Nov 2, 2013

Prunes and Rosaries

Pamela Kelley writes about problems associated with the dreaded bowel movement, and how she "attacks" this problem along with her mother Audrey who lives with Alzheimer's.

By +Pamela Kelley
+Alzheimer's Reading Room 

Forget Me Not | Alzheimer's Reading Room

Let’s get right to it – the nuts and bolts of caregiving are not subjects that generate fascination in the non-caregiving community.

Some of the matters we face are best not to mention to the squeamish.

That’s one reason we’re all fans of The Alzheimer’s Reading Room.

It’s one of the few places where our common challenges of hygiene, regularity and difficult behaviors can be addressed directly. Here, we don’t have to search our vocabularies for euphemisms.

Just now, my focus in my mother’s care is on poop and sleep. Neither one is coming very easily.

My mother consistently reports her urge to use the toilet. I like being able to act on those reports immediately. This has kept us clean and dry and comfortable for years.

But lately, a new pattern has emerged. When I get Mom on the toilet, she waits about three seconds before announcing, “Nothing’s coming” and attempting to stand up. Getting Audrey to sit on the toilet for any length of time is surprisingly difficult. Any progress we make toward completing a bowel movement is halted.

Unwilling to just let things go, unable to find the patience to sit until the job is done, Mom can get stopped up. And the more poop she’s storing, the more condensed and difficult it is to pass.

This leads to complaints that “it hurts” and even more insistence to get up off the toilet. The clean-up associated with these half efforts is … considerable.

It occurs to me that softening the mass of stool is one sensible approach. The tools we’re using are: Senna teas, morning and night, prunes and other fruits as snacks, and prune juice. I think these are beginning to show their value, and I intend to keep these in the daily rotation.

Keeping Mom, whose mobility is not compromised, seated on the toilet requires creative encouragement. I pull a chair into the bathroom with her, and we sit together holding hands. I encourage her to squeeze my hands, and sometimes she does.

When it looks like she’s going to get to her feet, I distract her with a song. She can’t resist singing along to “You are My Sunshine” or “Let Me Call You Sweetheart”. That buys a few more minutes.

We recite prayers together. But when she’s hit her limit, Mom will swat at me and swear. I relent, not wanting to provoke an agitated state unnecessarily. I’m not going anywhere; I’ve got the time.

We’ll get through this. It’s not as though she’s not moving her bowels, it’s that it is not done completely. She’s not soiling her undergarments. But we’re not wandering very far from the bathroom, and we’re making lots and lots of trips there.

I’m sure there’s a better way – but this is what I’ve come up with for the duration. I hope to have better tools at my disposal the next time this occurs, for I have no doubt that it will.

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While we’re contending with this, it’s a good time for me to be at Mom’s side more than I already am. For the last year, Mom has been a resident on the memory care unit of a reputable assisted living facility near my home.

I’m with her every morning, have lunch with her every afternoon before leaving to tend to other business. We have a routine that works, and it assures me that she has loving companionship every single day. My average visit lasts from three to five hours.

This week, I’ve been returning to spend a few more hours before slumber too. We have a cup of the senna tea. We snack on a couple of prunes. We watch part of The Sound of Music and sing along. We turn down the bed, pull down the blinds, dim the lights, go to the bathroom one last time. My mom asks her favorite question: “What are we doing to do next?”

“We’re going to get into that nice bed.” Sometimes she’ll tell me she not going to get into that bed. Sometimes she’ll tell me that it looks very nice, but it’s not hers. Sometimes she says there’s room for me in there too. No matter what she says, I keep on smiling and nodding and gently guiding her: sit on the edge, let me remove those shoes, lean back, here come the covers.

Once she’s in bed, I open her nightstand drawer and pull out the two rosaries stored there. She gets the green one; I get the black one. She goes through the motions as I say the prayers aloud. Mom mouths the words with me, silently. Before we’ve worked our way through all the beads, she’s fallen asleep. I listen for her breathing to deepen with slumber, and I quietly slip out of her room.

A quick check in with the staff, letting them know that Audrey is in bed asleep, provokes dismay. “How did you get her to do that?” they want to know. Mom will not sleep in her bed, hasn’t slept anywhere but her armchair for months. No wonder her back aches, her shoulder pinches, her legs retain water. I’m pretty shocked that her sleep hygiene has devolved to this point.

So now, I’m at work trying to distill the evening bedtime ritual into one that can be condensed to ten minutes or so, something the care staff can replicate.

I’m working to try to condition my mother to once again using the bed for sleep, to recreate a little muscle memory over the comfort derived from lying prone. I’m reminding myself that an increase my presence is in all likelihood the only way these two issues – poop and sleep hygiene – will be resolved to my satisfaction.

It’s merely coincidence that this week marks the one year anniversary of the day my mother moved from my home to residential care nearby.

It’s fortuitous that it’s time for another meeting with the director and nursing staff, to address the care plan and concerns on both sides.

I’ve spent the last year by word and example trying to demonstrate that we’re collaborators in providing Audrey with the best of care.

So I’ll be eager to hear what they have to say about matters of sleep and poop.

But I’d love to go into that meeting with some advice from my colleagues and friends from The Alzheimer’s Reading Room. 

Any suggestions?

*Pamela R. Kelley is the full-time caregiver for her mother; and, a long time contributor to the Alzheimer's Reading Room. She lives, works and writes in Anchorage, Alaska.
This article was first published in 2012.

Original content the Alzheimer's Reading Room