Time for Reflecting: Another Year Gone By

As another year comes to an end, many of us spend some time reflecting about how time has changed our lives, filled with moments of happiness and sadness. Fifty-nine years ago today, was a happy occasion for my Mom and Dad when they were married.

December 28, 1952

Their lives have changed dramatically since that day in 1952. They each lived full lives together and separately with their children and their families being the bond that brought them together for special times. Today, however, Alzheimer's has placed Mom & Dad in a time warp that takes them to moments of their lives to relive again and again. Each moment they relive becomes fragmented with other moments. Some days I can tell where they are at and at other times I cannot. It is a journey all their own and we are just observers.

The following photos are of Mom & Dad today, December 2011:

My mother Janet

My father David

Of the two years of blogging, this update has been the most difficult with tears blurring my writing. As I look at the photos of Mom and Dad of today, I reflect on their lives and the lessons learned.

What will you make of your 2012?

Enjoying a Feast with Dad at Pine Ridge Care Center

On Sunday, November 20, 2011 the Pine Ridge Care Center, Dad's home, invited the families of all their residents for a special feast.

The staff and their families made the entire feast enjoyable for all by serving everyone and making sure all were having a great time.

Here is a short video where a violinist is playing a familiar tune (especially for all my Texas family and friends) and shows Dad making his entrance. When the video begins to wave a bit it is because Dad is hugging me.

Here are some photos of the event:

Shelley, me & Dad.

Shelley, Dad's CNA, & Dad.

Waiting for the word to begin serving!

Dad digs into his meal.

See the sparkling cider on the left? Dad had 6 glasses!

One of the nurses that takes care of Dad.

Staff getting ready to serve.

Getting ready.

Ed, Dad's roommate.

The Executive Director standing behind two residents.

Kelli, the Social Services Director, and her son getting ready to serve everyone.

A Visit for a Smile or a Laugh: Well Worth the Effort

It is not easy to visit a nursing home when your parents are residents for the long term. It's heartbreaking to watch them forget all that was once their treasure chest of precious memories of a life long lived. It is also very depressing to think about their future as we know how it ends. But, that is the reality of life...

...Yet with all the sadness there are moments of happiness. Since they live in the moment, whatever we do with them at the time is all that matters. To tell them a story or a joke, to see them smile or hear them laugh out loud, well that's what it is all about. They may be confused, lost, and sad but when we are with them, at that moment in time, they know you are family and you care and that makes every visit well worth the effort.

Our visit with Dad on November 14, 2011

A smile for the family 

Shelley & Dad

Me & Dad

Shelley talking to the birds

Insight into Dad's the Inner World

Lately Dad just wants to sleep. No matter what time of day I visit, he is always mostly sleeping when I arrive. Most of the time I will try and wake him up, but there have been a few occasions where he just resists and so I leave him alone and let him sleep.

Interestingly, when I am able to wake him up and get a conversation going, he gives me some clues into the inner world of his mind. Sometimes I'll ask what he's done that day and he'll respond by saying, "I'm not sure but I did some exercising, I think I went for a run." Almost every question I ask him will begin with, "I'm not sure, but..." 

At times, when we are sitting in one of the visiting areas, I'll notice how he is lost in thought and I'll ask, "What are you thinking?" Over the last few visits he has responded with numerous answers such as, "I'm wondering how many miles it is to San Antonio?" or "I wonder how long it took me to finish that slab (as he is pointing to the patio)?"

Then there are times when we walk around the facility and workers and residents alike will greet him by name. I'll comment to Dad that everyone seems to know him and he"ll just smile and say, "I have no idea who they are." One nurse called Dad "Mr. Fast-Pitch," obviously because Dad must have told stories about his days as a softball pitcher. But when I ask Dad how the nurse knew about him being a pitcher, he said, "They read it in the newspaper."

As Dad's dementia progresses, I can see how most of his living is taking place in his inner world where fragments of his past occupy his mind, while in the outer world he just sleeps.

Dad sleeping when I arrived today.

Dad giving me "the look" because I woke him up.

Three Calls & A Visit

You never know what your day will be like when you have a parent with Alzheimer's. Thursday, September 22nd was a confusing day for Dad. On that day he made three calls to us and we made a visit with him. Here's what happened...

First Call
That morning Shelley received a call from a nurse at the nursing home. The nurse asked if Shelley was his daughter and Shelley replied that she is his daughter-in-law. The nurse said, "Well, he's asking to speak with Shelley, so here he is." When Dad got on the phone, Shelley asked Dad how he was. Dad replied, "Where are you?" Shelley asked what was wrong and Dad said, "I'm here at the hotel where you left me and I'm waiting for you to come get me. I don't have any money and can't find my car keys." Shelley reassured him and told him not to worry and we would see him soon.

Second Call
Later in the early afternoon, I received a call from Dad. When I answered the phone he said, "Where are you? I'm here at the theater and I don't know how to get home." I started to panic thinking that somehow Dad   had managed to leave the nursing home undetected, even though he does wear an alert bracelet, and manged to walk a mile to the mall nearby where the theaters are located. When I finally figured out he was still at the nursing home, I asked what was wrong. His reply made no sense whatsoever so I asked him to just go lay down in his room and told him I would see him later in the evening. He said, "Okay."

A Visit
In the early evening Shelley and I went for our visit with Dad. He was in a good and talkative mood but had no recollection of his previous calls (of course we knew wouldn't). When we visit Dad, we have to prompt him with questions to get him talking, this visit he needed no prompting and just talked away. The sad thing was we had no clue what he was talking about. We understood some fragments of the conversation but there was no context for providing a clear picture of the conversation. However, what made this visit memorable was that not only was he in a talkative mood, but everything was funny and he laughed a lot too (no, there was no change to his medications).

Here is one sampling of our conversation and humor during the visit. We were laughing about something when I pointed to Shelley and asked, "Do you know who she is?" He looked over to her, started laughing again and said, "No, I'm not too sure who she is but she is too white!" We all just kept laughing, while Shelley gave him another cookie (we usually bring him cookies when we visit).

Third Call
After our visit with Dad that evening, I received another call from the nursing home around 10:30 p.m. The nurse that called asked if I would speak with Dad to help calm him down as he was very confused and agitated. When I spoke with Dad he wanted to know when I was coming to get him to take him home. I tried to reassure him that he was where he supposed to be but he kept saying he didn't know where he was. I told him to ask the nurse to take him to his room to lay down and that I would be by to see him soon. He said, "No, I'm just going to sit here and wait for you." I told him okay but if he got tired to go lay down. He said, "Okay."

It has been a week now since that Thursday and there have been no phone calls. I did visit him again yesterday evening and he seemed fine and so we had our usual visit.

Before I go...
I want to share some educational and encouraging resources with you all about Alzheimer's and how we can better cope with it. Here are some links to articles I believe are worth reading/viewing. Please let me know what you think.

Moments to Forget - Coping with Alzheimer's, Dementia, and Short Term Memory Loss

Alzheimer's Journey 6: As a Caregiver, Take Care of Yourself

I will be posting more links on future blog posts.

No Way To Know OR Know Way To No - It's All In Our Mindset

Am I getting a bit too philosophical? Perhaps, but that is what happens when I have too much to think about. As I monitor my parents progression into the darkness and emptiness of the Alzheimer's cavern, I somberly reflect on what is happening to them, me, and my loved ones.

One mindset is "no way to know," that is whether I or my siblings are doomed to face the same sentence, after all look at the odds. This is a reactive approach, as the tendency  is to deal with the problem as it occurs. Fatalistic if you ask me.

The other mindset is "know way to no," or no-way will I let this get the best of me. I need to "know" as much information as possible to live a healthy and happy "mode de vie." Daily I must cultivate a mindset that responds with an emphatic "No!" to Alzheimer's. The only control I have is my own attitude or mindset as to how I address life's issues: proactively or re-actively, positively or negatively, resigned or determined.

I am determined in making my parents remaining lucidity as comforting as possible. I know that each time I speak to them (mom on the phone or dad in person) I try to live in their moment. To be empathetic to their concerns and comfort them. I will sit with dad and help him enjoy his meal by cutting his food into manageable pieces and reflect on other meals we enjoyed together. With mom, I listen to her trying to communicate her fears to me and respond to the desperation in her voice. I try to calm them and reassure them, for the moment at least, and then be prepared to do it all over again on the next visit. It is heartbreaking, but such is the reality of life. This we know, but we can all say NO! to letting it get the best of us and realize we are making the most of our lives now...in this moment.

Here are some pictures of recent visits with Dad:

Shelley help dad by cutting his food.
He doesn't always remember  when to use the proper utensil.

Here he is, with a big smile, waiting to see his doctor. 

These are the parakeets that are constantly chirping away when
I visit dad. He says those birds were the same ones that bothered
him when he finished the courtyard slab he says he worked on
many years ago. I just let believe what he wants to.

Alzheimer's: Our Legacy

An Alzheimer's legacy is not received with joy and anticipation. Yet we all have a choice as to how we view life - either optimistically or pessimistically - despite whatever challenges we must confront. No one can predict what will happen tomorrow but we can predict what our life would be like if we choose to face tomorrow optimistically.

Why Alzheimer's is Our Legacy 
By one degree or another, Alzheimer's touches us all. In my family's case our risk factor is high because both parents have been diagnosed with this brutal disease without a cure. Currently, we are witnessing both parents progress through the seven stages with both teetering between the sixth and seventh stage. Consequently, we can look at our situation and feel doomed, while waiting for a perceived eventuality OR we can take a positive action approach and make every day matter by doing something positive.

Dad is in a nursing home here in California, while Mom is in a nursing home in San Antonio, Texas. They separated in 1964 and divorced several years later. They always maintained a good relationship, doing things as a family (see photos below).

Whether I or anyone else in my family becomes afflicted with Alzheimer's remains to be seen. Knowing the risk factors motives me to live my life to the fullest and optimistically. To all my friends and family, I encourage you to take positive steps in your life to live it to the fullest and leave a legacy of optimism.

Steps to Take a Positive Approach:

1. Resolve to improve oneself though increased learning and self-development. Increase your brain power. Strive to learn a new language, understand calculus, or read a book-a-week on topics you normally would not be interested in pursuing. It is never too late to educate oneself! FACT: 19% of Alzheimer's cases are attributed to low educational attainment.
2. Stop smoking! Make the effort, seek support. FACT: Smoking contributes to 14% of Alzheimer's cases.
3. Get moving! Exercise, walk, bike, swim, garden, do whatever it takes to lead an active life. FACT: Physical inactivity is the greatest contributor to Alzheimer's by 21%! 

My source and link to more information: click here

Understanding Alzheimer's Impact
I highly recommend viewing the HBO documentary: The Alzheimer's Project - Clicking on the link will take to were you can view the documentary on-line. You will need a box of tissue, I have never cried so much through a video as I did with this heart-wrenching account on Alzheimer's impact.

Mom & Dad on their Wedding Day - December 1952

When Mom was Younger

This photo was taken April 2005 - Mom was already showing signs of dementia -  We hadn't noticed that Dad too was showing signs. My sister Joyce and my niece Taylor are also pictured.

Your thoughts are welcomed!

We Remember for Dad

Today is June 19th and it is my father's special day. It is the only date he remembers now. When anyone asks him what day he was born, he is quick to say, "June 19, 1928." But when I ask him what day is today, he says he can't think of it.

Shelley and I spent some time with Dad this afternoon. I read him a card he received from his sister Noemi that made him smile, especially when I read the part that said the card was from "Chata." Shelley then called Joyce so she could talk with Dad. Telephone conversations are difficult for Dad as he gets very emotional. So every visit I give Dad the latest family updates that I get from Facebook or from emails from family. He does seem to enjoy hearing family news.

Dad looking at the card his sister Noemi sent him.

On Friday, June 17th, I took Dad to see his neurologist. Doctor Cokgor diagnosed Dad at the beginning of Stage 7 Alzheimer's (That is the last stage characterized as severe). The condition seems to be progressing rapidly - at least it seems that way to me. Even at this late stage, he could hang-on for years and it breaks my heart to see the man that once was disappear. For all of us, family and friends, who know Dad, it is our memories of his life that I retell for him at every visit. Sometimes he'll give me a quizzical look and say, "I did that?"

So if any of you friends and family that have stories you'd like me to tell Dad then please post it here or send me an email and I'll read it to him. I always start my visit with him by telling him the latest.

This video is of Dad talking to his daughter Joyce in San Antonio. 

Dad Adjusting to Life at Pine Ridge - Not Easy, But Making Progress

Dad has now been at the Pine Ridge Care Center for over a month now and is beginning to adjust to a new routine, which can be very difficult for dementia patients. Shelley and I try to visit Dad three to four times a week and Tabitha does the same depending on her schedule.

Dad & Shelley during one of our visits.

When we visit, we make it a point to go around different meal times to help him make the most of his dining experience. When his food is brought to him, the dishes, cups, and glasses are covered to keep the contents warm. However, Dad is at a point in his dementia progression where he will not uncover his food automatically. He is not always sure how to lift a cover to get to his food so he'll skip a meal. Sometimes he is even confused about when to use a fork versus a spoon. So, when we are there we make sure all his food is uncovered and, if necessary, we cut his food into bite-size pieces. (We continually provide "feedback" to the staff so they can help him at the times when we are not there.)

He eventually ate everything and he has had a shave since this photo.

Yesterday, Saturday evening, we visited Dad along with Bruce and Bonnie. Dad was very happy to see us all, and he gets very emotional and weeps often.

During past visits with Dad we've called his brother Joe and his daughter Joyce so he could speak to them for a few minutes. Let me know if any of you would like to make similar arrangements.

Dad's latest story that he repeats quite often to all his fellow residents and care-givers, is about the courtyard slab (floor). As most of you know, Dad is a retired cement mason. So whenever he has the opportunity he will tell others how he finished the courtyard slab. He says it took him about a day to finished with no help. Most people play along and others just give him a quizzical look. Here's a photo of Dad pointing to "his work."

Well that's my update for May. I'll post another in June when Dad reaches 83.

New Beginnings Part Two

When I last updated this blog we had made arrangements for Dad to be admitted to The Rafael nursing home. However, too many problems and complications made me look for an alternative. And I found it!

Today has been a day with mixed emotions for me as I had Dad admitted to the Pine Ridge Care Center in San Rafael. We'd been preparing Dad for this day but, as I expected, he has no recollection of our discussions. In fact, I discussed it with him three times today about how he would now be in a place where he would receive better care on a 24/7 basis. All he said to me was, "I didn't know I was such a bother." His words hurt as I knew there was no way I could explain in a way that would make sense to him.

We walk around the facility and showed him the various features such as the patio, main dining room, and sitting areas. Shelley and Tabitha unpacked his bag and got him situated in his room while I sign all the admittance forms.

Dad has a room mate named Mario and he loves to talk in Spanish. Mario is from El Salvador and is confined to a wheelchair. He and his wife, Maria, are very nice and welcomed Dad with enthusiasm.

I will be visiting Dad on a regular basis as will Tabitha who lives one exit away. If any of you would like to send Dad cards or pictures, you can do so to the following address:

David Manriquez

c/o Pine Ridge Care Center

45 Professional Center Parkway

San Rafael, CA 94903

Here are a few photos I took of Dad getting settled in his room. We will be bringing his family pictures to put on his wall and some other personal items to make his room as comfortable as possible.

I asked Dad to try out his bed and this is how he positioned himself.

So I told him to loosen up and so he made this pose.

Shelley, Dad, and Tabitha

Shelley is trying to adjust his bed.

Now he is comfortable!

Around 5:15 p.m. Dad said he was hungry and by 5:30 he had been escorted to the dining room where he sat with three other residents. He didn't even notice we weren't in the room. We took this opportunity to quietly exit so as not to upset him.

I will continue to update this blog with Dad's progress. Also, if any family members would like to come to visit Dad, just let me know and I will help you make arrangements. You all know how to contact me if you have any questions.

Till next time and remember, it's not fun getting old!

A New Beginning

Spring time is a time of the year for renewal and growth. Next month, in the beginning of April, Dad will be moving into his new home, The Rafael. The Rafael is located in San Rafael, California, which is a few minutes drive from Tabitha and about 35 minutes from where Shelley and I live in Santa Rosa. The Rafael will be closer to Bruce too, making it easier for him to visit. By clicking on THE RAFAEL here, it will take you to their website where you can get see the types of services, rooms, and care he will receive.

Once he is settled in, I will provide you all with the information to send Dad cards. I will also continue to update this blog with pictures, videos, and stories related to Dad.

The timing is working out well as Dad has required much more help than what Shelley and I are able to provide. Dad cries on an almost daily basis because he knows something is wrong with him but he doesn't understand what is happening. Most evenings he is confused and will ask, "Where am I supposed to sleep tonight?' He will wander around at night, pacing up and down either looking for the bathroom or just trying to figure out where he is.

On good days, he tells his stories, laughs, and eats well. On typical days he just sits and thinks or sleeps.This coming week will be his last visits to Primrose where he came to really enjoy his visit with his peers and staff.

Here is a short video of one of the times I went to pick him up from spending the day at Primrose. He his finishing his dinner:

Enjoy the video!

Seems Like Only Yesterday

The Manriquez Family - Summer 1964

My Great-Grandmother, Me, Mom, & Grandma 1953

Me & Dad 1953

Dad Says Hello

I took this short RealPlayer video with my phone, so the quality is not all that great and I'm not sure how much you'll be able to hear. I asked him if he'd like to say hello to his brothers and sisters but he can't remember their names, so he looks at the family photo on the wall. He knows who you are...

Here are some photos of recent visits by Joyce, Bruce, Jeremy, Tabitha, and Kevin:

Dad's Latest Visit to the ER

We are becoming "regulars" at the Sutter Medical Center ER. Dad has visited the ER 3 times within a month. Here is what led to his latest visit (copied from an email I send Joyce and Bruce this morning):

Here's what happened. Dad is becoming increasingly obstinate and out of touch with what he can and cannot do. And, of course, he is weaker and loses his balance frequently (this past Sunday he fell 4 times of which I had to lift him 2 of those times and now I have a sore back). So yesterday, after seeing his doctor for a follow up, we stopped to get some burger since it was already 4:00 pm. I told him to go sit on his chair in his room and I'd bring him his food. Everything was set and ready. The next thing I know he is standing holding the TV folding table trying to figure out how it works. I go in and take the tray and tell him to sit down. Of course he is upset because I'm treating him like a child. As he turns around to sit, he loses his balance and falls sideways into the heater.

Now I'm struggling to lift him off the heater, that is on, and his foot is wedged under his bed so finally with Shelley's help we get him up and into his chair. He seems okay, just really pissed off and, not to be out done, I demonstrate that I am more pissed off because he won't listen to me. It gets ugly. And now he refuses to eat his lunch.
I am so upset I had to leave the house. I went to Target because I needed to pick up a new prescription for dad and get more Ensure and Depends. When I get back Shelley tells me that Dad is saying he's in pain and "It hurts like hell."
Shelley calls the nurse on call and he says to go to the ER. Getting ready to go to the ER, Shelley notices he's wet and she wants to change him. He doesn't want to be changed and is literally fighting us. I tell him his choice is to let me do it or I call the ambulance to have him restrained on the board. He relents somewhat and I get him changed.

At the ER, It's is deja-vu. Been here, done this, and it actually goes smoothly. What it comes down to is he has a fractured rib and is now on a heavy duty pain pill. It will take 6 week to heal and will take place at home. We are being given all this instructions on what to do and Shelley and I look at each with a look that says "[insert bad word]!"
So here I am writing to you two as my therapy and  because I'm trying to wake up after another bad night...
If you think this email is long, be grateful I didn't write the long version...

Today he seems to be doing better, however, he still refuses to use the walker and gave the nurses aide a bit of a difficult time for his bath. But it gotten done and he doesn't remember falling or the ER visit. This time, I told him, I took pictures to prove it!

Till next time!

A Traumatic Week

It is just after 1:00 a.m. Pacific Time, I am updating the blog while it's my shift to keep an eye on Dad. My daughter and her husband finished their shift a midnight, while Shelley and I slept. Shelley's shift begins at 5:00 a.m. We are taking turns because Dad has had a traumatic week with two ER visits, both by ambulance, and a 3-day hospital stay.

You all know how the week began from my previous post. Since his hospital release on Wednesday, Dad is supposed to be using a walker at all times. However, his dementia causes him to forget so we have to constantly remind him so that using a walker will become a pattern. Not an easy task!

This past Friday, Dad got out of bed to go to the bathroom, which is about 10 feet from his bed. As I was sitting at my computer in my office next to his bedroom, I heard a loud crash. As I quickly turned around I saw Dad laying face-down in the hallway between his bedroom and the bathroom. Rushing over to help, I notice blood coming out his right side and I could not move him. I yelled to Shelley to call 911 and within minutes the paramedics were here followed by the fire department.

The paramedics were great and as soon as I mentioned that he is suffering from dementia they provided the appropriate assistance. Once again Dad's sense of humor was in action. As the paramedics were assessing his injuries, they had to move his head to which Dad said, "Hey, my head's not a basketball!"

We arrived at the Sutter Medical Center ER around 5:45 p.m. on Friday and there we stayed until 12:30 a.m. Saturday. My wonderful daughter stayed with me and Dad, while Shelley and Kevin, my son-in-law, waited in the hospital's "quiet room." Tabitha helped me reassure Dad and repeated to him what was happening. A few times Dad did not remember who she was. Tabitha held his hand and spoke soothingly to him.

It was a busy Friday night at the ER. In the bed next to Dad was an 89 year old stroke victim that was not expected to make it through the night. Even though the curtains were draw we could hear all that was going on and the very difficult decision the family had to make. He was later transported to a special facility in San Francisco.

About an hour later, another person was brought in by the police. This person was hearing voices and wanted an x-ray taken of his head so he could prove that "chip" had been implanted in his head. It was an X-Files episode.

Finally, in the wee hours of Saturday, Dad was completely checked out, clean-up, and ready to go home. After getting him to bed at 1:00 a.m. I stayed up with him util 5:00 a.m when Shelley relieved me and I got 4 hours of a deep, sound sleep. So here I am 24 hours later on my second shift of Dad watch.

A traumatic week for us all!

This is the Sutter Medical Center of Santa Rosa, CA where Dad  spent most of the week.

Dad's Sense of Humor..Or Is It?

Many of you may already know that Dad spent all day yesterday in the ER and was admitted to Sutter Hospital here in Santa Rosa, CA. His condition is serious with a diagnosis of acute renal failure, however he is responding to treatment. The doctors will be taking tests daily to assess how his kidney's are responding and based on those results will determine what next steps we take. His condition with dementia also limits what treatments are available to him, for example he is not a candidate for dialysis. More on his condition as I get the information from his doctors and nurses and I'll pass it on to you.

And now about Dad's sense of humor. This story was related to me from the night nurse about what happened early this morning:

The nurse supervisor laid her glasses down on Dad's tray-table and Dad picked them up. The nurse said that "those are my glasses" and Dad said, "no they're mine!" Then Dad said, "Prove that they're your glasses." So the Nurse said, "Put them on." And, of course, Dad couldn't clearly see through them. So Dad takes the glasses off and looks at the nurse and says, "Well, you still don't look good."

Seems everyone got a laugh and the story has been making the rounds. Those of us that know Dad know he was serious!

Here are two photos I took of Dad today:

Dad Says Hi to Everyone!