Alone Again

Rosemarie had another fit yesterday morning.

It happened while they were changing her at about 7 in the morning. About a minute of convulsions followed by five minutes of clenched teeth and rolling eyes. She fell asleep almost immediately and slept for about two hours.

Good Nurse phoned me about 9.30 to tell me. She had made sure Rosemarie was ok and had called the doctor and spoken to him. Rosemarie was awake and taking some juice from one of the care workers, and seemed to be unaffected by the fit. She was very sleepy and went back to sleep almost immediately and slept through lunch. 

I arrived mid afternoon and she was awake. I must say she did not look unaffected to me. She was lying on the bed, twisting and pulling at the duvet and her nightdress, and making low grunting noises. The chattiness and interest in her surroundings was gone and to me she looked frightened and agitated. 

I was not able to calm or reassure her. She showed no interest in the new ballet DVDs I had brought her, although she could be persuaded to eat some melon pieces. She would not hold my hand and pulled away if I tried to kiss or hug her.

Nobody seems to think the fit was caused by the increase in the Sertraline dosage but we will have to monitor it closely. The logical part of my mind ticks away...

But I am more desperate than ever to be able to communicate with her and it is less possible than ever. It must have been very frightening for her, regardless of how much she understands about what is happening. 

She must feel very alone.

Sertraline and Teeth

Well, we had a medication review. I was concerned about the jolting and the possible fits and showed the doctor some videos I had taken. He was concerned but reluctant to label them as fits. It seems that 'fit' has a particular technical medical meaning to do with repetitive movement and shouldn't be used here. No other word was offered to describe spasmodic, muscular and quite violent movement that locks the body in a particular position for up to a minute at a time. 

He was more concerned about the signs of depression Rosemarie was exhibiting - the wet and dry crying, the withdrawal, and possibly even the tiredness. He suggested raising the Sertraline dose to 75mg for a trial period. He cautioned that this could aggravate the jolting, but suggested anyway that he refer her to a neurologist for an assessment. He added somewhat strangely that we should really only do this if we were willing to go along with what he or she suggested, and this might be dosing Rosemarie to the eyeballs with tranquilisers. I didn't think that this was how medicine worked and said so. Bit of back pedalling: looks like he was saying he didn't want to waste their time. Well neither do I, but I am the one responsible for her wellbeing and when it is not a medical emergency (and possibly even if it is) I think it is my decision or my daughter's (we both have Lasting Power of Attorney for Health and Welfare).  Anyway, I have no problem getting the input of a neurologist so we will see what happens. 

So the decision was made to increase the dose of Sertraline, and the doctor say he would write a letter to Rosemarie's GP accordingly, and in he meantime the staff at the Care Home should make detailed notes of the frequency and severity of the jolting to act as a baseline before the change in dosage. 

This will be interesting. The Carers are not bad people but detailed record keeping is not exactly their forte and recently there has been a significant turnover of staff.

We have had about two weeks of the new dosage (the doctor said it might take this long to show its effects - ????) and so far I don't think there has been an increase in the jolting, and on the plus side Rosemarie seem more engaged and slightly more articulate. We do get occasional words (usually No and Don't) but we also get more sounds that almost sound like words. We also have more laughter and smiles. This is good news - anything that makes her happier is good news.

It continues to vary, of course. Today she was quite subdued, but then she had a long day (for her) and also what must have been quite a stressful visit from the dentist to look at a chipped tooth. It seems they found a small hole and are planning to fill it without using a drill to clean out any decay. I hope this means there is no decay. 

Until recently the whole problem of dental care for dementia sufferers had not slouched onto my radar, but thinking about it I see nothing but problems. Rosemarie has no ability to communicate her needs, and this extends to such simple things as pointing. Is a reluctance to eat indication of toothache? I find myself watching her eat with an almost forensic attention. The left side of her mouth is quite slack and does not close properly, so often food falls out or settles inside her lips against her teeth. It is very difficult to get her to swallow and she sometimes retains food in her mouth for hours. I try to clean her teeth every night before I leave but sometimes she will not cooperate. Since my son noticed the chipped tooth I have been increasingly worried, and now the dentist has found a hole I am even more concerned that she may develop tooth decay. She has never liked dentists, and the prospect of her, in her present condition, allowing someone to put a needle in her gum then fingers and a drill in her mouth does not bear thinking about. The options are very limited unless you go for a general anaesthetic which means a hospital visit and Risk. Word Has It that one of the residents developed problems with some of their teeth and the only way the hospital would take her in and remove the teeth is if they could solve the problem once and for all and remove all her teeth. So they did.

That is not happening to Rosemarie.