Who are you, and why are you touching my feet?
Today I want to broach a topic that is very close to my heart. I have recently been treating a number of patients with Dementia.
As a podiatrist, when I am treating a person with dementia, I want to acknowledge how confusing and scary it must be for the patients’ especially when they are about to be treated but at the same time, how hard it must be for their loved one to see them in this way.
This blog will mean different things to each of you, but I hope you find something here that resonates with you.
What is Dementia?
Dementia is a syndrome (a group of related symptoms) and not a disease. It is associated with an ongoing decline of brain function such as deterioration in memory, thinking, behaviour and the ability to perform everyday activities. Although dementia mainly affects older people, it is not a normal part of ageing
There are many different forms of dementia such as Alzheimer's or Vascular Dementia to name a few. Different types of dementia can affect people differently, and everyone will experience symptoms in their own way.
Symptoms:
However, there are some common early symptoms that may appear some time before a diagnosis of dementia. These include:
difficulty concentrating;
finding it hard to carry out familiar daily tasks, such as getting confused over the correct change when shopping;
struggling to follow a conversation or find the right word;
being confused about time and place;
mood changes.
These symptoms are often mild and may get worse only very gradually. It's often termed "mild cognitive impairment" (MCI) as the symptoms are not severe enough to be diagnosed as dementia.
Whenever I treat a patient with dementia, it reminds me of my late father’s behaviour. He was not officially diagnosed with dementia but living in Kenya, it is not a condition that GPs tend to diagnose out there. They tend to associate it more with old age even though it is not a normal part of ageing. But, he did have Small Vessel Disease due to his affinity with smoking cigarettes as a teenager. It was a ‘cool kid look’ in the 50s. He eventually stopped smoking when he had a heart attack in the early 80’s, much to my mother’s amazement. I think he had mild cognitive impairment.
My late father‘s personality can be described as someone who is always the calm in a storm. He always had sunny disposition and he had the sweetest smile that would light up his eyes. He was a very thorough businessman, always keeping his cool even when faced with tough situations in business and in family life. As a youngster, I can count the number of times he lost his cool on my fingers. He was always the good cop to my mother who I feared the most. However in his later years, he would become easily agitated, feel anxious about the littlest of things, as well as suffering anger issues, sometimes followed with a string of colourful language that I had never ever heard him use, nor did I know he was aware of such vocabulary. But this could dissolve as instantly as it came on.
The effect it had on my mother was incredible.
As I have mentioned previously, I come from a Hindu culture and my parents rarely shared their inner most feelings. But I do recall taking my mother to her GP in the UK, and, as she spoke limited English, I went in with her to act as an interpreter. Her main concern on seeing the GP was not about her medical conditions, but mainly to ask the doctor whether the man she married would ever return. She described him as a handsome, even keeled gentleman with a heart of gold. I think this is the moment that had a severe impact on me – it was beyond belief. I realised that she did not really understand her husband’s condition. I went to great pains to explain the effects of dementia but due to my limited Gujarati vocabulary, I was unable to make her fully understand. I stressed that he was not himself and would never knowingly act like this. I tried to explain that he did not mean it. But having experienced my father’s anger on myself, I realised that it can still be very hurtful and kicks you in the gut, especially when in your mind the request to my father was genuinely a small matter. But to him, it felt like I was affecting his normal routine which is commonly associated with dementia.
I remember, I was visiting him in May 2014, the last time I saw him before he passed away in November of the same year. I suggested that I trim his toe nails which were long, plus he had an ingrown nail which was painful. I had done his nails previously over the years. It took me days to convince him as he kept changing his mind. When we did finally do his nails, he kept saying don’t hurt me. I reminded him that I wouldn’t but if he felt pain, he can just ask me to stop but avoid pulling his foot as I had a sharp instrument in my hand. I also reminded him that I have never hurt him previously. He was genuinely scared and petrified that I would hurt him.
My heart ached to see him in this manner. Our parents are the rock of our foundation and to see them as acting as a child was not only painful but a sense on how the tables have turned. This is the same guy who held my hand when I had my first blood test as I was petrified of needles (I was screaming the place down that the GP felt sorry for me- I think I was scaring all the other patients that he opted for a finger prick test – which was still just as dreadful but the very next minute, I was all smiles and giggles – could it be that dad produced a bar of chocolate for all my hard work!) It was the same for my father because as soon as I had finished, he was all smiles. He went to his cupboard and wanted to pay me for making his feet feel better.
What did I learn from it?
I learnt that when treating patients with dementia, I have to alter and adapt my treatment plan to suit their needs. Each time, I ensure that I have ample time regardless of the situation. I come prepared that I will need to be extremely patient. In my father’s case, it took me days to convince him to have his nails cut. With my other patients’, I had to see how they were feeling on the day. For example, one of my patients was having an extremely good day, that you would think she had no medical problems at all. She was an architect and lived in a block of flats with a panoramic view of London’s skyline. She wanted to tell me all about the different buildings we could see from her skyline and later went on to describe what she had designed and built.
Another patient had difficulty communicating but she loved singing. So I sang with her (I am tone deaf so I felt sorry for her to have to bear with my voice) and I explained at each stage, what I was doing so that she felt re-assured, even if I was putting down the instrument or if I was wiping her feet – I explained every stage. I learnt after a few times, to speak in small sentences or one word actions so she could understand, after some guidance from the carer. She talked to me through actions, when she suddenly pulled her foot away, she was keen to see where the nail clippings were going. She is house proud and she wanted to ensure I did not dirty her carpet. Another time, she was concerned every time I stopped to see if her shoes and socks were still there. So I would show them to her.
But each time, after I had finished their treatment, I would get this big smile on their face and that made my day. I realised that I had transformed the patient’s feet and made their life that little bit better. It made me proud to be a podiatrist.