Judy’s sensitivity to medications made me watch her for adverse reactions to the Exelon Patches Dr. Femsby had prescribed. One morning in July 2013, when I woke her up, she raised her head from her pillow, forced her eyelids apart, and stared at me through bleary eyes.
“…too tired to get up,” she mumbled as her head plopped back onto the pillow with her eyes closed.
“I’ll come back in an hour,” I said.
When I returned, Judy’s face lay flat on the pillow, her eyes closed, her body motionless, sound asleep. I let her sleep for another hour. When I got her up, she dressed and came into the den. Once seated in her chair, I handed her a warm breakfast roll. Judy loved Cinnabon rolls; she had asked me to see if I could get her some at the grocery store. I found exactly what I knew she liked.
“That medicine is turning you into a zombie,” I said.
She yawned in my face. “I feel dopey all day.”
“The doctor said to call him if you had side effects. I’m gonna get this prescription changed.”
I called Dr. Femsby.
“Let’s try Namenda XR,” he said. “It’s one of the new medications.”
There was something wrong with this picture. These medications were to reduce Judy’s fear and anxiety, but I had seen no signs of fear or anxiety in Judy. Her current problems were focused on memory issues. I later learned that when the destructive effect of the disease reached the amygdala which was positioned near the hippocampus, it caused feelings of fear and anxiety. Judy hadn’t progressed to that stage. I wondered if she even needed these medications but concluded that the new medications might reduce the severity of her memory issues by reducing the effect of the disease’s symptoms.
I started her on the new medication; two weeks later Judy sat in her chair bent over in pain.
“What’s the matter?”
“My stomach hurts and I have a migraine.”
The stomachache didn’t surprise me; new medications often caused Judy gastrointestinal issues. But the migraine concerned me. Judy hadn’t had migraines in decades. I recalled that Imitrex had controlled her migraines decades earlier; I got her a prescription for sumatriptan, an Imitrex generic. I recalled that an Imitrex taken with an extra-strength Excedrin stopped the migraine from developing into a full-fledged headache. I started treating her for migraines.
Judy’s parents had both taken medication for Alzheimer’s, but I didn’t recall which medication. I queried Judy’s sister, Susan, and learned that both had taken Aricept, which worked for them. My thinking was that Aricept had passed the time test and would be more suitable for Judy. I contacted Dr. Femsby about changing to Aricept.
“There’s another new drug we can try,” Dr. Femsby said, and he named it.
“With Judy’s sensitivity to medications, there’s not enough data on these new medications to decide if she’ll have an adverse reaction to them. Aricept has been around for a while.”
“I’d like to stick with the new medications. We have to find the one that works without causing serious side effects.”
Femsby wasn’t considering Judy’s sensitivity to medications. I wondered if it was true that doctors never took kickbacks from drug companies. I hung up.
“It’s time to change neurologists,” I told Judy.
“I never liked Femsby,” Judy volunteered.
I got the name of Dr. Stephanie Cochran from our primary care physician, and we changed neurologists. At our first appointment with her, I explained Judy’s history of side effects with medications.
“Let’s see how you do with Aricept,” Dr. Cochran said to Judy. “It’s been around for a while. It works for most people with Alzheimer’s. Aricept comes with some minor side effects, but none that you can’t deal with.”
I started Judy on Aricept. Soon, her memory and alertness showed marked improvements with no observable side effects. Even her migraines seemed to have tamed down a bit.
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In April of 2014, Judy and I took a trip to Oklahoma City to help our daughter, Suzanne, celebrate her fiftieth birthday with her two children, son Jeffrey, and daughter, Alyssa; they both had jobs in or near Oklahoma City. Since our route took us via interstate highways most of the way, I drove great distances without stopping.
For Suzanne’s birthday, we took Suzanne and her two children with their significant others to dinner at a Japanese restaurant where we all sat around a table-grille with a pit in the middle. Judy and I had grown to love this Japanese-style cooking during our four-year stint near Tokyo where the chef’s deft hand skillfully twirled shrimp into the air and directed them with his spatula toward the mouth of the intended diner guest. In Oklahoma City, our chef stood in the pit flipping and twirling his spatula, moving the searing sizzling meat and vegetables around, swirling aromatic around the area to whet the appetite. On this evening outing, Judy remained passive, but she answered questions if they were directed at her.
A few days after we got home from this trip, Judy developed abdominal pains she thought were from a UTI (Urinary Tract Infection). She made an appointment with Dr. Highlander, our Primary Care Physician, who prescribed a strong antibiotic. Judy took all of the pills, and the UTI was cured. However, a week or two later, the abdominal pain returned. She made an appointment with her urologist, Dr. Couvillion. When we arrived for that appointment, the nurse escorted us to an examination room.
“We’ll need a urine specimen. The room is across the hall.”
Judy forgot that she usually brought a urine specimen to her urology appointments since she had trouble peeing on demand; on this occasion, which didn’t seem to be a problem.
When Judy returned, the nurse pointed to the examination table with stirrups. “You can remove your pants and underwear and put on this gown. The doctor will be in soon.”
Dr. Couvillion came in and examined Judy then rolled his chair back and faced her.
“As a person ages,” he explained, “for a UTI, the strong antibiotics kill bacteria in the urinary tract, but a small amount of the bacteria lodge into the urethra walls to survive for another day. When those bacteria dislodge from the walls, they develop into another full-fledged UTI. The way to fight this, is to take a strong antibiotic for an extended period.”
Dr. Couvillion extended her antibiotic prescription. Judy’s UTI symptoms disappeared but the antibiotics wreaked havoc with her gastrointestinal system, which we treated with over-the-counter medication.
In researching the UTI issue, I learned that taking strong antibiotics could worsen the degenerative effect of Alzheimer’s in some people. With Judy’s history of adverse reactions to medications, I thought the strong antibiotics would worsen her symptoms of Alzheimer’s. But she needed the antibiotic to address her UTI. I watched her closely while she was taking this medication but didn’t see any changes in her condition.
Since driving without stopping on long trips was a causal factor in Judy’s UTI problem, my approach to travel was to fly if we would be travelling for an extended distance; that avoided the possibility of Judy coming down with a UTI caused by our travels.
Judy’s disease up to that point presented an occasional disruption but hadn’t significantly changed our lives. We continued our Friday evening dinners out, and afterwards, visited our grandchildren. I remember thinking at the time this Alzheimer’s thing isn’t all that bad.