Risperidone off
By M on Tuesday 6 February 2007, 16:44 - Journal - Permalink
I found mum in bed at 11:30, and though the promise of a cup of tea got her up
without too much effort, she hardly had a word to say. I asked her if she felt
cold; 'yes' she said. I closed the door and then had a thought...'are you hot,
mum?' I asked. 'Yes', she said.
She moved to her armchair and fell asleep right away. When Carrie, our new nurse, turned up I asked again about the chances of having the Risperidone administered in the evening. It seems mum has cooked her goose. No matter how sweet and mild she is now, she has already passed over the Rubicon, the system will never forgive her for hitting a nurse on the head with a packet of pills or, on another occasion, scratching her arm. Carrie discussed the situation as if the nursing service was a third party, and its rules were an unfortunate fact of life. However, she suggested that I speak to Dr Humerus, which I did, immediately.
'Dr Humerus.'
'Silvia, it is Mike Pritchard here. I think we may have gone a little too far in the other direction with the Risperidone.'
'Is she zombiefied?'
'That's the word, exactly.'
'Let's cut it. It will be the Risperidone. We'll get her off it and then see if she is over the aggressive blip.'
'OK...'
'If not, perhaps we can put her on a much smaller dose - 0.25mg. We can't have her hitting you on the head with a bin again.'
'No, I don't think I'll ever grow used to that.'
'I'll send a fax to the nursing service to ask them to stop it.'
'OK, great. How long should I leave it before calling you again to report on mum's progress?'
'Ohh, a week.'
'Righto, I'll talk to you then.'
Mum picked at her lunch, supporting her head with one hand, her elbow on the table. I've been carrying a minidisc recorder around with me for weeks, hoping for an opportunity to record some of mum's Jabberwocky speech, but nothing she's saying at the moment has that colour, that complexity, that quality of surprise. It is all just monosyllabic and slurred. Regan was right to raise the alarm the other day. Rachel told me she had pretty much the same experience with mum at the weekend.
Even dad was beginning to get concerned. He said as much when I asked him how the two of them were getting on.
So the pendulum swings...
She moved to her armchair and fell asleep right away. When Carrie, our new nurse, turned up I asked again about the chances of having the Risperidone administered in the evening. It seems mum has cooked her goose. No matter how sweet and mild she is now, she has already passed over the Rubicon, the system will never forgive her for hitting a nurse on the head with a packet of pills or, on another occasion, scratching her arm. Carrie discussed the situation as if the nursing service was a third party, and its rules were an unfortunate fact of life. However, she suggested that I speak to Dr Humerus, which I did, immediately.
'Dr Humerus.'
'Silvia, it is Mike Pritchard here. I think we may have gone a little too far in the other direction with the Risperidone.'
'Is she zombiefied?'
'That's the word, exactly.'
'Let's cut it. It will be the Risperidone. We'll get her off it and then see if she is over the aggressive blip.'
'OK...'
'If not, perhaps we can put her on a much smaller dose - 0.25mg. We can't have her hitting you on the head with a bin again.'
'No, I don't think I'll ever grow used to that.'
'I'll send a fax to the nursing service to ask them to stop it.'
'OK, great. How long should I leave it before calling you again to report on mum's progress?'
'Ohh, a week.'
'Righto, I'll talk to you then.'
Mum picked at her lunch, supporting her head with one hand, her elbow on the table. I've been carrying a minidisc recorder around with me for weeks, hoping for an opportunity to record some of mum's Jabberwocky speech, but nothing she's saying at the moment has that colour, that complexity, that quality of surprise. It is all just monosyllabic and slurred. Regan was right to raise the alarm the other day. Rachel told me she had pretty much the same experience with mum at the weekend.
Even dad was beginning to get concerned. He said as much when I asked him how the two of them were getting on.
So the pendulum swings...
Comments
Two things:
1. It occurred to me, as I was reading what appears to be the conclusion of your adventure with the visiting nurses, why is it that the nursing profession doesn't ever consider that, especially with clients such as your mother, maybe they need to think in terms of how to ameliorate their behavior to avoid such confrontations, or, if they are clearly unavoidable, figure out techniques for protecting themselves...take the responsibility for improving the situation. Consider it an opportunity to further the profession. Considering your mother a pariah sounds like an excuse, to me.
2. I can't exactly explain why I'm asking this...just a hunch, probably, gathered from several of your posts I've read here, lately: Has your mother been evaluated for Chronic Renal Failure? Don't freak. It's fairly common in the old. I would guess that, if her kidneys were at lowered function, they are probably still functioning pretty well. We are born with far more kidney capacity than we need, so Chronic Renal Failure in the elderly is often nothing to be concerned about. It's a good idea to know, though, because if her kidney function is down a third or more, she could be experiencing toxic reactions to medications at a much lower dosage than would have been true decades ago.
We’ve had a pretty positive experience with Seroquel (which I think is similar to Risperdone) for my father. The neurologist started him off on a very small dose and ratcheted it up from there, consulting by phone every two or three days for the first couple of weeks. We never got to the Zombie stage, which must be appalling for everyone (falling asleep at the table, etc.). Also did not notice any changes in speech patterns when he went on the drug, though his speech is deteriorating over time.
I assume this is a very particular to the individual. My father is a big burly guy who still eats well (although he gives not a thought to where the food is coming from), so the dosage would likely be far different from your mother’s.
The issue of sleep is interesting. He does sleep a lot, more than he did before the medication, but he wakes up easily and participates as much as he is able, given the dementia. However, both my mother and my mother-in-law (85 and 93) also sleep a great deal, and neither of them is taking any medication that would cause sleepiness. For some reason, I don’t find it strange or problematic that elderly people should spend a lot of time sleeping. Every elderly animal that I have known in my life spent a lot of time that way in their last years. For me the issue is not so much the amount of sleep, but the mood and tone of the waking hours.
In response to Redcedar: Thank you for talking about this. I continue, after some years, to experience occasional pangs of anxiety over this, and my mother is 89, with CRF, Anemia due to CRF, diabetes (well controlled, actually), Dementia-Lite (of the vascular type), and, you know, a variety of aches and pains that go along with a creaky, well used body. I never thought about it in terms of old animals, though. I've always thought of my mother as a cat, in terms of the way she has always slept: naps, fairly short nights. There are, though, days when I do believe she sleeps as much as our older cat. Hmmm...well, now I've got yet another optimistic internal tape to play for myself when observing the Ancient aging process gets to me. I am certain her time up is quality time, so, you know, thank you, Redcedar.