Communion Of Dreams


Learning the cost.
September 12, 2008, 7:53 am
Filed under: Alzheimer's, Health, Hospice, Preparedness, Sleep, Survival

I mentioned in a comment on UTI yesterday that I had a doctor’s appointment, and expected to find there that I had a respiratory infection that needed treatment.  Well, I did, and I do, and now I’ve started a 10-day regimen of antibiotics.

But that’s not the reason why I made the appointment two weeks ago.

* * * * * * *

Almost a year ago I wrote a very raw and painful post titled “Beats having a heart attack.”  Here’s the crucial passage:

And as I stood there at the sink, washing the dishes, thinking favorably on the option of having a heart attack, it sunk in that I was done. I mean, I’d been considering that a heart attack might be the best solution to my problems. Yeah, a heart attack. Hell, at 49, I’d probably survive it. It’d come as no surprise to anyone, given the kind of physiological and psychological stress I’m under. No one could blame me for no longer being a care-provider for someone with Alzheimer’s.

Well, I didn’t have a heart attack.  And I wasn’t done.  We made it through six months of hospice care for Martha Sr – easily the most demanding period of care providing.  But that doesn’t mean that there wasn’t a cost to me, physically.

* * * * * * *

I sat in the exam room, waiting to meet the new doctor.  My face was flushed, my heart racing.  I was having a low-grade anxiety attack.

No big deal, right?  Lots of people get nervous around doctors.

But I don’t.  Hell, I put myself through grad school working in an outpatient surgery unit.  Because it was a remote location far from the central supply facility for the hospital, they had established a large sterile storage area adjacent to the 8 surgical theatres.  For five years I manned that storage area, keeping the surgical teams supplied.  And I was in an out of operations constantly, bringing necessary sterile supplies to the surgical teams.  Even my designated break room was shared with the surgical staff.  In that five years I got to see and know a lot of doctors in almost every imaginable medical situation, as well as personally.  I’ve never been nervous around doctors since.

The doctor knocked and then came into the room.  I was sitting on the exam table, still fully clothed.  I hadn’t been told to undress or anything by the aide who had parked me there half an hour earlier, so there was no modesty issue connected with my anxiety.

“Hi, I’m Dr —.”

“Jim Downey.  Pleased to meet you.”

She held out a hand, relaxed.  “Likewise.  What can we help you with today?”

I shook her hand, then passed to her a book I had been browsing through.  One I had seen on the shelf there in the exam room.  “This was my life for the last 5 years.”

The book?  The 36 Hour Day:A Family Guide to Caring for Persons With Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life.

* * * * * * *

I’ve talked about the stress of care-giving before, and how I am now in a detox period from a prolonged norepinephrine saturation.  As I wrote in June:

The problem is, those stress hormones come with a price – they exact a toll on the body.  For most people, occasional jolts of this stuff isn’t really dangerous, but for someone with a heart condition or an aneurysm waiting blow, such an event can kill.  That’s why you see those warning signs on roller coasters.

And consider what happens to someone who slowly ramps up their stress hormone levels over a prolonged period.  That’s me.  My formerly excellent blood pressure and heart rate is now scary bad, and has been for a while.  I’m lucky that I started this in good condition – but think back to this episode last year, and you’ll see what kind of effect the excessive stress hormone levels had.  In the final year of care giving, my system became saturated with stress hormones – my ‘fight or flight’ reflex changed from being related to a sudden threat to being an ongoing condition.  I adapted.

That was why I made the doctor’s appointment.  And the reason I was nervous was because I was afraid of what the cost I had imposed on my body actually was.

* * * * * * *

Dr — took the book, looked at it.  She nodded, then looked at me.  “Tell me about it.”

We talked.

We talked about the care-giving, when it ended, what I had tried to do to care for myself during and since.  She looked over my records, asked a few questions, did a few of the typical exam things doctors do to confirm their innate understanding.

“Well, let’s treat this respiratory infection.”  She paused, looked at me.  “You know, your blood pressure is quite high.”

Actually, my blood pressure was scary bad.  When the aide took it earlier, she was startled by how high it was.  Let’s put it this way – it’s in the range where if it were just a bit higher, hospitalization would be indicated in most cases.  If I walked into an ER with that blood pressure, people would start rushing around.

“Yeah, I’m not surprised.”  I told the doctor what I’ve said in those post cited above.

She nodded, realized that I knew what I was talking about.  “How would you feel about starting a drug therapy to get it under control?”

“What did you have in mind?”

“Beta blocker.”  She looked at me.  “You may not need to be on it forever.  The other things you are doing and recovery from the care providing might be sufficient – later.  But for now, I think it would be wise.”

It was the right call.  Beta blockers act specifically to counter the effects of stress hormones, especially norepinephrine.

“Sure.  Let’s do it.”

* * * * * * *

So, that’s part of the cost of care-providing, documented by medical authority.  It’s too early to say whether this drug therapy will be sufficient.  I do still need to shed weight (though I’m now only about 20 pounds over what was my ‘normal’ weight about ten years ago), and keep an eye on diet and exercise, control stress, get plenty of sleep.  And there’s no way to say how much long-term damage I did to my system by my period of high blood pressure (which increases the risk of stroke, dementia, heart disease and kidney damage).  There’s no indication yet that there’s been any long-term damage, but . . .

I’m still glad I did it.

Jim Downey

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7 Comments so far
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A short run of beta blockers could be good – sometimes when your body overloads like that, it needs a bit of a kick to get reset. Then once it’s used to the new baseline, you can taper off the support. Here’s hoping.

Comment by ML

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