Mom’s knee surgery was over and she was in recovery. My sister and I breathed more easily believing that she would finally be free of pain due to arthritis in her left knee. How wrong we were.
My sister got the phone call to come to the hospital as quickly as possible. Mom had pulled her IVs and catheter out and was struggling to get out of bed in spite of the nurses urging her to get some rest. Mom screamed at the nurses to get out of her house and cried out every time the monitors beeped beside her bed. The loud speaker’s constant paging of doctors terrified her and she went into a state of panic, screaming out in fright. Her panic stricken behavior continued well into the night and her roommate complained that she could not sleep because of Mom’s yelling.
By the time Louisa arrived, Mom was completely out of control and was fighting with everyone who came into her room. She was moved to a private room near the nursing station where they could keep a closer eye on her, which made matters worse because of the constant activity outside her room. Mom was convinced that the voices she heard in the hallway were doctors and nurses conspiring to murder her. As the end of the second day approached, she had ripped out the IVs several times and desperately tried to escape from the bed. Louisa could not reason with her and her paranoia deepened.
At the end of the week, Louisa was exhausted and made plans with the healthcare aide for someone to be with Mom around the clock until discharged. Friends, family, and aides took turns around the clock trying to calm her fears and make her feel comfortable. She was frantic and disoriented, however, and could not be quieted.
The experience in the rehab hospital was no better. Mother continued to fear for her life, and believing she was in her own home at times, tore off the soft cast around her knee and struggled out of bed to rush down the hallway in an effort to get away. She couldn’t tell us what she was running away from, but something or someone - real or imagined - was a threat in her mind. She refused to cooperate with the physical therapist and made little progress toward recovery. When the rehab hospital finally released her to go home, the drama continued on a larger scale, and from that time on it became necessary for Mom to have someone with her at all times.
* * *
Mother’s behavior was distressing to us all and we looked for answers to her sudden decline. The first clue came when the social worker in her senior community told me that it is not unusual for those with dementia to exhibit a cognitive decline after major surgery. Further research showed that there may be a strong correlation between anesthesia and the sudden onset of confusion, delirium, and paranoia. Anesthesia and Alzheimer’s don’t mix. Usually the person will calm down after some time has passed following surgery, but my mother was not one of the usual. She never regained a place of comfort and ease until her passing a year and a half later.
* * *
“A Bandaid for the Caregiver” is dedicated to all those families who journey with memory loss in their lives and the sharing of hope and joy and new possibilities. In each difficult moment there lies an opportunity for love.
Journey with courage,
Elaine
Journey with courage,
Elaine
It is terribly difficult to see your Dad or Mom suddenly lose control and become so afraid and so helpless. Remember that Alzheimer’s takes away all rationale thinking and plays with the emotions, both your parent’s and yours.
You are stronger than Alzheimer’s, though! Your resolve to care for someone who doesn’t know they need help runs deep. Love and a spirit of caring resides in you in great quantities. You can overcome all the difficult moments because you are stronger than this disease.
“… we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope, and hope does not disappoint us because God’s love has been poured into our hearts through the Holy Spirit who has been given to us.” ~ Romans 5:3-5
“I believe that man will not merely endure. He will prevail. He is immortal, not because he alone among creatures has an inexhaustible voice, but because he has a soul, a spirit capable of compassion and sacrifice and endurance.” ~ William Faulkner
If you have a parent in a state of panic following major surgery, their blood pressure is already raised, their muscles tense with anxiety, and their nerves on edge. Staying active is not necessarily a concern as much as the need to reach a state of calmness.
TREAT YOURSELF…
Take frequent breaks when your Mom or Dad is hospitalized. If 24-hour care is necessary, make a schedule for friends and healthcare aides to sit with Dad while you take time to run errands, go home and take a nap, or have dinner with a friend. Go for a workout at the gym, stop off at the grocery store for a bouquet of your favorite flowers, or sit down at the piano for an hour of playing or singing to work out the emotional kinks.
Gentle Reminder:
Dad does not benefit from having an exhausted and cranky companion at his bedside. You still need time for yourself whether your father is at home or in the hospital. The location of a loved one does not reduce your own needs – it magnifies them.
IN THE NEWS…
CAREGIVER TIPS…
Many hospitals welcome and invite family members in the hospital room to help care for the patient. You are more in tune with Mom’s likes and dislikes and how she may communicate her needs. Some ways that you can assure a quicker recovery include:
- Avoid the use of catheters and physical restraints.
- Make sure that Mom stays properly hydrated.
- Orient Mom to where she is and what day and time of day or it may be. Keep the curtains open and the lights on during the day and close the curtains and dim the lights at night.
- Bring things from home such as her blanket, sweater, and family photos.
- Keep noise and activity to a minimum. Close the door, lower the volume on the television, and silence the beepers on equipment if allowed to.
- Assure that Mom gets enough sleep. Talk with the nursing staff about staying on a regular schedule for medications and meals, and ask that when they check on her, to be as quiet and calm as possible.
- Bring personal items from home that will aid in Mom’s comfort, such as glasses, dentures, and her watch.
ABOUT ALZHEIMER’S…
Care should be taken in deciding whether or not an Alzheimer’s individual should undergo major surgery. Studies are contradictory in determining a direct link between anesthesia and cognitive decline following surgery. However, most post-operative patients afflicted with dementia prior to the surgery do seem to go into a decline – some for a matter of weeks and others for years.
Studies have shown that elderly patients receiving hip or knee replacements enjoyed a significantly improved quality of life despite the high prevalence of moderate to severe post-operative cognitive impairment. The pros and cons of each individual should be carefully weighed before making the decision to proceed with surgery.
The likelihood of developing cognitive decline can be reduced by talking to the doctor, the anesthesiologist and the surgeon to make sure they understand that your parent has Alzheimer’s. They should understand that anticholinergic drugs should be avoided and Diazepam should not be used. Likewise, Benzodiazepines and meperidine should not be used for pain control after the surgery.
For more information on the topic of anesthesia and Alzheimer’s go to
http://alzlibrary.wordpress.com/2009/05/17/anesthesia-and-alzheimers/
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