The Alzheimer’s Plateau

Tonight I watched Jon lead Bo from the kitchen to the family room,  Jon walking backward with Bo’s  hands in his. Bo moved with mincing steps, unsure of where to put his feet, pulling back, as Jon  pulled him along.  “Stand up, look at me,” Jon said.  Bo’s shoulders were bent, his head down;  he looked so old and weak.

In my heart I see a tall, healthy man — a tennis player, a golfer,  a skier, an enthusiastic guy headed out for his next activity.

But this is what we see  now.  We  lead him from one place to the other, making sure he doesn’t fall and that he understands where to go.  Often our instructions,  like “Turn around”  or “Sit down here,” make no sense to him. We tell him to lift his arms but he tries to take off his socks. We repeat then repeat again.  Sometimes he needs physical pressure to get him to step or sit. Sometimes he thinks the floor has depth and tries to step over a flower in the carpet or over the edge between the carpet and the hardwood floor.  Stairs seem to scare him.

People have always told me that the way of Alzheimer’s is decline from plateau to plateau, always downward, and it’s what we’ve experienced over these nine years.  For several months he has been on one of these plateaus.  There has been little change.  At night he sleeps without turning — anywhere from 12, even 14,  to 16 hours.  We keep the baby monitor on so we can check on him,  go to him when he’s restless.

In the morning each day,  I  awaken him to make sure he’s clean and dry, and then he goes back to sleep until Jon (or Cynthia) gets him up about one o’clock, gives him orange juice, then showers, shaves  and dresses him. Occasionally he’s so weak that we let him rest a while before going downstairs, but most days he is able to walk the steps with help and have his first meal of the day at the kitchen table. Then he sleeps on the sofa until dinner.

His eating is unpredictable.  Sometimes, like last night,  he picks up the fork and eats his food, slowly and messily, but he is in charge.  Others,  we feed him, reminding him to raise his head or even wake up for the next mouthful.  His old passion for ice cream has waned. Some times we offer it and he asks, “What’s that?” even with the dish in front of him.

Although I say he’s been on a plateau,  I try to gauge the changes  over this past year.  Jon has seen a big drop. Cynthia, who has been helping us since June, says she also has seen a decline.  This rotten, cruel disease just moves at a snail’s pace,  taking Bo away from me,  from one plateau down to the next.

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Mattie, the YorkiePoo


There’s a new visitor at our house:  Mattie, the YorkiePoo.   He comes with Cynthia, our second caregiver,  dressed in his latest outfit or  sometimes just  in his “jammies.”  He rides in his own little car seat then comes into the house in his soft side portable carrier.  Mattie’s a show all his own —  cute, funny, extremely spoiled  —  a little piece of lovable entertainment every time he visits, which is every time Cynthia cares for Boris.  So he’s here at least 2 days a week.


Mattie weighs 6 pounds; my Emma weighs 71.  Emma’s bed takes up a huge space the size of a rowboat at the end of the family room; Mattie’s bed is the size of a frying pan.  He also  has his own soft-side playpen sitting by the fireplace, plus  his own plush blanket.

Mattie has toys of every kind, all new and tidy;  Emma has a basket of ragtag stuffed animals that no longer have stuffing or shape.  I said to her the other day,  “It’s a darned shame that you live like an orphan.  No decent toys.”   The difference is, of course, that Emma gets a new toy and in 15 minutes it’s in shreds. Then she chews on the shreds.  Mattie also has various collars and leashes to match his outfits, a rain jacket and a hoodie. Emma has one collar, one leash, and a thunder shirt that she refuses to wear.


Mattie comes in the door and Emma heads for her spot on the sofa, announcing that she has the most important place here. Mattie’s  goal all day long is to get to her, to sniff her, clean her eyes, and in general bug her. Emma will  sit and let him circle around her for a while, then she gives that low growl that she would have given to her own puppies — a warning to “back off,  I’m tired of this.”  I actually think she likes him though  because sometimes she  goes to Mattie and  just sits watching  him. I think she’s curious … and dismayed.

IMG_2262Mattie’s favorite spot is in Cynthia’s arm. She picks him up, cuddles him and he falls asleep, his little head nodding.  If Cynthia leaves the room, Mattie cries and barks until she returns. Emma watches this with one eye open, and I  wonder what she’s thinking.  Something like, ” Is this noisy little guy really a dog?”

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What else?

Are the stars misaligned? I can’t keep up with the things that are going wrong …. hoping it all ends today, the last day of September.

First,  of course, I had my knee surgery so I’m essentially out of commission.  Still no driving for a couple more weeks, so no trips to the store or bank or …

Ever since the hot dry weather attacked us in August and September, my trees and bushes have been under stress and attacked by insects.  Had to remove my plum tree,  take huge pieces off the Japanese cherry and laurel hedge, have sick azaleas, rhododendrons, lilac and pachysandra.  I really love my yard and spend a lot of time maintaining it. I had a contract with a local man who obviously didn’t do his job despite my calls, so  this week I signed with a new service to treat everything.

I sent my car to Conte’s for a wheel alignment and found out I need new tires.

I’ve finally given up on the front yard, which has been struggling in the heat for several summers.  It has more brown than grass and needs to be sodded.  Bite the bullet.  Do it.  I don’t want our house to look less than it did when Bo was in charge.

And then there are the hardwood floors throughout our house.  Again, Bo was the person who maintained them.  He did the hard work, the stripping and waxing.  I did them myself twice when he wasn’t able to do it,  but it’s too hard;  I can’t do it anymore. I’ve searched  for someone to do the job.  No success.  So now I’m faced with floors that are badly in need of care after two years of heavy use.  Looks as if I’ll have to have them polyurethaned …. another lovely expense.

So,  there’s the car,  the sod, the insects, the floor,  and  ….. oh, yes, —  the piece de resistance!  Yesterday, my refrigerator died.  Just died.  Bad compressor, the repairman said.  “$800 for a compressor, lady.  Might as well buy a new refrigerator.”  Great. A fast decision and shopping on a bum knee.  Jon has to get me to the stores.  The measurements of the refrigerator opening are smaller than needed for your average refrigerator, so that adds to the problem.  Got to find the right one.  I am not happy.

And, as I add to so many of my blogs now,  Bo has no idea of any of this.  I’m the caregiver and the caretaker.  The decision maker and the bill payer.  Just me. I hate this.

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The way things were.

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Knee Surgery … over!

I did it.  Had my knee replaced this past week.  I could have waited, but for what … ? For more pain and less mobility.  Last year I had arthroscopic surgery on it, but the arthritis set in and soon my knee was permanently bent.  When I walked Emma, it hurt; when I tried dancing, it hurt terribly for four or five days after.


So,  I scheduled it, and now it’s over — already a week of recovery, the worst week,  the week  living on a buffet of drugs.  One day I didn’t take them in time, and I learned — there’s a reason why I’m taking these pills.  Now I’m beginning to feel a lot better, am more mobile,  and am doing physical therapy.

Actually, my recovery was complicated by a respiratory infection I came down with right after coming home (one day after surgery.)  I had a fever and coughed and coughed,  but it is subsiding too. Friends called to tell me they would take me to the doctor today, but I may not need to go.

I actually went upstairs and slept in my own bed last night after nearly a week on the family room sofa surrounded by all of the things that make a “hospital” room. Time to clean that up.  Sleeping upstairs worked out fine.  The cat was very happy to have me back,  and this morning Emma came up to awaken me just before eight when Vern was arriving for her walk.   This meant that Jon got a good night’s sleep.  Cynthia will be here at noon today with her little dog Mattie, who deserves a whole blog just about him!

Two  friends, Pamela and Michele,  took me to Penna Hospital  for the surgery (in the city at 5 am) and stayed throughout the day until I was settled in my room. Jon had to do the long night hours with Bo at home last week, and  Cynthia came weekdays so he could sleep and she could look after me too.  Our  friend, Vern, comes every morning to walk Emma, who sits with her nose in the door now waiting for him and his morning treats. She’ll be so spoiled. My friends have all been wonderful — calling, texting, stopping by with gifts.

Bo, meanwhile, has absolutely no idea any of this happened.  One day when he walked past me (here on the family room sofa with the walker and a cane propped in front of me,) he looked questioningly and I said I had hurt my knee.  “Oh,”  he said.   Later, I think he said something to Jon that seemed to question hurting myself.  He is slowly becoming so remote that he doesn’t seem to connect every day events to anything real.  He’s weak, doesn’t eat much,  forgets he’s eating,  and sleeps on the sofa.  (Do I write this in every blog now?) Yesterday he had no idea I am his wife, but then I haven’t been with him for a week.  Does it make a difference?

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A New Reality …

(This blog continues the August 2 post,  “Some Days are Just bad ….”   Jon and Adriana left; we had another caregiver during the week, then I was alone with Bo for three days.)

Jon reminds me that every time he’s away,  Bo declines and Jon has to “bring him back.” Well,  it happened again.   Since Bo had been doing rather well up until a few days before Jon left — I could get Bo up and put him to bed,  go up and down the stairs with him,  cook for him,  sleep with him at night — the plan was that Cynthia would come the first six  days from 1-10 pm, and I would do nights, but then I would handle the weekend alone.  That was the plan.

But the plan didn’t work. Bo declined so drastically — so quickly — that he was barely conscious;  so weak that I couldn’t get him out of bed because he might fall.   He was sleeping nearly all  of the time;  we could feed him small amounts of food but it required getting him sitting upright which was hard to do. He couldn’t follow  directions to move toward the pillows or roll over.   Getting pills into him was more and more difficult (crush them,  sprinkle them,  mix them with chocolate ice cream and chocolate sauce;  even mixed a crushed pill into a spoonful of orange marmalade.)

As the week progressed,  his continued decline was different from previous ones.  I saw new changes.  By Friday, when Cynthia left at 5, I was dreading the weekend.  She would  return on Monday noon. That meant that  I was to be  alone with Bo almost 72 hours. By Saturday evening after 24 hours alone,  I was almost desperate.  He was getting harder to move, to turn, to change.

In addition, on Friday he became more agitated — not really the right word — but he simply didn’t stop moving, especially his arms.   While sleeping  he would reach his arms out as if to touch something, then pull at the sheets,  then wave his arms around again.  Was he seeing something?  Was he having hallucinations?  We have anti-agitation meds which I gave him, hoping he wouldn’t feel as restless as he appeared,  but it didn’t calm him.

Also,  his sleep apnea set in, so extreme that his gasps for air could be heard throughout the house.  For the first time, I couldn’t sleep with him.  It was impossible.  I tried the floor,  then the hallway, then finally, I moved to another bedroom and hoped he would be safe in his bed because he hadn’t moved  for days.  I watched him on the baby monitor. He was  lying there moving his arms, pulling at the bed pads and sheets with his background of  heavy snoring and yawning. Sometimes when I walked quietly into the room,  he tried to talk to me between the snores as if he was asleep and awake at the same time, but he had no real communication left,  just gibberish.

Miraculously,  on Sunday morning Cynthia texted me that she could come in the afternoon to help me. I can’t describe how relieved I was, how grateful. She was with me from 2 to 7 pm. She bathed and calmed him and together we turned him on his side so for a few hours his apnea was quiet. She insisted that I LEAVE THE HOUSE to get a break. Emma and I just drove around, then stopped to visit a friend for a short while.

I called Hospice and asked that Bo’s nurse, Ronnie, visit us on Monday morning.  “He’s aged 10 years in the past week,” she said when she saw him.  He was so weak and unresponsive that we discussed some new things:  a reclining chair, a hospital bed,  an additional caregiver, what I will do if/when he stops eating … the kinds of topics that I have avoided.  When Hospice first began coming to us,  they sent oxygen and I hid it in the back of our closet.  On Monday when he had extremely bad apnea and was struggling to breathe, Ronnie suggested using it but  I didn’t;  I knew Bo would pull it away immediately.

Did he have a urinary tract infection?  Was it constipation?  TIA’s? We don’t know.

And so the nine days passed and by the time Jon returned on Tuesday, Bo was a little better, but Jon saw the difference in him.  This bout took its toll, although  after a few days, Jon had him back downstairs.  Bo is changed though.  It’s as if there’s less life behind his eyes…  not blank, but often unfocused, sometimes asleep.

For me, it was a rough nine days of decline,  and during that time, I had to face a new reality: I need more help.  I can’t — I don’t want to — do this anymore.  And so Cynthia is coming to help regularly when Jon has days off.  I still do nights and mornings while Bo  sleeps. But I’m tired;  we’re both tired, and Bo isn’t really living.  It’s so hard to watch.

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And summer comes to an end

Can’t believe it’s already August 22 and the last Adult NancyCamp event was last evening:  a 2-hour leisurely boat ride around Philadelphia.  It rained a little but it didn’t matter.  We had a good time. In a week the children will be back at school and their events will end.  One last, big one remains –  a trip to New York City next Sunday.  The Times Square Disney store is high on the list.

Despite all of the difficulties  this summer ( Bo’s declines,  my time alone,  searching for a second caregiver to provide extra help, new challenges with his illness)  my summer had some absolutely wonderful moments.  I did the things I love most:  visited museums, gardens, mansions; had afternoon tea and  lovely luncheons and even fit in a couple of concerts. All with good friends.  It looks as if Adult NancyCamp may be here to stay.

While I thrive on these outings, poor Bo sleeps,  sits passively with his head drooping,  is confused,  has difficulty understanding how to eat.  He went from the high point of visiting Jon’s garden one evening to an extreme low point when we thought he may be going unconscious.  We needed a hospital bed, help from Hospice.  It was terrible.  But he rallied, although not back to where it started.

His eyes look less bright,  his answers are slower and less cogent.  He taps me in bed and asks who I am, then when I tell him,  I’m not sure he understands.  Yet the next day he may be calling for me.



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Some days are just bad ….

Yesterday was one of those days, the really difficult kind that you can’t explain. Bo had been having a slump for 3 or 4 days — confused, not as strong, needed to be fed to keep the meal going.  Then came yesterday.

Early last evening Jon and family left for 9 days and I was alone with Bo.  He was on the living room sofa sleeping, as usual.  I prepared his dinner, then went into the room to get him up to come to the kitchen. (Jon was now gone perhaps 45 minutes. ) Bo got up with much effort on my part, and then I realized he needed very badly to stop on the way.  The bathroom is in the other direction, so I got him headed that way, holding both of his hands and walking backward to sort of pull him along.  But he wasn’t strong enough, nearly fainted, and we stopped at the base of the stairs, which we had to pass, where he could hang on to the banister while I figured out what to do.  His knees were buckling.

I ran outside and got a metal lawn chair,  grabbed a waterproof bed pad on the way, a rubber backed rug from the bathroom and got him seated.  As I kept saying,  “I’ll be with you in a moment,  don’t move!” I got a basin of water and supplies to correct the situation right there in the front hall.

When I was finished re-dressing him, I tried to get him into the kitchen.  He took 4 or 5 steps and hung precariously from the railing, so I got the chair behind him and he sat down.  Then I just put a TV tray in front of him, got myself a chair and his dinner, and fed him  there in the hall.

Friends were coming in about an hour to watch a movie, so I  propped Bo’s head on a pile of pillows on the TV tray, soothing him  and rubbing his back until they arrived.  Then Rodney and I started the job of getting Bo upstairs  to bed. FullSizeRender It was such a difficult job.  Jon knows how to handle handicapped persons so when this has happened in the past, he almost carried Bo to bed.  (One time he actually picked him up in his arms like a baby and carried him to the car.)

When we got Bo standing, our arms around him,  he couldn’t move because he didn’t know how to move his legs.  So I got in front of him and backed up the stairs,  pulling him and encouraging him with, “You can do this. You can.  Lift your leg,”   as Rodney actually moved his legs forward until he completed each separate movement.  My pulling him up helped. Finally we got to the top  where he fell to his knees and climbed the final three steps and into the bedroom where we were able to get him onto the bed. Not an easy feat.

I tucked him in,  turned out the lights and watched him on the baby monitor downstairs.  He didn’t move. I think this may just be part of the ups and downs of Alzheimer’s, but the timing was unbelievable.

It’s hard to know what to expect today. Will he be equally as weak?  or not? I plan to leave him in the bedroom and go there with him rather than risk the stairs.

Friends will be here this evening if I need help.  His other caregiver will be here afternoons and evenings all week, but I’ll probably be alone with him again next weekend until Jon returns, either Sunday or Monday.

On bad days like this,  I joke with friends, “This wasn’t part of the bargain.”  But it was.

(I am posting this story with its details because  people ask me what advanced stage Alzheimer’s is like.  This decline combined with his inability to finish sentences makes Bo so sad and, surely, he must be terribly frustrated.  I know that I am.)

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Because It Feels Good

I just taught Bo how to eat ice cream with a spoon.  Half an hour ago, I taught him how to eat baked beans.

Knowing that I should keep my mouth shut,  I still asked him,  “WHY do you do that?”

“Because it feels good,” he said.

I was stunned.  My question was rhetorical;  I didn’t expect an answer.  I was voicing my displeasure at something he did.  (Why do I do that?)

Because it feels good.  Is that really why he puts down his fork and eats with both hands? Why we now put a towel on the table in front of him to catch the food  that he drops or sometimes just puts there? Or did his real response get caught in his internal  map that seems to re-route words and ideas so that they come out garbled?

I’ll never know.

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The Garden


Jon has a garden.  He fenced it in, built a swinging gate and a compost box, raised his beds and even built a double birdhouse with solar lighting!  It’s a few blocks away in our community gardens… a wonderful place to take Bo and Emma for time out in nature.  Bo even has his own chair there.

It’s not often that Bo goes, but last night Jon took him (and a big cup of ice cream) to sit  while he checked on his tomatoes and corn and harvested some beautiful vegetables.

I drove Emma down to take a walk, but she had only one thing in mind:  get to Bo. And when she discovered him eating ice cream …. !  They ended up sharing the same spoon.  Oh, well.


It’s hard to believe Bo could even be sitting in the garden after the year that he has had.  I’m not sure he understood what he was doing there, but in his usual easygoing nature,  he just seemed to enjoy it.

I left with Emma, then Jon  finished pulling weeds and they went riding … and riding … and riding.  Came home at midnight!  He said Bo was enjoying himself so much,   keeping time with Jon’s loud music, “conducting” with his hands,   smiling and laughing,  that he just kept on driving.

The thing is that Jon can do things with Bo that I can’t because he’s strong and can handle any situation.    If Bo needs help walking or needs a restroom,  Jon’s there to help him.  I wouldn’t take him to the garden or to a picnic in the park because if he became too weak to walk, as often happens,  or if he fell,  I couldn’t handle it.  Jon can.



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Three Days Alone

While Jon and his family were on their trip,  I had a part-time caregiver, a wonderful woman who is kind and efficient.  But she wasn’t here every day so I was alone with Bo for three days…in a row.    Three days over the Fourth of July weekend.

Those three days emphasized, once again,  what caregiving 24-hours a day means:  Always on watch.

Luckily,  I now have a baby monitor so I can watch him from downstairs while he’s still sleeping upstairs.  I can sit on the patio or do yard work by keeping the monitor with me.  But I can’t take the dog for walks or drives, go to Starbucks,  shop for a few groceries, or run to the bank. Can’t take a nap.

I need to be there when he gets out of bed , walks from room to room,  goes to the bathroom.  (He fell out of bed last week.)  I fix his meals and sometimes have to feed him or  even awaken him if he falls asleep over his plate.    I shower and dress him,  make sure he gets his pills and enough liquids, and usually hold his hand to aid balance when he walks. Most of all, he doesn’t feel alone when I’m with him.

Jon’s better at giving him a shower; I end up completely wet and have to clean up the  bathroom then change my own clothes and wash all the towels after dressing him.

Entertainment is, for me, the biggest  issue.  How can I add some interest to Bo’s otherwise uneventful, sleep-filled life?  He can’t watch TV or read books or even have a conversation,  but he does  enjoy car rides.  Today I drove for 2 1/2 hours with Johnny Cash, Beethoven and Madonna. Bo liked it.   Emma dog liked it.

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