It Robs

It Robs

When I decided on medicine some seven decades ago, I didn’t think I would become one of my subjects, patients, or a victim of this dreaded fate. Let me explain quickly before I forget what I want to say.

When I received money for my birthday, Christmas, or an “A” on my report card, I’d buy the latest New England Journal of Medicine; as early as 12. I wanted to be the one who cured that foggy problem gramps had in the evenings. It was hard to watch my hero not be able to remember what he entered a room for after 5 pm at first. Mom nor Papa was around to notice that he was struggling to formulate and speak his thoughts. It got worse after grandma died two Easters back.

Grandma had realized something was wrong with him that weekend before she passed because they had a fender bender after church, and he couldn’t remember the way home or how to tell her where he was trying to go. Although there was minimal damage to the car, they both got injured in the accident, and grandma had to drive them home. Outward appearances only showed scratches, but grandma passed during the night. We didn’t know they had the accident until the funeral when gramps remembered she had been angry about him wrecking “Betsy,” her lovely two-tone black and gray pristine 1956 Cadillac. Everyone who knew grandma Rachel knew that “Betsy” was her “Sunday go to the meeting car.” The family was hurting too much over her death to notice gramps’ decline. I decided that day that I had to do two things: 1) to help gramps recover, and 2) I had to understand that thing that was robbing his mind slowly.

After four years of medical school, a rotation on Barringer 3, the oncology ward, and ten years in the research lab at Blue Ridge, I set in to practice at the World Conquest Building in Philadelphia. We were nowhere near as well-known as Johns Hopkins, but it’s a disease worthy of multiple studies.

Alzheimer's is a progressive neurologic disorder that causes the brain to shrink (atrophy) and brain cells to die. Alzheimer's disease is the most common cause of dementia — a continuous decline in thinking, behavioral and social skills that affect a person's ability to function independently. Traditionally, Alzheimer's disease was only diagnosed with complete certainty after death, when examining the brain with a microscope revealed the characteristic plaques and tangles. Clinicians and researchers are now able to diagnose Alzheimer's disease during life with more certainty. Biomarkers can detect the presence of plaques and tangles, such as specific types of PET scans or measuring amyloid and tau proteins in plasma and cerebral spinal fluid.

A diagnostic work-up would likely include the following tests: Your doctor will perform a physical exam and likely assess overall neurological health by testing the following: Reflexes, muscle tone, strength, ability to get up from a chair and walk across the room, sense of sight and hearing, coordination, and balance. Additionally, a diagnosis of Alzheimer's disease is based on tests your doctor administers to assess memory and thinking skills. Laboratory and imaging tests can rule out other potential causes or help the doctor better identify the disease-causing dementia symptoms. Images of the brain are now used chiefly to pinpoint visible abnormalities related to conditions other than Alzheimer's disease — such as strokes, trauma, or tumors — that may cause cognitive change. New imaging applications — currently used primarily in major medical centers or clinical trials — may enable doctors to detect specific brain changes caused by Alzheimer's.

I noticed problems remembering new students’ names about five years ago. Years back, I only needed my roster to record test scores. Now it is like I’m a newbie all over. Once I get the introductions out of the way, then I am good. The lesson plan is the same. This college added a new science wing seven years ago. Several times I broke my #1 rule, don’t be late to class. Forgetting about the relocation, I parked across campus in my old space. It took me a month to get used to my classroom being on C block.

 Repetitive actions are good for someone with Alzheimer’s.  Doing the same activities every day at the same time sometimes establishes a routine that can be familiar. Changes to daily routines, even only slightly, can be disorienting. The person with cognitive decline will often become angry, defensive, and abusive. Even the mild-mannered grandma can become frustrated by her challenges and inability to express their feelings. Equally frustrating to the family is the “sundowning” effect that time plays; the later in the day, the more confused they become.

Asking for help or admitting that something is wrong is hard for anyone, especially if it will or could cause someone to question your actions, decisions, or abilities to lead the family. I remember gramps getting paranoid that everyone was plotting against him when he witnessed a conversation between two or more people that didn’t involve or include him. Sometimes even when he was included in the discussion, we could lose his attention, and when he snapped back, he would get angry. Alzheimer’s attacks the whole family! The poem below is dedicated to everyone that has ever loved and lost someone to Alzheimer’s:

Trapped Inside

Can’t recall events of today but know the past vividly

Light dimming on a vibrant soul and memories fading to black

Missing loved ones that have gone ahead to welcome us home

Hating the presence for being alive, vulnerable, and alone

Giving up on life, all prayed out and sun-downing at dinner

Regretting the longevity and wishing for the end

Alzheimer’s steals grandparents too soon

It took my favorite uncle in his fifties

Alzheimer’s robs families of time, money, and love

It turns wives and children into caregivers

It alienates individuals and shuns friends

Medicine is baffled but exploring

I hope for a cure before I can’t remember my children and yesterday!