4th March 2008
Papa, those ships in the distance, are they coming back?
We are getting more and more distant from each other, can everything go back to like it was in the past?
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4th March 2008
This is a blog published by my Papa and I. Whenever I drop by this blog, I will always be reminded of how intimate and close we used to be. We seem to share with each other everything in this world. However, ever since I begin working as a professional doctor, it seems like we will never have the chance to talk to each other due to my busy lifestyle, let alone sharing with each other our daily encounters, experiences and troubles. I still remember that when we first set up this blog together, we promise each other that no matter what happens in future, we will always be in each other’s heart and not allow the other to walk alone during the long journey in life. My heart ached when you told me yesterday that you are really afraid, that we will continue to drift further and further apart from each other to the extent that one day, we may just become strangers to each other.
Papa, I just want to let you know that I am really sorry. I’m sorry for not realising that I have actually hurt you by forgetting our promise to each other over the years. I’m really sorry for not being a dutiful son, and I’m sorry to let you know how much I love and cherish you as someone whom I cannot lose in my life only now when I am so afraid of losing you. I fear that one day, you may not recognize me as your dearest son anymore, Papa. You have sacrificed so much for me to realise my dream as a renowned doctor. I have not forgotten how much we have been through together. Believe me that I will never let you forget about me and anything regarding our past. I will go through the toughest with you and I am determined to find a cure for your disease.
Papa, can you recover soon?
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23th Feb 2008
Er…what’s the thing called? I couldn’t find it. When I asked my son, “Did you see the thing, the thing for my mouth?” My son looked confused. Then I made a lot of descriptions until he realized what I was talking about. Oh yeah, it was the ‘toothbrush’.
These days, I find myself having problems with language. I have difficulties talking to people. And I even lost several chess games which I used to be good at. I find it difficult to think about which step I should take next when in the past I didn’t even need to pause to ponder where to move my chessman.
Today the new neighbours arrived, and they are going to live in the unit next to us. Alex introduced them to me this morning…I think the lady was called Jenny, or was it Janice? Anyway, she has a small daughter around Jack’s age. I find them rather nice.
By the way, the newest issue of Alex’s favourite science journal arrived today…I must remind him to send the bill out later; he is always so busy that he forgets.
Which reminds me, today, something happened. I lost my watch. It is my favourite watch, my most valuable watch; given to me by my late wife…I always wear it wherever I go…now where did I put it? I really cannot remember. I asked Alex, but after a thorough search, he couldn’t find it too. Must be Jack, he must have taken it to play with it. Sometimes he is really naughty, recently even more so. I must remember to give him a good dressing down later. I feel really upset…this is the worst thing which happened to me today…
Just awhile before, I was sitting on the sofa staring at the TV. Suddenly, I found tears on my face but after a few seconds I found myself laughing. It seems like I cannot control my emotions, but why?
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25th Feb 2008
Recently, I discovered something unusual about Papa.
Within this week, he has lost his key of our house twice and yesterday, he asked me whether I knew where he has placed the remote control.
Last week, when I reminded him to switch off the lights and air-conditioning before leaving the house, he became moody and impatient all of a sudden. He slammed the door, stayed in his bedroom for that night and even rejected to have dinner with us. No matter how I apologized, he did not reply. He seems to be very emotional at times. He even scolded his grandson, Jack, for watching TV and eating snacks at the same time, when in the past he spoils Jack and allowed him to do whatever he liked as long as it was safe.
Yesterday, Jack asked Papa to help him with his arithmetic homework. At that time, I was reading the latest issue of my science journal and could overhear them. Papa seemed to be rather subdued and withdrawn, and he didn’t teach Jack much. Has he forgotten how to do simple multiplication and division? I asked Jack later about it and he told me ‘Yeye (grandpa) gave me all the wrong answers.’
Sometimes, when Papa talks to us, he repeats himself. He may talk about the same experience for a couple of times without realizing it. When we remind him of that, a vague expression would appear on his face and he looks lost…
Today is Papa’s birthday, but he forgot about it himself and asked me why I wanted to bring him to a restaurant for dinner. Instead he insisted that he cook dinner for us, even when I told him that it was his birthday. I couldn’t refuse him. However, he mixed salt with sugar while cooking, which was not the way he usually cooked that dish in the past. In order not to make him feel upset, Jack and I ate the dinner that he cooked silently. This reminds me…the past few nights I have witnessed him spending the whole night sitting on the sofa, staring into space.
I’m really worried about him. I fear he might be getting Alzheimer’s disease…
For readers who need some background knowledge on Alzheimer’s disease, here is what I found in one of my medical books on common illnesses of the elderly.
Alzheimer's disease is a brain disorder in which there is a steady deterioration of brain function, resulting in progressive loss of memory, recognition, personality, and mental powers.
On the left: a brain without the disease, as compared to a brain from advanced alzheimer's on the right, followed by a comparison of the two brains, showing the shrinking in the size of the brain of an Alzheimer's patient.
Picture showing the decrease in the amount of spinal fluid in the brain of an Alzheimer's patient.
A picture showing the changes in the brain of a patient suffering from Alzheimer's disease: the cortex shrivels up and the ventricles (fluid-filled spaces within the brain) grow larger.
Plaques, abnormal clusters of protein fragments, build up between nerve cells.
Dead and dying nerve cells contain tangles, which are made up of twisted strands of another protein.
Even though some lapses in memory are normal as we grow older, Alzheimer’s disease is different from the symptoms one might see in someone with normal age-related memory changes. A person with Alzheimer’s disease forgets entire experiences instead of just a part of an experience, and rarely remembers later. As the disease progresses, the person will gradually be unable to follow written or spoken direction, as well as use notes as reminders, which a normal elderly person still can. Alzheimer’s disease is fatal.
Although I do not specialize in the field of neurology, I have found out that it is actually plaques and tangles in the brain that damage nerve cells and cause the brain to gradually shrink in size, and this is known as Alzheimer’s disease. To understand exactly how, you can take this
brain tour
I have read up on the stages of Alzheimer’s disease here – these have also more or less confirmed my suspicions about my Papa.
Stage 1: No impairment; no memory problems
Stage 2: Very mild cognitive decline
Memory lapses, esp. in forgetting familiar words or names or the location of everyday objects
Stage 3: Mild cognitive decline
Problems with memory or concentration
Misplacing things, decline in ability to plan/ organise
Stage 4: Moderate cognitive decline (Mild or early-stage Alzheimer's disease)
Impaired ability to perform challenging mental arithmetic-for example, to count backward from 75 by 7s
Decreased capacity to perform complex tasks, such as planning dinner for guests, paying bills and managing finances
Reduced memory of personal history
Individual may seem subdued and withdrawn, especially in socially or mentally challenging situations
Stage 5: Moderately severe cognitive decline (Moderate or mid-stage Alzheimer's disease)
Become confused about where they are or about the date or day of the week
Need help choosing proper clothing for the season or the occasion
Stage 6: Severe cognitive decline (Moderately severe or mid-stage Alzheimer's disease)
Lose most awareness of recent experiences/ events and of their surroundings
Recollect personal history imperfectly
Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces
Need help getting dressed properly; may make errors like putting pajamas over daytime clothes or shoes on wrong feet
Experience disruption of normal sleep/ waking cycle
Need help with handling details of toileting (flushing toilet, wiping and disposing of tissue properly)
Have increasing episodes of urinary or fecal incontinence
Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor);
hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding
Tend to wander and become lost
Stage 7: Very severe cognitive decline (Severe or late-stage Alzheimer's disease)
Final stage
Lose their capacity for recognizable speech, although words or phrases may occasionally be uttered
Lose the ability to control movement (walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up)
Reflexes become abnormal and muscles grow rigid
Swallowing is impaired
I went on to do further research…and found out that the greatest known risk factor for Alzheimer’s disease is increasing age. Most individuals with the disease are 65 or older. After age 85, the risk reaches nearly 50%. However, a common misconception is that Alzheimer’s disease happens only to the elderly, this is not totally true – Alzheimer’s disease is just more prevalent in the elderly. Another risk factor is family history. Research has shown that those who have a parent, brother or sister, or child with Alzheimer’s are more likely to develop the disease. Genetics also plays a part – so far scientists have identified one Alzheimer risk gene, apolipoprotein E-e4 (APOE-e4). For those who wish to know more, visit
here
I have read up on the stages of Alzheimer’s disease here – these have also more or less confirmed my suspicions about my Papa.
Other risk factors which we can influence include head injury, which appears to have a link to Alzheimer’s disease. The risk of developing Alzheimer’s disease also appears to be increased by many conditions that damage the heart or blood vessels, for example high blood pressure, heart disease, stroke, diabetes and high cholesterol. Strategies for overall healthy aging may also help keep the brain healthy and may even offer some protection against developing Alzheimer’s or related diseases.
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After bringing Papa for a health check-up, the doctor confirmed that Papa is suffering from Alzheimer’s disease, true to my suspicions.
My deepest fear has come true. What can I do? I do care for my papa, but, how can I take good care of him now?
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26th Feb 2008
Alex brought me to the doctor yesterday. He said I was suffering from some kind of disease though I insisted that I was alright. I really felt perfectly fine!
Maybe it was just an excuse from him to send me to the old folks' home. I'm old and frail, it's only right that he doesn't want me anymore. Yes, maybe it's ok if he doesn't want me anymore…I will only be a burden to him. I keep telling myself that it doesn't really matter to me whether he still wants me to live with him, yet I tear upon the thought of losing him soon…I don't know why, but I just can't control my emotions sometimes.
Sometimes, I feel that nobody understands me…no one will understand. I don't even know why I do the things I do. Alex, I fear that you will leave me. I'm really afraid that you will forget about me, forget about our past and the thick and thin we've been through together, the beautiful memories we once shared. I just want you to stay by my side.
Even though you're just sitting next to me, I feel that we are a mile apart...
we used to be so closed...
I promised I will never let go of your hand, until you let go of mine...
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28th Feb 2008
This afternoon, I felt like going out for a walk. On the road, everyone was staring at me strangely as if I was from Mars. I overheard one of them saying, “Doesn’t he feel hot wearing so many layers on such a warm day?” But I really don’t feel hot at all! Do I have such poor judgment?
As I walked on, the surroundings became darker and darker. As I walked alone down the endless road, the streets and buildings became unfamiliar to me. Where am I? I began to feel lost and hopeless. At that moment, how I wished someone could accompany me on this long and lonely journey. I felt tired so I sat down on the bench beside a tree. Not long after, a man in blue uniform came to me. He asked where I lived but I could not remember anything and could not answer any of his questions. Then he found a small phone number book in my pocket and called someone. The next thing I knew, Alex came in his car to fetch me home.
Alex has been so busy lately, and he seems stressed out over something, I wonder what it is…
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1st March 2008
I should have known better than to let Papa go for a walk by himself! I should have known he would get lost…I should have taken more precaution. Thank goodness he’s alright. I have already asked the family next door to help keep a lookout for Papa. I feel bad troubling them, but I don’t want to take anymore chances.
This morning he wanted to go out for a morning walk. I was reluctant but he had already put on his shoes and had such an expectant and longing look on his face that I had not the heart to refuse him. That was when I saw that he had on his walking shoe on his left foot and on the right, mine. One was grey and one was blue, how could he mix them up?!
Yesterday Papa woke Jack up at 7am to go to school but he forgot that it was a Saturday…Jack threw a tantrum because of that. Recently Papa often gets confused over the date and day of the week, but the worst was that time, I think it was yesterday, he asked me who the person in the painting in my room was. I got a shock! The person in the painting is my beloved wife, Jack’s mother, who is currently on a business trip overseas. Papa used to tell me how capable and smart and responsible she was, and often praised himself jokingly for choosing the right wife for me…he used to be so humorous and fun in the past, where has his sense of humour gone? What if one day, he even forgets who I am? I know that day will come sooner or later, and I dread its coming. On the photos which we took during his birthday a week ago, I have written down the names of everyone on the photographs. I fear that one day he would not recognize me anymore as his son, his son who loves him with all his heart. Even if my Papa is old and senile, he will still be my precious Papa, forever. My heart aches for him…
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3rd Mar
I know that Alzheimer’s disease currently has no cure, therefore recently I have started to consider letting Papa take medication to control his symptoms as it is rapidly worsening. After some research I have found some treatments for Alzheimer’s disease. They are often divided into treatments for “cognitive” and “behavioral and psychiatric” symptoms. Cognitive symptoms affect memory, language, judgment, planning, ability to pay attention and other thought processes, and behavioral and psychiatric symptoms affect the way we feel and act.
To treat cognitive symptoms
Currently there are two types of approved medications for this. These drugs affect the activity of two different chemicals involved in carrying messages between the brain’s nerve cells. Cholinesterase inhibitors prevent the breakdown of acetylcholine, a chemical messenger important for learning and memory. These drugs support communication among nerve cells by keeping acetylcholine levels high. On average, this drug delays the worsening of symptoms for 6 to 12 months for half the people who take them. The second kind is Memantine, which works by regulating the activity of glutamate, another messenger chemical involved in learning and memory.
To treat behavioral and psychiatric symptoms – non-drug
Treatments include drug and non-drug treatments, of which the latter should always be tried first. Caregivers of the patient, including family members, should understand how the patient of Alzheimer’s disease feels, and try their best to change his/her environment to improve comfort, security and ease of mind. They should take note of some reasons for the difficulties and conditions that the patient might be experiencing. These include drug side effects as many people with Alzheimer's take prescription medications for other health problems. Drug side effects or interactions between drugs can sometimes affect behavior. As the disease gets worse, the patient may have increasing difficulty communicating their experiences. As a result, symptoms of common illnesses may go undetected. Pain from infections of the urinary tract, ear or sinuses may lead to restlessness or agitation. Discomfort from a full bladder, constipation, or feeling too hot or too cold may also be expressed through behavior. In addition, uncorrected problems with hearing or vision can also contribute to confusion and frustration and foster a sense of isolation.
Events or changes in a person's surroundings may contribute to a sense of uneasiness, or increase fear or confusion. Changes and instances like moving to a new residence or nursing home, changes in caregiver arrangements, admission to a hospital, being asked to bathe or change clothes, and fear and fatigue resulting from trying to make sense out of an increasingly confusing world all contribute to the behavioral symptoms .
For readers, especially those who are also caregivers for Alzheimer’s patients, here are some solutions for you, as much as they are for me:
Monitor personal comfort by checking for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation. Maintain a comfortable room temperature. Avoid being confrontational or arguing about facts; instead, respond to the feeling behind what is being expressed. For example, if a person expresses a wish to visit a parent who died years ago, don’t tell him/her that the parent is dead. Instead, say, “Your mother is a wonderful person. I would like to see her too,” and redirect the person’s attention. Try to remain flexible, patient and supportive. Create a calm environment, avoiding noise, glare, insecure space, and too much background distraction, including television. Simplify the environment, tasks and solutions and allow adequate rest between stimulating events. Provide a security object or privacy for the patient, and equip doors and gates with safety locks.
To treat behavioral and psychiatric symptoms – drug
If medication is preferred or necessary, it is best to start with a low dose of a single drug to avoid serious side effects. The medications commonly used to treat behavioral and psychiatric symptoms of Alzheimer's disease, include the following antidepressant medications for low mood and irritability, anxiolytics for anxiety, restlessness, verbally disruptive behavior and resistance, and antipsychotic medications for hallucinations, delusions, aggression, agitation, hostility and uncooperativeness. Antipsychotics are the most frequently used medications for agitation.
Doctors sometimes prescribe vitamin E to treat Alzheimer’s disease. A study showed that vitamin E slightly delayed loss of ability to carry out daily activities and placement in residential care. Scientists think vitamin E may help because it is an antioxidant, and may protect nerve cells from certain kinds of chemical wear and tear. Warning: no one should use vitamin E to treat Alzheimer’s disease except under the supervision of a physician, as the doses used are relatively high, and vitamin E can negatively interact with other medications, including those prescribed to keep blood from clotting.
A growing number of herbal remedies, vitamins and other dietary supplements are also promoted as memory enhancers or treatments for Alzheimer’s disease. However, claims about the safety and effectiveness of these products, are based largely on testimonials, tradition and a rather small body of scientific research. Perhaps in the near future, more will be known about these forms of treatments.
Currently there are many projects and researches going on to find cures for Alzheimer’s disease. Researchers and scientists have also begun experimenting with genes and other drugs to improve the way Alzheimer’s disease can be diagnosed and treated. I really look forward to the day when an immense breakthrough in Alzheimer’s disease research would be made.
Papa’s conditions continue to worsen, and he will gradually forget more and more, but I know that the last thing we will ever lose is love. Papa’s memories may be gone, and intellect and logic may not exist. He may have forgotten our names and where he is and what he is doing. But he remembers love. He has taught me that love is the greatest gift, to be given freely, without reservation or limit, with no expectation of return.
To Papa:
May the love I give you be felt just like how I feel yours, and may it be a beacon, a shining light, which lights the darkest night to warm the coldest heart.
And i'll never let go of your hand, just like you have never let go of mine...
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5th March 2008
Yesterday, when I went into papa’s bedroom, I found papa staring at an old album taken ten to twenty years ago. I walked nearer to him, squatting down on the floor. There are photos taken when I was a little child and a teenager. I saw photos of my whole family. The time we went to the zoo and botanic garden; the time we climbed Bukit Timah Hill; the time we went to East Coast and had a barbecue… Papa seemed not to remember anything about them. He asked me, “Who is this?” pointing at that little me in the photo, in which he was standing beside me. I felt that my eyes were wet. I looked into papa’s eyes. I saw blankness. He was just like a child, pointing naively to figures and images that he could no longer recall.
I recollected myself after a while. Then I began talking with papa just like a kindergartener teaching a kid how to count numbers from 0 to 10. I pointed to the picture and told him that that is a photo of our family. “This is you, this is mama, this is June (my sister) and this is me. I was 7 years old at that time.” Papa nodded, his eyes reflecting only emptiness. As we continue to browse through the album, I recounted those happy times we had together and tried to remind him of them by narrating them to him. Life seemed to be inversed now. While papa had been telling me stories of my childhood several years ago, this time I was telling the same stories to my father. At that moment, I felt that life was really simple and meaningful. I have once again found the connection between papa and me. After all, he is still my father and I will take care of him, and let him enjoy the final years of his life.
I have decided. I will not send him to the geracomium to spend the rest of his life with unfamiliar people. I know he needs me, his closest family and only son, to care and love him. Life is just like this. We only realize what we should have cherished after we lose it. I will not let this happen; I will do my best to change the situation while I still can, and while he still can, before it’s all too late.
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5th March 2008
I love you, Alex.
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5th March 2008
I love you too.
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