How do I talk to Mom's doctor?
I've provided a lot of details in my other posts here about her behaviors, so I'lll keep that part brief.FWIW I generally like her doc. But I have raised concerns with him before, privately, and was surprised to see hat his office basically said evertyhing was fine because her labs were good. She did say they gave her a basic "are you having thought s of jumping off a cliff" depression screening, which she passed. They set her a follow up for 6 months out. (She's 76).
Today was the appointment and quite honestly, I dragged my feet calling the doc because I didn't know what to say. So the appt came and went, with(thankfully) her labs being fine, and a followup appt 6 mos out.
Here's the thing. I see issues. I see confusion quite often, trouble understanding things. Some daily tasks are too much for her (the remote control for instance). She relies a lot on notes. She sometimes shakes. She is often irrational when presented with something and shuts it down, although that may be from lack of understanding combined with overwhelm. She is childlike, dependent, clingy, some of the things she says are, I'm sorry, but just embarrassingly dumb. She is also heavily anxious to the point of dangerously raising her blood pressure when scared, all the time and loops on things.
That said, she can also be demanding, stubborn, and refuse to do or try even small things if they are new. So it's possible she refused anything other than a blood test since she prefers to "heal herself."
i have raised all of these issues with him and she comes back with a clean report. I'm not sure what to say to him because she's not doing the typical Alzheimer's things, like forgetting (except when she;'s stressed - when she's baseline, (these days her memory is better than mine). She's not forgetting what the car keys are for. She's not making appointments and then insisting she didn't do it. She recognizes people. She is having trouble doing simple things on bad days, but generally can manage her finances (well maybe not completely, because she wasn't provided for before my dad passedI but she can manage her acct, etc.
All this makes me think that maybe she's not got dementia although something, now as in the past, is definitely not right.
I've already raised these things with the doctor. What is the best way to appraoch it again? Should he have done something different? What should I be looking for? What should I say?
She would likely resist any meddling of mine in her health affairs (so it has to be on the down low) and resist any test her would ask her to take. He may have also decided it's best not to stress her, since any test would make her anxiety loop for months. When I take her to the doctor, she is so stressed that day and before and after that she can barely function.
What should I be watching for/asking about? And shouldn't se have more frequent checkups at her age?
Thx in advance
I told her that i might at some will be moving out, that the situation was working alrgitht for us right now but was not long-term, and that might mean relocating close-by (in-state) for work. I don't anticipate doing that(relocating) though. but you never know.
I told her that if she is uncomfortable being alone we can get her a medical alert button. She laughed at that too but I think the point was made.
If there were genuine medical issues going on it would be a different situation- broken hip, stroke, etc, so that's a grounded fear. But at this point it's mostly anxiety and dependence along with a basic level of care such as household tasks/business, driving etc. Be a babysitter to her anxiety disorder? Over it.
It was helpful to just confront this head-on and it helped to dissipate some of the anger so that I can sleep tonight. This board has been very helpful.
I think if I was on my own now, I would seriously move into a retirement community, have my own nice condo, and make some new friends who would be just be down the hallway from me. A very short walk to the on-site doctors if I was having any issues.
My mother was resistant to any testing for dementia for a couple of years after I got here. In her case, I don't know if diagnosing cognitive impairment would have been useful. Her problem is more with reasoning than memory, so I don't know if any of the dementia drugs would have helped. As my mother became more impaired she opened the gate for me to help more. This may happen with your mother, too.
It would be great to live on our own again. I've been feeling like I'm getting lost. There's nothing to stop us from rebuilding a life from where we are. It is what I am aiming for. I hope you're able to get a good job close by and set up help for your mother when needed. That would help things fall in place for you. I get the feeling you are doing a good job with a difficult situation.
It's hard because she's here. My original plan was to live a few hours away but she insists she wants me in town in case she "gets sick." At first i was angry at what i viewed as pure manipulation, but now that she is having some real issues cognitively II'm not so sure that's all of it. It would be heaven to live two hours away (a thousand miles away) but I think she needs more help. II don't think I could send her to a home because it would be awful for her. She would be so unhappy. I can't wait to move out of here and get back to some kind of independent life though. Even if close by. But being able to make a living will be an important factor.
You can, of course, just continue as you are. But even then, to maintain your sanity, you should seek counseling and perhaps meds to get you through this.
=)
Originally the idea was to coach her on things to try to make her more independent, but she's so resistant to anything new and unable to handle some tasks such as shopping I no longer think that's realistic, especially after seeing her struggle with sequencing some tasks. Sometimes she seems ok (for her, not really 'normal' per se) but when pressed with stress she becomes confused and usually needs to be rescued - by the sales person, by someone who notices, etc. I think it's genuine at this point and not pure manipulation. So I think the goal of her being fully independent is unrealistic, although partially independent is doable. When she is under less stress she is much better. I would like to see her get a cat scan though or something objective to evaluate her. ALthough her memory seems to be decent at this point other than an excessive reliance upon notes, which might be excused due to her age and confusion.
If it was just anxiety it would be one thing, but combined with a certain amount of confusion that the anxiety makes worse, there are secondary issues.
I will keep a log and talk to the doc. It's frustrating for me because I end up being a babysitter (literally, "taking" her to the store because she "can't handle it"), but it does appear to be the case that she "can't handle it.' I guess what I am saying is that i resent being a babysitter, but there are so many cognitive and physical issues that kick in for her I would be afraid to just turn her loose to, say, the grocery store for fear she would become confused or so anxious she could not function on her own.
Man how I hate this. I really, really hate this. Sorry but that's the truth. I'm trying though to deal with it and to get better but I spent about 80% of my time outwardly helpful and internally angry.
If she had been willing to do something about her anxiety years ago it would not be this bad. And she won't do anything about it now, which leaves me with the lifelong role of babysitter. It's infuriating. But I don't think she's capable of helping herself or being turned loose. She finds tasks such as the gas pump and the credit card swipe very overwhelming.
Disorders other than dementia can cause irrational behavior.
If she isn't being followed for a chronic condition (COPD, CHF, diabetes, etc.) the 6 month schedule sounds OK to me. But I'm wondering if she is seeing the right kind of doctor. As Jessie mentions, a Geriatrician would be a good bet. Or a geriatric psychiatrist. Or a behavioral neurologist. But how would you convince her to accept such an appointment? If she happens to acknowledge that she has a lot of anxiety, you could say, casually, "Did you know there are doctors who specialize it treating anxiety?"
I suggest keeping a notebook of the irrational or out-of-character things she does -- the things that concern you. Before the next 6-month appointment summarize the notebook. Send it to the doctor ahead of the appointment. Ask for a referral to a specialist (if you haven't gotten Mom in to a specialist before that.)
It sounds like her behaviors are annoying and concerning, but not at this time urgent or dangerous. Get her into a specialist if you can. Document your concerns for the next regular appointment if you can't.
Doctors many times do ignore signs of dementia. I can understand, since there is usually no cure and diagnosing it can cause distress. So they let it go. If you do want your mother to be evaluated to see if there is something that can help, schedule her an appointment with a geriatric specialist. They know what to look for and are not afraid of the word dementia. The doctor may also be able to refer you to a geriatric psychiatrist who can work with the psychotropic medications to make your mother less anxious and more comfortable.