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Thursday, May 24, 2012

Ativan to the Rescue

Wedding week has come and gone. We are intact and unscathed. I had imagined all kinds of calamity and mayhem, all too likely with Michael now.  My motto the past few years has been: Prepare for the worst, hope for the best.

The beautiful bride arrived home two days before her fiance, her siblings and their partners. Having learned that forewarned means that Michael usually forearms - literally if I let him - I chose not to tell him that the house would soon fill up with his children and a wedding was looming. Instead I simply let our daughter come home and quietly greet her father. He seemed calm on her arrival, but then he always does.  His anxiety percolates below the surface for a few hours, hidden behind his Parkinson's mask, then breaks loose to wreak havoc, usually in the wee hours of the night.

Last Tuesday was no different. It wasn't until bedtime that the demons began their work. Anna and I sat up for a very welcome intimate visit after Dad had been put to bed.  I knew right away we were in for trouble when his heavy sleep-breathing lasted only a few minutes. Sure enough the clanging began early; the anxiety was mounting.  I gave him his usual dose of clonazepam for anxiety which normally takes effect on a moderately crazy night within half an hour. By the second wake-up he was hallucinating wildly and panicky, pointing to flames spewing from his deodorant stick on the bureau. Not so far-fetched, I suppose; it is red after all. More clonazepam.

By this time, with only a couple of hours left to the night, I was sleepless and less than friendly. I ordered him to sleep the rest of the night - please. By now I was strung out myself with apprehension that if things were this bad with only one child home, how much worse could they get when all were loudly clattering around the house? I knew the clonazepam was too lightweight for our needs. If we were to have any hope of a peaceful week I had to take a different course than usual.

The next morning, through the fog of no sleep, I scrabbled through his medication box to find the Ativan. This drug was prescribed back in 2010 when he had a terrifying, mysterious breathing attack that, at first, was mistaken for a pulmonary embolism, launching us into yet another hellish hospital experience. It is no exaggeration to say that force, restraints, and security officers were all employed to subdue my crazed husband. Heavy support was called for pharmaceutically too, drugs that are never prescribed outside the hospital setting. The best they could offer me for home use was the Ativan.

The instructions on the Ativan prescription label clearly state that the drug is to be used for his breathing issues. After eliminating all other possible causes for that frightening attack, the doctors concluded severe anxiety must be the source of the problem.  Mysteriously, Michael has had only a couple of minor attacks since that terrible one so I have much of the prescription still available.  Good thing. I resolved to dope him as heavily as necessary, within the prescribed amounts, in the hopes of getting all of us through to the wedding on the Saturday and relieve him of his torment, if possible.

Wednesday night I gave Michael a single 1 mg pill at bedtime, vowing to increase if necessary. He was actually quite calm throughout the day, having exhausted himself with panic the night before, but I knew from past experience that we'd be in for a repeat performance as soon as his head hit the pillow.  The dosage on the pill bottle said I could give as many as six pills a day. Frightening. Peace reigned throughout the night on that single pill with more extreme dopiness than usual all the next morning.

Four more house guests arrived home on Thursday. I held my breath. By way of explaining the houseful, I risked telling him that Anna's wedding was in two days, reassuring him that he could take in as much or as little as he could manage. Our brilliant caregiver would be at his side all evening. I got no response. No emotion. Deadened. At that point I think I could have dropped a bomb on him and he wouldn't have flinched.

The two busiest days leading up to the big day were tranquil and pleasant. The bride was calm, well-organized and unruffled, creating an atmosphere that descended on all of us who were trying so hard to keep Michael's world serene. Through the many calamities that Michael's disease has created over the years,we have all learned to be ready to shift gears in an instant if necessary. This event was no different with various plans of action considered and at the ready if the situation dictated. That flexibility and detachment are strengths and blessings we have all garnered from this experience with Parkinson's disease, that we will carry forth in all that we do.

I can report that the weekend went off without a hitch, except, of course, the obvious one.  After that nightmarish first night, Michael slept heavily thereafter on the single daily dose of Ativan and was pretty oblivious to the excitement throughout the day. Though he seemed almost flatlined emotionally - more than usual - I did witness a rare laugh from him in response to one of his hilarious children. He even participated very briefly in a boisterous game of football in the yard. Miraculous. He could only manage to see his little girl married; he had to return home shortly after and miss the meal and the party. But that was okay. I'd like to think he took in what was happening. When the minister asked us all to stand to pledge our support to this couple, he rose, proud and tall, from his wheelchair. I think everyone suppressed loud applause and tears at that moment.

After the house emptied out, I slowly weaned him off the drug, fearful that to do otherwise might send him into a psychotic episode as we have seen before with other drug withdrawals.  I did have to make a few slight adjustments in the first two days as anxiety crept back in, but as of today, Thursday, he is off the drug completely. And he's calm. I entertained thoughts of keeping him on it permanently but then quickly rejected the idea. I want this drug to work whenever our quiet lives get stirred up in the future. To keep him on it would probably reduce the efficacy of the drug over time.  Better to keep it in reserve for the important events.

The only wedding day calamity was when I tried to dress Michael for the event. The pants that had fit two months ago now needed to be safety-pinned together at the last minute then cinched tightly with a belt. Unlike most Parkinson's patients who are losing weight rapidly by this stage of the disease, Michael has an ample spare tire around his middle.  I hadn't noticed because he always wears elasticized waistbands now for simplicity and comfort. Good thing he wasn't going to be walking anywhere with my hasty, last minute adjustments to his pants. And apparently I don't know how to buy my husband a dress shirt because the white one I picked up three weeks ago was so tight around the neck that, at the last minute, we scrapped the nice new silk tie and went for the open-necked casual look. He's a handsome devil regardless.

The Parkinson's tulip-themed wedding was a huge success.


  1. I am so very happy for you that the wedding went off without a hitch. Right now, clonazepam does it for me, anti-anxiety wise, but I'll have to make sure Kyle knows to ask for Ativan if i get too uppity. The other night he tells me that I woke in the middle of the night during a thunderstorm and loudly announced, "I can't sleep with all that racket going on!" I have no memory of it!

  2. Save the Ativan for the three other weddings.