30 June 2006

Alzheimers and the Knee Replacement Theory

The Knee Replacement

Oh yeah, the knee replacement surgery went off without a hitch.... like a charm!
But wait!
There's more!
Guess what didn't go off without a hitch and not anything like a charm??
The pain med cocktail! The doctors, who did an excellent job on his knee, gave my dad a pain med pump. All you have to do is press the little button and voila! More pain meds! How convenient! How easy!
In reality, it was "insanity in a bag".
The hallucinations started not long after he got back to the room from recovery. They started off small so we weren't concerned. Who doesn't say odd things when on a pain med cocktail after surgery? Tylox and morphine will just end up being your best friend. Dad got plenty of visitors who liked (as usual) to talk about things that were happening in their lives. He heard all of this. It all went into his head and came out as stark, raving hallucinations. He became angry, uncontrollably angry. We had to actually chase him because he was sprinting down the hall (one day after knee replacement surgery!). He screamed, he ranted and he raved about anything and everything. He told us that we were holding him prisoner (ah, the paranoia that runs rampant in dementia patients!) in a jail cell that was located over a skating rink. At one point, we had 11 people in his room. This included 2 sheriff's deputies, 3 hospital security guards, 3 nurses, mom, my sister and me. Everyone tried in vain to talk to him to calm him down to no avail. Finally a nurse gave him something in a shot to calm him down. It took a while for it to work since he had had so many other meds.

Now you think, didn't you know what was coming? Didn't you know that a person with dementia would react differently after being put to sleep?

Nope. We sure didn't. We even consulted his neurologist first, before he had the surgery. His neurologist said, "oh no, there should be no problems". In the years since, we have learned that it is a 'no-no' (or something to think long and hard about) to put people to sleep who have dementia. Most people have a reaction to it, as little as not waking up fully for days or even weeks to something as severe as hallucinations with aggression.

Once all the pain meds had run their course and out of his system, another neurologist put him on a med that was supposed to keep the aggression in check. He was at home by this time and just as ill-tempered as ever. The new med did what it was supposed to do. He calmed down alot. On the flip side though, he had a serious weight gain of about 75 pounds due to a side effect from this med. We figured, 'at least he was eating normally again'. I would come by his house, while mom was at work, and make sure he was ok, that he had everything he needed, etc. My dad's parents (grandmama #1 and granddaddy #1) only lived at the beginning of our short dead-end road so they were in and out of his house a good bit too.

A little background info here..... my grandparents (gm#1 and gd#1) have lived at the beginning of our little road for more than 50 years. My dad built the house that he lives in at the end of the road so he lived at my gp's house half his life and in the house that he built the other half. It's about a 1/4 mile walk between the two houses. My sister and I walked back and forth between the two houses when we were younger, back when there wasn't so much talk about kids being picked up by strangers. We are a close knit family, especially since both my mother and my father are the 'only-child' in each side of the family. About 5 yrs ago, my husband and I bought my mom and dad's house from them so we are still very close to my grandparents' house. My mother still lives with us and gm#1 lives by herself in her house since my dad and gd#1 are in the nursing home together.

The few years go on and we were getting accustomed to having to do things a little differently, like reminding dad of eating, reminding him that we were taking him to the dentist, etc. At Christmas, we would put a gift-wrapped package on his lap. He would just smile and sit there. We had to remind him to open it. Sometimes my kids would 'help him get started' on a present and then he was able to finish opening it. Dad would laugh and have a good time until all of a sudden, he wouldn't smile anymore. It's like something popped up in his head, a bad thought, and he would dwell on it until he went to sleep that night.

All of this wouldn't sound so bad but it would make us think of how dad used to be. He was always a strong man, firm in his opinions, and very settled in life. Now, he had to be gently pushed to take a bath, to eat his lunch, to just get up from the chair and move around. It wasn't that he was like a child (yet) but it was just so different. We felt like we had to furnish explanations to people on why he didn't work anymore, why he didn't recognize people, or why he didn't participate in things. It felt like a cloud over our heads when now I look back and see that it was a sort of 'grief' setting in. It was the grief of losing the man I knew as my dad for a person who didn't know me sometimes, for the shell that was my dad.


Coberae


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