CALS Roll Call Continued

Paul was able to tolerate the low doses of morphine and stayed awake with this. We went quite awhile on the lower doses and he was able to work at the computer and listen to audio books. The drug schedule does get pretty busy but we gave the morphine under the tongue so at least it wasn't another pill to crush or put down the g-tube. You are doing a great job! Hang in there! Are you still going to the food market? Maybe you could have the food delivered for awhile or send the personal care assistant to the store. Is there an audio book you can both enjoy together? I treasure the memories of sitting with Paul listening to an audio book.
 
Thank you Mary. I know nothing about morphine so your post is very helpful. I am encouraging him to listen to books he has interest in. At this time, a book about barbary pirates. We lost verizon home for almost 2 days recently and I read short stories to him. We watch some TV together. He is fading away. But Sunday when our daughter's family visited, we all sat in his room and he enjoyed that.
 
Surprised by reality. I know Tom has ALS and he is almost paralyzed and needs a Bipap to breathe and he gets meds and food in his Peg tube.
Sometimes, most of the time I know this. I have been living with this reality and so has he for months.
But there are times when I am shocked. There are moments when the reality of what he is going through and his condition is raw and new. I realize, almost anew, this is my husband, in a hospital bed, suffering and stuck with ALS. I cant believe this is real. I just cant believe this is happening. Those times of ridiculous surprise, as if I have just woken from a dream where there is no ALS, are the most painful. I want to rip this disease out of his body. We need to stop this and go back to the way we were.
Sick to my stomach, I shove those painful feelings down. Wake up. This is real. Dont feel. Dont think. I tell him I love him and smile.
 
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Thank you, Tom’s wife, for expressing what many of us must feel. I’m right there with you.❤️
and , MJT, I am grateful every day that our children are adults. Can’t even imagine how much more difficult your situation must be
 
To have children with a PALS parent must be so very heart wrenching and life upending. I cant imagine. Our daughter will be 38 at the end of May. She is a trooper, and has benefited from visits by our Deacon. But I can see confusion, hesitancy in 4 year old Ryder's face when he visits. Here is a photo of poppop and Evelyn, almost 2yo. It was taken April 13. Now Tom is barely awake, only one month later.
My heart goes out to PALS with children.
 

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I have a young child and full time job while moving between two homes (PALs and mine).

It's extremely stressful. Thought I was over the initial shock and was gradually doing better. But anticipatory grief and horror of what lies ahead, as well as stress and overwhelm have floored me again today.

feel in emotional and psychological freefall. And could vomit.

Can't believe this is our life. Six months ago we had the world at our feet. So happy and in love (sickeningly so) and blending our families and ridiculously excited and joyful about the present and future together.

Now it's all a living nightmare. I feel completely disconnected from the normal world. Living in this alternate hell. Want to crawl out of my skin this is so unbearable.

Sorry for rant. Really bad day.
 
I apologize for the misleading post. I don't have young children. My heart breaks for those with young children. My heart breaks for us all.
 
Marnes, my heart goes out to you! I hope the day improves. Take a deep breath and rest for a minute. You are in a very tough situation. However you are strong! Know that I and others will be thinking about you today.
 
Thought I’d write here some, it helps me to get some thoughts out.
Being an ancillary CALS, watching the decline and being active in helping with accommodations, the worst part is to see his attitude decline so. My Father-in-law being the PALS in this case; let me caveat it that my wife (as am I) is an only-child so while he is not my dad, we are a close family and have been married nearly 20 years (holy cr@p!) so I cant help but do all I can for him. My own dad is 80 now and in oddly remarkable health generally. Anyway, for FIL the experience has been so gradual, so slow, that even now that he is no longer able to walk, it just seems like it has been a gradual progression. It all started in 2020, looking back, just very slowly. Not until 2021 was an EMG done before some foot surgery, which did in fact indicate he was consistent with anterior horn cell disease; none of us bought it at the time, his lumbar MRI also showed nerve compression and neurologist said “go ahead get the surgery.” A dx was finally made in June 2022, and he walked until March of this year. But its been down down since then. His voice is weaker, he pauses to breathe more, and says he feels it. He still eats and swallows etc, fine. He has just lost interest in doing anything, trying to do much of anything. He was never a reader or game player, so why would he start now. There isn’t much to fill a day’s time. And he doesn’t have a lot of friends calling him up much. They live 10 miles away and we visit weekly. I’m able to help fix up things he needs, like this week I welded up and bolted on a handle for his hospital bed, modified so he could get a better grip at a certain spot to move around.

He has no interest in a feeding tube or a breathing machine, and I totally understand that. He stopped the Rilutek because, honestly, its clinically shown to “extend life” and he has a good point that “why would I want to extend this condition?!” I told him that gradually it will just be more difficult for him to expel CO2 and he will at some point become unconscious from that. We all seem to be able to live with that. Whats amazing is how many doctor visits a ‘healthy’ senior citizen needs to go to, and in his condition…..he really never needs to go anywhere anymore. The doctor at the VA was telling him he needs to be eating more and taking this and that. We have this saying “re arranging the deck chairs on the Titanic.” My mother in law said “oh what if he catches a cold or something” and I said…maybe it will turn into pneumonia. Pneumonia has been called “the old man’s friend” I told her. She thought and said, “youre right, actually!”

I am wondering if he will just gradually stop breathing before he loses arm and swallowing function. Because he just seems to be “fading out” more than “progressing” at this point. But he’s got a good comfortable room on the first floor, a home care aid for 12 hours per day (some are better than others), and a supportive family.

I know everyone here has different goals, different progression, and different enjoyment of their lives. In fact some of what I’ve read here is very heart warming; people in poor circumstances who find a reason to want to keep enjoying what life can offer. FIL is not one of these folks, sadly. And I just have to accept that for what it is. Life is contingent, as they say, and most of the human condition is learning to adjust our minds to our circumstances as they change.

Anyway sorry to waste a lot of characters here but it helps to have somewhere to put some thoughts down…. 🤔
 
I am sorry you, your wife and family are all suffering from this terrible thief of a disease.
I respect and understand the thoughts expressed here about final months. Despite PALS disease, my husband and family have tried not to lose hope of finding some good in life.

My husband, PALS, was just listening to and enjoying the new Tom Hanks novel last week. Before that it was a book about the barbary pirates. He sees his grandchildren many times a week. Even stuck in his hospital bed he enjoys their visits.

Sometimes in life, circumstances , disease, accidents, and events prohibit a persons ability to live fully. Legs dont work, hard to breathe, feeling in pain...and more, make each day very difficult. My father was blind the last 40 years of his life. We have PALS on this forum who are in pain every day. They can not live fully, but they do live and try to find some purpose and interest and even joy in moments. A fatalistic viewpoint is not one I would want to see anyone live with. Many PALS take medication such as an anti-depressant to help them through this very difficult journey.

I know my husband of 48 years. He would not turn away from the moment with the book, music, or family and think it has no benefit. When I tell him I love him, I know he hears me. Is a day being loved useless?

Tom is dying now and has been for days. He will leave us when the Lord decides to take him. I have prayed "thy will be done", please call him home.
 
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Everyone is different. Love and peace to all who are suffering from ALS.
 
AndrewF, thank you for sharing your thoughts and musings out loud. I and others on this journey are interested in your FIL's journey and in your efforts to support your FIL. His journey is his alone and if he doesn't feel like doing much than that is okay. As you say he is probably building up Co2 and doesn't have the focus, energy or strength to do much. He is with your MIL and if they just sit together that is enough. Certainly his wishes and his comfort are the priority. An anti-depressant is his choice. It sounds like he can still enjoy a bit of food. Sit with him and hold his hand if he'll let you. Never compare activities that your FIL is/isn't doing with anyone elses activities.
You love your FIL and he knows this. You have a close family. Treasure this. My heart goes out to you, your father in law and your family as you go through this time together.

At some point your FIL won't be able to make MD appointments any longer. I don't know how VA benefits work with hospice. Maybe someone else on the Forum knows.
 
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Marnes, don't hold back from asking your extended network for help, especially in regards to the kids and your respective homes. And if there is some workplace accommodation that could help you, I would develop that proposal. There is only so much you can do in a day.

Thank you, MJT, for reminding us that in the end, it's the love we make.

Kathy, I'm sorry to hear of Tom's continued decline. He has the best wife at his side.

Mary, often, by the time PALS go on hospice, they do not need to see their pre-existing clinicians any longer. Most rx only require having been seen in the last year (may be less for opioids).

But there are many options, including for veterans (the VA has an active telehealth program), for home and virtual care, whether by physicians, PAs, NPs, or nurses. And with shared medical records, there are fewer barriers to "distributed care."

Andrew, keeping it real, your FIL will likely not just fall unconscious and die, even without a BiPAP or feeding tube. Without intervention, there could be considerable suffering. So I would have and document conversations now about his wishes, using scenarios such as increasing air hunger.

Though it's not a moral imperative to find joy in every day, if your FIL needs a BiPAP and doesn't have one, that does affect cognition and therefore can foster or add to apathy. You might at least make that point to him, that a clear head only adds options and he still drives the train.

And watch for fatalism by proxy -- it's easy to get yourself more locked into a state of mind than the other person really is, and sometimes they need help to get free without losing face.

Any given day that you show up, either he has something that he wants to do or not. If so, you can help. And success breeds success.
 
At some point your FIL won't be able to make MD appointments any longer. I don't know how VA benefits work with hospice. Maybe someone else on the Forum knows.
The thing about it is, there isnt ever any need for him to enter a "formal" hospice situation. He's kind of already in one...he goes to medical stuff he wants to and doesnt go things he doesn't. Between the VA's disability, R1, and R2 level payments to him, he has all the care he needs now, and can get more when he needs it. All the equipment he needs, etc. But I see your point now, thinking about it more, maybe he'd need care aides who are more equiped to deal with "hospice" related situations, like patients who may acutely die at any moment. We're not there, yet. Yet.
Its like turning down a lightbulb, really slowly. My second-cousin-once-removed Bob (full disclosure, no love lost for him) grabbed his chest at 60 and had a triple-A that ruptured.....gone. So....20 less years, but one second of suffering.
 
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