Anyone can have trouble word-finding, but I am daily having to use less-than-satisfactory substitutes for the word I want.
Second, these symptoms may be normal for some people, but they are decidedly not normal for me:
  • It wasn't until yesterday when I reread last week's post on the difference between Alzheimer's and normal aging that I recognized I'd written about the same thing at least twice before.
  • I've been forgetting some of the "shortcut keys" that I've used in my word processing program almost every day for over ten years. Only later do they come back to me. (My wife Marja is unimpressed: "I can't remember any of those shortcuts at all," she says.)
Maybe some other people have trouble with such things, but I never did before.
Because I've been aware, however, of how my normal tests this might seem to some others, I've become almost embarrassed to be writing these posts.

But then I remember the purpose of this blog: to describe my own experience of cognitive impairment, whether or not it's convincing to others. I'm to write down the truth of my experience, and it's up to others to decide whether it's helpful for them or not. My truth at this point includes my defensiveness and my reluctance to write about my symptoms.

If this turns out to be a chronicle of a "worried well," so be it.

Wednesday, September 25, 2013

We're Invisible in the Medical System, Too

Several months ago, a man named Jim emailed me. He lives in the Washington area, and he, too, has early Alzheimer's. We got together, enjoyed a walk in the woods near our apartment, and promised to get back together.

Recently, Marja and I along with Jim and his wife, Nikki, went down to the annual Folk Life Festival on the National Mall. We found much in common. I was especially happy that Marja and Nikki—both spouses of men with cognitive impairment—could spend some time together.

Then I received an email from Nikki informing me that Jim had had a bike accident, breaking a collar bone and several ribs—which can be very painful—and causing internal bleeding. The bleeding was probably not serious but deserving a couple of days observation in the hospital.
Nikki wrote:

"When medical professionals ask about medical conditions and medications, I tell them what he's on and that he has early onset Alzheimer's. There's a moment's pause as they take this in, ignore it, and carry on with what they were saying. When I brought it up again yesterday (because they were expecting Jim to manage his own pain medication schedule and that wasn't working), the medical personnel overreacted in the other direction. Now, Jim says, twenty people accompany him to the bathroom and he is being fed with a spoon!

The ignorance of what having Alzheimer's means among medical professionals and how they should adjust their behavior is shocking and awfully frustrating."
The next day Nikki emailed me again:

"I've had many conversations with the doctors, nurses, nurse supervisor, and social worker and they are all abysmally ignorant about how to treat and help a person with a cognitive disability like Alzheimer's.

The numerical scale (1-10) for example, that they use as the standard protocol for determining pain level baffles Jim, especially when the pain is increasing. Even the alternative scale of "happy faces" is difficult for him to answer at times. Last night, he went from 12 midnight to 9 am with no pain medicine! When I arrived, he was frantic with pain: it seemed to have crept up on his brain [unrecognized until it was severe], another symptom of Alzheimer's. We negotiated that he'll be given meds regularly without having to ask for them—with some extras he can get for breakthrough pain. I plan to set an alarm to check on his status through the night."

The ignorance is shocking, but it's also completely understandable to me as a physician because I know how little training medical people receive in recognizing and treating cognitive impairment.
We learn in our training to take care of the seriously demented but not to care for people with less severe levels of cognitive impairment, especially the early stages.

Let me guess what was going through the doctors' minds: Nikki tells them that Jim has Alzheimer's.
They take one look at him sitting on the examining table, responding normally to their questions, looking like everybody else. "Looks okay to me," they tell themselves. So they essentially ignore Nikki's comment, perhaps not even mentioning it to the nurses. Nothing is done to determine the level of Jim's impairment and how his care needs to be tailored, because they aren't skilled in it or perhaps don't even recognize the need for it.

Later, Jim has some difficulty with his medications. Nikki explains again about the Alzheimer's, and the nurses spring into the kinds of action they've been trained in: put the side rails up, accompany him everywhere, talk slowly in loud voices, spoon feed him, and all the other things they believe appropriate to a severely demented person.

As a person with early Alzheimer's, Jim is invisible within the medical system.
Most of the nurses and doctors literally don't know how to recognize him, much less care for him. I don't blame the individual medical people; they've not been trained, and they are subject to all the same constraints of fear and embarrassment as the rest of us.

Nevertheless, it's simply bizarre that most medical people don't know how to deal with a disease more common than heart disease and more common than all the cancers taken together.

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