At our followup with the neurology NP last Wednesday, she prescribed an alternative anti-depressant, emphasizing that this was really a sleep aid. Apparently over the counter sleep aids are not recommended as they make the patient very groggy, which increases the chance of confusion, disorientation, and falls. However she did allow that melatonin was the one over the counter sleep aid that they are allowed suggest. So for one night we gave Dad a very lose dose of melatonin, 1.5 mg. Well, the upshot was that he slept so well that for the next few days all he wanted to do was sleep. Even when he was awake he was quite loopy and even more confused than usual. This past weekend he refused to get out of bed without his mouthguard (more on that later), which resulted in a huge bed-wetting accident. Mom, who is the ultimate Wonder Woman, managed to cajole him out of bed twice on Saturday and 3 times Sunday so he would eat his meals and take his meds. She even got him to take out the mouthguard for a few of those meals.
Saturday night Mom decided to start Dad on a half-dose of the new anti-depressant. He slept okay, but the real difference is that during the day he was less groggy, and more like his "usual" self. However, Mom has developed a routine of waking him at 11 pm to go to the bathroom and take more meds, and for two nights he would refuse to go back to sleep for a while, insisting he had seen people right in front of him who were dying. I did ask if she thought he had a dream about it, or if he was saying they were right there in the moment. She thinks he had a dream because he kept talking about it as if it had already happened. Clearly there is a lot of noise between the meds, his sleep cycles, and his general mental state, because we can't pin down how well anything is working. But since he is doing so much better during the day we're not fighting it.
Doing better means of course, that he is not having any tantrums, and there haven't been any standoffs over the mouthguard. Mom has decided to let it go for the time being. She lets him wear it most of the time, but insists on him taking it off right when he is about to start eating. There's some confusion in his mind as to when he is supposed to have it, but he hasn't been resisting. Much.
The high point of this past week was yesterday evening, when Mike got home from work. He was at the kitchen counter when Dad walked in, so he turned and said, "Hi Dad!" Dad didn't respond, so as usual Mom said, "Mike just said, 'Hi,' aren't you going to say hi back??" Then Dad's eyes seemed to actually see Mike, and his face just lit up. He walked forward and put out his hand saying, "Mike! Wow, I haven't seen you in a while!" Mike just plays along and laughs, shakes his hand, "yeah it's great to see you too!" It's just too much and the 3 adults just started laughing. Later Mike told me Dad reacted as if he was here for a visit.
Cognitively it's clear that Dad is more confused than ever. It's almost impossible to explain anything anymore, like why he only had one slipper (the other was drying after he had another accident). There are no more "Why" questions, there are only diversions. In fact there are very few, "W" questions, except for those that can be answer in one or two concrete words. Yet, we are all currently in a better place because his mood, for the moment at least, is stable.
This grasping at any good moment is running parallel with an exercise we've been doing with the kids. Each night at dinner we ask them to share one good thing that happened that day. The first couple of days one of them had a really hard time. It took a while for them to understand that something routine, like dance class, can be a good thing. And that even in what seems like a rotten day, there is at least one redeeming moment to be found. This has been especially helpful for The Gift, who in the past could have an entire day ruined by one single incident. Yesterday she didn't have the best of days, to be made even worse by a disagreement before dinner with her sister. At first she had nothing to say that was good. When pressed later on though ("After you share one good thing, you can tell me your story") she was easily able to come up with an anecdote that happened at school. We took on this exercise after a spell of negativity in the last month. While I shouldn't expect miracles, I'm hoping that it's enough to keep the dumps from coming on so frequently.
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