Scrub, a dub, dub...

On the page “Leave or Stay” (http://immortalalcoholic.blogspot.com/p/leave-or-stay.html) I write about the difficulties of caretaking an end-stage alcoholic. Many times potential caregivers don’t see the whole range of chores that come with the job. One of those chores is the cleaning up of bodily fluid messes. Alcoholics have a tendency to vomit blood as well as lose control of their bowels and bladder at any time and any place. Cleaning up can be dangerous for the caregiver if not done properly. Below are some suggestions and hints about cleaning up after the alcoholic in your home.

1. Use latex gloves and protective masks when handling any of the articles of clothing or bedding whether or not they contain excrement.
2. Put waterproof pads between the sheets and mattress.
3. The alcoholic’s laundry must be done separate from the family laundry.
4. Keep a very small trash can by his bed. Use a plastic can liner – doubled. He can use this if he needs to vomit and can’t get to the bathroom. Clean using the bleach mixture.
5. Don’t allow him to handle any food. Prepare his meals. If he eats during the night, prepare food and snacks that he can eat while you’re sleeping. There’s no point in designating breakfast from dinner. He can’t make that leap – so just fix what you know he will like.

When Riley was drinking a handle of vodka a day, I was left with a lot of clean up. I used the bleach/water mixture, but I still had to do a lot of scrubbing. Below are some of the methods and products that worked best for me.

General cleaning: 1 part bleach, 2 parts hot water, 1 cup of Borax Laundry Soap, 1 cup Washing Baking Soda and a bit of Dawn dishwashing liquid. I used this for hard surfaces except hardwood floors. I used a scrub brush, paper towels and old face cloths.

Laundry:  Amway sells the best laundry products I have ever used.  The SA8 is awesome by itself, but for Riley’s clothes and bedding, I used the SA8, Tri-Zyme additive and bleach. The Tri-Zyme is great for getting out blood and feces. I separated colors from whites and then pre-washed the whites in very hot water, high water level, hot wash & hot rinse.  Then I sent them thru a regular wash cycle with fresh ingredients. I dried them in a very hot dryer.

For colored laundry, I used the same cleaning combo of SA8, Tri-Zyme, but omitted the bleach and added Borax and Baking Soda. I did a pre-wash and then a regular wash using warm water, warm rinse. If they clothes were still smelly, I put them thru a second wash – same as the first. They were then dried in a hot dryer.

Carpet: This was by far the most difficult to clean. Fortunately I had a Bissell Pro-Heat Pet Carpet Cleaner. I pre-treated the area with Oxi-Clean and got on my hands and knees with a scrub brush. I used a mask and double latex gloves to prevent inhalation and touching the gunk. If I wasn’t happy with the results, I added a bit of hydrogen-peroxide (be careful, it can lighten the carpet color), scrubbed it around and hoped it looked better. Then I used the regular carpet cleaner with the intended for pets and used the cleaning machine. After that I did a rinse with Borax and Baking Soda. I put it into the tank where I would normally put the cleaning liquid. It worked pretty well, but the stain does keep reappearing after a couple of weeks. The best thing I did for the carpets was to have a professional carpet cleaner come in every three or four months and do just the areas where Riley spent most of his time.

Bathroom: This room was the smelliest, sickening room of all. There were feces on the floor, toilet, walls, light switch, door handle, sink, faucets, etc. We had a tile floor so I made my bleach/water combo and literally poured it on the tile. Then I let it stand for about 30 minutes. I had a deck brush and used that to scrub up and loosen the stuff. Then I used the broom and swept it up into the dust pan, dumped it into the toilet and flushed. Then I used another lighter pour of the liquid onto the floor and mopped it up. After that, I used my steam mop to go over the floor which further sanitized it. Now I could actually walk into the bathroom to clean the rest.

For the outside of the toilet, I used a hand-held steam gun and then wiped it down with bleach. For the sink and countertops, I sprayed bleach directly onto the areas and wiped them down. Then I used the steam gun just to sanitize it even more. I used Comet inside the sink, rinse, and wipe with bleach.

I made a new batch of the bleach/water and added Borax and Baking Soda for wiping down the walls, door handles, anywhere else that need a cleaning. In the bathroom, bleach was my friend.

A lot has changed for me since those days. Riley is not drinking and is not making nearly the mess that he did when he was inebriated. However, his current physical condition means he makes a mess when he changes his underwear. It isn’t nearly as bad as having poop smeared on the walls. Do not doubt – he is messy – he’s just not so unsanitary.

There are lots of products on the market that I have not tried, but have discovered their uses since my heavy cleaning days. I’ve made a table of some of the things I used and my discoveries so you can see what may work in what capacity. From this you may end up making your own concoctions that work best for you.

Product	Tile / Hard floors	Wood floors	Counter-tops	Bath fixtures	Walls	Carpet	Laundry	Upholstery / Mattresses
Bleach	X		X	X	X		X	X
Borax	X		X	X	X	X	X	X
Baking Soda	X	X	X	X	X	X	X	X
Dawn	X	X	X	X	X	X		X
Tri-Zyme	X		X	X	X	X	X	X
SA8							X	X
Oxi-Clean	X		X	X	X	X	X	X
Murphy’s Oil Soap		X
White Vinegar		X						X
Pledge Liquid Wax		X
Mineral Spirits		X
Club Soda						X		X
Meat Tenderizer				X	X	X	X	X
Hydrogen Peroxide	X		X	X	X	X	X	X

To purchase any of the Amway products, use the below link:

http://www.amway.com/SherrieRidge/Shop/Product/Category.aspx/Laundry

Now that you have a list of possible products, here are some links to tell you exactly how to use them to get that fresh, clean home that hard to achieve with an alcoholic in the house.

http://www.wikihow.com/Remove-Blood-from-Hardwood-Floors

http://www.howtocleanthings.com/stains/how-to-clean-blood.htm

http://www.stain-removal-101.com/feces-stain-removal.html

http://www.ehow.com/how_5783632_clean-human-feces-carpet.html

That’s it for my housekeeping tips. Be sure to post in the comments what has worked for you and what has not. Give us your tips, we could all  use them.

Dementia... in case you forget

As per Google:  Dementia (noun) – A chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning.

As per Merriam-Webster: Dementia (noun) – A mental illness that causes someone to be unable to think clearly or to understand what is real and what is not real; A usually progressive condition (as Alzheimer’s disease) marked by deteriorated cognitive functioning often with emotional apathy.

A simple explanation of dementia was described to me by an employee at the Alzheimer’s office. She said imagine the synapses in the brain which are electrical currents traveling to a nerve ending where it zaps a nearby nerve-ending thereby completing its process. Now imagine that when the electrical current gets to the first nerve-ending, there is no other nerve-ending for it to zap onto. The thought contained in that first nerve-ending never gets completed and gets lost somewhere in the brain. Those thoughts are still there, stored somewhere in the gray matter, but retrieving them is problematic and sometimes impossible.

There is more than one type of dementia.

1. There is the ever looming Alzheimer’s Disease which slowly erodes memory and thinking skills which is the most common in the dementia family.
2. Frontal Temporal Dementia is a group of diseases which affects decision-making, behavioral control, emotion and language. They are:
1. Primary Progressive Aphasia – which gradually degenerates speech and language;
2. Progressive Supranuclear Palsy – which gradually degenerates walking and balance;
3. Corticobasal Degeneration – which gradually degenerates nerve cells that control mobility and vision;
4. Behavioral Variant FTD – which involves changes in personality, behavior and judgment.
3. Lewy Body Dementia – This type of dementia is associated with Lewy bodies and Parkinson ’s disease. It is the second most common dementia.
4. Mild Cognitive Impairment – This is defined in deficits in memory that do not significantly impact daily functioning. Memory problems are minimal.
5. Vascular Dementia – This is a subtlety progressive form of dementia causing progressively worsening memory due to reduced blood flow in the brain.

Riley’s primary care physician is concerned that his problems with memory and weakness in his right side are not improving. After Riley was released from hospice in August 2012, he improved from not being able to walk, feed himself or tend to his personal needs to being able to do all those things with little assistance. Now, today, he cannot walk without the assistance of a walker because he has very little balance and even then he falls almost daily. At the same time, his memory of current personal events has become shorter. It was the primary doctor’s hope that an appointment with a neurologist might be able to reveal the cause his decline.

Our appointment with Dr. Brain was informative as far as the damage from Riley’s previous strokes, but an MRI was needed to provide more clues. The results of the MRI were that he has brain atrophy, a common occurrence of excessive alcohol abuse which contributes to dementia, but there were no signs of any other condition that would cause dementia. Dr. Brain’s conclusion was that Riley is choosing not to remember things and that he only has mild cognitive impairment. He did not explain that this diagnosis was in fact a term for a form of dementia.

My reaction to this diagnosis was shock. I wondered if Riley had been “playing” me and really was able to function far better than he was showing just to keep me under his thumb. I could hear the words in my head, but something was just not right. It made no sense. Riley’s main goal is to be rid of me to stop me preventing his drinking and driving drunk. If he were truly capable of remembering and has no dementia, he would be making sure I knew so that he could prove that he was perfectly capable of living without me and managing his own life. We left Dr. Brain with me being more confused than ever.

Of course, those of you who have been following me know that I wouldn't just leave it at that. I started researching, making phone calls and trying to sort it all out. Drs. Google and Wikipedia have always given me great answers, but this time I added the Alzheimer’s Organization North Carolina, Merck Medical Dictionary and a whole array of other means of information. Below is a “in a nutshell”, condensed and straight to the point kind of things I learned in my quest for understanding.

MRI and CT scans do NOT provide a good determination of dementia. The only true test for dementia of any sort is a brain biopsy which cannot be performed while the patient is alive. It is done during autopsy. So you may not get an absolute “dementia” diagnosis until after the diagnosis doesn’t matter anymore – after all – the patient is dead.

The very best indicator of dementia is the observation of family and friends as to the changes in the behavior of the patient. It is helpful if the primary caretaking person, spouse, family, etc. – whoever is around the patient the most – keep a journal of odd or out of the ordinary actions of the patient.

As in the case of an alcoholic, there are other factors that can be documented that are helpful in determining the true state of mind. For example, the drinking history must be considered as to quantities of liquor over specific periods of time; how many times the alcoholic went through the detoxification process; has there been a diagnosis of hepatic encephalopathy or Wernicke-Korsakoff; has there been any strokes or heart attacks; and, is the alcoholic still drinking.

In Riley’s case there has been drinking to extreme, cessation of drinking, and back to drinking to extreme many times over and over again encompassing more than 30 years. While he most likely had hepatic encephalopathy long before, it was diagnosed in 2008 along with Wernicke-Korsakoff. Both conditions are brain function related and destroy the synapse connections. Riley had a stroke in 2009 which left him with some function and memory defaults, but not to the extreme. The heart attack and mini-strokes in 2012 further caused havoc in his brain. With all the trauma to Riley’s body and brain, the question shouldn’t be does he have dementia, but rather why wouldn’t he have dementia?

An MRI or CT scan can’t record as an image that is not visible. I tried to find a test that would measure the synapse activity, but found only research material using rodents. It appears that there is no test for the living breathing person who may have dementia.

My best measurement of Riley’s mental capabilities is what he presents to me each and every day. The inability to remember what’s for dinner tonight; the lack of ability to use the tv remote; his idea that if I would just let him drink his life would be so much better even if it kills him; the absolute insistence that he will be shot at the age of 103 by a jealous husband; the continual references to childhood friends and circumstances and inability to remember how to use the car seat controls; the contradictions in what he knows to be true and that the truth will not apply to him; his inflated sense of entitlement; and, thinking that he can still buy a new car for about $2,500  simply reconfirms to me that he has dementia. Add to all that the increasing inability to walk; his struggle with using the correct word in a sentence; his vision impairments; a difficulty swallowing; and a loss of emotional connections.

In fact, I believe he has Frontal Temporal Dementia, both Corticobasal Degeneration and Behavioral Variant FTD, which gradually affects all the functions performed in the frontal lobe of the brain. This makes sense to me because the toxins from alcohol usually settle in the frontal lobe region of the brain. I ask again – why would anyone not expect him to have dementia?

In my opinion, Dr. Brain’s diagnosis does not take into consideration the other factors of Riley’s condition. In all fairness to the good doctor, he has requested the records of a prominent forensic psychiatrist who recently examined Riley and found him to have dementia and lack competence to care for himself. He is doing further review of Riley’s case.