Saturday, November 6, 2010

When is Dementia not Dementia?

Modern medicine is amazing.  I know that first hand.  As much as I respect and prefer natural and homeopathic remedies, and a holistic approach to medicine, I also know that modern medicine can be nothing short of miraculous.  I take a miracle drug called Sinemet.  When I take it regularly, I can walk, talk, breathe, and move, in a relatively normal manner.  If I am without it for a full day, all of those tasks are more difficult for me.  In fact, walking is not possible.
I also know that modern medications can cause as many complications as they cure.  That is why we look to the doctors to tell us what medicines to take.  They are the experts, or should be, anyway.  Sometimes they get it pretty mucked up.
For the last year, we have been helping my parents cope with my mom's diagnosis of vascular dementia.  She has had major ups and downs, times when she didn't realize what city she was in and thought my dad was her older brother, George.  Sometimes she packed her paper bags and purse and demanded to go home, even though she was already at home.  This sounds like typical dementia.
I wasn't totally convinced but I trusted the doctors' judgment.  They've had experience with many patients with dementia; they ought to know.  What confused me was that Mom could remember many details about conversations that she'd had over the previous week.  She could remember what was coming up in my schedule and remind me about it.  She might not know what town she was in or what year it was, but she knew that I was going to the eye doctor the next day.  This does not sound like typical dementia.
An attempt to convince our parents to go to geriatric specialists didn't go over well.  They had gone to their doctors for years and that was that.  At last, things progressed beyond what we could handle without support and we were able to sign both our parents up for Total Longterm Care, a managed Medicare/Medicaid program. 
This has truly been a blessing.  Their new doctor, Dr. Pham, is a geriatric specialist and the first thing she did was to meet with a pharmacist and go over all of the medications that my mom had been taking.  They made a number of changes.  I had the opportunity a couple of weeks later to talk with a psychiatric nurse practitioner, who confirmed the importance of the changes that were being made.  The previous combination of medicines were, according to this nurse, a "recipe for delirium". 
This means that we don't know whether Mom really has dementia or whether her confusion issues were solely due to the medications that had been prescribed to her over the last years.  Mom has been clear and not confused at all over the last couple of weeks. 
Our new challenge is the withdrawal symptoms she is experiencing after going off certain drugs.  She is extremely anxious, nervous, shaky, and at times, she goes through deep depression.  She is still on medication to treat these symptoms; however, until some of the old drugs clear out of her system, there will be some withdrawals.  She understands what is happening and, though she sometimes says it would be easier to be confused, she is determined to get through this challenge.  At least, she was more determined last night than she has been so far.  It continues to be a day to day battle.
We've all learned a lot.  Doctors are good but not infallible.  It's important to ask questions and to seek another opinion, especially when you are taking a lot of medications.  At 81, going through drug withdrawals is hell.  I keep telling her that this will be worth the effort.  She might just buy some time to actually enjoy life for awhile. 
That would be an incredible gift.

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