Cerebral Amyloid Angiopathy and Death
To recap, my mom was diagnosed with CAA in 2008 when she was 71. When she was 77 she went into assisted living, moving three times. The first one was in her hometown, a small town where everyone knew her as a nurse and she felt she was taking care of them. The second one was near me and a big fancy facility with all the bells and whistles, but every time her dementia got worse she liked it less. The cost nearly doubled and they wanted to put her in the memory care wing, which we felt she didn't need quite then. Then I found an adult foster care home ran by a great family where there were just 5 residents. Once they had an opening, it was amazing how well she did there. No longer confined to one room, but she was a part of a family. They gave her the best care ever. They'd even take her out shopping! Their family became our family for one whole year. Of course, when I'd be there 2-3 times a week, we got to know one another very well. But, they gave me my own life back, because I didn't feel guilty when I wasn't with her anymore. She was in perfectly good hands!
During the past 6 months or so, she started having more small bleeds and then the past few months they were in the back of her head, affecting her more. Usually she needed some real good sleep for a few days and all would be back to her new normal. In May she was put on hospice. Mom never really knew she was going to die, because she had her wisdom teeth pulled 6 months earlier and couldn't get over the holes in the back of her mouth. I'd bring her to the dentist to assure her all was okay. When she had her appointment with her doctor to discuss hospice, she thought he was a dentist. I asked her if she understood what we were talking about and if she understood what hospice meant. Even though she was a nurse her whole life, she replied she understood everything, and that she would get used to the gaps in the back of her mouth and would be "good as new" after that. I guess there is something sweet about not knowing. That day when I dropped Mom and her caretaker off, she got real mad at me for not bringing her to her house (2 hours away). Her boyfriend (also a resident) and she would always talk about moving into either his house or hers and that day she really meant it! A week or two later she was doing better and there was talk of taking her off of hospice. In addition to doing better, apparently the insurance / medicare / whatever looks at CAA as a condition, not a life-threatening prognoses. Then she had some more "strokes" (reworded the orders) and it became obvious she was unlikely to get better. Some days she could walk. Some days she couldn't get out of bed. Some days she wanted to go shopping (we used a wheelchair), and some days she was really quite good. The last few days in July, although she wanted to get up, her brain couldn't tell her legs what to do anymore. Her three sisters all came to visit so John (her caretaker) carried her to the living room so they had more room. She enjoyed the reminiscing, but was virtually bedridden from then on. She would want to get up, but her brain was not able to tell her feet/legs how move. She fed herself some ice cream on July 31st, but she was so very weak and slept almost all the time. I asked her if she was ready to go see dad (he died in 2013). She could talk just enough to say, "Yes". I promised her I'd make sure she looked pretty for him. My sisters both came that day prepared to stay for weeks or however long it took. The following morning we held the phone next to her ear as each grandchild (10 of them) called to say their goodbyes. That night I checked her oxygen and pulse (little finger monitor) on and off all night, holding her hand from 3 am on. My sisters were talking, as I was still holding her hand, half sleeping, when she peacefully slept away at 7:47 A.M. on August 2nd. As I had promised, I put some lipstick on her before they took her away.
We watched our father suffer for 13 days from metastatic prostate cancer. My biggest regret with him was that we allowed Mom to control his meds and she refused to give him much (if any) morphine, claiming as a nurse it was her duty to keep him alive. Also, Mom didn't want people in her home and Dad could have and should have reaped the benefits of how great the hospice program really is. Not until he passed did we really understand how much her cognitive thinking was already off.
CAA is an interesting condition. The first year after Dad died, she managed to spend thousands of dollars on anything and everything. I think there are peddlers who prey on widows and when they came knocking, selling cleaning supplies, or removing trees, etc. she handed over big bucks. She also thought everyone was stealing from her. She misplaced everything and hid things in weird places. We'd have to take her Bose remote with us wherever we took her! We learned to keep her room as simple as possible. She constantly thought she needed new cell phones (never admitting it was operator errors). She was very good at masking her disability, talking mostly about things like the weather and other small talk. There is a lot of fabrication or denial that occurs with CAA patients. Later on she would repeat certain phrases that were etched in her memory making her come across as perfectly normal. She could fiddle for HOURS with jewelry, usually breaking it and then blaming someone else. There were times she was nasty, nasty. But, then a few hours later she would forget she was mad and all was good again. The biggest change we saw was that she went boy crazy. But, she met Dad when she was 16 and would rather been with virtually any man than by herself. What she wanted mostly from us girls was to take her and her latest boyfriend out to eat. Men liked her because she was beautiful, classy and witty. She was insistent she was going to marry each one of them and would gladly have turned everything (assets) over to any one of them. But, luckily her guy friends were good people and we would take them to concerts and out to eat with us.
We never sold the house that we grew up in, even though it was not lived in for 5 years. It gave Mom comfort knowing "when she got better, she could go home." There was no need to list the house with a realtor, as people have been wanting to buy it for years. By November it will be turned over to the new school superintendent and his children. Located right across from the city park & swimming pool, baseball/softball/football and track fields, it was the best place to grow up.
If anyone is still reading this long message, and either have CAA or a loved one with it, my advice is to embrace it. It is not a bad way to live and it is not at all a bad way to die. God bless you all.