FOR GREGORY. He was not a VICTIM of ALZHEIMER'S DISEASE, he was a HERO!

PLEASE NOTE: Even though this blog is now dormant there are many useful, insightful posts. Scroll back from the end or forward from the beginning. Also, check out my writer's blog. Periodically I will add posts here if they provide additional information about living well with Dementia / Alzheimer's Disease.

Showing posts with label Medications. Show all posts
Showing posts with label Medications. Show all posts

Tuesday, November 11, 2014

Risperidone

I continue to be so impressed with the care Gregory is receiving from Lieberman. I went in to inquire about the changes I had seen (and reported in previous post.) The head nurse had already been studying the situation for a few days. 

We were ready for a sign off on a new medication after she explained the reason for the change and how the it should help.

They had already done  a sleep study, observed Gregory, consulted with his Lieberman provided psychiatrist, and decided on a “baby dose” of Risperidone. 

They had been using Ativan on an as necessary basis, had found it necessary to use it every morning for the last week, but that drug is short lived and it was only helping Gregory for a two hour window.

The Risperidone should help throughout the day without over “drugging” him. He will be drowsy for the first week or so but then should acclimate to the drug. 

Risperidone is an antipsychotic medicine. It works by changing the effects of chemicals in the brain. Risperidone is used to treat schizophrenia and symptoms of bipolar disorder (manic depression.) It is also used in autistic children to treat symptoms of irritability. Risperidone may also be used of other purposes, like irritability due to dementia.

The online research I have done says that Risperidone is not approved for use in psychotic conditions related to dementia. It may increase the risk of death in older adults with dementia-related conditions.

However, it has been found to help even mood and behavior of residents with Alzheimer's and should help Gregory be more even. It will help him feel more calm (which he has not been for a little while now.)

Also, honestly, the "risk of death" is worth helping Gregory be more comfortable for the time he has left. 

I will deeply grieve when he dies but do not need to "hold on" to him for my own sake. I will survive. And so will Gregory, just maybe not in this life.


Monday, June 23, 2014

Behavior Changes Due To Medication Change

Lots of posts today as it was a very active day for Gregory.

First his helper Manny called in sick so I spent all day and evening with him, then Pat dropped in for a visit, and then Jan came and spent dinner with us.

Also, less than a week ago, the doctor at Lieberman changed one of Gregory's medications. Aricept, the most well known of the Alzheimer's drugs, can cause stomach problems.

Gregory had been having some digestive problems so they changed from the Aricept to an Excelon Patch. Because the patch is absorbed through the skin into the blood stream, stomach problems are avoided.

We were told to be on the lookout for unexpected changes because of the switch in medications. I didn't expect to see happen what has been happening.

Gregory is more alert, more talkative (although not more coherent,) more animated, and more present (although still unable to communicate.)

One problem with this is that he has been more talkative but still has problems with word use and therefore has been a little more frustrated. So we listen to him, agree, and nod our heads affirmatively. This seems to comfort him.

Also, he seems to be "thinking" more and trying to express what he is thinking, but again is unable to do so and this also frustrates him. I express it this way: It is as if he gets a complete visual image of something he wants to share but as he is struggling to find the words to express the image which he is unable to find, the image slowly fades away.

So he has been alternating between very happy, smily, laughing, joking around and crying, being frustrated, and being mildly angry.

Will be interesting to see what tomorrow brings.


Monday, February 10, 2014

Fast Seizure Update

Just a fast update. Gregory is doing well and returned to Lieberman on Saturday after three days in the hospital. He ended up being in the hospital for the requisite 3 midnights of Medicare so he will be eligible for up to 100 days of skilled nursing care (read my not having to pay Lieberman) and occupational therapy and physical therapy as well. This should help him get back onto his feet more confidently. It is said that for every day in the hospital, three days are needed to regain your strength!

The care Gregory received at the hospital was stellar however an advocate is always needed, especially when the person cannot advocate for themselves. Turns out he hadn't pooped for two days so Alaksh and the nurse's aid sat him on the toilet and he was successful. Last thing one needs is to be constipated. The hospital was a little hesitant about G's being up in the bathroom but Alaksh convinced them. It isn't that Gregory couldn't walk or be on his feet. It is just that he is unsure on his feet and needs support. Also the verbal communication of expectations takes longer then most people are used to and sometimes doesn't work at all. This makes it look like Gregory cannot get up but also there are the times when Gregory just doesn't know how to "sit!"

Another thing that happened. Gregory's medical records are now on the hospital system's computers. For the most part that is good. But somehow it was assumed that an old, unused prescription for Xanex, an anti-panic medicine was to be administered three times a day. When I found that out I threw a hissy fit! First why? Second don't assume, ask me! Third his doctor has only known Gregory for the three weeks since he was admitted at Lieberman, I have known Gregory for 39 years!

When Gregory got back to Lieberman, the nurse called me early the next day to re-check his medications. I guess they do that every time a resident returns from a hospital visit. Good for them! They put him in a wheel chair to move him about but take him out and help him into a regular chair when they reach their destination. Good for them.

Today or tomorrow we will have another "Care Conference" to discuss Gregory's progress so far at Lieberman, especially with all the "interruptions."

Monday, December 23, 2013

As you know Gregory's recent downhill adventure, along with my journey beside him, has been dramatic.
A month ago, I took him off his meds because it was not obvious that they were doing anything and he was having trouble swallowing pills (a battle every morning and bedtime.) I did this with an OK from his doctors.

I decided that I would observe to see if taking off the meds made a big difference. Well it has. His abilities have been plummeting and all kinds of bizarre behaviors are showing up. It could be just a function of this next stage of his Alzheimer's or it could be because he is off the meds.

The other part of the experiment was that when first put on the meds some ten years ago, his abilities peaked with improvement. The doctors were surprised because the meds are supposed to "slow down loss" not "peak improvement." 
I thought that if I took him off meds and watched and then put him back on and watched I might see a difference and thereby proof that the medications were worthwhile.

So we will go back on the meds in January.

Monday, June 25, 2012

Pill Box

My friend Pat send a humorous e-mail that read: 


"Hi. Have you ever verified what day of the week it is by the compartment on your vitamin box?
 P


I just replied with something like: "Sounds like a fun series of silly questions!"


Actually didn't want to go into detail for her (eventually did) but the "daily pillbox" has a sad connotation for me. 


In the beginning, Gregory used to take his pills, then he started using a pillbox and would set four of them up at the beginning of the month (four for AM and four for PM.)


Eventually I had to make a list of what went into the AM's and what went into the PM's.


Then I realized, what he was putting in the pillboxes was not consistent so I took over filling them at the beginning of each month. 


Soon, every morning and every evening he was confirming, "Is today the 'W'?" You can imagine how confusing the "T" and "S" were. After a while of this I figured out that the association with "W" and "Wednesday" (and all the others as well) was gone.


The pillbox, if you can imagine, no longer had a reference or association or connection or purpose in relation to what day of the week it happened to be.


Now we have two bowls. I empty the night's pills out of the pillbox into the small bowl and put it next to the water on his nightstand. I put the next day's pills in another small bowl and put that bowl out by his breakfast area.


For now, at least, the bowls get back to the bathroom to be used the next day. I suspect at some point I will have to begin searching for the bowls.

Friday, February 10, 2012

New Hope

Woa! It has been along time since I posted. Partly because we are getting ready to visit family & friends in TX and then on to MX for a month. I am sure I'll do a lot more posting then. Meanwhile, this article in the Wall Street Journal caught my attention. Very interesting. Will do a follow up post on the image of the mice.



The Wall Street Journal

New Attack on Alzheimer's

Cancer Drug Reverses Disease's Symptoms in Mice; Human Tests to Start Soon


A cancer drug quickly and dramatically improved brain function and social ability and restored the sense of smell in mice bred with a form of Alzheimer's disease, suggesting a new way to tackle the illness in people.

Alzheimer's is associated with the accumulation of protein fragments called amyloid-beta in the brain. The new research found that an existing skin-cancer drug called bexarotene cleared the protein in the brains of stricken mice within days. The study was published Thursday in the journal Science.

A skin-cancer drug has shown some success in treating Alzheimer's disease in mice, according to a study in Science. Stefanie Ilgenfritz has details on The News Hub.

Because bexarotene is known to be safe for treating skin cancer, "it might be worth trying in Alzheimer's patients as well," said Rada Koldamova, a neuroscientist who works on Alzheimer's at the University of Pittsburgh and wasn't involved in the study. However, she added, the drug's effectiveness against the brain malady would first have to be established in human trials. Test results in mice often don't pan out in humans.

Everyone's brain produces amyloid-beta protein, but while a healthy brain can efficiently remove the protein fragments, the brain of a person with Alzheimer's can't. The resulting buildup is believed to result in impaired learning and memory functions.

The disease is a growing problem, especially in aging societies, but no effective treatment has been found. The drugs used today work just for a short time and only relieve symptoms, instead of halting the disease. Over the years, drugs in about a half-dozen late-stage human trials have failed to make the cut.

In 2010, Eli Lilly & Co. abandoned a treatment that blocked an enzyme linked to amyloid formation after the drug appeared to worsen some patients' condition. Another technique, currently being tested in patients, is to reduce protein formation by triggering an immune response.

The new research, funded by a number of foundations, takes a completely different approach, said Gary Landreth, a neuroscientist at Case Western Reserve University in Cleveland and a co-author of the study. His team's method, he said, is to "help Mother Nature do what she normally does" in clearing amyloid fragments from the brain.
ALZHEIMER

Scientists know that a protein called ApoE acts as a sort of garbage-disposal unit, helping to degrade amyloid-beta proteins. Dr. Landreth figured that if he could get the brain to make more ApoE, the protein clearance would be enhanced.

He set his sights on bexarotene, an orally administered drug known to activate a protein that helps switch on the ApoE gene. In 2009, Dr. Landreth asked a newly minted postgraduate student in his lab to give the drug to some "Alzheimer mice." Three days later, the amyloid plaques in their brains had largely disappeared.

"It was unprecedented," Dr. Landreth recalled. "I initially thought she had screwed up."

In the Science report, Dr. Landreth and his colleagues describe similar tests done with over 100 mice. When the drug was fed to mice with Alzheimer-like symptoms, it quickly improved their cognitive, social and olfactory functions. Losing the sense of smell, a disorienting and often debilitating experience, can be one of the first signs of Alzheimer's in humans.

Healthy mice typically will gather tissue paper strewn around their cage and use it to make a nest. Alzheimer mice stop doing that. When the drug was given to diseased mice they made nests, a sign of cognitive improvement. The benefits lasted up to three months, at which stage the scientists stopped their observations because that was sufficient time to show the drug's effects weren't transitory.

It is widely believed that the memory problems seen in the affected mice and human Alzheimer patients are caused by small soluble forms of amyloid beta. The researchers found that within a mere six hours of getting the drug, soluble amyloid levels had dropped by 25%. This effect lasted for three days.
In the U.S., bexarotene is sold under the name Targretin, which is owned and marketed by Japan's Eisai Co. Patents on the drug—and hence its profitability—will start to expire this year, one reason drug companies may be reluctant to jump on bexarotene as a possible Alzheimer's treatment.
Dr. Landreth and a study co-author, Paige Cramer, are founding scientists of ReXceptor Inc., which has licensing options from Case Western to use bexarotene to treat Alzheimer's disease.

Bexarotene is a long way from being an approved Alzheimer's drug, or even being deemed ready for off-label use—when a doctor legally prescribes a drug for an unapproved use. As a first step, Dr. Landreth plans to start a safety trial in a dozen patients in the next few weeks.

He needs to figure out the right dose and duration of the treatment for prospective Alzheimer's patients, and judge the effects over several months. If all goes well, he hopes to engineer a version of the medicine that is more potent and works at a lower dose, to minimize any side effects.

Carl Wagner, an organic chemist at Arizona State University who is collaborating with Dr. Landreth on the project, said he had synthesized half a dozen such versions and was testing them.
Write to Gautam Naik at gautam.naik@wsj.com
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Wednesday, June 29, 2011

Setting Expectations

I am part of an online Alzheimer's Support Group called "Circle of Care" which is sponsored by the Novartis Drug Company. This is a chain of conversation which I recently had with Deborah, one of the facilitators.


INTRODUCTION: Hundreds of years ago, the medicine we have today would have seemed like magic. Today we know that medicine is all about science and each medicine works in very specific ways. How we learn about the ways a medicine might work is varied though – some of us gather information online, some from our MDs and some from friends and family – or maybe a mix of it all. In this discussion, we want you to think back to when your loved one first started their current medication for Alzheimer’s disease or dementia and tell us a bit about your expectations of the medication at that time.


MY REPLY: Right from the beginning the doctors said that Aricept and Namenda would only slow down the disease NOT cure it. We were surprised when Gregory began first Aricept his functioning improved greatly. If he had been functioning at 60%, he shot back up to 80%. Doctors and we were pleased. Then within a few months the functioning was on a downward roller coaster ride so we began Namenda. The same amazing improvement happened and the decline has been very slow since. We still do not expect things to ever be normal again but I do believe the medications have helped. Just recently Aricept has been approved at a little over double the dose and we have begun taking them. Here's hoping for improvement ... certainly NOT cure. P.S. I have always said, "If it would just stop here." But it doesn't. Does it?


DEBORAH'S COMMENTS: But, hope is always there....Michael, before you talked to your doc, did you have expectations of what the Aricept would do? If so, where did the expectations come from? I'm trying to understand how we build our mental map of what we can expect from these medications --where we gather our info to make the mental map. What do you think?


MY REPLY: I have always believed that the "patient" (or caregiver in this case) has at least as much responsibility for understanding the illness, the medications, the precautions, the prognosis, etc ... as does the doctor. Both must be part of the team that makes the best possible decisions and makes the best possible use of the information available. So many people will reply, "I just do what the doctor told me." I say, "Question and understand. Challenge if necessary. Do not accept blindly." I have also heard, "It is just too confusing so I didn't bother." I say, "Bother! If you don't understand ask again. A good doctor will take the time to help you understand and/or send you in the direction of getting the extra help to understand that you need. Have someone help you understand. Don't just settle."

What I knew about Alzheimer's Drugs came from discussions with our doctors and study online. From the beginning, I knew that Aricept and Namenda would not CURE or REVERSE the dementia. I knew that it would help to slow it down so the quality of life would last for a little longer. I also knew that everyone reacts differently within the general pattern of things. Therefore, I was not so surprised when the medications gave Gregory a jump start of renewed "availability." 

And I agree, Deborah, it doesn't stop but the hope is always there. Even if it is the hope to get through one day, one success, one failure at a time. Hope to be strong, supportive, able for your loved one. And storng, supportive, and able for yourself.