Combover

Geriatric doctor from Clinica Golf, co-owner of El Olivar Casa de Reposa, San Isidro

(Juan) Fernando Lizarraga Luyo. Dr. in neurology and neurophysics.
Part of El Instituto de la Memoria (IMEDER) in Miraflores, which treats "memory disorders, Alzheimers and depression." Members of the institute also participate in international studies on Alzheimer's and dementia. Spoke ENGLISH. Co-authors papers in English.
35 yo neurologist, we found him on a website. www. institutodelamemoria.com, he was compatriot of Dr. Carlos Vega. Looked like Bela Lugosi. Made house calls and was first to fully diagnose my dad with Alzheimer's.
First visit: evaluation 150 soles.
Subsequent visits: 100 soles each.

Geriatric doctor with the Policlinico Maria Grana (naval hospital). Also, specialist in infectious diseases. How did we find out about him?
It turns out that he works with Dr. Lizarraga.
First evaluation at home: 200 soles, second eval followup 150 soles. Thereafter visits are 100 soles.
Recommended by Dr. Lizarraga. After Dr L first saw my dad, other doctor wasn't as available. that's shen Jorge asked him and he recommended dr vela.

Discharge instructions from North Florida Rehab read: "crf mild" (mild chronic renal failure), anemia, BPH benign prostate enlargement, chronic back paid, DAT mild (dementia alzheimer's type)."
10 different medications precribed, including Arodart 5 mg.
Xanax 5 mg PO every 12 hours (4 tablets) for "airplane"

Consulta en casa 200 soles.
Prescribed Xalatan, Donepezil, Avodar, Iron, resto and oral Risperidona (2 drops one time a day). Risperidona is a liquid suspension that the pharmacy has to mix up. This doctor spells "John" correctly.
My dad looks at him, says, "Who are you? Get out of here. You're fired." Del Castillo never stops referring to this. He's the only patient who's ever fired me!

Order on prescription: 5 drops every 8 hours. Can besix to seven drops.
100 soles
Haldol is super strong sedative. Gave because he would not drink Risperadona prescribed March 25. Ordered injection but then appears that he also prescribed drops....
Information from Wikipedia on Haloperidol: Haloperidol is a dopamine inverse agonist of the typical antipsychotic class of medications. It is a butyrophenone derivative and has pharmacological effects similar to the phenothiazines.

Haloperidol is an older antipsychotic used in the treatment of schizophrenia and acute psychotic states and delirium. A long-acting decanoate ester is used as an injection given every four weeks to people with schizophrenia or related illnesses who have poor adherence to medication regimens and suffer frequent relapses of illness, or to overcome the drawbacks inherent to its orally administered counterpart that burst dosage increases risk or intensity of side effects. In some countries, such as the United States of America, injections of antipsychotics such as haloperidol can be ordered by a court at the request of a psychiatrist. For szicophrenics.

Reaches maximum concentration in blood 6 days after administration. Long lasting. Very powerful.
A multiple-year UK study by the Alzheimer's Research Trust suggested this drug and other neuroleptic antipsychotic drugs commonly given to Alzheimer's patients with mild behavioural problems often make their condition worse.[22]

Four people pinned my father down -- Anna Maria, Jorge, Gabriela and Rossie -- to give him Haldol. They wrapped his hands in socks so it wouldn't hurt so much when he punched.

During in-home visit, Dr. Lizarraga writes prescription for complete bloodword: "perfil hepatico, perfil lipidico, electrolites, examen de orina complete." A representative from a company comes to our house to take the blood and urine samples.

prescribes Exelon Patch 5, 1 patch every 24 hours, at 7 p.m. (490 soles or $185 US dollars. Too expensive for most Peruvians.). company gives free box of 15 with each order of 30 and sponsors training sessions for nurses. Company = Novartis. We later find out in US it is buy one box, get one box free.
Risperidona 2 grams, 10 drops.

English speaking, geriatric doctor. My dad insults him and Dr. Vela laughs. "Oh, he isn't ready to die yet. He has too much fight left in him."

Prescribes for my dad to be hooked up to an IV. Gives us a whole list of item to purchase. Jorge has to run around the find. Dextrosa, ranitiona, the drip line, the syringe... Also to drink Ensure plus give Megace. This treatment saves his life.

Via phone, Dr Vela says it is okay to remove the IV. He will come the next day.

7:30 p.m. 100 soles visit to house. prescribes antibiotic cefalogen 40 mg every 24 hours. Megace to increase 10 ml for appetite. Zoloft 100 mg, Risperidona split dosage between morning and night.

By the end of the first week of April, the neurologist and second geriatric doctor had put together a series of drugs to help with my father's depression, violence, lack of appetite.
Exceleon 10 mg (1 patch every 24 hours); risperidona (15 dropes one time a day at 10 pm), Zoloft 50 mg once a day crushed and put in drink; Megace syrup, Cefalogen 1 gram (antibiotic) injection intramuscular, every 24 hours (2 more dosages)

prescribes Exelon patch 10 g, one every 24 hours
memetix 10 mg in themorning This is a new short term memory drug.

Celebrex 200. 1 capsulte every 24 hours in the morning.

"Servicio complete." Was head cook for casa de reposo near embassy. full of energy, flirtaceous, knew how to handle elderly, assisted nurses, made meals. too bad a thief.
Started at 600 soles a month, which works out to 27.50 soles per day. increased to 700 soles per month august 15

The most normal day my father will have in a long while. According to Carmen's notes about "Jhon Drake", my father goets up, poops, brushes teeth, eats breakfast ("Kornflex c/leche," coffee, a banana), walks in the park for one hour. "Todo okey." Sleeps at 11 a.m. Has lunch, potatoes gratinee, chicken and a glass of Inca Kola. Watches TV, takes naps, talks a bit. When sun goes down, it's a different story.:
6 p.m. "No desea tomar la pastilla. Nada se pone. Terco."
7 . "Paciente no obedecia ordenes." "Muy iritado el paciente."
Little stickers on Carmen's notebook: Animals with exaggeratedly large eyes: "What not to love?"

From Sra Carmen's notes: Father begins downward slide. Eats a banana and drinks coffee for lunch. Refuses to go to park. He says to the nurse: "no, no," when she asks him to do things. He talks to his brother Edwin on the phone. He is able to look at pictures in books. For lunch has half a banana and some soda. Sits in his chair, naps, plays a little with Lola, says little. Asked a second time to go out for a walk. He puts on jacket but refuses to go out. Has a little supper with the family and talks to the family. Not taking a drug. Refuses to put on his pyjamas at night. He sleeps on top of sheets, not inside.

Wakes up and has a small breakfast. OK until noon. In the morning he listens to music, watches tv, plays with Lola. Talks to himself. At noon he takes off all his clothes. "Todo le pregunte para una ducha y no pero lo convenci para lavar los genitales." Lies in bed in the afternoon and refuses to eat lunch. At 1 takes off his clothes again. Drinks a little. Sra Carmen convinces him to put on a bathrobe. 3 pm takes off clothes. Jorge tells him to put on his clothes because Sammy is coming home and my dad does it. Eats a banana and drinks. Sits at dinner table but doesn't eat. At 7 pm refuses to go to his bed. "no no." Sleeps upright in his lazyboy.

Breakfast: only coffee, comes to dining room table, looks out window, naps. Refuses to walk, refuses to go to park. Refuses to eat lunch of chicken and mashed potatoes. Says "no" all day to offers of food, drink.... "Conversar un rato con su hija y esta triste, muy triste" (him or me?). Sleeps a lot

Stays in bed that morning. 8 am in bed. "Sin animo." Does not say hello to Sra Carmn. Refuses to eat breakfast. Eats Kornflex at 10 a.m. Sits in chairs with eyes closed. "Hoy dia lo veo un poco triste. No quiere conversar. Me ignora."
At night he gets up and down all night, wanders from bedroom to living room. He sometimes sleeps in living room. This might be the night he peed on the couch.
Dr. Carlos del Castillo comes and my dad tells him to get out. Dr del castillo is mystified that the patrient doesn't "like him." (duh).
I invite my dad to have chinese food and he sits at table and talks a bit and perks up.

My father's rhythms are off all day. He was up and down the night before. Is only eating mangoes and fruit, not regular food. He goes from the bedroom to the living room (this drives Jorge crazy),. Watches a bit of TV. Now refuses to sleep in bed. Sleeps in lazyboy.
According to Gaby's note: my father pees on himself in the middle of the night (before he had been getting up to pee), then at 5:20 he goes to kitchen to eat cereal.

This is the day that my father goes Haldol shot. Gaby is with him all day. Four of us have to hold him down. He is basically lying in bed, wanting to die.

Sra Carmen was there. Father agitated all day. Leaving his room naked. Would not put on clothes "para nada." Eating mango and grapes, nothing else. (Like a chimp!) Lies in his bed with eyes closed, pretending to be asleep. For lunch, takes off clothes, goes to dining room, looks at food and doesn't eat. "no obedece, sale sin ropa a la sala. "El Sr Jhon sigue durmiendo no desea nada no quiere nada no desea ni converser. Got up to pee in night, according to Gabby.

Sra Carmen on duty. Short notes. She is getting tired and frustrated, I think. She comes in at 8 in the morning to find my dad sitting in his underwear on the bed. Lies on bed with eyes closed, sometimes opens them and stares at ceiling. Sleeps a lot in the morning and afternoon. He pees on the bed iat 3:30 and when Sra Carmen tries to change the sheets, he "casi me ha golpeado le cozi el brazo." So either he did hit her and she didn't admit it, or she did catch his arm. At 7 pm, I help Sra Carmen change the sheets. We put a diaper on my dad. I think this might have been the day that he hit me.

My dad slept in bed the night before. Still with Sra Carmen, and Gaby. It was a challenge for Rosy to clean the room, but she convinced my dad to get up so she could change the sheets and clean the floor. He was eating just a little marmelade and chocolate, refused water. Lying in bed, looking at ceiling, peeking at Sra Carmen in the monring. From Sra Carmen's notes: "He got up and started talking to his hands."

Sleeping during the day, eating fruit, sitting up in his chair at night. On patch by now.

Dad sleeps in bed, nurse puts patch on in the morning while he is sleeping, eats a little, "no desea nada, solo quiere dormir alli sentado,"according to Sra Carmen's notes. Won't put on shoes. Sleeping profoundly during the day. Rosy helps give him a shower, "limpio y dueme como un angelito."Takes off his clothes. Sra Carmen gets him to put on his bathrobe. "Todo okey."Looks at movie a bit with me at 6 p.m. Sleeps overnight in his lounge chair.

We fire Sra Carmen. New nurse. Elvia. In her notes on first meeting my father: "Habla ingles y uo no lo entendi lo que me dijo fue una pena para mi paciente con depresion, no tiene apetito, no desea beber liquido." We put on music for him. Goes to bathroom by himself in afternoon. EAts a little mango and yohurt at 4 pm. "No tiene horario con sus alimento." Elvia is noticing my dad's patterns w greater attention than did Sra Carmen.

Sleeps a lot, refuses breakfast. Dr Vela has us put in on an IV, to basically to save his life. He's now on a medication routine followed by nurses. Tranquilo is the word used by nurse.

IV in, sleeping, coughing up fluid, drank a little water, talks and smiles with me and Sammy,

Father with IV, respiradona, Excelon patch, starts eating a little more, is on Megace, wearing diaphers

Nurses are taking out the via (IV line) to get him bathed, change clothing. My dad is going a long with it and sleeping a lot. "The doctor came and said my father is well hydrated. Eating and drinking tiny amounts. The doctor adjusts amounts of Risperadona, etc. My dad changes diaper. Megace.

Ön my birthday, my dad was getting better and ate and drank a little. His anger started coming out more. ägresivo, wrote the nurse evelyn. He took off his socks, "no quiere recibir nada despues toma ......esta agresivo, se saco el pantalon toda salo con el panal. Doesn't want to have his diaper changed.

Elvia. Dad sleepng in lounge chair, goes back to bed, won't eat breakfast. I brought him some breakfast and he had a little coffee. Drinking Gatorade. At 5 in the morning, he takes off all his clothes and can't be confinced to put on anything else.

from Lorgia's notes: he is up and down, into bed all the time, eating and drinking tiny amounts, agresivo, by 4 pm he is getting fesity and obstenant, kicking off socks and clothng, pretending to be asleep, I want to die I think this is when he is saying this

Goes out to patio for first time at 8 in the am. Plays with Lola. With Elvia today. Starts to watch TV. Eats a few spoonfuls of braeakbast and then ice cream.

Lorgia on duty. Says my dad is a handful, won't do what she says. He is talking to himself in English. Won't take much food from her.

Has breakfast with Sammy, tranquilo, he is brushing his teeth, takes off his jacket, is drinking ün vaso de milkshey, also ice cream. watching tv, in bed a lot but coming back to life

Lorgia on duty. Went in wheelchair to dining room and ate cereal. Didn't want to bruch his teeth. Looked out the window at the street. Drinking Gatorade and hanging out with Lola. Walks with assistance. Asked for a sandwich in English. Eats dinner with family a bit. At night gets up to pee and refuses to put on a diaper.

Elvia on duty. Before she arrives, my father takes off all his clothes and argues with Lorgia. "Molesta," she writes. Seems calmer with Elvia. With her, he agrees to brush his teeth and gets dressed. Watches TV, plays with Lola, peeing in the pappagallo, Eats sandwich for lunch. Jorge brings him a notepad and pencil, and my father writes things down. Looking out at garden behind his room. My dad is sitting up at the end of the day, talks to me, Jorge and Sammy.

Lorgia on duty. My dad takes up diaper and refuses to put another one on for Lorgia. He does not like this woman. Cereal and gatorade. Half a sandwich. Put respiradona in gatorade. Listens to music in his wheelchair, looking out window. Goes to sleep in his loungechair. At 6 in the morning, strips and goes to bathroom, doesn't want Lorgia's help.

listening to music, walking a little, looking out the window. Takes off clothing and throws it on the ground. Lordes with help of Rose gets him dressed. Whent to shower. Had MacDonald's hamburger and pepsi. "su MacDonal". I was brining him some dinner to entice him, buthe didn't want to eat.

Lourdes on duty. had breakfast in dining room, on wheelchair, played cards with me. Ate and slept througout day. I brought warm milk at night to make him sleepy. No more comments about aggression.

Elvia on duty. Jorge talks to the nurses about medications and when to give them. My dad goes out to the garden in the back. Plays with Lola. Watches Rosy cleaning the room and laughs at her jokes. This is when Rosy's ability to cheer up begins to be felt by my dad. When I come home from UPC I stop by and say hi to my dad. Nurse reports that my father talks in English in his sleep.

Lorgia on duty. He's eating breakfast, taking medication. Four drops of Respiradona in Gatorade. Eats all of his lunch and two balls of ice ceram. Starts to eat a lot. Eats mashed potatoes, chicken and gatorade, two more balls of ice cream.

Elvia on duty. In the bathroom, she suggests that he go potty and he says, "no no no." looks at a magazine. weird entry at 11:30 am: "se le observa el pie derecho y izkierda." plays with the TV remote control. Eats mashed potatoes, and sausage adn milk for lunch. Goes in wheelchair and then walks in afternoon.

Lourgia on duty. Eats breakfast, sits in dining room, afterward takes a nap, gets up for lunch, aji de gallina, then takes big long nap. Eats a little sausage for dinner and gives the rest to Lola "que pena" writes the nurse. Eats aji de gallina at 10 pm with a milkshake.

Before Elvia comes, Lorgia is with my dad. He is up and down all night, as usual. At 7 a.m., he goes back into his bedroom and looks at photos on his desk. He talks to her in English and says that the woman in the photo is named "Diana." Who was this? Princess Di? We had a photo of princess di? . 10:30 a.m., they collaborateively dress him (this is Elvia now). At 11 a.m., he helps Barb color easter eggs and smiles, Eats two almuerzos, aji de gallina and then two hours later fish. He doesn't eat dinenr because he ate so much taht day.

Lorgia on duty. Playing cards in the dining room. He plays some kind of dolls with me,

Elvia on duty. Eats well. Plays cards in the morning and then for 2 hours in the afternoon. This appears to make him tired because by 4 pm he is inhis pjs, sleeping in his bed.

At 7:50 am. gets his Excelon patch, is up playing cards. Lorgia arrives. This is the day Dr Vela returns. Lorgia puts my dad's hat. "Se le lleva a la sala hasta la puerta le digo para ir al parque. Dile si pero cuando estamos en la puerta se para y dice no." They walked around the the hour four times but he wouldn't go out. I must have told her to try it. The doctor visits. He says that my dad is well and it isn't necessary to buy a thing to check his blood pressure. By this time my dad is on Excelon 10 mg, Omepazol 20 mg, Setralina 50 mg, Respiradona 2 mg 3 drops in the morning, 10 drops at night,

A quiet day with Elvia. Walked a bit, ate a bunch of fruit during day, had supper in his room at night. Walked a bit inside house but not outside. Watched TV and was tranquil.

at 7 am had breakfast and got a sponge bath from Elvia. Lorgia arrives. Looked at pictures in book. Won't go to bathroom with Lorgia. Poops in pants at dining room table at 10 am. Rosy helps Lorgia give him a shower. Obviously Lorgia can't manage him. Language barrier might be exacerbating problem.

Elvia on duty. Tranquil day. He's eating regularly. Pees by self. Up and down all night peeing. 1 am, 3:15 pm, 5 a.m. the poor tech

Lorgia on duty. "no no no" to food and drink. Has breakfast and almuerzo later. Dr Lizurraga comes, say to continue with Excelon 10 mg, Mimetia once every 24 hours. . Listens to music. I serve my father dinner at the table.

with Elvia, eating sleeping looking at books. We wtch Young Frankenstein. Gaby on at night.

My dad plays cards with Rosy and the nurses all this month. He plays solitaire and they advise him. But early on it is clear that he has forgotten the rules and then he gets frustrated when they say he can't do a move. The frustration is bad for my dad so by the end of the month, we switch his attention to coloring books full time.

Gabriela on duty. Lorgia has been fired because of insisting that she be paid 3x normal wage for feriada. Listens to music. I bring coffee for breakfast. Looks tranquilly out at the garden. It is obvious that this garden is calming and reassuring to him. He eats a big lunch and Gaby notes "orina tiene olor fuerte." Also eats a substantial dinner. My dad mainly watches TV and sleeps. At 2:45 am, "se levanta va al bano micciona y se pasea 4 o 5 veces entre su cuarto, el bano y la sala. He's up and down all night, wandering.

Elvia on duty. Eats well, plays cards with Rosy, up and down all night peeing.

Eatings, taking drugs, sleeping. At some point Erika observes taht he has a rash on his genitals and she applies a cream. Hmmm.

Erika notes that Elvia says that my father seems "disoriented" when Erika arrives in the morning. This must be a manifestation of brain changes. Note that in the week before, he was playing cards with Rosy. I often saw that he would be more together just before a cognitive drop. Erika notes that he seems disoreinted during the day. Or maybe this is result of Mimitex

Erika on duty. We get my father out the front door of the house, but he stops at the gate between the front garden and the street and refuses to go outside. He goes to the bathroom at night by himself to poop but is "disoriented."

5 am: "se levanta a orinar desorientado queriendo orinar en la ventana." Plays cards but starts to forget rules of solitar and gets mad when a nurse corrects him.

Jorge must have bought coloring books because the nurse observes that he is coloring today. The following day we try to get him to go to the park, but he refuses. This is the time when he says that everyone outside is dead.