Thursday, June 21, 2012

Live cells v. dead cells...

Last week Riley had an appointment with a Veterans Administration doctor in order to set up a primary care relationship with the local VA clinic. I had originally thought it was an evaluation for his disability compensation claim, but I was wrong. This appointment was only to do with his request for VA medical services.

I’ve heard a lot of horror stories about these clinics and the medical staff. If this clinic is representative of other centers, those horror stories are without merit. I found the clinic to be very clean and well equipped. The staff was friendly and cooperative. Things felt as though they had all been trained in the art of efficiency and customer service. I was impressed.
I was also impressed with the demeanor of the doctor that had been assigned to us. He was knowledgeable and spoke to me as one human being to another. He didn’t use medical-eze which would leave me running to Wiki to find out what he had said. He was a real person who used his own personal experiences to show that he understood what we had been going through. He explained and when I left I felt we had a plan of action and I knew the consequences of all the possibilities.

While we were all talking and relating, he was examining Riley. It wasn’t a huge exam. There was no disrobing or standing and touching his toes, but rather simple things.  To a lay person it might seem that he did next to nothing of a real exam. That assumption would have been wrong.
This is what I learned –

The liver can, in fact, regenerate new cells and continue to function. However, there must be a sufficient amount of LIVE cells for regeneration. DEAD cells are just dead. They cannot regenerate. The just remain as scar tissue impeding proper function. If the liver has been constantly asked to recreate itself over and over again, it will get to a place where the regeneration cannot replace all the cells that have been killed by the intruding factor. New cells WILL regenerate, but the question is will it happen fast enough?

The only way to really determine how much of the liver is functioning is to do a biopsy. It’s a simple procedure of inserting a needle into the liver and withdrawing a sampling of the cells. Without the biopsy there is no way of telling the percentage of dead cells versus the live ones. However, the procedure generally causes heavy amounts of bleeding. Alcoholics are susceptible to having bleeding issues and are not good candidates for the biopsy. In Riley’s case the risk of him bleeding out is not worth taking the chance that a biopsy would present. So for Riley -- we don’t know and we won’t know how much of his liver has the capacity to regenerate.
The same theory works for LIVE cells and DEAD cells in the brain. However, the brain is not as forgiving as the liver. Alcohol anesthetizes many of the cells so that they do not function properly. Other brain cells are simply killed off. As the alcohol stops entering the brain, these anesthetized cells seem to wake up and start functioning again. But the dead ones are just gone forever.

It is obvious from observing Riley that he has made a remarkable improvement. However, he is now about a month from the heart attack and the condition he is in currently is about as good as he is going to get.  He will have very good days and very bad ones. But this is what it is and this is what it will be.
I’ve been trying to visit Riley at least every two days. Sometimes it’s longer. Visiting him less often allows me to see his progress more clearly. If I see him every day the subtle changes may not be as noticeable to me.  And I DO see changes. His eyes are much clearer and skin is not as yellow. He doesn’t mumble so much when he talks. He is able to follow a conversation – to a certain degree. He is also developing a desire to maintain his personal cleanliness and keep track of the schedule. He knows that does NOT want to be there. He wants to come home so that he can drink.

 S..i..g..h..

This puts me in a Catch-22 position. If he stays in the facility, he will not drink and live longer and healthier. If he comes home and can get alcohol, he will most likely die within a year but be happier about where he lives. I would like to say that this is about the “quality” of his life. But that is subjective. What would be a quality life for me would probably make him miserable.
There is the issue of having him come home endangering my health. Caretaking him has had a huge negative effect on me personally and medically. I have no desire to die. I asked Riley how he would feel if he came home and then woke up one day to find me dead on the kitchen floor. His response was that he would be worried about who would be taking care of him now. WOW!! There was no expression of regret or even that he would miss my company. His only concern was how my death would possibly upset his living arrangements.

The doctor at the clinic has noted in Riley’s file that he should be institutionalized because he is a danger to himself and others due to the fact that he will not stop drinking. Even if Riley is not displaying any outward signs of needing hospice, he is still terminally ill which will only be intensified by his return to drinking.
On my plate for today, I must request a comprehensive neurological psychiatric evaluation to determine if he is competent to make his own decisions. If he is deemed incompetent, he will not be able to make the choice of staying in a facility or coming home. If he is, in fact, competent he will be allowed to make his own bad choices. But… really… isn’t that what he’s been doing all along??

Saturday, June 16, 2012

Help me help Anonymous...

I would like to refer my readers to a post written on March 14, 2012 "Crying wolf..." Not only is this post appropriate for the current time, it also contains a comment from a person who needs a little help.

This person is addicted to alcohol and drugs and has managed to achieve some sobriety after a visit to rehab. Currently he/she has slipped and is struggling to get "back on track." I'm asking all of my readers who have been in this position to please offer some encouragement and support.

I'm not an alcoholic so I can't ever truly understand to my core how difficult it is to "get a gripe." I know my limitations. So I'm reaching out to all of you to help me help Anonymous find the way back to sanity.

Thank you very much --- Linda

To Anonymous (the last commenter on "Crying wolf...") --

I hope you are reading this and will know that the support here is heartfelt from people who could have written your story themselves. Please reach out and return to a life filled with possibilities.

Linda

Friday, June 15, 2012

No longer sequestered...

I just spent the past week in the Outer Banks of North Carolina. The time spend with my grandkids and great-grandkids is priceless.  However, this visit was a bit more stressful for me.

Whenever I visit, I always think to myself that I can maintain all my communication and contact with my readers and OARS members via the internet. My left-coast family and the Riley’s nursing home/staff always can reach me via my cell phone. I’m not cut off from the world. I’m still here.
The only problem with that scenario is that the kids’ internet access was not working. They usually have free public access as a benefit for living in a resort community. But, for some reason it was not working. I packed up the laptop and went to the local MacDonald’s where there was always free wi-fi. But I got zip. Nada. Nothing. I spied another person on their laptop and asked if they were able to connect with the web. She told me she hadn’t been able to connect no matter where she was on the OBX. Oh! Well… this was not good.

After a couple of days the frustration seemed to fade away and I was able to relax and not be glued to the computer. It was actually rather pleasant. I was worried that my readers might think I had abandoned them, but realized that this was just a way of having a forced vacation.
I played hide and seek and build forts out of sheets and dining chairs. I cooked dinners that contained all four food groups. My great granddaughter went out looking for houses. I watched a countless number of Storage Wars with my granddaughter-in-law. I focused only on those days and I didn’t seem to worry much about what was going to happen when I went home.

There was a down side to my visit. I had taken Jade with me because I had no one to check on her at home. I had no dog sitter. She loves an adventure, so she happily jumped into the van when I called her. She was even happier when I made a stop at the nursing home so she could visit with Riley. She climbed right into the bed with him and gave him doggie kisses all over him. Clearly, she had missed him and was happy to make the reconnection. So far so good…  I thought.
The kids live in a typical beach box with is just a bit larger than a three bedroom apartment sitting on top of pilings. There is a yard, but it is not fenced in. They have a dog of their own – a sweet grey dog about half of Jade’s size.  He’s a little boy named Bently who is really still a puppy, so he’s full of energy. Bently walks on a leash and also does his business on a designated area of the deck. He’s a good boy. But – he is not neutered yet and thinks Jade, who lost her puppy-making-equipment  several  years ago, should be his girlfriend. Never mind that Jade is twice his size and totally not interested – Bently loves her. Bently wants her. Jade tolerates him.

Jade was pretty good about using the deck, but she would often go to the door and ask to go out. She’s 65 pounds and is not well trained in leash etiquette. She pulls as I try to walk her and I’m not strong enough to keep her under control. As a result, her outdoor time was limited. Indoors, she would play with Bently until she would get tired of his unwanted advances and then snap at him. They would both settle down for naps when Jade made it clear she had had enough. Jade is very patient with the little ones and allowed them to pull on her ears and give her hugs.
I can image the frustration Jade felt from being cooped up in a relatively small space with no freedom to run the fields or chase after mice, rabbits or birds. I equate her frustration to being similar to what I feel when I’m cooped up in the house with Riley for weeks on end. I can also see how it would be similar to Riley now being in a small nursing home room rather than the big space he had in the country house.

Now I am faced with giving up this country home and moving to the OBX. I know it will be a move that will make me more accessible to the kids which is what I want. As much as I dislike living in the OBX, I know it will be good for me. However, this will be a challenge. Rentals are scare here at this time unless, of course, I want to pay $3K for a place right on the beach. I must provide a place for Jade to have some access to the outdoors. There must be room for Riley if he should be able to return home. And I prefer it to provide some privacy and not be on pilings. It’s a tall order for that area.
For me, this move will mean I’m no longer sequestered in a remote area. As much as I love it here, I love my family more. All of the space out here, creates a similar frustration as Jade being coped up inside my grandson’s house. The loneliness of the open space makes it feel confining.

If I could pick up this property with the horse paddocks and open fields and transport it to Kill Devil Hills, none of us would feel confined or restricted. It would be the perfect situation. Even Bently could come to visit and chase Jade all around the paddocks. He’d never catch her – but he’d certainly have fun trying.

Wednesday, June 6, 2012

Am I an alcoholic?

I received this e-mail yesterday and I thought I should respond openly so that others may have the benefit of my response. I want to emphasis here that I’m not a professional anything. I’m also not an alcoholic and so my viewpoint is from someone who has not had the painfully gripping experience of addiction. That is – except for my morning coffee.

Hi Linda –
 I've been reading your blog for probably a year or so now. I don't recall how I stumbled upon it exactly, but I immediately took an interest. I'm 24 years old and I'm working on figuring out the extent of my problem with alcohol. I identify with a lot of what you have written in your blog, enough so that it causes me to worry about what the future may have in store for me if I continue along my current path.

It's certainly been addressed to some extent in what I have read in your blog, but I'm curious about Riley's history with alcohol. I would like to know how he got to where he is now. I'm very curious how much drinking it takes to wreck the havoc upon one's body that it has in Riley's case. How long did he drink and how much? I realize this may be a somewhat nebulous question, but as I read your blog I always find myself wondering how much does it take for a person to end up like Riley has.
As well, if it's not too difficult or personal to discuss, I'm also curious about your son, and his drinking in contrast to Riley's and the fact that Riley has some how managed to survive despite all odds.

If this is something you would like to post on your site I have no problem with you sharing my email.
Thank you.

Steve
In one of the pages on my blog, I write about the different stages of alcoholism. For the most part, Riley’s drinking route follows that road map. In my opinion, Riley’s alcoholism kind of snuck up on him and once it was there it was a permanent resident. I don’t know if it is that way for most alcoholics, but no one ever says “I’m going to start drinking booze until I become so addicted that I cannot live without it.” No one has ever made a conscious decision to become an alcoholic.

Back in the Navy days of the late 70s and early 80s, alcohol was an accepted form of beverage at recreational activities. There were “beer ball games” and “initiations” and “balls” and “cook outs” – and getting drunk was a pretty accepted way of celebrating. In Riley’s case, when the recreational time was over, he had difficulty making the transition back to serious work mode. While others were able to put aside the beer and wine, Riley was hooked on the euphoric feeling of drunkenness. I don’t know of ANYONE in Riley’s group during the late 70s and early 80s who became alcoholics from all the carousing that was done during that time. There may have been – I just don’t know about it.
So, for Riley, I believe it all started honestly enough. I think he truly believed he was not an alcoholic, but thought he was able to maintain his askew mental state by drinking small amounts each day. The only problem was that as he continued to drink, he was unable to drink in large enough quantities to keep up the desired “high” that he no longer wanted – but, in fact, needed.

Brian, on the other hand, follows a different scenario. In his teenage years into his early twenties, he did all the experimentation that parents frown upon. Alcohol did not seem to be something he was most interested in – it was other drugs that called his name. But, fortunately, he out-grew that craziness and went on to a wonderful job travelling the world and enjoying his bachelor life. He became a rational, responsible young man.
Alcohol did not become a part of his life until he became involved with a woman who was an alcohol abuser. To make a very long story shorter – he ended up quitting his travelling job and trying to settle down with this woman to whom he lost his heart. His life was never the same after that. He joined her in drinking and was often as drunk as she was.  That relationship ended, but the drinking remained.

It was only three years later, that Brian’s new girlfriend tried to communicate to me that his drinking had become a problem. In my opinion, she didn’t try hard enough to make me understand what was happening. I heard bits and pieces of things – innuendos and comments – but nothing that would alarm me to take a more proactive stand.
Less than one year after that brief communication by his girlfriend, my son was dead. 

The bottom line to all this is that there is no true and correct answer to the question of how long it will take for the alcohol level to become so high as to cause death. The style and progress of the drinking doesn’t really matter. The end result is the same – death.
Steve – my suggestion to you is to honestly look at your drinking and why you are imbibing. If you’re trying to maintain a certain level of “float-y-ness” then you are certainly on your way to a life of craziness. The fact that it is disturbing to you is also a cause for concern. Ask yourself this – is drunkenness the goal of a social function or is the goal enjoyment of family and friends? Would you decline an invitation to an event that doesn’t include alcohol? Do you leave the non-alcoholic event just to find the nearest means of getting drunk? If you are drinking at lunch or going to happy hour every night – you have a problem.

No one can say for sure if someone else is an alcoholic. Only you can make the determination. But, before you decide you are NOT, maybe you should go to a few AA meetings and talk to the people there. OR just listen -- you don’t have to say anything. The meetings are free and they are taking place everywhere.
One more thing you can try – just stop drinking. After a few days you will either be anxious to find a drink or you will not really care one way or the other. But, this is a dangerous precedent because often alcoholics say “I’m not an alcoholic because I quit drinking for (X number) of days and I was fine.” But, if that alcoholic returned to drinking and increased the intake – well – Houston -- there is a problem.

There is an excellent book named “Almost Alcoholic” that may help you. I’m not sure if it’s even been released yet. It was sent to me for review. The authors are Robert Doyle, MD and Joseph Nowinski, PhD and the book is being published by Hazelden. It was supposed to be out in April 2012. I think it might answer a lot of questions for you.
In my opinion, if you have the slightest little inkling that you MIGHT have a problem with alcohol – then stop drinking. If you find out you can’t stop – seek help. Do it now. Don’t wait until you’re under hospice care in a nursing home and think that you spend each night in the back of a truck at a residential fire. Don’t wait until you have no idea where you are or where you live or the names of the people who visit you. Don’t wait until you end up like Riley.

Saturday, June 2, 2012

Life in Riley World...

The nursing home called me late Thursday evening. In fact, they called me twice. Riley had fallen out of bed two times and they needed to inform me of that right away. He was not physically hurt. It’s not clear if he simply rolled out of bed or if he tried to get out of bed. They no longer use bed rails in the home because patients try to climb over them and hurt themselves. So they have placed soft mats all around Riley’s bed in case he falls again.

If any of you get cards returned to sender, it is because the nursing home had a little “snafu” last week. There was a temp on the front desk and no one had informed her of Riley Riley being a patient. If your card was returned, I apologize. The situation has been resolved and if you want to try to send it again, the card WILL get to Riley.  He truly enjoys getting these cards and even asked me to read Syd’s card to him twice. Thanks Syd!
So… when I visited Riley on Friday morning, I asked him how he was feeling after his fall out of bed. He responded with laughingly telling me he had been forced out of bed by the baby which hasn’t been born yet. I asked him if he was the baby’s father. He said that Tom was the father. He proceeded to tell me that he spent most of the night in a truck with two other guys. The two guys were able to get out of the truck, but that he had to stay inside because they were on private property and it would have been illegal for him to step foot on the soil. He said he sat there for more than three hours.

He was in a talkative mood. Riley told me that there had been a lot of sirens last night. He knew there was something going on because the green fire trucks were out. He said they were a puke-colored green and this was the only town he knows of that has them.  They have yellow lights instead of red. I asked where these fire trucks were from and he said “right here”. I asked where we were and he said Clinton, IA. Well… he’s only about 1,500 miles from his actual location.
I wanted to see how much he was really mentally here. I asked him who I was. He said I was his wife. I asked him what my name was. He hesitated and then said “Linda?” I talked to him about Jade and Jax, but he had no response to that subject. I don’t think he knew who they were. I told him I was going to move in with the kids for a while. He said OK but he didn’t want to stay in the country without me. So it seemed he was able to connect a few things accurately. He also told me that Janet (he meant Debbie), the nurse, told him that he may have to go to an assisted living facility. I asked how he felt about that and he said he didn’t know.

I promised his brother that we could try a phone call. I dialed the number and put it up to Riley’s ear. I don’t know how disjointed the conversation was because I couldn’t hear his brother’s end. But, when he hung up Riley explained to me that his brother had been snowed into his house for the past few days because the storm hit him hard. His brother didn’t know how long it would be until the snow plows would be able to get him out. That was interesting because his brother lives in the San Francisco Bay Area and there has never been enough snow on the ground to create any sort of hazard let alone enough to “snow him in”.
At the end of our visit, as I was driving off to run some errands, it occurred to me that Riley was getting better as far as his body was concerned. But, his brain function is way off. It was entertaining to talk to him. He didn’t take any sips from his imaginary glass. He didn’t ask me when he was going to come home. Mostly he was just in his own world and he seems to be enjoying it there. For some reason, it makes me feel better about the entire situation. Maybe that’s because he actually appears to be happy in Riley World.