Drowsy

When Rosemarie was initially in King's and began jolting she was prescribed Clonazepam 0.5 mg and has been on that dosage ever since. At the last medication review I raised this as something to be reviewed because it seemed to me that the jolting was getting worse.

Last Friday I had a meeting with a lovely nurse from the Palliative Care Team that advise the Care Home. This was the woman who had assessed Rosemarie previously in my absence. I approached the meeting with as much of an open mind as I could and any of my residual anger and frustration evaporated within a few minutes. It was a emotional encounter that I may blog about separately when I am ready, but I mention it because the topic of Rosemarie's medication came up.

The nurse had a lot of experience with Alzheimer's patients and was familiar with the jolting and the seizures. She pointed out that they were two different symptoms of same deterioration in Rosemarie's brain, and she suggested that increasing the dose of Clonazepam would actively work towards preventing future seizures. 

I mentioned this to Good Nurse and she raised it with the GP, and he suggested that the easiest way was to supplement the morning dose with an evening one. This started on Saturday.

As previously described Sunday was a Bad Day anyway, but by Monday it was clear that the increased dosage was having a significant effect. On the plus side, the jolting had virtually disappeared, on the minus side, she was sitting there motionless most of the time with her eyes closed to slits. She would open her eyes and respond if I tried to feed her the thickened juice but was much less interested in food.

By Wednesday it was clear that this was no temporary change of state. The feeding records showed that she ate almost no breakfast and was too sleepy to eat any lunch. With persistence I was able to feed her all her supper but she was almost dozing off between spoonfuls. 

This presents us with a bit of a dilemma. We obviously want to do everything we can to prevent future seizures and minimise jolting, but at the same time if she is not eating (she has lost 2 kg in the last week) then we have a serious problem. It is just about three weeks till the next medication review and at the current rate she could be a wraith by then. 

I spoke to Good Nurse and we discussed a Plan. As always it is about getting reliable data. Feeding her when she is sleepy is not ideal (the SALT recommended she should always be alert during feeding) but I have shown that with persistence it can be done. If the staff are feeding her in the lounge (as I suspect) and have several other residents to feed maybe they are just giving up, and reporting that Rosemarie is in fact too sleepy to feed easily. If this is the case the problem could be addressed as a management issue. 

Loss of appetite, incidentally, is a recognised side effect of taking Clonazepam.

So the plan is to monitor her food intake and weight for a few days and if the data continues in the current direction we will get the GP to reverse the change and see what happens then.

The other thing is that Rosemarie's delight in being in the new chair, so obvious on Saturday, is now muffled by her drowsiness.