By spring of 2015, Judy had been on Aricept for over a year without any adverse side effects. Aricept helped her memory and made her more self-assured. Getting her on Aricept had worked out. This episode with Dr. Femsby told me to not take a doctor’s recommendation as gospel, but to question what was in Judy’s best interest. Judy did complain once of nausea, but I associated this with her sensitive stomach, not the Aricept. A tablespoon of antacid took care of her malaise.
Late one evening in May, I heard Judy retching in our bathroom; I rushed in and found her bent over the toilet, vomiting. I placed my hand on her shoulder until she finished throwing up and then handed her a damp washcloth from my sink. She passed the cloth across her face and handed it back to me and left the bathroom. I followed her to the kitchen where she opened the refrigerator and bent at the waist as if searching for something.
I leaned back against the sink counter. “What are you looking for?”
“I need to put something on my stomach,” she said. She closed the refrigerator door, picked up a banana from the bowl on the kitchen counter, cut it in half, and walked to her chair in the den.
“Shouldn’t you wait until your stomach feels better to eat that? ” I asked. “Eating a banana will make your nausea worse.”
“I need to put something on my stomach,” she repeated.
I didn’t think a mother of three and grandmother of eight would ever suggest giving a child who had just thrown up something to eat.
I examined her face. She had that determined look of hers. She’s going to eat that banana no matter what I say I thought.
Sitting in her chair in front of the TV, Judy calmly peeled her half of the banana and proceeded to eat it. Almost at once, she sprang to her feet and ran for the bathroom, dropped to her knees, and vomited. I placed my hand on her shoulder thinking stop this foolishness; do what you used to do when our kids had an upset stomach.
Judy washed her face at my sink, smiled faintly, and walked past me on her way to the front of the house. This was so unlike my Judy. Raising three kids alone for extended periods, she had managed with cool deliberation much worse situations than a child with an upset stomach. But now, she didn’t seem able to manage her own upset stomach.
“Would you like some Pepto-Bismol?” I asked.
“I need something on my stomach,” she repeated.
I saw my Judy in her determination, but in her logic I saw a process I didn’t recognize.
Judy threw up four more times that evening. With eyes rimmed red, face flushed, and hair dangling in damp clumps, she looked like hell. I knew this evening wouldn’t end well.
“Want me to take you to the emergency room?” I asked.
Relief swept across her face. “Yes, please.”
I should have suggested this earlier I thought.
I cleaned her face, helped her brush her hair, and got her to the car. I headed for the new Haymarket hospital, only three miles from our house, but thought better of it. That hospital was new and inadequately staffed, so I drove some twenty miles to Oakton. Judy had been admitted there once before and liked the friendly nurses.
Judy didn’t connect throwing up that evening to how she had solved the same issue when one of the children had an upset stomach. When Suzanne, a one-year-old in northern Quebec in 1965, began throwing up, Judy insisted on taking her to the hospital. Suzanne’s severe dehydration kept her in the hospital for three days.
At the Oakton hospital, the ER nurse ushered us into an examination room and probed Judy’s arm for a vein to start an IV drip. Judy didn’t drink enough liquids on any given day to sufficiently inflate her veins to draw blood or hook her up to an IV. Her expression as the needle probed under her skin spoke louder than words she could have uttered. Finally, the nurse found a vein and set up a saline drip with anti-nausea medication. It didn’t take long for the anti-nausea medication to kick in.
Much calmer now, Judy said, “Let’s go home.”
“The ER doctor has to see you before she’ll release you.”
Judy glared at me but remained quiet.
When the ER nurse returned, I told her, “She wants to go home.”
The nurse approached Judy’s bed. “The doctor will release you after she sees the lab report.”
When the nurse left the room, Judy crowed at me. “Can’t we just leave?”
“Dehydration can be serious,” I said. “We need to know how severely you are dehydrated.
A few minutes later, the ER doctor entered Judy’s room and approached the bed holding the lab report. “You’re seriously dehydrated,” she said. “I’m going to admit you so we can continue the IV.”
Convincing Judy to stay in the hospital overnight might be a challenge I thought. “How long will she be here?” I asked.
“Two, perhaps three days.”
“That long?”
“It takes that long to bring hydration levels back into the normal range.”
I stood beside Judy’s bed, watching her for any signs of resistance. She seemed relaxed as if pleased to have someone else making decisions for her. She must have forgotten her dislike for hospitals. Her memory lapses worked both ways.
“Admit her if you think it’s necessary,” I said.
Since this was Friday evening, Judy would be in the hospital over the weekend. On Saturday, I had a Knights of Columbus function and wouldn’t be free to visit during normal visiting hours; I coordinated a visit after 10 pm on Saturday but I feared the night shift wouldn’t get the word.
That night, I approached the guard and stated my name; he waved me to the elevator. When I entered Judy’s hospital room, she lay wide-awake as if waiting for my visit. She looked fresh, her hair neat, her lips in full color. She had made friends with the nursing staff. Shortly after I arrived, Jenny, the night nurse came into Judy’s room for a chat.
“She’s our favorite patient,” nurse Jenny said.
“Don’t get too attached to her. I’m hoping to take her home tomorrow.”
“If she keeps improving like she has been, she’ll be released in the morning. I was just telling her; she doesn’t look old enough to have a thirty-year-old grandson.”
Judy smiled. “Well, you know I’m 73 years old.”
Mouth agape, nurse Jenny grabbed Judy’s medical chart tied to the foot of her bed, opened it, and stared, obviously checking the date of birth. She looked at Judy. “I sure hope I look as good as you do when I’m 73 years old.”
Judy’s dementia hadn’t affected her looks.
Judy was released from the hospital on Monday morning. On the way home, I thought about her inability to come up with a viable solution to her nausea. This didn’t bode well for her handling unusual incidents in the future. I worried about what effect her inability to reason to a suitable solution would have on future events. For the first time since Judy’s diagnosis, an Alzheimer’s-caused episodic event called for changes to our lives. I would have to be more alert for situations where Judy might be unable to fend for herself. I was pleased with myself for suggesting going to the emergency room; for someone who had never been in a hospital, suggesting going to the emergency room had seemed like the right thing to do.
#
Switching to Aricept had not abated Judy’s migraines. A Sumatriptan taken with an extra-strength Excedrin had been keeping the headaches from becoming severe but didn’t address their cause. I thought that dust in the bedroom and den where Judy spent most of her time might be triggering the headaches. Over the years, I remembered that Judy had some adverse reactions to dust. Removing dust from those two areas might prevent her migraines.
I dismantled our queen-sized bed, washed its frame and vacuumed the carpet under the bed, then ran the vacuum over the wall behind the headboard, and the curtain valence across the three-window expanse. I dusted pictures on the walls and the wall surfaces, cleaned the things on the lamp tables beside the bed, polished the bedroom furniture, and took the queen-sized bed spread to the dry cleaners. I then hired professionals to clean and spray the air conditioning ducts throughout the house. Finally, I did a cursory run through the den.
Judy’s headaches persisted, but with less frequency and less intensity. Could Alzheimer’s be the culprit? I didn’t know. Nothing I had read mentioned Alzheimer’s as a causal factor for migraines. I continued to treat the migraines with Imitrex and Extra Strength Excedrin and they eventually disappeared altogether.
Online research revealed that Aricept caused nausea in a small percentage of patients. Judy was so sensitive to medications that she would be a prime candidate for this reaction. Since I thought that Aricept abated Judy’s Alzheimer’s symptoms, I continued its use and Aricept became Judy’s long-term solution to addressing symptoms of Alzheimer’s. An anti-nausea prescription from her primary care physician addressed her nausea.
At this stage, even though Alzheimer’s adversely affected Judy’s ability to reason, she wasn’t a danger to herself or to others. Despite her memory issues, that loving, easy-going Judy who looked out for her loved ones hadn’t changed. I didn’t consider her at risk leaving her at home alone.
I realized that things in our future were unpredictable and wished for more information on what we were likely to face in the future so I could better prepare myself.
Judy’s reactions during the following year were mostly those of her normal self. For her 74th birthday on June 9th, 2015, I ordered her three dozen red roses; Judy loved roses—she had kept a rose garden the whole time we lived in Centreville. The florist delivered a magnificent floral arrangement with small white flowers interspersed with greenery that presented a beautifully impressive arrangement. Judy made room for the huge vase on the dining room table. Those roses lasted two full weeks. Every evening, Judy went into the dining room, stood at the edge of the table, and uttered, “These roses are so beautiful!”