Circulation, or, rather, the lack of it, is one of the facets of Vascular dementia, which seems to be both a cause and an effect. As I have often said, I am not a doctor, all I’ve got is the book learning and the experience of the difference between Alzheimer’s and vascular dementia. I am also absolutely not telling anyone what to do. I am simply making observations that might help someone studying the disease, or dealing with it as a carer.
I do know that my mother has had poor circulation her entire life. She remembers at the age of five standing in an orchard and crying because her feet were so cold. I remember her having chilblains and coming home from the bus stop and sitting with her feet in the washing up bowl full of hot water topped up with the nearby kettle. You might well think that boiling your feet is inadvisable, and so do I, but I’m not here to criticise, just to report. My mother has also been fabulously inactive, always. In the 1960s we lived in a lovely house my father had built that deliberately had very little garden, mostly laid to concrete because he was a builder, not a gardener. In the summer my mother used to buy trays of plants to fill the pots, not out of any strong horticultural desire but because she had a lime-green hot pants suit and very good legs. You’ve never seen anyone plant a seedling as slowly in your life; quite why my mother never featured on the front cover of Vogue carefully positioned with a trowel, I cannot say, it certainly wasn’t for lack of practising in our front garden. My mother liked to have coffee in the morning, possibly with her sister or mother and tea in the afternoon with a friend and go shopping, ideally, until she got her own car, with a lift, there and back. She was very keen on supervising the domestic help and will tell you without batting an eyelid that she doesn’t do housework. I have spent an entire lifetime feeling inferior until I lived with her again and saw that her skill lay in nagging everyone else to do things rather than doing them herself. She could easily have been an actress; she has certainly spent a lifetime resting.
Then there’s the butter. My mother has suffered from wartime rationing for 77 years. The story of how her brother used his entire weekly two ounces of butter on one slice of bread on a Friday teatime is trotted out as often as the butter dish, which is permanently on the table. Rationing was actually a wonderful thing. In the first World War, the fastest fed and the slowest including children and mothers, went hungry. When the Second World War was announced my grandmother, for the first and only time in her life, fainted. The children she had conceived and borne during the first conflict were, in one case sickly, and in the second did not survive. The horrors of actual hunger were deeply impressed upon my mother, born in 1925. So, once rationing ended in the fifties, she began making up for it in earnest and has eaten half a pound of butter, all on her own, every week ever since. I think she may have given me lots when I was small, which was a waste because I don’t like it and was once discovered, escaped from my pram eating the dry bird’s bread on the lawn and to this day, I do prefer dry bread.
The amazing thing is that my mother has never been fat. She is big and square with bones and big shoulders which does help but she has been able, for all of her life that I know about, to eat whatever she likes and never worry about weight gain.
Or so it seems, because it is now apparent from the scans of every little vein and artery, packed to the gunnels with thick yellow fat, though which the weedy little tickles of blood are doing their best to crawl, that all this time she has been fat on the inside.
Being fat on the inside is a phenomenon I first encountered in the husband of a lovely local lady who runs the art shop. He looks stick-thin and has lived happily on a diet of pies until it all caught up with him and bypasses and other urgent procedures were required to circumvent the pie-clogged arteries.
The poor circulation that my mother has constitutionally is a trial to her now in this illness in several ways. She perceives her feet to be always cold. If you feel them they are the same temperature as the rest of her. I think it is very likely that she boiled the nerves out of existence, along with the chilblains. I bought her some microwave heated slippers without which she declares herself unable to exist and which she now has heated for her every two hours. I don’t believe it has occurred to her to shuffle into the kitchen, heating her feet up with the walking as she goes, and microwave the slippers for herself. That’s what carers are for, apparently, and every single carer could sit A level slipper microwaving tomorrow and pass A*****.
The paucity of circulation, coupled with the lack of shuffling around, is causing spectacular constipation. At first I was the only person who could get her to take the really quite pleasant fruity fibre bulking agent, but one home visit from the district nurse to administer an enema and a hospital visit with whatever is the modern day equivalent of high speed syrup of figs, seem to have cured her of the reluctance. Currently she will wait with no movement in the property market for up to three days before she gives in and takes the potion, or until her trousers won’t go round her, whichever happens first.
Poor circulation is also causing major sleep disturbance. In about two out of three nights at the moment she is waking about three in the morning chilled to the marrow despite adequate blankets and so on. It seems that lying down causes the blood to go nowhere much until she is chilled through and hard to heat up again. She has been most appreciative of the carers who get up with no complaint to make her a cup of tea and heat her heating pads until she is warm enough to go back to sleep, which often doesn’t happen until morning.
The biggest problem caused by poor circulation, of course, mini strokes. In these the blood does not circulate to areas of the brain which then die. This is the well spring and greatest problem of vascular dementia. My mother’s amazing resilience has allowed her to survive what seem to me to be quite major cerebral incidents of up to twenty minutes duration, during which she can neither move nor speak and which have been happening regularly for three years, with small impairment of important abilities. She is still eloquent, continent, mostly mentally present, organising, controlling, directing the kitchen, able to count, walk, lift a knife and fork and butter bread on the top, the bottom and, if anyone makes mention of the fact, all round the edges, defiantly.
Is she living on borrowed time?
The lesson to take is the one where you keep your blood nice and runny by being nice and runny because one thing is for sure, karma catches up with you eventually because what goes around comes around ( if it can get through the arteries.)
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